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Rizzo S, Bellesi L, D'Ermo A, Bonomo L, D'Ecclesiis O, Magoga F, Presilla S, Spanò A, Minzolini V, Lo Piccolo F, Heinkel J, Rezzonico E, Del Grande M, Merli M, Del Grande F. Body CT examinations in oncologic patients: the impact of subspecialty radiology on radiation exposure in the clinical practice. A quality care study. LA RADIOLOGIA MEDICA 2024; 129:429-438. [PMID: 38341817 PMCID: PMC10943144 DOI: 10.1007/s11547-024-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/13/2024]
Abstract
PURPOSES The primary objective of this retrospective study was to assess whether the CT dose delivered to oncologic patients was different in a subspecialty radiology department, compared to a general radiology department. The secondary explorative objective was to assess whether the objective image quality of CT examinations was different in the two settings. MATERIALS AND METHODS Chest and abdomen CT scans performed for oncologic indications were selected from a general radiology department and a subspecialty radiology department. By using a radiation dose management platform, we extracted and compared CT dose index (CTDIvol) and dose length product (DLP) both for each phase and for the entire CT exams. For objective image quality evaluation, we calculated the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) at the level of the liver and of the aorta. A P-value < 0.05 was considered significant. RESULTS A total of 7098 CT examinations were included. CTDIvol was evaluated in 12,804 phases; DLP in 10,713 phases and in 6714 examinations. The CTDIvol and DLP overall were significantly lower in the subspecialty radiology department compared to the general radiology department CTDI median (IQR) 5.19 (3.91-7.00) and 5.51 (4.17-7.72), DLP median and IQR of 490.0 (342.4-710.6) and 503.4 (359.9-728.8), p < 0.001 and p = 0.01, respectively. The objective image quality showed no significant difference in the general and subspecialty radiology departments, with median and IQR of 4.03 (2.82-5.51) and 3.84 (3.09-4.94) for SNRLiv (p = 0.58); 4.81 (2.70-7.62) and 4.34 (3.05-6.25) for SNRAo (p = 0.30); 0.83 (0.20-1.89) and 1.00 (0.35-1.57) for CNRLiv (p = 0.99); 2.23 (0.09-3.83) and 1.01 (0.15-2.84) for CNRAo (p = 0.24) with SNRLiv (p = 0.58), SNRAo (p = 0.30), CNRLiv (p = 0.99) and CNRAo (p = 0.24). CONCLUSION In a subspecialty radiology department, CT protocols are optimized compared to a general radiology department leading to lower doses to oncologic patients without significant objective image quality degradation.
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Affiliation(s)
- Stefania Rizzo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland.
| | - Luca Bellesi
- Service of Medical Physics, Maging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Andrea D'Ermo
- Service of Process Organization and Information, EOC, Support Area, Via Lugano 4D, 6500, Bellinzona, Switzerland
| | - Luca Bonomo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Magoga
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Stefano Presilla
- Service of Medical Physics, Maging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Arturo Spanò
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Veronica Minzolini
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesca Lo Piccolo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Jurgen Heinkel
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Ermidio Rezzonico
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Matteo Merli
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Filippo Del Grande
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
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O'Regan PW, Dewhurst C, O'Mahony AT, O'Regan C, O'Leary V, O'Connor G, Ryan D, Maher MM, Young R. Split-bolus single-phase versus single-bolus split-phase CT acquisition protocols for staging in patients with testicular cancer: A retrospective study. Radiography (Lond) 2024; 30:628-633. [PMID: 38330895 DOI: 10.1016/j.radi.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Computed tomography (CT) imaging has become indispensable in the management of medical oncology patients. Risks associated with high cumulative effective dose (CED) are relevant in testicular cancer patients. Split-bolus protocols, whereby the contrast medium injection is divided into two, followed by combining the required phase images in a single scan acquisition has been shown to provide images of comparable image quality and less radiation dose compared to single-bolus split-phase CT for various indications. We retrospectively evaluated the performance of split-bolus and single-bolus protocols in patients having follow-up CT imaging for testicular cancer surveillance. METHODS 45 patients with testicular cancer undergoing surveillance CT imaging of the thorax, abdomen, and pelvis who underwent split-bolus and single-bolus protocols were included. Quantitative image quality analysis was conducted by placing region of interests in pre-defined anatomical sub-structures within the abdominal cavity. The signal-to-noise ratio (SNR) and radiation dose in the form of dose length product (DLP) and effective dose (ED) were recorded. RESULTS The DLP and ED for the single-bolus, split-phase acquisition was 506 ± 89 mGy cm and 7.59 ± 1.3 mSv, respectively. For the split-bolus, single-phase acquisition, 397 ± 94 mGy∗cm and 5.95 ± 1.4 mSv, respectively (p < 0.000). This represented a 21.5 % reduction in radiation dose exposure. The SNR for liver, muscle and fat for the single-bolus were 7.4, 4.7 and 8, respectively, compared to 5.5, 3.8 and 7.4 in the split-bolus protocol (p < 0.001). CONCLUSION In a testicular cancer patient cohort undergoing surveillance CT imaging, utilization of a split-bolus single-phase acquisition CT protocol enabled a significant reduction in radiation dose whilst maintaining subjective diagnostic acceptability. IMPLICATIONS FOR PRACTICE Use of split-bolus, single-phase acquisition has the potential to reduce CED in surveillance of testicular cancer patients.
