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Zeng SL, Grier AJ, Langdell HC, Blevins KM, Tian WM, French RJ, Mithani SK, Hammert WC, Klifto CS. Comparison of Low-Dose Computed Tomography Versus Conventional-Dose Computed Tomography in the Evaluation of Distal Radius Fractures. Hand (N Y) 2024:15589447241232016. [PMID: 38450618 DOI: 10.1177/15589447241232016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Distal radius fractures (DRFs) are common upper extremity fractures and often require surgical fixation when they are intraarticular. Preoperative computed tomography (CT) has emerged as a surgical planning tool to evaluate intraarticular DRFs. Although CT affords additional details, patients receive higher radiation doses than standard radiographs. We aim to develop a low-dose CT (LDCT) protocol, relative to the institutional standard-dose CT wrist for intraarticular DRFs although providing adequate detail for surgical decision-making. METHODS A single-institution prospective study was conducted on patients with intraarticular DRFs who underwent closed reduction and below-elbow splinting who otherwise would undergo wrist CT. Observations were defined as total measurements taken, with each view undergoing 44 measurements. Patients underwent 2 scans with a standard dose and a 10× dose reduction. Articular step and gap measurements were recorded in the sagittal and coronal images. RESULTS A total of 11 patients were enrolled (7 women and 4 men). The mean age was 55 years (SD = 20.1). There were a total of 4 reviewers: 1 attending surgeon, 2 resident physicians, and 1 student. When comparing LDCT and conventional-dose CT (CDCT), there were no significant differences in step and gap measurements across all reviewers. CONCLUSION This study demonstrated that LDCT provides comparable imaging quality for surgical planning as a CDCT without significant diagnostic decay in the setting of DRFs. This comes with the added benefit of a 10-fold reduction in radiation exposure. These results suggest that LDCT is an opportunity to reduce effective radiation in patients although providing beneficial preoperative imaging.
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Affiliation(s)
| | - A Jordan Grier
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Hannah C Langdell
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Kier M Blevins
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Suhail K Mithani
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Warren C Hammert
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
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2
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Nabrawi E, Alanazi AT. Imaging in Healthcare: A Glance at the Present and a Glimpse Into the Future. Cureus 2023; 15:e36111. [PMID: 37065355 PMCID: PMC10098436 DOI: 10.7759/cureus.36111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
The utilization of artificial intelligence (AI) applications in medical imaging relies heavily on imaging informatics. That is a one-of-a-kind professional who works at the crossroads of clinical radiography, data science, and information technology. Imaging informaticians are becoming crucial players in expanding, assessing, and implementing AI in the medical setting. Teleradiology will continue to be a cost-effective healthcare facility that expands. Vendor neutral archive (VNA) isolates image presentation and storing systems, permitting platforms to develop quickly, and is a repository for organization-wide healthcare image data. Efforts are made to incorporate and integrate diagnostic facilities such as radiography and pathology to fulfill the needs and demands of targeted therapy. Developments in computer-aided medical object identification may alter the environment of patient services. Finally, interpreting and processing distinct complex healthcare data will create a data-rich context where evidence-based care and performance development may be driven.
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3
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Masuda T, Funama Y, Nakaura T, Sato T, Urayama K, Kiguchi M, Oku T, Yoshida M, Arao S, Ono A, Hiratsuka J, Awai K. Usefulness of large beam-shaping filters at different tube voltages of newborn chest CT. Phys Eng Sci Med 2023; 46:289-293. [PMID: 36633769 DOI: 10.1007/s13246-023-01217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/10/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND To investigate optimizing the use of different beam shaping filters (viz. small, medium and large) when using different tube voltages during the newborn chest computed tomography (CT) on a GE Lightspeed VCT scanner. METHODS We used pediatric anthropomorphic phantoms with a 64 detector-row CT scanner while scanning the chest. A real-time skin dosimeter (RD - 1000; Trek Corporation, Kanagawa, Japan) was positioned into the phantom center of the body, the surface of the body back, and the right and left mammary glands. We performed and compared six scan protocols using small, medium, and large beam shaping filters at 80 and 120 kVp protocols. RESULT There were no significant differences in the image noise for the chest scan among the different beam shaping filters. By using the large beam shaping filter at 80 kVp, it was possible to reduce the exposure dose by 5% in comparison with the small beam shaping filter, and by 10% in comparison with the medium beam shaping filter. By using the large beam shaping filter at 120 kVp, it was possible to reduce the exposure dose by 15% in comparison with the small beam shaping filter and by 20% in comparison with the medium beam shaping filter (p < 0.01). CONCLUSION The large beam shaping filter had the most dose reduction effect during newborn chest CT on a GE Lightspeed VCT scanner. The additional copper filtration being present in the large bowtie filter of the GE Lightspeed CT scanner when using different tube voltages is more effective in reducing radiation exposure in children.
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Affiliation(s)
- Takanori Masuda
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288, Matsushima, Kurashiki, 701-0193, Kurashiki-city, Okayama, Japan.
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, 860-8556, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, 860-8556, Kumamoto, Japan
| | - Tomoyasu Sato
- Department of Diagnostic Radiology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, 730-8655, Hiroshima, Japan
| | - Kotaro Urayama
- Department of Pediatric cardiology, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, 730-8655, Hiroshima, Japan
| | - Masao Kiguchi
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, 734-8551, Hiroshima, Japan
| | - Takayuki Oku
- Department of Radiological technologist, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, 730-8655, Hiroshima, Japan
| | - Masato Yoshida
- Department of Radiological technologist, Tsuchiya General Hospital, Nakajima-cho 3-30, Naka-ku, 730-8655, Hiroshima, Japan
| | - Shinichi Arao
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288, Matsushima, Kurashiki, 701-0193, Kurashiki-city, Okayama, Japan
| | - Atsushi Ono
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288, Matsushima, Kurashiki, 701-0193, Kurashiki-city, Okayama, Japan
| | - Junichi Hiratsuka
- Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288, Matsushima, Kurashiki, 701-0193, Kurashiki-city, Okayama, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, 734-8551, Hiroshima, Japan
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4
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Espiritu J, Berangi M, Yiannakou C, Silva E, Francischello R, Kuehne A, Niendorf T, Könneker S, Willumeit-Römer R, Seitz JM. Evaluating metallic artefact of biodegradable magnesium-based implants in magnetic resonance imaging. Bioact Mater 2022; 15:382-391. [PMID: 35386351 PMCID: PMC8958470 DOI: 10.1016/j.bioactmat.2021.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 11/13/2022] Open
Abstract
Magnesium (Mg) implants have shown to cause image artefacts or distortions in magnetic resonance imaging (MRI). Yet, there is a lack of information on how the degradation of Mg-based implants influences the image quality of MRI examinations. In this study, Mg-based implants are analysed in vitro, ex vivo, and in the clinical setting for various magnetic field strengths with the aim to quantify metallic artefact behaviour. In vitro corroded Mg-based screws and a titanium (Ti) equivalent were imaged according to the ASTM F2119. Mg-based and Ti pins were also implanted into rat femurs for different time points and scanned to provide insights on the influence of soft and hard tissue on metallic artefact. Additionally, MRI data of patients with scaphoid fractures treated with CE-approved Mg-based compression screws (MAGNEZIX®) were analysed at various time points post-surgery. The artefact production of the Mg-based material decreased as implant material degraded in all settings. The worst-case imaging scenario was determined to be when the imaging plane was selected to be perpendicular to the implant axis. Moreover, the Mg-based implant outperformed the Ti equivalent in all experiments by producing lower metallic artefact (p < 0.05). This investigation demonstrates that Mg-based implants generate significantly lower metallic distortion in MRI when compared to Ti. Our positive findings suggest and support further research into the application of Mg-based implants including post-operative care facilitated by MRI monitoring of degradation kinetics and bone/tissue healing processes. Mg-based implants produce lower metallic artefact than Ti in MRI. Metallic artefact production of Mg reduces as degradation increases. Mg implants provide sufficient visualisation in MRI for better postoperative care.
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Affiliation(s)
| | - Mostafa Berangi
- MRI.TOOLS GmbH, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | | | - Eduarda Silva
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Roberto Francischello
- Chemistry and Industrial Chemistry Department, Università di Pisa, Via Moruzzi 13, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, Pisa, Italy
| | | | - Thoralf Niendorf
- MRI.TOOLS GmbH, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sören Könneker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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5
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Bernard FC, Kaiser J, Raval SK, Nepiyushchikh ZV, Doan TN, Willett NJ, Dixon JB. Multichromatic near-infrared imaging to assess interstitial lymphatic and venous uptake in vivo. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210078R. [PMID: 34881527 PMCID: PMC8654485 DOI: 10.1117/1.jbo.26.12.126001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/21/2021] [Indexed: 05/12/2023]
Abstract
SIGNIFICANCE Changes in interstitial fluid clearance are implicated in many diseases. Using near-infrared (NIR) imaging with properly sized tracers could enhance our understanding of how venous and lymphatic drainage are involved in disease progression or enhance drug delivery strategies. AIM We investigated multichromatic NIR imaging with multiple tracers to assess in vivo microvascular clearance kinetics and pathways in different tissue spaces. APPROACH We used a chemically inert IR Dye 800CW (D800) to target venous capillaries and a purified conjugate of IR dye 680RD with 40 kDa PEG (P40D680) to target lymphatic capillaries in vivo. Optical imaging settings were validated and tuned in vitro using tissue phantoms. We investigated multichromatic NIR imaging's utility in two in vivo tissue beds: the mouse tail and rat knee joint. We then tested the ability of the approach to detect interstitial fluid perturbations due to exercise. RESULTS In an in vitro simulated tissue environment, free dye and PEG mixture allowed for simultaneous detection without interference. In the mouse tail, co-injected NIR tracers cleared from the interstitial space via distinct routes, suggestive of lymphatic and venous uptake mechanisms. In the rat knee, we determined that exercise after injection transiently increased lymphatic drainage as measured by lower normalized intensity immediately after exercise, whereas exercise pre-injection exhibited a transient delay in clearance from the joint. CONCLUSIONS NIR imaging enables simultaneous imaging of lymphatic and venous-mediated fluid clearance with great sensitivity and can be used to measure temporal changes in clearance rates and pathways.
