1
|
Afroz S, Østerås BH, Thevathas US, Dohlen G, Stokke C, Robsahm TE, Olerud HM. Use of ionizing radiation in a Norwegian cohort of children with congenital heart disease: imaging frequency and radiation dose for the Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) study. Pediatr Radiol 2023; 53:2502-2514. [PMID: 37773444 PMCID: PMC10635954 DOI: 10.1007/s00247-023-05774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The European-funded Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) project is a multicenter cohort study assessing the long-term effects of ionizing radiation in patients with congenital heart disease. Knowledge is lacking regarding the use of ionizing radiation from sources other than cardiac catheterization in this cohort. OBJECTIVE This study aims to assess imaging frequency and radiation dose (excluding cardiac catheterization) to patients from a single center participating in the Norwegian HARMONIC project. MATERIALS AND METHODS Between 2000 and 2020, we recruited 3,609 patients treated for congenital heart disease (age < 18 years), with 33,768 examinations categorized by modality and body region. Data were retrieved from the radiology information system. Effective doses were estimated using International Commission on Radiological Protection Publication 60 conversion factors, and the analysis was stratified into six age categories: newborn; 1 year, 5 years, 10 years, 15 years, and late adolescence. RESULTS The examination distribution was as follows: 91.0% conventional radiography, 4.0% computed tomography (CT), 3.6% diagnostic fluoroscopy, 1.2% nuclear medicine, and 0.3% noncardiac intervention. In the newborn to 15 years age categories, 4-12% had ≥ ten conventional radiography studies, 1-8% underwent CT, and 0.3-2.5% received nuclear medicine examinations. The median effective dose ranged from 0.008-0.02 mSv and from 0.76-3.47 mSv for thoracic conventional radiography and thoracic CT, respectively. The total effective dose burden from thoracic conventional radiography ranged between 28-65% of the dose burden from thoracic CT in various age categories (40% for all ages combined). The median effective dose for nuclear medicine lung perfusion was 0.6-0.86 mSv and for gastrointestinal fluoroscopy 0.17-0.27 mSv. Because of their low frequency, these procedures contributed less to the total effective dose than thoracic radiography. CONCLUSION This study shows that CT made the largest contribution to the radiation dose from imaging (excluding cardiac intervention). However, although the dose per conventional radiograph was low, the large number of examinations resulted in a substantial total effective dose. Therefore, it is important to consider the frequency of conventional radiography while calculating cumulative dose for individuals. The findings of this study will help the HARMONIC project to improve risk assessment by minimizing the uncertainty associated with cumulative dose calculations.
Collapse
Affiliation(s)
- Susmita Afroz
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Grønland 58, Drammen, Norway.
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway.
| | - Bjørn H Østerås
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
| | - Utheya S Thevathas
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Grønland 58, Drammen, Norway
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Gaute Dohlen
- Department of Pediatric Cardiology, Oslo University Hospital, Oslo, Norway
| | - Caroline Stokke
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Trude E Robsahm
- Research Department, Cancer Registry of Norway, Oslo, Norway
| | - Hilde M Olerud
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Grønland 58, Drammen, Norway
| |
Collapse
|
2
|
Serrano B, Amblard R, Beaumont T, Hugonnet F, Dietz M, Berthier F, Garnier N, Villeneuve R, Nataf V, Mocquot F, Montemagno C, Faraggi M, Paulmier B. Quantitative analysis of 99mTc-pertechnetate thyroid uptake with a large-field CZT gamma camera: feasibility and comparison between SPECT/CT and planar acquisitions. EJNMMI Phys 2023; 10:45. [PMID: 37522931 PMCID: PMC10390438 DOI: 10.1186/s40658-023-00566-3] [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: 04/03/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023] Open
Abstract