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Affiliation(s)
- P W O'Regan
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - C Dewhurst
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - A T O'Mahony
- Department of Radiology, Cork University Hospital/Mercy University Hospital, Cork, Ireland.
| | - C O'Regan
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - V O'Leary
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - G O'Connor
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - D Ryan
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - M M Maher
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - R Young
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College, Cork, Ireland.
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Wakileh GA, Ruf C, Heidenreich A, Dieckmann KP, Lisson C, Prasad V, Bolenz C, Zengerling F. Contemporary options and future perspectives: three examples highlighting the challenges in testicular cancer imaging. World J Urol 2021; 40:307-315. [PMID: 34779884 PMCID: PMC8921012 DOI: 10.1007/s00345-021-03856-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/04/2021] [Indexed: 10/27/2022] Open
Abstract
PURPOSE One of the main issues in testicular germ cell tumors (TGCTs) management is to reduce the necessary amount of treatment to achieve cure. Excess treatment burden may arise from late diagnosis of the primary as well as from false positive or negative staging results. Correct imaging is of paramount importance for successful management of TGCT. The aim of this review is to point out the current state of the art as well as innovative developments in TGCT imaging on the basis of three common challenging clinical situations. METHODS A selective literature search was performed in PubMed, Medline as well as in recent conference proceedings. RESULTS Regarding small testicular lesions, recent studies using elastography, contrast-enhanced ultrasound or magnetic resonance imaging (MRI) showed promising data for differentiation between benign and malignant histology. For borderline enlarged lymph nodes FDG-PET-CT performance is unsatisfactory, promising new techniques as lymphotropic nanoparticle-enhanced MRI is the subject of research in this field. Regarding the assessment of postchemotherapeutic residual masses, the use of conventional computerized tomography (CT) together with serum tumor markers is still the standard of care. To avoid overtreatment in this setting, new imaging modalities like diffusion-weighted MRI and radiomics are currently under investigation. For follow-up of clinical stage I TGCTs, the use of MRI is non-inferior to CT while omitting radiation exposure. CONCLUSION Further efforts should be made to refine imaging for TGCT patients, which is of high relevance for the guidance of treatment decisions as well as the associated treatment burdens and oncological outcomes.
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Affiliation(s)
- Gamal Anton Wakileh
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Christian Ruf
- Department of Urology, Armed Forces Hospital Ulm, Ulm, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, Cologne University Hospital, Cologne, Germany
| | | | - Catharina Lisson
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
| | - Christian Bolenz
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
| | - Friedemann Zengerling
- Department of Urology and Paediatric Urology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany. .,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany.
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Borgbjerg J, Bylling T, Andersen G, Thygesen J, Mikkelsen A, Nielsen TK. CT-guided cryoablation of renal cancer: radiation burden and the associated risk of secondary cancer from procedural- and follow-up imaging. Abdom Radiol (NY) 2020; 45:3581-3588. [PMID: 32285178 DOI: 10.1007/s00261-020-02527-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To estimate radiation dose and the associated risk of secondary cancer risk related to percutaneous cryoablation (PCA) and follow-up imaging in a cohort of patients treated for small renal masses (SRMs). METHODS A total of 149 patients underwent PCA for a SRM at our institution. Based on CT dose reports, we calculated the mean effective dose for a CT-guided PCA procedure and post-ablative follow-up CT. Applying follow-up recommendations by a multidisciplinary expert panel, we calculated the total radiation dose for the PCA procedure and the CT surveillance program corresponding to a minimal and preferable follow-up regime (5-year vs 10-year). Estimates of the lifetime attributable cancer risk for different age groups were calculated based on the cumulative effective dose based on the latest BEIR VII report. RESULTS Total dose for the PCA treatment and follow-up CTs amounted to 174 and 294 mSv for a minimal and preferable protocol, respectively. Follow-up CTs accounted for the majority of the total effective dose for the minimal and preferable protocol (89% vs 94%). CT fluoroscopy contributed only to a limited amount of the total radiation dose for the minimal and preferable protocol (1.8% vs 1.1%). A 70-year-old male undergoing PCA treatment has a lifetime attributable cancer risk of 0.8% (1 in 131) when completing the preferable follow-up protocol. The same regimen in a 30-year-old female results in a lifetime attributable risk of cancer of 3.4% (1 in 29). CONCLUSION Radiation dose and the associated risk of secondary cancer are high for patients with SRMs undergoing PCA and post-ablative follow-up imaging in particular in younger patients. Radiation exposure in the PCA procedure itself accounts for only a limited amount of the total radiation. Radiologists and clinicians must strive to implement radiation dose saving measures especially with respect to the follow-up regime.