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Affiliation(s)
- Fabrice C. Bernard
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Jarred Kaiser
- Emory University, Department of Orthopaedics, Atlanta, Georgia, United States
| | - Sarvgna K. Raval
- Emory University, Department of Orthopaedics, Atlanta, Georgia, United States
| | - Zhanna V. Nepiyushchikh
- Georgia Institute of Technology, George W. Woodruff School of Mechanical Engineering, Atlanta, Georgia, United States
| | - Thanh N. Doan
- Emory University, Department of Orthopaedics, Atlanta, Georgia, United States
| | - Nick J. Willett
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University, Department of Orthopaedics, Atlanta, Georgia, United States
- Atlanta Veteran’s Affairs Medical Center, Department of Orthopaedics, Atlanta, Georgia, United States
- Georgia Institute of Technology, Parker H. Petit Institute for Bioengineering and Bioscience, Atlanta, Georgia, United States
| | - J. Brandon Dixon
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Georgia Institute of Technology, George W. Woodruff School of Mechanical Engineering, Atlanta, Georgia, United States
- Georgia Institute of Technology, Parker H. Petit Institute for Bioengineering and Bioscience, Atlanta, Georgia, United States
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6
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Winder M, Owczarek AJ, Chudek J, Pilch-Kowalczyk J, Baron J. Are We Overdoing It? Changes in Diagnostic Imaging Workload during the Years 2010-2020 including the Impact of the SARS-CoV-2 Pandemic. Healthcare (Basel) 2021; 9:healthcare9111557. [PMID: 34828603 PMCID: PMC8621920 DOI: 10.3390/healthcare9111557] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/30/2022] Open
Abstract
Since the 1990s, there has been a significant increase in the number of imaging examinations as well as a related increase in the healthcare expenditure and the exposure of the population to X-rays. This study aimed to analyze the workload trends in radiology during the last decade, including the impact of COVID-19 in a single university hospital in Poland and to identify possible solutions to the challenges that radiology could face in the future. We compared the annual amount of computed tomography (CT), radiography (X-ray), and ultrasound (US) examinations performed between the years 2010 and 2020 and analyzed the changes in the number of practicing radiologists in Poland. The mean number of patients treated in our hospital was 60,727 per year. During the last decade, the number of CT and US examinations nearly doubled (from 87.4 to 155.7 and from 52.1 to 86.5 per 1000 patients in 2010 and 2020 respectively), while X-ray examinations decreased from 115.1 to 96.9 per 1000 patients. The SARS-CoV-2 pandemic did not change the workload trends as more chest examinations were performed. AI, which contributed to the COVID-19 diagnosis, could aid radiologists in the future with the growing workload by increasing the efficiency of radiology departments as well as by potentially minimizing the related costs.
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Affiliation(s)
- Mateusz Winder
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, 40-055 Katowice, Poland; (J.P.-K.); (J.B.)
- Correspondence: ; Tel.: +48-32-789-47-51
| | - Aleksander Jerzy Owczarek
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Joanna Pilch-Kowalczyk
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, 40-055 Katowice, Poland; (J.P.-K.); (J.B.)
| | - Jan Baron
- Department of Radiology and Nuclear Medicine, Medical University of Silesia, 40-055 Katowice, Poland; (J.P.-K.); (J.B.)
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7
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Narasimhamurthy RK, Mumbrekar KD, Satish Rao BS. Effects of low dose ionizing radiation on the brain- a functional, cellular, and molecular perspective. Toxicology 2021; 465:153030. [PMID: 34774978 DOI: 10.1016/j.tox.2021.153030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/16/2021] [Accepted: 11/08/2021] [Indexed: 02/08/2023]
Abstract
Over the years, the advancement of radio diagnostic imaging tools and techniques has radically improved the diagnosis of different pathophysiological conditions, accompanied by increased exposure to low-dose ionizing radiation. Though the consequences of high dose radiation exposure on humans are very well comprehended, the more publicly relevant effects of low dose radiation (LDR) (≤100 mGy) exposure on the biological system remain ambiguous. The central nervous system, predominantly the developing brain with more neuronal precursor cells, is exceptionally radiosensitive and thus more liable to neurological insult even at low doses, as shown through several rodent studies. Further molecular studies have unraveled the various inflammatory and signaling mechanisms involved in cellular damage and repair that drive these physiological alterations that lead to functional alterations. Interestingly, few studies also claim that LDR exerts therapeutic effects on the brain by initiating an adaptive response. The present review summarizes the current understanding of the effects of low dose radiation at functional, cellular, and molecular levels and the various risks and benefits associated with it based on the evidence available from in vitro, in vivo, and clinical studies. Although the consensus indicates minimum consequences, the overall evidence suggests that LDR can bring about considerable neurological effects in the exposed individual, and hence a re-evaluation of the LDR usage levels and frequency of exposure is required.
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Affiliation(s)
- Rekha K Narasimhamurthy
- Department of Radiation Biology and Toxicology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Kamalesh D Mumbrekar
- Department of Radiation Biology and Toxicology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - B S Satish Rao
- Research Directorate Office, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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8
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Baygin M, Dogan S, Tuncer T, Datta Barua P, Faust O, Arunkumar N, Abdulhay EW, Emma Palmer E, Rajendra Acharya U. Automated ASD detection using hybrid deep lightweight features extracted from EEG signals. Comput Biol Med 2021; 134:104548. [PMID: 34119923 DOI: 10.1016/j.compbiomed.2021.104548] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Autism spectrum disorder is a common group of conditions affecting about one in 54 children. Electroencephalogram (EEG) signals from children with autism have a common morphological pattern which makes them distinguishable from normal EEG. We have used this type of signal to design and implement an automated autism detection model. MATERIALS AND METHOD We propose a hybrid lightweight deep feature extractor to obtain high classification performance. The system was designed and tested with a big EEG dataset that contained signals from autism patients and normal controls. (i) A new signal to image conversion model is presented in this paper. In this work, features are extracted from EEG signal using one-dimensional local binary pattern (1D_LBP) and the generated features are utilized as input of the short time Fourier transform (STFT) to generate spectrogram images. (ii) The deep features of the generated spectrogram images are extracted using a combination of pre-trained MobileNetV2, ShuffleNet, and SqueezeNet models. This method is named hybrid deep lightweight feature generator. (iii) A two-layered ReliefF algorithm is used for feature ranking and feature selection. (iv) The most discriminative features are fed to various shallow classifiers, developed using a 10-fold cross-validation strategy for automated autism detection. RESULTS A support vector machine (SVM) classifier reached 96.44% accuracy based on features from the proposed model. CONCLUSIONS The results strongly indicate that the proposed hybrid deep lightweight feature extractor is suitable for autism detection using EEG signals. The model is ready to serve as part of an adjunct tool that aids neurologists during autism diagnosis in medical centers.
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Affiliation(s)
- Mehmet Baygin
- Department of Computer Engineering, College of Engineering, Ardahan University, Ardahan, Turkey.
| | - Sengul Dogan
- Department of Digital Forensics Engineering, College of Technology, Firat University, Elazig, Turkey.
| | - Turker Tuncer
- Department of Digital Forensics Engineering, College of Technology, Firat University, Elazig, Turkey.
| | - Prabal Datta Barua
- School of Management & Enterprise, University of Southern Queensland, Australia.
| | - Oliver Faust
- Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield, United Kingdom.
| | - N Arunkumar
- Department of Electronics and Instrumentation, SASTRA University, Thirumalaisamudram, Thanjavur, 613401, India.
| | - Enas W Abdulhay
- Biomedical Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, P.O.Box 3030, Irbid, 22110, Jordan.
| | - Elizabeth Emma Palmer
- Department of Medical Genetics, Sydney Children's Hospital, High Street, Randwick, NSW, Australia.
| | - U Rajendra Acharya
- Ngee Ann Polytechnic, Department of Electronics and Computer Engineering, 599489, Singapore; Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore; Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung, Taiwan.
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9
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Chen X, Li W, Wang F, He L, Liu E. Early recognition of necrotizing pneumonia in children based on non-contrast-enhanced computed tomography radiomics signatures. Transl Pediatr 2021; 10:1542-1551. [PMID: 34295769 PMCID: PMC8261593 DOI: 10.21037/tp-20-241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Necrotizing pneumonia (NP) is an infrequent but severe complication of pneumonia in children. In the early stages of NP, CT imaging shows lung consolidation, which cannot be detected in time. This study aimed to explore the ability of non-contrast-enhanced CT radiomics features to recognize NP in early stage. METHODS This was a retrospective study, and 250 patients who presented with lung consolidation on initial CT images were included in this study. After a follow-up period of 1-3 weeks, 116 patients developed NP, whose CT or X-ray shows cavitation or liquefied necrosis. Manual segmentation of lesion sites in the initial non-contrast-enhanced CT scans was performed with RadCloud (Huiying Medical Technology Co., Ltd., China), and 1,409 radiomics features were extracted. We used Variance threshold (0.8), SelectKBest, and the least absolute shrinkage and selection operator (LASSO) methods for feature dimension reduction. Three machine learning algorithms, k-nearest neighbor (KNN), support vector machine (SVM), and logistic regression (LR) models, were established to recognize NP early. To assess the recognition performance, the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and other indicators were used in the validation cohort. RESULTS Radiomics features helped to recognize NP in early stage in both the training and validation cohorts. The AUC (sensitivity, specificity) for the training and validation cohorts were 0.81 (0.73, 0.68) and 0.71 (0.61, 0.65) for KNN, respectively; 0.81 (0.72, 0.70) and 0.77 (0.66, 0.65) for SVM, respectively; and 0.82 (0.73, 0.73) and 0.76 (0.63, 0.70) for LR, respectively. Recall and F1-scores determined that LR performed better at diagnosing early NP, with the values of the above two indexes being 0.70 and 0.67, respectively. CONCLUSIONS Non-contrast-enhanced CT-based radiomics models may be helpful for recognizing NP in early stage.