PURPOSE The main objective of this study was to evaluate the ability of a large field Cadmium Zinc Telluride (CZT) camera to estimate thyroid uptake (TU) on single photon emission computed tomography (SPECT) images with and without attenuation correction (Tomo-AC and Tomo-NoAC) compared with Planar acquisition in a series of 23 consecutive patients. The secondary objective was to determine radiation doses for the tracer administration and for the additional Computed Tomography (CT) scan. METHODS Cross-calibration factors were determined using a thyroid phantom, for Planar, Tomo-AC and Tomo-NoAC images. Then Planar and SPECT/CT acquisitions centered on the thyroid were performed on 5 anthropomorphic phantoms with activity ranging from 0.4 to 10 MBq, and 23 patients after administration of 79.2 ± 3.7 MBq of [99mTc]-pertechnetate. We estimated the absolute thyroid activity (AThA) for the anthropomorphic phantoms and the TU for the patients. Radiation dose was also determined using International Commission on Radiological Protection (ICRP) reports and VirtualDoseTMCT software. RESULTS Cross-calibration factors were 66.2 ± 4.9, 60.7 ± 0.7 and 26.5 ± 0.3 counts/(MBq s), respectively, for Planar, Tomo-AC and Tomo-NoAC images. Theoretical and estimated AThA for Planar, Tomo-AC and Tomo-NoAC images were statistically highly correlated (r < 0.99; P < 10-4) and the average of the relative percentage difference between theoretical and estimated AThA were (8.6 ± 17.8), (- 1.3 ± 5.2) and (12.8 ± 5.7) %, respectively. Comparisons between TU based on different pairs of images (Planar vs Tomo-AC, Planar vs Tomo-NoAC and Tomo-AC vs Tomo-NoAC) showed statistically significant correlation (r = 0.972, 0.961 and 0.935, respectively; P < 10-3). Effective and thyroid absorbed doses were, respectively (0.34CT + 0.95NM) mSv, and (3.88CT + 1.74NM) mGy. CONCLUSION AThA estimation using Planar and SPECT/CT acquisitions on a new generation of CZT large-field cameras is feasible. In addition, TU on SPECT/CT was as accurate as conventional planar acquisition, but the CT induced additional thyroid exposure. Trial registration Name of the registry: Thyroid Uptake Quantification on a New Generation of Gamma Camera (QUANTHYC). TRIAL NUMBER NCT05049551. Registered September 20, 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT05049551?cntry=MC&draw=2&rank=4 .
Collapse
Affiliation(s)
- Benjamin Serrano
- Medical Physics Department, Centre Hospitalier Princesse Grace, Monaco, Monaco.
| | - Régis Amblard
- Medical Physics Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Tiffany Beaumont
- Laboratoire d'évaluation de la dose interne, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Florent Hugonnet
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Matthieu Dietz
- Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Berthier
- Department of Biostatistics, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Nicolas Garnier
- Medical Physics Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Rémy Villeneuve
- Medical Physics Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Valérie Nataf
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - François Mocquot
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | | | - Marc Faraggi
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Benoît Paulmier
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| |
Collapse
|
3
|
Peiro A, Chegeni N, Danyaei A, Fatahiasl J, Tahmasbi M. Pelvic radiation dose measurement for trauma patients in multifield radiographic examinations: A phantom-based TLD dosimetry study. Health Sci Rep 2023; 6:e1424. [PMID: 37484057 PMCID: PMC10356977 DOI: 10.1002/hsr2.1424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023] Open
Abstract
Background and Aims Trauma patients often suffer from multiple injuries and require undergoing various radiography which is referred to as multifield radiographic examinations. Protective measures may be ignored for these examinations due to stressful emergency situations or patients' conditions. This study was conducted to evaluate the scattered doses received by the pelvis during different common multifield radiographic examinations with an emphasis on field size adjustment. Methods A whole-body phantom, PBU-50, resembling the body mass, was used to carry out the common examinations for trauma patients (extremities, skull, chest, abdomen, pelvis, femur, and lumbar radiography), using a Pars Pad X-ray machine. To measure the primary entrance skin doses, three calibrated GR 200 thermoluminescence dosimeter (TLD) chips were placed in the central X-ray beam of scanned organs. Three TLDs were also placed on the pelvis symphysis pubis to measure the scattered dose received by the pelvis due to each carried-out radiography for standard and clinically used field sizes. A Harshaw 3500 TLD Reader was used to read the chips. TLD readouts (nano-Coulomb) were converted to dose (milli Gray [mGy]) using the predefined calibration curve. Results The scattered doses to the pelvis due to scanning a single organ differed from 0.80 to 1.70, and 0.82 to 4.09 mGy for standard and clinically used field sizes, respectively. The scattered doses to the pelvis in multifield examinations varied from 0.80 to 8.43 and 0.82 to 13.6 mGy for standard and clinically used field sizes, respectively, depending on the number of scanned organs and their distances from the pelvis. Conclusions Multiple and repeated radiographs combined with insufficient protective measures can increase the patient's dose. The findings indicate that the scattered doses received by the pelvis can exceed the reference values in multifield radiography, especially if the radiation field is not restricted properly to the scanned organ.