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Joyce S, O'Connor OJ, Maher MM, McEntee MF. Strategies for dose reduction with specific clinical indications during computed tomography. Radiography (Lond) 2020; 26 Suppl 2:S62-S68. [PMID: 32682731 DOI: 10.1016/j.radi.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
Increasing integration of computed tomography (CT) into routine patient care has escalated concerns regarding associated radiation exposure. Specific patient cohorts, particularly those with cystic fibrosis (CF) and Crohn's disease, have repeat exposures and thus have an increased risk of high lifetime cumulative effective dose exposures. Thoracic CT is the gold standard imaging method in the diagnosis, assessment and management of pulmonary disease. In the setting of CF, CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography. Furthermore, in specific cases of Crohn's disease, CT demonstrates diagnostic superiority over magnetic resonance imaging (MRI) for radiological evaluation. Low dose CT protocols have proven beneficial in the evaluation of CF, Crohn's disease and renal calculi, and in the follow up of testicular cancer patients. For individuals with chronic conditions warranting frequent radiological follow up, the focus must continue to be the incorporation of appropriate CT use into patient care. This is of particular importance for the paediatric population who are most susceptible to potential radiation induced malignancy. CT technological developments continue to focus on radiation dose optimisation. This article aims to highlight these advancements, which prioritise the acquisition of diagnostically satisfactory images with the least amount of radiation possible.
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Affiliation(s)
- S Joyce
- Department of Radiology, University College Cork, Cork, Ireland.
| | - O J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M M Maher
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F McEntee
- Discipline of Diagnostic Radiography, University College Cork, Cork, Ireland
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Lehnich AT, Rusner C, Chodick G, Katz R, Sella T, Stang A. Actual frequency of imaging during follow-up of testicular cancer in Israel-a comparison with the guidelines. Eur Radiol 2019; 29:3918-3926. [PMID: 31016446 DOI: 10.1007/s00330-019-06148-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Computed tomography (CT) examinations are frequent in follow-up care of testicular cancer (TC) but may increase the risk for other cancers. We wanted to assess the actual number of CT and X-ray examinations within the first 5 years after a diagnosis of TC in Israel during 2003-2007. METHODS The database of Maccabi Healthcare Services, Israel, was searched for TC patients diagnosed in 2003 to 2007 by direct linkage with the Israel National Cancer Registry. Data on diagnostic imaging examinations (CT of chest, abdomen, or pelvis, unspecified sites; X-ray of chest) were extracted during a 5-year follow-up for 226 incident patients. The actual number of CT and X-ray examinations was compared to the National Comprehensive Cancer Network (NCCN) guideline. We tabulated the median with 10th and 90th percentiles (P10, P90) for the number of CTs and X-rays considering histology, stage, and adjuvant strategy. RESULTS The number of abdomen or pelvis CTs for TC patients receiving chemo- or radiotherapy was in accordance with the NCCN guideline. The median of abdomen or pelvis CTs for surveillance patients was 8.5 (P10, P90: 3; 13) for nonseminoma and 5.0 (P10, P90: 5; 13) for seminoma patients compared to 14 to 17 CTs recommended. The number of chest X-rays was lower than recommended in the guideline for all adjuvant strategies. CONCLUSIONS The NCCN guidelines regarding CTs were met for TC patients treated with chemo- or radiotherapy but fell below recommendations for surveillance. Guidelines from 2011 and 2012 were updated in favor of fewer CTs during surveillance. KEY POINTS • The number of CTs followed the NCCN guidelines in patients treated with chemo- or radiotherapy. • Surveillance patients received fewer CTs and X-rays than recommended in the NCCN guidelines from 2005. • The number of applied CT examinations corresponded to a radiation dose that did not substantially raise the lifetime risk for cancer.
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Affiliation(s)
- Anna-Therese Lehnich
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Carsten Rusner
- Radiology Office, Hospital St. Elisabeth and St. Barbara, Mauerstraße 5, 06110, Halle, Germany
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Ramat Aviv, 69978, Tel Aviv, Israel
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
| | - Rachel Katz
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
| | - Tal Sella
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
- Department of Medical Oncology, Dana-Faber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
- School of Public Health, Department of Epidemiology, Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
- German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
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Moloney F, Fama D, Twomey M, O’Leary R, Houlihane C, Murphy KP, O’Neill SB, O’Connor OJ, Breen D, Maher MM. Cumulative radiation exposure from diagnostic imaging in intensive care unit patients. World J Radiol 2016; 8:419-427. [PMID: 27158429 PMCID: PMC4840200 DOI: 10.4329/wjr.v8.i4.419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/03/2015] [Accepted: 01/31/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To quantify cumulative effective dose of intensive care unit (ICU) patients attributable to diagnostic imaging.