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Affiliation(s)
- Xin Chen
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Weiguo Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Department of Respiratory, Medicine Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fang Wang
- Huiying Medical Technology Co. Ltd., Beijing, China
| | - Ling He
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Enmei Liu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Department of Respiratory, Medicine Children's Hospital of Chongqing Medical University, Chongqing, China
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10
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99mTc-antitumor necrosis factor-alpha scintigraphy for the detection of inflammatory activity in rheumatoid arthritis. Nucl Med Commun 2020; 42:389-395. [PMID: 33306625 DOI: 10.1097/mnm.0000000000001333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tumor necrosis factor-alpha (TNF-α) is an important inflammatory cytokine. 99mTc-anti-TNF-α antibody scintigraphy has proven to be a viable alternative to MRI in specific cases. The objective of this study was to evaluate the performance of scintigraphy with 99mTc-anti-TNF-α in the identification of inflammatory foci in individuals diagnosed with rheumatoid arthritis using MRI as the gold standard. METHODS This cross-sectional, descriptive and analytical-qualitative clinical study compared the performance of 99mTc-anti-TNF-α scintigraphy with that of MRI with intravenous administration of gadolinium (used as the gold standard) and a clinical examination (Disease Activity Score 28) in 220 joints of 20 patients with a diagnosis of rheumatoid arthritis and one healthy control. RESULTS The concordance of scintigraphy with MRI in individuals with a diagnosis of rheumatoid arthritis was 79%. The accuracy, sensitivity and specificity of scintigraphy for distinguishing between inflammatory and noninflammatory sites were 92, 89, and 93%, respectively. No adverse reactions to the examinations were reported. CONCLUSIONS Scintigraphy with 99mTc-anti-TNF-α was well-tolerated and had a good ability to distinguish between inflammatory and noninflammatory lesions in patients with rheumatoid arthritis.
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11
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Ramoutar DN, Thakur Y, Batta V, Chung V, Liu D, Guy P. Orthopaedic Surgeon Brain Radiation During Fluoroscopy: A Cadaver Model. J Bone Joint Surg Am 2020; 102:e125. [PMID: 33208643 DOI: 10.2106/jbjs.19.01053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of this study were to quantify exposure of the surgeon's brain to radiation during short cephalomedullary (SC) nailing, to extrapolate lifetime dose, and to determine the effects of personal protective equipment (PPE) on brain dose. METHODS Two cadaveric specimens were used: (1) a whole cadaveric body representing the patient, with a left nail inserted to act as the scatter medium, and (2) an isolated head-and-neck cadaveric specimen representing a surgeon, with radiation dosimeters placed in specific locations in the brain. The "patient" cadaver's left hip was exposed in posteroanterior and lateral radiographic planes. Measurements were performed without shielding of the head-and-neck specimen and then repeated sequentially with different PPE configurations. An average surgeon career was estimated to be 40 years (ages 25 to 65 years) with the caseload obtained from the department's billing data. RESULTS The mean radiation dose to the surgeon brain without PPE was 3.35 µGy (95% confidence interval [CI]: 2.4 to 4.3) per nail procedure. This was significantly reduced with use of a thyroid collar (2.94 µGy [95% CI: 1.91 to 3.91], p = 0.04). Compared with use of the thyroid collar in isolation, there was no significant additional reduction in radiation when the collar was used with leaded glasses (2.96 µGy [95% CI: 2.15 to 3.76], p = 0.97), with a lead cap (3.22 µGy [95% CI: 2.31 to 4.13], p = 0.55), or with both (2.31 µGy [95% CI: 1.61 to 3.01], p = 0.15). The extrapolated lifetime dose over 40 working years for SC nailing without PPE was 2,146 µGy (95% CI: 1,539 to 2,753), with an effective dose of 21.5 µSv. CONCLUSIONS The extrapolated cumulative lifetime radiation to a surgeon's brain from SC nailing based on our institution's workload and technology is low and comparable with radiation during a one-way flight from London to New York. Of note, we studied only one of many fluoroscopy-aided procedures and likely underestimated total lifetime exposure if exposures from other procedures are included. This study also demonstrates that thyroid collars significantly reduce brain dose for this procedure whereas other head/neck PPE such as lead caps appear to have minimal additional effect. This study provides a methodology for future studies to quantify brain dose for other common orthopaedic procedures. CLINICAL RELEVANCE This study, based on our institutional data, demonstrates that although the lifetime brain dose from SC nailing is low, thyroid collars significantly reduce this dose further. As such, in accordance with the "as low as reasonably achievable" radiation exposure principle, radiation safety programs and individual surgeons should consider use of thyroid collars in this setting.
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Affiliation(s)
- Darryl Nilesh Ramoutar
- Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Yogesh Thakur
- Department of Radiology, Faculty of Medicine (Y.T.), and Division of Orthopaedic Trauma, Department of Orthopaedics (P.G.), University of British Columbia, Vancouver, British Columbia, Canada
| | - Vineet Batta
- Department of Trauma and Orthopaedics, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Vivian Chung
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Danmei Liu
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Department of Radiology, Faculty of Medicine (Y.T.), and Division of Orthopaedic Trauma, Department of Orthopaedics (P.G.), University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
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Choi KS, Choi YH, Cheon JE, Kim WS, Kim IO. Application of T1-weighted BLADE sequence to abdominal magnetic resonance imaging of young children: a comparison with turbo spin echo sequence. Acta Radiol 2020; 61:1406-1413. [PMID: 31979979 DOI: 10.1177/0284185120901512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The image quality of abdominal magnetic resonance imaging (MRI) in children who cannot hold their breath has been severely impaired by motion artifacts. PURPOSE To evaluate the usefulness of T1-weighted (T1W) BLADE MRI for axial abdominal imaging in children who cannot hold their breath. MATERIAL AND METHODS Two different BLADE sequences, with and without an inversion recovery (IR-BLADE), were compared to conventional turbo-spin echo (TSE) with a high number of excitations in 18 consecutive patients who cannot hold their breath. Overall image quality, motion artifact, radial artifact, hepatic vessel sharpness, renal corticomedullary differentiation, and lesion conspicuity were retrospectively assessed by two radiologists, using 4- or 5-point scoring systems. Signal variations of each sequence were measured for a quantitative comparison. The acquisition times of the three sequences were compared. RESULTS IR-BLADE and BLADE showed significantly improved overall image quality and reduced motion artifact compared with TSE. IR-BLADE showed significantly better hepatic vessel sharpness and corticomedullary differentiation compared to both BLADE and TSE. Radial artifacts were only observed on IR-BLADE and BLADE. In nine patients with lesions, there were no significant differences in lesion conspicuity among three sequences. Compared to TSE, both IR-BLADE and BLADE showed decreased signal variations in the liver and muscle, and an increased signal variation through air. The mean acquisition times for IR-BLADE, BLADE, and TSE were comparable. CONCLUSION Compared to the TSE sequence, T1W IR-BLADE for pediatric abdominal MRI resulted in improved image quality, tissue contrast with a diminished respiratory motion artifact, and a comparable acquisition time.
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Affiliation(s)
- Kyu Sung Choi
- Graduate School of Medical Science and Engineering, Korea Advanced Institute for Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - In One Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Weyland CS, Seker F, Potreck A, Hametner C, Ringleb PA, Möhlenbruch MA, Bendszus M, Pfaff JAR. Radiation exposure per thrombectomy attempt in modern endovascular stroke treatment in the anterior circulation. Eur Radiol 2020; 30:5039-5047. [PMID: 32328765 PMCID: PMC7431433 DOI: 10.1007/s00330-020-06837-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
Objective To quantify radiation exposure (RE) of endovascular stroke treatment (EST) in the anterior circulation per thrombectomy attempt and determine causes for interventions associated with high RE. Methods A retrospective single-center study of an institutional review board−approved stroke database of patients receiving EST for large vessel occlusions in the anterior circulation between January 2013 and April 2018 to evaluate reference levels (RL) per thrombectomy attempt. ESTs with RE above the RL were analyzed to determine causes for high RE. Results Overall, n = 544 patients (occlusion location, M1 and M2 segments of the middle cerebral artery 53.5% and 27.2%, carotid artery 17.6%; successful recanalization rate 85.7%) were analyzed. In the overall population, DAP (in Gy cm2, median (IQR)) was 113.7 (68.9–181.7) with a median fluoroscopy time of 31 min (IQR, 17–53) and a median of 2 (IQR, 1–4) thrombectomy attempts. RE increased significantly with every thrombectomy attempt (DAP1, 68.7 (51.2–106.8); DAP2, 106.4 (84.8–115.6); p value1vs2, < 0.001; DAP3, 130.2 (89.1–183.6); p value2vs3, 0.044; DAP4, 169.9 (128.4–224.1); p value3vs4, 0.001; and DAP5, 227.6 (146.3–294.6); p value4vs5, 0.019). Procedures exceeding the 90th percentile of the attempt-dependent radiation exposure level were associated with procedural complications (n = 17/52, 29.8%) or a difficult vascular access (n = 8/52, 14%). Conclusions Radiation exposure in endovascular stroke treatment is depending on the number of thrombectomy attempts. Radiation exposure doubles when three attempts and triples when five attempts are necessary compared with single-maneuver interventions. Procedural complications and difficult vascular access were associated with a high radiation exposure in this collective. Key Points • Radiation exposure of endovascular stroke treatment (EST) is dependent on the number of thrombectomy attempts. • Reference levels as means for quality control in hospitals performing endovascular stroke treatment should be defined by the number of thrombectomy attempts—we suggest 107 Gy cm2, 156 Gy cm2, 184 Gy cm2, 244 Gy cm2, and 295 Gy cm2for 1 to 5 maneuvers, respectively, for EST of the anterior circulation • Cases with high rates of radiation exposure are associated with periprocedural complications and difficult anatomical access as a probable cause for a high radiation exposure.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Fatih Seker
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Arne Potreck
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Hametner
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter A Ringleb
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes A R Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Protecting sensitive patient groups from imaging using ionizing radiation: effects during pregnancy, in fetal life and childhood. LA RADIOLOGIA MEDICA 2019; 124:736-744. [PMID: 30949891 DOI: 10.1007/s11547-019-01034-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
The frequency of imaging examinations requiring radiation exposure in children (especially CT) is rapidly increasing. This paper reviews the current evidence in radiation protection in pediatric imaging, focusing on the recent knowledge of the biological risk related to low doses exposure. Even if there are no strictly defined limits for patient radiation exposure, it is recommended to try to keep doses as low as reasonably achievable (the ALARA principle). To achieve ALARA, several techniques to reduce the radiation dose in radiation-sensitive patients groups are reviewed. The most recent recommendations that provide guidance regarding imaging of pregnant women are also summarized, and the risk depending on dose and phase of pregnancy is reported. Finally, the risk-benefit analysis of each examination, and careful communication of this risk to the patient, is emphasized.