Collapse
Affiliation(s)
- Ameneh Peiro
- Department of Medical Physics, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Nahid Chegeni
- Department of Medical Physics, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Amir Danyaei
- Department of Medical Physics, School of MedicineAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Jafar Fatahiasl
- Department of Radiologic Technology, School of Allied Medical SciencesAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Marziyeh Tahmasbi
- Department of Radiologic Technology, School of Allied Medical SciencesAhvaz Jundishapur University of Medical SciencesAhvazIran
| |
Collapse
|
4
|
Establishment of national diagnostic dose reference levels (DRLs) for routine computed tomography examinations in Jordan. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2023. [DOI: 10.2478/pjmpe-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abstract
Background: Dose reference levels (DRLs) are used as indicators as well as guidance for dose optimization and to ensure justification of appropriate dose for a given clinical indication. The main aims of this study were to establish local DRLs for each CT imaging protocol as a reference point to evaluate the radiation dose indices and to compare our DRLs with those established in other countries and against the internationally reported guidelines.
Materials and methods: 2000 CT dose reports of different adult imaging protocols from January 2021 until April 2022 were collected retrospectively at different hospitals in Jordan. Data were collected from CT scans that were performed using different types and models of CT scanners and included four adult non-enhanced, helical CT imaging protocols; Head, Chest, Abdomen-Pelvis, and Chest-Abdomen-Pelvis.
Results: The average doses of CTDIvol, DLP, and effective dose were (65.11 mGy, 1232.71 mGy·cm, 2.83 mSv) for the head scan, (16.6 mGy, 586.6 mGy·cm, 8.21 mSv) for the chest scan, (17.91 mGy, 929.9 mGy·cm, 13.9 mSv) for the abdomen-pelvis scan, and (19.3 mGy, 1152 mGy·cm, 17.25 mSv) for the chest-abdomen-pelvis scan. In comparison with results from different international studies, DLP values measured in the present study were lower for the chest-abdomen-pelvis and abdomen-pelvis CT scans, and higher for the head CT and chest CT scans.
Conclusions: It is very important that each country establishes its own DRLs and compares them with those reported by other countries, especially the developed ones. It is also important that these levels are regularly updated.
Collapse
|
5
|
Croci DM, Nguyen S, Streitmatter SW, Sherrod BA, Hardy J, Cole KL, Gamblin AS, Bisson EF, Mazur MD, Dailey AT. O-Arm Accuracy and Radiation Exposure in Adult Deformity Surgery. World Neurosurg 2023; 171:e440-e446. [PMID: 36528322 DOI: 10.1016/j.wneu.2022.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In long thoracolumbar deformity surgery, accurate screw positioning is critical for spinal stability. We assessed pedicle and pelvic screw accuracy and radiation exposure in patients undergoing long thoracolumbar deformity fusion surgery (≥4 levels) involving 3-dimensional fluoroscopy (O-Arm/Stealth) navigation. METHODS In this retrospective single-center cohort study, all patients aged >18 years who underwent fusion in 2016-2018 were reviewed. O-Arm images were assessed for screw accuracy. Effective radiation doses were calculated. The primary outcome was pedicle screw accuracy (Heary grade). Secondary outcomes were pelvic fixation screw accuracy, radiation exposure, and screw-related perioperative and postoperative complications or revision surgery within 3 years. RESULTS Of 1477 pedicle screws placed in 91 patients (mean 16.41 ± 5.6 screws/patient), 1208 pedicle screws (81.8%) could be evaluated by 3-dimensional imaging after placement. Heary Grade I placement was achieved in 1150 screws (95.2%), Grade II in 47 (3.9%), Grade III in 10 (0.82%), Grade IV in 1 (0.08%), and Grade V in 0; Grade III-V were replaced intraoperatively. One of 60 (1.6%) sacroiliac screws placed showed medial cortical breach and was replaced. The average O-Arm-related effective dose was 29.54 ± 14.29 mSv and effective dose/spin was 8.25 ± 2.65 mSv. No postoperative neurological worsening, vascular injuries, or revision surgeries for screw misplacement were recorded. CONCLUSIONS With effective radiation doses similar to those in interventional neuroendovascular procedures, the use of O-Arm in multilevel complex deformity surgery resulted in high screw accuracy, no need for surgical revision because of screw malposition, less additional imaging, and no radiation exposure for the surgical team.
