A novel technique for CT imaging the brain of the obese patient

Imaging of suspected pulmonary embolism and deep venous thrombosis in obese patients

Obesity is a growing problem around the world, and radiology departments frequently encounter difficulties related to large patient size. Diagnosis and management of suspected venous thromboembolism, in particular deep venous thrombosis (DVT) and pulmonary embolism (PE), are challenging even in some lean patients, and can become even more complicated in the setting of obesity. Many obstacles must be overcome to obtain imaging examinations in obese patients with suspected PE and/or DVT, and to ensure that these examinations are of sufficient quality to diagnose or exclude thromboembolic disease, or to establish an alternative diagnosis. Equipment limitations and technical issues both need to be acknowledged and addressed. Table weight limits and scanner sizes that readily accommodate obese and even morbidly obese patients are not in place at many clinical sites. There are also issues with image quality, which can be substantially compromised. We discuss current understanding of the effects of patient size on imaging in general and, more specifically, on the imaging modalities used for the diagnosis and treatment of DVT and PE. Emphasis will be placed on the technical parameters and protocol nuances, including contrast dosing, which are necessary to refine and optimize images for the diagnosis of DVT and PE in obese patients, while remaining cognizant of radiation exposure. More research is necessary to develop consistent high-level evidence regarding protocols to guide radiologists, and to help them effectively utilize emerging technology.

European obesity and the radiology department. What can we do to help?

Obesity is a chronic disease that is now a global epidemic. The numbers of obese people are exponentially rising in Europe, and it is projected that in Europe by 2010 there will be 150 million obese people. The obesity-related health crisis does not only affect adults, with one in four European children now overweight. Radiologists, both adult and paediatric, need to be aware of the magnitude of the problem, and obese patients cannot be denied radiologic evaluation due to their size. Missed diagnosis, appointment cancellation and embarrassing situations for patients when they are referred for a radiological examination for which they are not suitable are all issues that can be avoided if careful provision is made to accommodate the needs of the obese patient requiring radiologic evaluation. This paper will discuss the epidemiology of obesity and the role of radiology in the assessment of obesity and disorders of fat metabolism. The limitations obesity poses to current radiological equipment and how the radiologist can optimise imaging in the obese patient will be described. Dose reference levels and dose control are discussed. Examples of how obesity both hinders and helps the radiologist will be illustrated. Techniques and pre-procedural preparation to help the obese patient in the interventional suite are discussed.