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15
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Chan A, Parent E, Lou E. Reconstruction and positional accuracy of 3D ultrasound on vertebral phantoms for adolescent idiopathic scoliosis spinal surgery. Int J Comput Assist Radiol Surg 2018; 14:427-439. [PMID: 30519871 DOI: 10.1007/s11548-018-1894-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Determine the positional, rotational and reconstruction accuracy of a 3D ultrasound system to be used for image registration in navigation surgery. METHODS A custom 3D ultrasound for spinal surgery image registration was developed using Optitrack Prime 13-W motion capture cameras and a SonixTablet Ultrasound System. Temporal and spatial calibration was completed to account for time latencies between the two systems and to ensure accurate motion tracking of the ultrasound transducer. A mock operating room capture volume with a pegboard grid was set up to allow phantoms to be placed at a variety of predetermined positions to validate accuracy measurements. Five custom-designed ultrasound phantoms were 3D printed to allow for a range of linear and angular dimensions to be measured when placed on the pegboard. RESULTS Temporal and spatial calibration was completed with measurement repeatabilities of 0.2 mm and 0.5° after calibration. The mean positional accuracy was within 0.4 mm, with all values within 0.5 mm within the critical surgical regions and 96% of values within 1 mm within the full capture volume. All orientation values were within 1.5°. Reconstruction accuracy was within 0.6 mm and 0.9° for geometrically shaped phantoms and 0.5 and 1.9° for vertebrae-mimicking phantoms. CONCLUSIONS The accuracy of the developed 3D ultrasound system meets the 1 mm and 5° requirements of spinal surgery from this study. Further repeatability studies and evaluation on vertebrae are needed to validate the system for surgical use.
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Affiliation(s)
- Andrew Chan
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada
| | - Eric Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G2G4, Canada
| | - Edmond Lou
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, 8308-114 Street, Edmonton, AB, T6G 2V2, Canada. .,Department of Electrical and Computer Engineering, University of Alberta, Donadeo ICE 11-371, 9211-116 Street, Edmonton, AB, T6G 1H9, Canada.
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16
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Al-Mula Abed OWS, Srirangam SJ, Wemyss-Holden GD. Upper Tract Imaging in Patients with Initial or Terminal Hematuria Suggestive of Bleeding from the Lower Urinary Tract: How Often is the Upper Urinary Tract Responsible for the Hematuria? Oman Med J 2018; 33:374-379. [PMID: 30210715 DOI: 10.5001/omj.2018.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Visible hematuria (VH) is a common urological complaint. A history of initial or terminal VH in men is indicative of a lower urinary tract (LUT) source. A careful clinical history could limit unnecessary extensive upper tract imaging in this group of patients with VH. We conducted a single-center prospective study to examine the usefulness of investigating the upper tract in patients with a history of VH likely from a LUT source (initial and/or terminal VH) with specific reference to the incidence of demonstrable significant upper tract abnormalities. Methods We conducted a single-center prospective study of consecutive male patients presenting with VH over eight months. All patients underwent standard investigations including physical examination, flexible cystoscopy (FC), and radiological imaging (ultrasound scan (USS) and/or computed tomography urogram (CTU)). Those with a clear history of initial or terminal VH were identified for further scrutiny with regards to detectable upper tracts abnormalities. Results In total, 57 patients (aged 23-95 years) with initial or terminal VH were identified. Of these, 56 had FC and nine patients were subsequently diagnosed with a LUT malignancy. With regards to upper urinary tract (UUT), 35 patients (61.4%) had an USS, 46 (80.7%) underwent a CTU, and 25 (43.9%) patients had both. In this group, no UUT malignancy was identified on upper tract imaging. Conclusions Initial or terminal VH patients may not need extensive upper tract imaging. FC is recommended, but a non-invasive USS can be a safe initial investigation for the UUT, with a CTU subsequently considered in those with abnormalities on USS and those with ongoing bleeding. Further combined multicenter analysis will help corroborate these findings and could have several beneficial outcomes including a reduction in investigations cost, patient inconvenience, and ionizing radiation.
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Affiliation(s)
| | - Shalom J Srirangam
- Department of Urology, East Lancashire Hospitals Trust, Blackburn, United Kingdom
| | - Guy D Wemyss-Holden
- Department of Urology, East Lancashire Hospitals Trust, Blackburn, United Kingdom
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Kamal A, Faghih M, Moran RA, Afghani E, Sinha A, Parsa N, Makary MA, Zaheer A, Fishman EK, Khashab MA, Kalloo AN, Singh VK. Persistent SIRS and acute fluid collections are associated with increased CT scanning in acute interstitial pancreatitis. Scand J Gastroenterol 2018; 53:88-93. [PMID: 29017354 DOI: 10.1080/00365521.2017.1383510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of computed tomography (CT) in acute pancreatitis (AP) continues to increase in parallel with the increasing use of diagnostic imaging in clinical medicine. AIM To determine the factors associated with obtaining >1 CT scan in acute interstitial pancreatitis (AIP). METHODS Demographic and clinical data of all adult patients admitted between 1/2010 and 1/2015 with AP (AP) were evaluated. Only patients with a CT severity index (CTSI) ≤ 3 on a CT obtained within 48 h of presentation were included. RESULTS A total of 229 patients were included, of whom 206 (90%) had a single CT and 23 (10%) had >1 CT during the first week of hospitalization. Patients undergoing >1 CT had significantly higher rates of acute fluid collection (AFC), persistent SIRS, opioid use ≥4 days, and persistent organ failure compared to those undergoing 1 CT (p < .05 for all). On multivariable analysis, only persistent SIRS (OR = 3.6, 95% CI 1.4-9.6, p = .01) and an AFC on initial CT (OR = 3.5, 95% CI 1.4-9, p = .009) were independently associated with obtaining >1 CT. CONCLUSION An AFC on initial CT and persistent SIRS are associated with increased CT imaging in AIP patients. However, these additional CT scans did not change clinical management.
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Affiliation(s)
- Ayesha Kamal
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Mahya Faghih
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Robert A Moran
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Elham Afghani
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Amitasha Sinha
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Nasim Parsa
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Martin A Makary
- b Division of Surgical Oncology, Department of Surgery , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Atif Zaheer
- c Pancreatitis Center, Johns Hopkins Medical Institutions , Baltimore , MD , USA.,d Department of Radiology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Elliot K Fishman
- d Department of Radiology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Mouen A Khashab
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Anthony N Kalloo
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA.,c Pancreatitis Center, Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Vikesh K Singh
- a Division of Gastroenterology , Johns Hopkins Medical Institutions , Baltimore , MD , USA.,c Pancreatitis Center, Johns Hopkins Medical Institutions , Baltimore , MD , USA
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Imaging appropriateness in an academic emergency medicine program. Int Emerg Nurs 2018; 36:16-21. [DOI: 10.1016/j.ienj.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022]
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Campbell BR, Gonzalez Trotter D, Hines CDG, Li W, Patel M, Zhang W, Evelhoch JL. In Vivo Imaging in Pharmaceutical Development and Its Impact on the 3Rs. ILAR J 2017; 57:212-220. [PMID: 28053073 PMCID: PMC5886324 DOI: 10.1093/ilar/ilw019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 06/28/2016] [Accepted: 08/04/2016] [Indexed: 12/17/2022] Open
Abstract
It is well understood that the biopharmaceutical industry must improve efficiency along the path from laboratory concept to commercial product. In vivo imaging is recognized as a useful method to provide biomarkers for target engagement, treatment response, safety, and mechanism of action. Imaging biomarkers have the potential to inform the selection of drugs that are more likely to be safe and effective. Most of the imaging modalities for biopharmaceutical research are translatable to the clinic. In vivo imaging does not require removal of tissue to provide biomarkers, thus reducing the number of valuable preclinical subjects required for a study. Longitudinal imaging allows for quantitative intra-subject comparisons, enhancing statistical power, and further reducing the number of subjects needed for the evaluation of treatment effects in animal models. The noninvasive nature of in vivo imaging also provides a valuable approach to alleviate or minimize potential pain, suffering or distress.