Collapse
Affiliation(s)
- Davide Marco Croci
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Sarah Nguyen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Seth W Streitmatter
- Medical Imaging Physics and Radiation Safety, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Brandon A Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Hardy
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Austin S Gamblin
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
| |
Collapse
|
6
|
Weber L, Hansson M, Geijer M. Computed tomography with adjusted dose for body mass index may be superior to whole-body radiography especially in elderly patients with multiple myeloma. Acta Radiol 2023; 64:1896-1903. [PMID: 36760071 DOI: 10.1177/02841851231152325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Whole-body skeletal radiography has traditionally been used in the management of multiple myeloma for defining treatment strategies. For several reasons, radiography has been replaced by computed tomography (CT) covering the same regions. PURPOSE To evaluate the body mass index (BMI) adjusted effective radiation dose from two different methods of whole-body radiologic imaging for multiple myeloma assessment. MATERIAL AND METHODS The current investigation analyses the dose to patients resulting from the two methods, conventional radiography supplemented with tomosynthesis (203 examinations) and CT (264 examinations). All patients subject to myeloma staging for 4.5 years were included in the study. Exposure parameters were collected from the PACS and conversion factors were calculated using the software packages PCXMC and VirtualDose enabling the calculation of the effective dose to each patient based on BMI. The Mann-Whitney U test was used for comparisons between groups. RESULTS Patients were subject to a median effective dose of 2.5 mSv for conventional radiography and 5.1 mSv for CT, a statistically significant difference. CONCLUSION The effective dose for whole-body CT in assessing multiple myeloma is twice as high as for whole-body skeletal survey with modern digital radiography, but at a low level and considerably less than the levels quoted in the earlier studies of ∼30 mSv when the technique was first explored.
Collapse
Affiliation(s)
- Lars Weber
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University and Radiation Physics, Division of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Markus Hansson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, Department of Hematology, Gothenburg, Sweden.,Hematology, Division of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden
| | - Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg, Sweden.,Department of Clinical Sciences Lund, 5193Lund University, Lund, Sweden
| |
Collapse
|
7
|
Parker LA, Moreno-Garijo A, Chilet-Rosell E, Lorente F, Lumbreras B. Gender Differences in the Impact of Recommendations on Diagnostic Imaging Tests: A Retrospective Study 2007-2021. Life (Basel) 2023; 13:life13020289. [PMID: 36836646 PMCID: PMC9965980 DOI: 10.3390/life13020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
(1) Background: The frequency of imaging tests grew exponentially in recent years. This increase may differ according to a patient's sex, age, or socioeconomic status. We aim to analyze the impact of the Council Directive 2013/59/Euratom to control exposure to radiation for men and women and explore the impact of patients' age and socioeconomic status; (2) Methods: The retrospective observational study that includes a catchment population of 234,424. We included data of CT, mammography, radiography (conventional radiography and fluoroscopy) and nuclear medicine between 2007-2021. We estimated the associated radiation effective dose per test according using previously published evidence. We calculated a deprivation index according to the postcode of their residence. We divided the study in 2007-2013, 2014-2019 and 2020-2021 (the pandemic period). (3) Results: There was an increase in the number of imaging tests received by men and women after 2013 (p < 0.001), and this increase was higher in women than in men. The frequency of imaging tests decreased during the pandemic period (2020-2021), but the frequency of CT and nuclear medicine tests increased even during these years (p < 0.001) and thus, the overall effective mean dose. Women and men living in the least deprived areas had a higher frequency of imaging test than those living in the most deprived areas. (4) Conclusions: The largest increase in the number of imaging tests is due to CTs, which account for the higher amount of effective dose. The difference in the increase of imaging tests carried out in men and women and according to the socioeconomic status could reflect different management strategies and barriers to access in clinical practice. Given the low impact of the available recommendations on the population exposure to radiation and the performance of high-dose procedures such as CT, deserve special attention when it comes to justification and optimization, especially in women.