METHODS: This was a prospective, interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center. Demographic and clinical data including age, gender, date of ICU admission, primary reason for ICU admission, APACHE II score, length of stay, number of days intubated, date of death or discharge, and re-admission data was collected on all patients admitted over a 1-year period. The overall radiation exposure was quantified by the cumulative effective radiation dose (CED) in millisieverts (mSv) and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board. Pediatric patients were selected for subgroup-analysis.
RESULTS: A total of 2737 studies were performed in 421 patients. The total CED was 1704 mSv with a median CED of 1.5 mSv (IQR 0.04-6.6 mSv). Total CED in pediatric patients was 74.6 mSv with a median CED of 0.07 mSv (IQR 0.01-4.7 mSv). Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED. Computed tomography (CT) accounted for 16% of all studies performed and contributed 97% of total CED. Trauma patients received a statistically significant higher dose [median CED 7.7 mSv (IQR 3.5-13.8 mSv)] than medical [median CED 1.4 mSv (IQR 0.05-5.4 mSv)] and surgical [median CED 1.6 mSv (IQR 0.04-7.5 mSv)] patients. Length of stay in ICU [OR = 1.12 (95%CI: 1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mSv.
CONCLUSION: Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs. CED should be minimized where feasible, especially in young patients.
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Murphy KP, Crush L, O’Neill SB, Foody J, Breen M, Brady A, Kelly PJ, Power DG, Sweeney P, Bye J, O’Connor OJ, Maher MM, O’Regan KN. Feasibility of low-dose CT with model-based iterative image reconstruction in follow-up of patients with testicular cancer. Eur J Radiol Open 2016; 3:38-45. [PMID: 27069978 PMCID: PMC4811850 DOI: 10.1016/j.ejro.2016.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We examine the performance of pure model-based iterative reconstruction with reduced-dose CT in follow-up of patients with early-stage testicular cancer. METHODS Sixteen patients (mean age 35.6 ± 7.4 years) with stage I or II testicular cancer underwent conventional dose (CD) and low-dose (LD) CT acquisition during CT surveillance. LD data was reconstructed with model-based iterative reconstruction (LD-MBIR). Datasets were objectively and subjectively analysed at 8 anatomical levels. Two blinded clinical reads were compared to gold-standard assessment for diagnostic accuracy. RESULTS Mean radiation dose reduction of 67.1% was recorded. Mean dose measurements for LD-MBIR were: thorax - 66 ± 11 mGy cm (DLP), 1.0 ± 0.2 mSv (ED), 2.0 ± 0.4 mGy (SSDE); abdominopelvic - 128 ± 38 mGy cm (DLP), 1.9 ± 0.6 mSv (ED), 3.0 ± 0.6 mGy (SSDE). Objective noise and signal-to-noise ratio values were comparable between the CD and LD-MBIR images. LD-MBIR images were superior (p < 0.001) with regard to subjective noise, streak artefact, 2-plane contrast resolution, 2-plane spatial resolution and diagnostic acceptability. All patients were correctly categorised as positive, indeterminate or negative for metastatic disease by 2 readers on LD-MBIR and CD datasets. CONCLUSIONS MBIR facilitated a 67% reduction in radiation dose whilst producing images that were comparable or superior to conventional dose studies without loss of diagnostic utility.
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Affiliation(s)
- Kevin P. Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Lee Crush
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Siobhan B. O’Neill
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - James Foody
- Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | - Micheál Breen
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Adrian Brady
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Paul J. Kelly
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Derek G. Power
- Department of Medical Oncology, Cork and Mercy University Hospitals, Cork, Ireland
| | - Paul Sweeney
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Jackie Bye
- General Electric Healthcare Technologies, Herdfordshire, UK
| | - Owen J. O’Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Kevin N. O’Regan
- Department of Radiology, Cork University Hospital, Cork, Ireland
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Rusner C, Stang A, Dieckmann KP. Recommendations Regarding Computed Tomography Imaging in Follow-Up for Stage I Nonseminoma Testicular Cancer Remain a Challenge. J Clin Oncol 2015; 33:2323. [PMID: 26033807 DOI: 10.1200/jco.2014.60.6681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Carsten Rusner
- Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg Halle, Germany
| | - Andreas Stang
- Universitätsklinikum Essen, Essen, Germany; and School of Public Health, Boston University, Boston, MA
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