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Affiliation(s)
- Barry R Campbell
- Barry R. Campbell is an Associate Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Kenilworth, New Jersey. Dinko Gonzalez Trotter, PhD, is a Senior Director in Early Clinical Development at Regeneron Pharmaceuticals, Inc., in Tarrytown, New York. Catherine D. Hines, PhD is a Director in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Manishkumar Patel, PhD is a Principal Scientist in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Weisheng Zhang is a Senior Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Boston, Massachusetts. Jeffrey L. Evelhoch, PhD, is Vice President of Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania
| | - Dinko Gonzalez Trotter
- Barry R. Campbell is an Associate Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Kenilworth, New Jersey. Dinko Gonzalez Trotter, PhD, is a Senior Director in Early Clinical Development at Regeneron Pharmaceuticals, Inc., in Tarrytown, New York. Catherine D. Hines, PhD is a Director in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Manishkumar Patel, PhD is a Principal Scientist in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Weisheng Zhang is a Senior Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Boston, Massachusetts. Jeffrey L. Evelhoch, PhD, is Vice President of Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania
| | - Catherine D G Hines
- Barry R. Campbell is an Associate Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Kenilworth, New Jersey. Dinko Gonzalez Trotter, PhD, is a Senior Director in Early Clinical Development at Regeneron Pharmaceuticals, Inc., in Tarrytown, New York. Catherine D. Hines, PhD is a Director in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Manishkumar Patel, PhD is a Principal Scientist in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Weisheng Zhang is a Senior Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Boston, Massachusetts. Jeffrey L. Evelhoch, PhD, is Vice President of Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania
| | - Wenping Li
- Barry R. Campbell is an Associate Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Kenilworth, New Jersey. Dinko Gonzalez Trotter, PhD, is a Senior Director in Early Clinical Development at Regeneron Pharmaceuticals, Inc., in Tarrytown, New York. Catherine D. Hines, PhD is a Director in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Manishkumar Patel, PhD is a Principal Scientist in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Weisheng Zhang is a Senior Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Boston, Massachusetts. Jeffrey L. Evelhoch, PhD, is Vice President of Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania
| | - Manishkumar Patel
- Barry R. Campbell is an Associate Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Kenilworth, New Jersey. Dinko Gonzalez Trotter, PhD, is a Senior Director in Early Clinical Development at Regeneron Pharmaceuticals, Inc., in Tarrytown, New York. Catherine D. Hines, PhD is a Director in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Manishkumar Patel, PhD is a Principal Scientist in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Weisheng Zhang is a Senior Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Boston, Massachusetts. Jeffrey L. Evelhoch, PhD, is Vice President of Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania
| | - Weisheng Zhang
- Barry R. Campbell is an Associate Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Kenilworth, New Jersey. Dinko Gonzalez Trotter, PhD, is a Senior Director in Early Clinical Development at Regeneron Pharmaceuticals, Inc., in Tarrytown, New York. Catherine D. Hines, PhD is a Director in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Manishkumar Patel, PhD is a Principal Scientist in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Weisheng Zhang is a Senior Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Boston, Massachusetts. Jeffrey L. Evelhoch, PhD, is Vice President of Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania
| | - Jeffrey L Evelhoch
- Barry R. Campbell is an Associate Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Kenilworth, New Jersey. Dinko Gonzalez Trotter, PhD, is a Senior Director in Early Clinical Development at Regeneron Pharmaceuticals, Inc., in Tarrytown, New York. Catherine D. Hines, PhD is a Director in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Manishkumar Patel, PhD is a Principal Scientist in Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania. Weisheng Zhang is a Senior Principal Scientist in Translational Biomarkers at Merck Research Laboratories in Boston, Massachusetts. Jeffrey L. Evelhoch, PhD, is Vice President of Translational Biomarkers at Merck Research Laboratories in West Point, Pennsylvania
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Wildman-Tobriner B, Parente VM, Maxfield CM. Pediatric providers and radiology examinations: knowledge and comfort levels regarding ionizing radiation and potential complications of imaging. Pediatr Radiol 2017; 47:1730-1736. [PMID: 28852812 DOI: 10.1007/s00247-017-3969-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/12/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pediatric providers should understand the basic risks of the diagnostic imaging tests they order and comfortably discuss those risks with parents. Appreciating providers' level of understanding is important to guide discussions and enhance relationships between radiologists and pediatric referrers. OBJECTIVE To assess pediatric provider knowledge of diagnostic imaging modalities that use ionizing radiation and to understand provider concerns about risks of imaging. MATERIALS AND METHODS A 6-question survey was sent via email to 390 pediatric providers (faculty, trainees and midlevel providers) from a single academic institution. A knowledge-based question asked providers to identify which radiology modalities use ionizing radiation. Subjective questions asked providers about discussions with parents, consultations with radiologists, and complications of imaging studies. RESULTS One hundred sixty-nine pediatric providers (43.3% response rate) completed the survey. Greater than 90% of responding providers correctly identified computed tomography (CT), fluoroscopy and radiography as modalities that use ionizing radiation, and ultrasound and magnetic resonance imaging (MRI) as modalities that do not. Fewer (66.9% correct, P<0.001) knew that nuclear medicine utilizes ionizing radiation. A majority of providers (82.2%) believed that discussions with radiologists regarding ionizing radiation were helpful, but 39.6% said they rarely had time to do so. Providers were more concerned with complications of sedation and cost than they were with radiation-induced cancer, renal failure or anaphylaxis. CONCLUSION Providers at our academic referral center have a high level of basic knowledge regarding modalities that use ionizing radiation, but they are less aware of ionizing radiation use in nuclear medicine studies. They find discussions with radiologists helpful and are concerned about complications of sedation and cost.
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Affiliation(s)
| | | | - Charles M Maxfield
- Department of Radiology, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA
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Lemon JA, Phan N, Boreham DR. Single CT Scan Prolongs Survival by Extending Cancer Latency inTrp53Heterozygous Mice. Radiat Res 2017; 188:505-511. [DOI: 10.1667/rr14576.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jennifer A. Lemon
- Medical Sciences Division, Northern Ontario School of Medicine, Sudbury, Canada, P3E 2C6
| | - Nghi Phan
- Department of Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Canada, L8S 4K1
| | - Douglas R. Boreham
- Medical Sciences Division, Northern Ontario School of Medicine, Sudbury, Canada, P3E 2C6
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22
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Chan A, Parent E, Narvacan K, San C, Lou E. Intraoperative image guidance compared with free-hand methods in adolescent idiopathic scoliosis posterior spinal surgery: a systematic review on screw-related complications and breach rates. Spine J 2017; 17:1215-1229. [PMID: 28428081 DOI: 10.1016/j.spinee.2017.04.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Severe adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity requiring surgery to stop curve progression. Posterior spinal instrumentation and fusion with pedicle screws is the standard surgery for AIS curve correction. Vascular and neurologic complications related to screw malpositioning are concerns in surgeries for AIS. Breach rates are reported at 15.7%, implant-related complications at 1.1%, and neurologic deficit at 0.8%. Free-hand screw insertion remains the prevailing method of screw placement, whereas image guidance has been suggested to improve placement accuracy. PURPOSE This study aimed to systematically review the screw-related complication and breach rates from posterior spinal instrumentation and fusion with pedicle screws for patients with AIS when using free-hand methods for screw insertion compared with image guidance methods. STUDY DESIGN This is a systematic review of prognosis, comparing image guidance with no image guidance in surgery. PATIENT SAMPLE One randomized controlled trial and multiple prospective cohort studies that reported complication or breach rates in posterior spinal instrumentation and fusion with pedicle screws for AIS. OUTCOME MEASURES Number of complications and breaches reported in databases or recorded from postoperative imaging. METHODS Databases searched included MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science. Studies of Level 3 evidence or greater as defined by the Centre for Evidence-Based Medicine were included. Articles were screened to focus on patients with AIS undergoing posterior fusion with pedicle screws or hybrid systems. Two independent reviewers screened abstracts, full texts, and extracted data. The Quality in Prognostic Studies (QUIPS) appraisal tool was used to determine studyrisk of bias (ROB). Level of evidence summary statements were formulated based on consistency and quality of reporting. RESULTS Seventy-nine cohort studies were identified, including four comparing computed tomography (CT) guidance with free-hand methods head-to-head, eight on image guidance, and 671. on free-hand methods alone. Moderate evidence from individual head-to-head studies show CT guidance has lower breach rates than free-hand methods. No complications were found in these studies. From individual cohort studies, moderate evidence shows CT guidance has lower point estimates of breach rates than free-hand methods at 7.9% compared with 9.7%-17.1%. Screw-related complication rates are conflicting at 0% in CT navigation compared with 0%-1.7% in 13 low- and moderate-quality studies. CONCLUSIONS Although point estimates on breach rates are decreased with CT navigation compared with free-hand methods, complication rates remain conflicting between the two methods. Current evidence is limited by small sample sizes, lack of comparison groups, and poorly predefined complications. Randomized controlled trials with larger samples with standardized definitions and recording of predefined breach and complication occurrences are recommended.
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Affiliation(s)
- Andrew Chan
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, 1098 Research Transition Facility 8308-114 St, Edmonton, Alberta T6G 2V2, Canada
| | - Eric Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 St 2-50 Corbett Hall, Edmonton, Alberta T6G 2G4, Canada.
| | - Karl Narvacan
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre 8440 112 St NW, Edmonton, Alberta T6G 2R7, Canada
| | - Cindy San
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Edmond Lou
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 2D, Walter C Mackenzie Health Sciences Centre - 8440 - 112 St, Edmonton, Alberta T6G 2B7, Canada
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Safiullah S, Patel R, Uribe B, Spradling K, Lall C, Zhang L, Okhunov Z, Clayman RV, Landman J. Prevalence of Protective Shielding Utilization for Radiation Dose Reduction in Adult Patients Undergoing Body Scanning Using Computed Tomography. J Endourol 2017; 31:985-990. [PMID: 28719979 DOI: 10.1089/end.2017.0294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Ionizing radiation is implicated in nearly 2% of malignancies in the United States; radiation shields prevent unnecessary radiation exposure during medical imaging. Contemporary radiation shield utilization for adult patients in the United States is poorly defined. Therefore, we evaluated the prevalence of protective shielding utilization in adult patients undergoing CT scans in United States' hospitals. MATERIALS AND METHODS An online survey was sent to established radiology departments randomly selected from the 2015 American Hospital Association Guide. Radiology departments conducting adult CT imaging were eligible; among 370 eligible departments, 215 departments accepted the study participation request. Questions focused on shielding practices during CT imaging of the eyes, thyroid, breasts, and gonads. Prevalence data were stratified per hospital location, size, and type. Main outcomes included overall protective shielding utilization, respondents' belief and knowledge regarding radiation safety, and organ-specific shielding prevalence. RESULTS Sixty-seven of 215 (31%) hospitals completed the survey; 66 (99%) reported familiarity with the ALARA (as low as reasonably achievable) principle and 56 (84%) affirmed their belief that shielding is beneficial. Only 60% of hospitals employed shielding during CT imaging; among these institutions, shielding varied based on CT study: abdominopelvic CT (13, 33%), head CT (33, 83%), or chest CT (30, 75%). CONCLUSIONS Among surveyed hospitals, 40% do not utilize CT shielding despite the majority acknowledging the ALARA principle and agreeing that shielding is a beneficial practice. Failure to address the low prevalence of protective shielding may lead to poor community health due to increased risk of radiation-related cancers.
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Affiliation(s)
- Shoaib Safiullah
- 1 Department of Urology, University of California , Irvine, Orange, California.,2 Division of Urology, University of Missouri , Columbia, Missouri
| | - Roshan Patel
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Brittany Uribe
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Kyle Spradling
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Chandana Lall
- 3 Department of Radiology, University of California , Irvine, Orange, California
| | - Lishi Zhang
- 4 Institute for Clinical and Translational Science, University of California , Irvine, Irvine, California
| | - Zhamshid Okhunov
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Ralph V Clayman
- 1 Department of Urology, University of California , Irvine, Orange, California
| | - Jaime Landman
- 1 Department of Urology, University of California , Irvine, Orange, California.,3 Department of Radiology, University of California , Irvine, Orange, California
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Chan A, Aguillon J, Hill D, Lou E. Precision and accuracy of consumer-grade motion tracking system for pedicle screw placement in pediatric spinal fusion surgery. Med Eng Phys 2017; 46:33-43. [PMID: 28602642 DOI: 10.1016/j.medengphy.2017.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/12/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature and axial rotation. Surgical intervention involves insertion of pedicle screws into the spine, requiring accuracies of 1mm and 5° in translation and rotation to prevent neural and vascular complications. While commercial CT-navigation is available, the significant cost, bulk and radiation dose hinders their use in AIS surgery. The objective of this study was to evaluate a commercial-grade Optitrack Prime 13W motion capture cameras to determine if they can achieve adequate accuracy for screw insertion guidance in AIS. Static precision, camera and tracked rigid body configurations, translational and rotational accuracy were investigated. A 1-h camera warm-up time was required to achieve precisions of 0.13mm and 0.10°. A three-camera system configuration with cameras at equal height but staggered depth achieved the best accuracy. A triangular rigid body with 7.9mm markers had superior accuracy. The translational accuracy for motions up to 150mm was 0.25mm while rotational accuracy was 4.9° for rotations in two directions from 0° to 70°. Required translational and rotational accuracies were achieved using this motion capture system as well as being comparable to surgical-grade navigators.
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Affiliation(s)
- Andrew Chan
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta T6G 2V2, Canada
| | - Janelle Aguillon
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Doug Hill
- Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7, Canada; Alberta Health Services - Glenrose Rehabilitation Hospital, Edmonton, Alberta T5G 0B7, Canada
| | - Edmond Lou
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta T6G 2V2, Canada; Department of Surgery, University of Alberta, Edmonton, Alberta T6G 2B7, Canada; Alberta Health Services - Glenrose Rehabilitation Hospital, Edmonton, Alberta T5G 0B7, Canada.
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25
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Chi YH, Hsiao JK, Lin MH, Chang C, Lan CH, Wu HC. Lung Cancer-Targeting Peptides with Multi-subtype Indication for Combinational Drug Delivery and Molecular Imaging. Theranostics 2017; 7:1612-1632. [PMID: 28529640 PMCID: PMC5436516 DOI: 10.7150/thno.17573] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/30/2017] [Indexed: 02/03/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related death worldwide. Most targeted drugs approved for lung cancer treatment are tyrosine kinase inhibitors (TKIs) directed against EGFR or ALK, and are used mainly for adenocarcinoma. At present, there is no effective or tailored targeting agent for large cell carcinoma (LCC) or small cell lung cancer (SCLC). Therefore, we aimed to identify targeting peptides with diagnostic and therapeutic utility that possess broad subtype specificity for SCLC and non-small cell lung cancer (NSCLC). We performed phage display biopanning of H460 LCC cells to select broad-spectrum lung cancer-binding peptides, since LCC has recently been categorized as an undifferentiated tumor type within other histological subcategories of lung cancer. Three targeting phages (HPC1, HPC2, and HPC4) and their respective displayed peptides (HSP1, HSP2, and HSP4) were able to bind to both SCLC and NSCLC cell lines, as well as clinical specimens, but not to normal pneumonic tissues. In vivo optical imaging of phage homing and magnetic resonance imaging (MRI) of peptide-SPIONs revealed that HSP1 was the most favorable probe for multimodal molecular imaging. Using HSP1-SPION, the T2-weighted MR signal of H460 xenografts was decreased up to 42%. In contrast to the tight binding of HSP1 to cancer cell surfaces, HSP4 was preferentially endocytosed and intracellular drug delivery was thereby effected, significantly improving the therapeutic index of liposomal drug in vivo. Liposomal doxorubicin (LD) conjugated to HSP1, HSP2, or HSP4 had significantly greater therapeutic efficacy than non-targeting liposomal drugs in NSCLC (H460 and H1993) animal models. Combined therapy with an HSP4-conjugated stable formulation of liposomal vinorelbine (sLV) further improved median overall survival (131 vs. 84 days; P = 0.0248), even in aggressive A549 orthotopic models. Overall, these peptides have the potential to guide a wide variety of tailored theranostic agents for targeting therapeutics, non-invasive imaging, or clinical detection of SCLC and NSCLC.
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26
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Bakhtiary Z, Saei AA, Hajipour MJ, Raoufi M, Vermesh O, Mahmoudi M. Targeted superparamagnetic iron oxide nanoparticles for early detection of cancer: Possibilities and challenges. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 12:287-307. [PMID: 26707817 DOI: 10.1016/j.nano.2015.10.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/22/2015] [Accepted: 10/25/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED Nanomedicine, the integration of nanotechnological tools in medicine demonstrated promising potential to revolutionize the diagnosis and treatment of various human health conditions. Nanoparticles (NPs) have shown much promise in diagnostics of cancer, especially since they can accommodate targeting molecules on their surface, which search for specific tumor cell receptors upon injection into the blood stream. This concentrates the NPs in the desired tumor location. Furthermore, such receptor-specific targeting may be exploited for detection of potential metastases in an early stage. Some NPs, such as superparamagnetic iron oxide NPs (SPIONs), are also compatible with magnetic resonance imaging (MRI), which makes their clinical translation and application rather easy and accessible for tumor imaging purposes. Furthermore, multifunctional and/or theranostic NPs can be used for simultaneous imaging of cancer and drug delivery. In this review article, we will specifically focus on the application of SPIONs in early detection and imaging of major cancer types. FROM THE CLINICAL EDITOR Super-paramagnetic iron oxide nanoparticles (SPIONs) have been reported by many to be useful as an MRI contrast agent in the detection of tumors. To further enhance the tumor imaging, SPIONs can be coupled with tumor targeting motifs. In this article, the authors performed a comprehensive review on the current status of using targeted SPIONS in tumor detection and also the potential hurdles to overcome.
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Affiliation(s)
- Zahra Bakhtiary
- Research Center for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Ata Saei
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Mohammad J Hajipour
- Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mohammad Raoufi
- Department of New Materials and Biosystems, Max Planck Institute for Intelligent Systems, Stuttgart, Germany; Department of Nanotechnology & Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ophir Vermesh
- Molecular Imaging Program at Stanford (MIPS), Department of Radiology, Stanford University, CA, USA
| | - Morteza Mahmoudi
- Department of Nanotechnology & Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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27
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Emergency Department Use of Computed Tomography for Children with Ventricular Shunts. J Pediatr 2015; 167:1382-8.e2. [PMID: 26474707 DOI: 10.1016/j.jpeds.2015.09.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/16/2015] [Accepted: 09/04/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization in children with ventricular shunts, estimate radiation exposure, and evaluate the association between CT utilization and shunt revision. STUDY DESIGN Retrospective longitudinal cohort study of ED visits from 2003-2013 in children 0-18 years old with initial shunt placement in 2003. Data were examined from 31 hospitals in the Pediatric Health Information System. Main outcomes were cranial CT performed during an ED visit, estimated cumulative effective radiation dose, and shunt revision within 7 days. Multivariable regression modeled the relationship between patient- and hospital-level covariates and CT utilization. RESULTS The 1319 children with initial shunt placed in 2003 experienced 6636 ED visits during the subsequent decade. A cranial CT was obtained in 49.4% of all ED visits; 19.9% of ED visits with CT were associated with a shunt revision. Approximately 6% of patients received ≥10 CTs, accounting for 37.2% of all ED visits with a CT. The mean number of CTs per patient varied nearly 20-fold across hospitals; the individual hospital accounted for the most variation in CT utilization. The median (IQR) cumulative effective radiation dose was 7.2 millisieverts (3.6-14.0) overall, and 33.4 millisieverts (27.2-43.8) among patients receiving ≥10 CTs. CONCLUSIONS A CT scan was obtained in half of ED visits for children with a ventricular shunt, with wide variability in utilization by hospitals. Strategies are needed to identify children at risk of shunt malfunction to reduce variability in CT utilization and radiation exposure in the ED.
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Frush DP. Deciding why and when to use CT in children: a radiologist's perspective. Pediatr Radiol 2014; 44 Suppl 3:404-8. [PMID: 25304695 DOI: 10.1007/s00247-014-3016-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/16/2014] [Accepted: 04/25/2014] [Indexed: 12/21/2022]
Abstract
Defining what is appropriate or inappropriate with respect to CT scanning is challenging. There are a variety of influences on scan utilization in children, some more widely recognized and acknowledged than others. It is important to understand the contribution of these elements as we move toward improved utilization. This must be through partnerships and shared efforts and accountability. These efforts include improved resources such as consensus appropriateness criteria and guidelines including decision rules and support. But there also need to be trench-based strategies on the part of practicing radiologists to model cooperative behavior rather than blame-centered behavior.
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Affiliation(s)
- Donald P Frush
- Departments of Radiology and Pediatrics, 1905 McGovern-Davison Children's Health Center, Duke University Medical Center, Erwin Road, Durham, NC, 27710, USA,
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29
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Kuo W, Ciet P, Tiddens HAWM, Zhang W, Guillerman RP, van Straten M. Monitoring Cystic Fibrosis Lung Disease by Computed Tomography. Radiation Risk in Perspective. Am J Respir Crit Care Med 2014; 189:1328-36. [DOI: 10.1164/rccm.201311-2099ci] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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30
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Radiation protection and dose monitoring in medical imaging: a journey from awareness, through accountability, ability and action…but where will we arrive? J Patient Saf 2014; 9:232-8. [PMID: 24257067 DOI: 10.1097/pts.0b013e3182a8c2c4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radiation awareness and protection of patients have been the fundamental responsibilities in diagnostic imaging since the discovery of x-rays late in 1895 and the first reports of radiation injury in 1896. In the ensuing years, there have been significant advancements in equipment that uses either x-rays to form images, such as fluoroscopy or computed tomography (CT), or the types of radiation emitted during nuclear imaging procedures (e.g., positron emission tomography [PET]). These advancements have allowed detailed and indispensable evaluation of a vast array of disorders. In fact, in 2001, CT and MRI were cited by physicians as the most significant medical innovations in the previous 3 decades. Rapid technological advancements in the last decade with CT, especially, have required imaging professionals to keep pace with increasingly complex technology to derive the maximum benefits of improved image acquisition and display techniques, in essence, the improved quality of the examination. It has also been challenging to fulfill the fundamental responsibilities of safety during this period of rapid growth (e.g., radiation protection, management of the risk of additional interventions driven by incidental findings, performing studies that were not indicated). The purpose of this paper is to define critical issues pertinent to ensuring patient safety through the appropriate assessment, recording, monitoring, and reporting of the radiation dose from CT.
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31
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Lee CYS, Koval TM, Suzuki JB. Low-Dose Radiation Risks of Computerized Tomography and Cone Beam Computerized Tomography: Reducing the Fear and Controversy. J ORAL IMPLANTOL 2014; 41:e223-30. [PMID: 24669832 DOI: 10.1563/aaid-joi-d-13-00221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Regulations for protecting humans against stochastic biological effects from ionizing radiation are based on the linear no-threshold (LNT) risk assessment model, which states that any amount of radiation exposure may lead to cancer in a population. Based on the LNT model, risk from low-dose radiation increases linearly with increasing doses of radiation. Imaging procedures in medicine and dentistry are an important source of low-dose ionizing radiation. The increased use of computerized tomography (CT) and cone beam computerized tomography (CBCT) has raised health concerns regarding exposure to low-dose ionizing radiation. In oral and maxillofacial surgery and implant dentistry, CBCT is now at the forefront of this controversy. Although caution has been expressed, there have been no direct studies linking radiation exposure from CT and CBCT used in dental imaging with cancer induction. This article describes the concerns about radiation exposure in dental imaging regarding the use of CT.
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Affiliation(s)
- Cameron Y S Lee
- 1 Private practice in oral, maxillofacial and reconstructive surgery, Aiea, Hawaii; Department of Periodontology and Oral Implantology, Temple University Kornberg School of Dentistry, Philadelphia, Penn
| | - Thomas M Koval
- 2 Center for Biotechnology Education, Advanced Academic Programs, Krieger School of Arts and Sciences, Johns Hopkins University, Rockville, Md
| | - Jon B Suzuki
- 3 Temple University, Kornberg School of Dentistry, Department of Periodontology and Oral Implantology, School of Medicine, Department of Microbiology and Immunology, Philadelphia, Penn
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Abstract
Computed tomography plays a central and increasingly important role in medical imaging. From the very beginning more than 30 years ago, computed tomography technology has continued to develop and provide a wide variety of applications for evaluation of disorders of virtually any organ system in both children and adults. The benefits are particularly evident with the newer, fast, high-resolution multidetector scanners. However, these benefits must be carefully weighed against the potential risks, which include a relatively high radiation dose. Current research efforts are directed at both further improvements in the diagnostic potential with computed tomography, as well as managing radiation dose.
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Affiliation(s)
- Donald P Frush
- Division of Pediatric Radiology, Duke University Medical Center, 1905 McGovern-Davison Children's Health Center, Box 3808, Department of Radiology, Durham, NC 27710, USA.
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Piccinini M, Cugnoni J, Botsis J, Zacchetti G, Ammann P, Wiskott A. Factors affecting subject-specific finite element models of implant-fitted rat bone specimens: critical analysis of a technical protocol. Comput Methods Biomech Biomed Engin 2013; 17:1403-17. [DOI: 10.1080/10255842.2012.736502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tepper B, Brice JH, Hobgood CD. Evaluation of Radiation Exposure to Pediatric Trauma Patients. J Emerg Med 2013; 44:646-52. [DOI: 10.1016/j.jemermed.2012.09.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 08/30/2012] [Accepted: 09/18/2012] [Indexed: 11/17/2022]
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Goldin D, Emerson S, Farah MC, Sokhandon F, Nandalur KR, Kumar S, Mezwa DG. Shielding artificially increases the attenuation of water: study of CT gradient attenuation induced by shielding (CT GAINS). Acad Radiol 2013; 20:231-7. [PMID: 22981602 DOI: 10.1016/j.acra.2012.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 06/27/2012] [Accepted: 07/31/2012] [Indexed: 01/31/2023]
Abstract
RATIONALE AND OBJECTIVES Quantitatively analyze the computed tomography (CT) attenuation effects caused by bismuth shields, which are used to reduce superficial organ dose. MATERIALS AND METHODS The solid water uniformity section of the American College of Radiology CT phantom was scanned with a modified chest CT protocol. Scans were performed with a bismuth breast shield in multiple configurations, emphasizing three clinically relevant orientations. Attenuation effects were measured as changes in mean Hounsfield unit (HU) values of equal midsagittal regions of interest (ROI). Multiple statistical techniques were used in regression analysis. RESULTS Bismuth shielding resulted in significant positive shifts of the expected Hounsfield unit values. The mean nonshielded CT attenuation was -0.16 ± 0.75 HU. Based on the clinically relevant ROI distance from the shield (~3-16 cm), the shielded values ranged from 43.8-4 HU, 45.8-10.1 HU, and 50.6-4.5 HU for shields 1, 2, and 3, respectively. All shield configurations displayed a statistically significant shift (P < .0001) at all distance ranges. The best fitting regression model was a quadratic function of distance versus logarithmic function of HU. A prediction table of the approximate shift in water HU values as a function of ROI distance from the shield was generated per shield type from their respective close-fitting regressions. CONCLUSIONS The data support the claim that bismuth shields increase the attenuation of water, which can cause inaccurate characterization of simple fluid, giving the appearance of complex fluid or even solid density. However, there is potential for anticipation of the attenuation effects to validate continued use of these shields for dose reduction.
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Affiliation(s)
- Dmitry Goldin
- Department of Radiology, Beaumont Health System, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
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Performance of Iterative Reconstruction and Automated Tube Voltage Selection on the Image Quality and Radiation Dose in Abdominal CT Scans. J Comput Assist Tomogr 2013; 37:897-903. [DOI: 10.1097/rct.0b013e3182a73fa6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Ordering of CT by Emergency Department Provider Type: Analysis of a Nationally Representative Sample. AJR Am J Roentgenol 2012; 199:1054-9. [DOI: 10.2214/ajr.11.8303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Jones JGA, Mills CN, Mogensen MA, Lee CI. Radiation dose from medical imaging: a primer for emergency physicians. West J Emerg Med 2012; 13:202-10. [PMID: 22900113 PMCID: PMC3415811 DOI: 10.5811/westjem.2011.11.6804] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/31/2011] [Accepted: 11/09/2011] [Indexed: 12/13/2022] Open
Abstract
Introduction Medical imaging now accounts for most of the US population's exposure to ionizing radiation. A substantial proportion of this medical imaging is ordered in the emergency setting. We aim to provide a general overview of radiation dose from medical imaging with a focus on computed tomography, as well as a literature review of recent efforts to decrease unnecessary radiation exposure to patients in the emergency department setting. Methods We conducted a literature review through calendar year 2010 for all published articles pertaining to the emergency department and radiation exposure. Results The benefits of imaging usually outweigh the risks of eventual radiation-induced cancer in most clinical scenarios encountered by emergency physicians. However, our literature review identified 3 specific clinical situations in the general adult population in which the lifetime risks of cancer may outweigh the benefits to the patient: rule out pulmonary embolism, flank pain, and recurrent abdominal pain in inflammatory bowel disease. For these specific clinical scenarios, a physician-patient discussion about such risks and benefits may be warranted. Conclusion Emergency physicians, now at the front line of patients' exposure to ionizing radiation, should have a general understanding of the magnitude of radiation dose from advanced medical imaging procedures and their associated risks. Future areas of research should include the development of protocols and guidelines that limit unnecessary patient radiation exposure.
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Desai GS, Uppot RN, Yu EW, Kambadakone AR, Sahani DV. Impact of iterative reconstruction on image quality and radiation dose in multidetector CT of large body size adults. Eur Radiol 2012; 22:1631-40. [PMID: 22527370 DOI: 10.1007/s00330-012-2424-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 01/15/2012] [Accepted: 02/11/2012] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare image quality and radiation dose using Adaptive Statistical Iterative Reconstruction (ASiR) and Filtered Back Projection (FBP) in patients weighing ≥ 91 kg. METHODS In this Institution Review Board-approved retrospective study, single-phase contrast-enhanced abdominopelvic CT examinations of 100 adults weighing ≥ 91 kg (mean body weight: 107.6 ± 17.4 kg range: 91-181.9 kg) with (1) ASiR and (2) FBP were reviewed by two readers in a blinded fashion for subjective measures of image quality (using a subjective standardized numerical scale and objective noise) and for radiation exposure. Imaging parameters and radiation dose results of the two techniques were compared within weight and BMI sub-categories. RESULTS All examinations were found to be of adequate quality. Both subjective (mean = 1.4 ± 0.5 vs. 1.6 ± 0.6, P < 0.05) and objective noise (13.0 ± 3.2 vs.19.5 ± 5.7, P < 0.0001) were lower with ASiR. Average radiation dose reduction of 31.5 % was achieved using ASiR (mean CTDIvol. ASiR: 13.5 ± 7.3 mGy; FBP: 19.7 ± 9.0 mGy, P < 0.0001). Other measures of image quality were comparable between the two techniques. Trends for all parameters were similar in patients across weight and BMI sub-categories. CONCLUSION In obese individuals, abdominal CT images reconstructed using ASiR provide diagnostic images with reduced image noise at lower radiation dose. KEY POINTS • CT images in obese adults are noisy, even with high radiation dose. • Newer iterative reconstruction techniques have theoretical advantages in obese patients. • Adaptive statistical iterative reconstruction should reduce image noise and radiation dose. • This has been proven in abdominopelvic CT images of obese patients.
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Affiliation(s)
- Gaurav S Desai
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA
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Sun Z, Al Ghamdi KS, Baroum IH. Multislice CT of the head and body routine scans: Are scanning protocols adjusted for paediatric patients? Biomed Imaging Interv J 2012; 8:e3. [PMID: 22970059 PMCID: PMC3432222 DOI: 10.2349/biij.8.1.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 11/08/2011] [Accepted: 11/08/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate whether the multislice CT scanning protocols of head, chest and abdomen are adjusted according to patient's age in paediatric patients. MATERIALS AND METHODS Multislice CT examination records of paediatric patients undergoing head, chest and abdomen scans from three public hospitals during a one-year period were retrospectively reviewed. Patients were categorised into the following age groups: under 4 years, 5-8 years, 9-12 years and 13-16 years, while the tube current was classified into the following ranges: < 49 mA, 50-99 mA, 100-149 mA, 150-199 mA, > 200 mA and unknown. RESULTS A total of 4998 patient records, comprising a combination of head, chest and abdomen CT scans, were assessed, with head CT scans representing nearly half of the total scans. Age-based adjusted CT protocols were observed in most of the scans with higher tube current setting being used with increasing age. However, a high tube current (150-199 mA) was still used in younger patients (0-8 years) undergoing head CT scans. In one hospital, CT protocols remained constant across all age groups, indicating potential overexposure to the patients. CONCLUSION This analysis shows that paediatric CT scans are adjusted according to the patient's age in most of the routine CT examinations. This indicates increased awareness regarding radiation risks associated with CT. However, high tube current settings are still used in younger patient groups, thus, optimisation of paediatric CT protocols and implementation of current guidelines, such as age-and weight-based scanning, should be recommended in daily practice.
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Affiliation(s)
- Z Sun
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, Australia
| | - KS Al Ghamdi
- Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, Australia
| | - IH Baroum
- Department of Radiology, King Abdul Aziz Hospital and Oncology Centre, Jeddah, Saudi Arabia
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Phan N, De Lisio M, Parise G, Boreham DR. Biological effects and adaptive response from single and repeated computed tomography scans in reticulocytes and bone marrow of C57BL/6 mice. Radiat Res 2011; 177:164-75. [PMID: 22059980 DOI: 10.1667/rr2532.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study investigated the biological effects and adaptive responses induced by single and repeated in vivo computed tomography (CT) scans. We postulated that, through the induction of low-level oxidative stress, repeated low-dose CT scans (20 mGy, 2 days/week, 10 weeks) could protect mice (C57BL/6) from acute effects of high-dose radiation (1 Gy, 2 Gy). The micronucleated reticulocyte (MN-RET) count increased linearly after exposure to single CT scans of doses ranging from 20 to 80 mGy (P = 0.033). Ten weeks of repeated CT scans (total dose 400 mGy) produced a slight reduction in spontaneous MN-RET levels relative to levels in sham CT-scanned mice (P = 0.04). Decreases of nearly 10% in γ-H2AX fluorescence levels were observed in the repeated CT-scanned mice after an in vitro challenge dose of 1 Gy (P = 0.017) and 2 Gy (P = 0.026). Spontaneous apoptosis levels (caspase 3 and 7 activation) were also significantly lower in the repeated CT-scanned mice than the sham CT-scanned mice (P < 0.01). In contrast, mice receiving only a single CT scan showed a 19% elevation in apoptosis (P < 0.02) and a 10% increase in γ-H2AX fluorescence levels after a 2-Gy challenge (P < 0.05) relative to sham CT controls. Overall, repeated CT scans seemed to confer resistance to larger doses in mice, whereas mice exposed to single CT scans exhibited transient genotoxicity, enhanced apoptosis, and characteristics of radiation sensitization.
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Affiliation(s)
- Nghi Phan
- Department of Medical Physics and Applied Radiation Sciences, Nuclear Research Building Room 227, 1280 Main St. West, McMaster University, Hamilton, Ontario, Canada, L8S 4K1.
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Abstract
The chest is the most frequently evaluated region of the body in children. The majority of thoracic diagnostic imaging, namely "conventional" radiography (film screen, computed radiography and direct/digital radiography), fluoroscopy and angiography, and computed tomography, depends on ionizing radiation. Since errors, oversights, and inattention to radiation exposure continue to be extremely visible issue for radiology in the public eye it is incumbent on the imaging community to maximize the yield and minimize both the real and potential radiation risks with diagnostic imaging. Technical (e.g. equipment and technique) strategies can reduce exposure risk and improve study quality, but these must be matched with efforts to optimize appropriate utilization for safe and effective healthcare in thoracic imaging in children. To these ends, material in this chapter will review practice patterns, dose measures and modality doses, radiation biology and risks, and radiation risk reduction strategies for thoracic imaging in children.
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Affiliation(s)
- Donald P Frush
- Pediatric Radiology, Department of Radiology, 1905 Children's Health Center, Duke University Medical Center, Durham, NC 27710, USA.
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Abstract
Pediatric CT radiation dose and risk assessment are important but challenging, especially given inherent uncertainties. It is still necessary for those involved in medical imaging of children to have an understanding of the extent of existing knowledge for dose assessment and risk, as well as ongoing work at improvements.
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Matsumoto-Takeda S, Yamamoto N, Nishida I, Saeki K, Oda M, Yamauchi K, Miyamoto I, Tanaka T, Kito S, Wakasugi-Sato N, Seta Y, Shiiba S, Matsumoto Y, Yamashita Y, Maki K, Takahashi T, Morimoto Y. Importance of magnetic resonance imaging for evaluation of a child with prominent swelling of the facial region after trauma: report of a case. Dent Traumatol 2011; 27:300-4. [DOI: 10.1111/j.1600-9657.2011.00985.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zeman RK, Herlihy V, Branham TA, Bhargavan M, Bush KM, McCollough CH. Can experienced CT radiologists use technique parameters to predict excessive patient dose? An analysis of the ACR CT accreditation database. J Am Coll Radiol 2011; 8:275-80. [PMID: 21458767 DOI: 10.1016/j.jacr.2010.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 08/25/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study was to determine, for 3 basic clinical examinations, whether blinded, experienced CT radiologists participating in the ACR's CT Accreditation Program could use scan parameters such as tube current-time product (mAs), tube voltage (kVp), and pitch to predict scanner output settings, expressed as weighted CT dose index (CTDIw) and volume CT dose index (CTDIvol), exceeding CTDIw diagnostic reference levels (DRLs) set by the ACR in 2002 and CTDIvol DRLs adopted by the ACR in 2008. METHODS CT sites with 829 scanners submitted examinations to the ACR between 2002 and 2004, yielding 518 eligible examinations for analysis (138 adult head CT scans, 333 adult abdominal CT scans, and 47 pediatric abdominal CT scans). The sites' measured CTDIw values for each type of examination were compared with the ACR's CTDIw DRLs in effect from 2002 to 2004 and compared with comments regarding excessively high mAs or kVp made by radiologist clinical reviewers to determine if excessively high-dose index measurements could be predicted. The same analysis was repeated using CTDIvol DRLs adopted by the ACR in 2008 and compared with excessively high mAs or kVp and excessively low-pitch comments. RESULTS Excessively high mAs or kVp comments yielded sensitivity of only 21.2% in predicting examinations above the CTDIw DRLs, with specificity of 87.6%. Using the 2008 CTDIvol DRLs, the corresponding sensitivity was 13.1% and specificity was 86.2%. Significance was not achieved for use of clinical parameters in predicting either the CTDIw or CTDIvol. CONCLUSION Experienced CT radiologists cannot reliably use scan parameters to predict examinations that exceed CTDIw or CTDIvol DRLs.
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Affiliation(s)
- Robert K Zeman
- George Washington University Medical Center, Washington, District of Columbia 20037, USA.
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Comparative Analysis of Radiation Dose and Image Quality Between Thyroid Shielding and Unshielding During CT Examination of the Neck. AJR Am J Roentgenol 2011; 196:611-5. [DOI: 10.2214/ajr.10.4955] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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de Ville de Goyet J, Monti L, Tomà P. With great power comes great responsibility--what pediatricians referring babies and small children to radiological interventions should know. Pediatr Transplant 2011; 15:1-4. [PMID: 21241435 DOI: 10.1111/j.1399-3046.2010.01422.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Friedman DP, Levin DC, Rao VM. Trends in the Utilization of CT Angiography and MR Angiography of the Head and Neck in the Medicare Population. J Am Coll Radiol 2010; 7:854-8. [DOI: 10.1016/j.jacr.2010.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 05/03/2010] [Indexed: 10/18/2022]
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Molecular MRI for sensitive and specific detection of lung metastases. Proc Natl Acad Sci U S A 2010; 107:3693-7. [PMID: 20142483 DOI: 10.1073/pnas.1000386107] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Early and specific detection of metastatic cancer cells in the lung (the most common organ targeted by metastases) could significantly improve cancer treatment outcomes. However, the most widespread lung imaging methods use ionizing radiation and have low sensitivity and/or low specificity for cancer cells. Here we address this problem with an imaging method to detect submillimeter-sized metastases with molecular specificity. Cancer cells are targeted by iron oxide nanoparticles functionalized with cancer-binding ligands, then imaged by high-resolution hyperpolarized (3)He MRI. We demonstrate in vivo detection of pulmonary micrometastates in mice injected with breast adenocarcinoma cells. The method not only holds promise for cancer imaging but more generally suggests a fundamentally unique approach to molecular imaging in the lungs.
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Shetty MK. Abdominal Computed Tomography During Pregnancy: A Review of Indications and Fetal Radiation Exposure Issues. Semin Ultrasound CT MR 2010; 31:3-7. [DOI: 10.1053/j.sult.2009.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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