Collapse
Affiliation(s)
- Lucy A. Parker
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Andrea Moreno-Garijo
- Faculty of Pharmacy, University Miguel Hernández de Elche, 03550 Alicante, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Fermina Lorente
- Radiology Department, University Hospital of San Juan de Alicante, Sant Joan d’Alacant, 03550 Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, University Miguel Hernández de Elche, 03550 Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-965-919510
| |
Collapse
|
8
|
Bebi C, Bilato M, Minoli DG, De Marco EA, Gnech M, Paraboschi I, Boeri L, Fulgheri I, Brambilla R, Campoleoni M, Albo G, Montanari E, Manzoni G, Berrettini A. Radiation Exposure and Surgical Outcomes after Antegrade Sclerotherapy for the Treatment of Varicocele in the Paediatric Population: A Single Centre Experience. J Clin Med 2023; 12:jcm12030755. [PMID: 36769404 PMCID: PMC9917517 DOI: 10.3390/jcm12030755] [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: 10/25/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Antegrade sclerotherapy (Tauber) effectively treats varicocele. However, fluoroscopy exposes young males to ionizing radiation. We aimed to evaluate radiation exposure and surgical outcomes after the Tauber procedure. MATERIALS AND METHODS We retrospectively analysed data from 251 patients. Dose area product (DAP) and fluoroscopy time were recorded. The effective dose was calculated with the PCXMC software. Descriptive statistics and linear regression tested the association between clinical predictors and radiation exposure. RESULTS Median (IQR) age and body mass index (BMI) were 14 (13-16) years and 20.1 (17.9-21.6) kg/m². Five (2.1%) patients developed clinical recurrence and two (0.81%) developed complications. Median fluoroscopy time and DAP were 38.5 (27.7-54.0) s and 89.6 (62.5-143.9) cGy*cm2. The effective dose was 0.19 (0.14-0.31) mSv. Fluoroscopy time was higher in patients with collateral veins (41 (26-49) s vs. 36 (31-61) s, p = 0.02). The median amount of sclerosing agent (SA) used was 3 (3-4) ml. DAP was higher when SA > 3 mL was used (101.4 (65-183) cGy*cm2 vs. 80.5 (59-119) cGy*cm2; p < 0.01). At univariable linear regression, age, BMI, operative time and SA > 3 mL were associated with higher DAP (all p < 0.01). At multivariable linear regression, only BMI (beta 12.9, p < 0.001) and operative time (beta 1.9, p < 0.01) emerged as predictors of higher DAP, after accounting for age and SA > 3 mL. CONCLUSIONS The Tauber procedure is safe and associated with low effective doses. Operative time and the patient's BMI independently predict a higher radiation dose.
Collapse
Affiliation(s)
- Carolina Bebi
- Department of Paediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-55038690; Fax: +39-02-5032545
| | - Marco Bilato
- Department of Paediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Dario Guido Minoli
- Department of Paediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Erika Adalgisa De Marco
- Department of Paediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Michele Gnech
- Department of Paediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Irene Paraboschi
- Department of Paediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Irene Fulgheri
- Department of Vascular Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Roberto Brambilla
- Medical Physics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Mauro Campoleoni
- Medical Physics Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Gianantonio Manzoni
- Department of Paediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alfredo Berrettini
- Department of Paediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|
9
|
Almodóvar A, Ronda E, Flores R, Lumbreras B. Appropriateness of radiological diagnostic tests in otolaryngology. Insights Imaging 2022; 13:126. [PMID: 35925527 PMCID: PMC9352825 DOI: 10.1186/s13244-022-01263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the appropriateness of imaging tests associated with radiation in the field of otolaryngology according to the available recommendations, and to estimate the effective radiation dose associated. METHOD Cross-sectional epidemiological study of the totality of the imaging test requests carried out by two Spanish hospitals (n = 1931). We collected the following information: patient demographic data, type of imaging test, imaging tests referred in the previous 12 months, referrer department and diagnostic suspicion. In accordance with the available guidelines, we considered the requests: (a) Appropriate; (b) Inappropriate; (c) Not adequately justified; (d) Not included in the guidelines. We calculated the prevalence of each category and their variation according to the different variables. Collective and per capita effective dose were calculated for each category. RESULTS Of the 538 requests, 42% were considered appropriate, 34.4% inappropriate, 11.9% not adequately justified and 11.7% not included in the guidelines. Imaging tests requested by general partitioners (aOR: 0.18; 95% CI: 0.06-0.50) and clinical departments (aOR: 0.27; 95% CI: 0.11-0.60) were less likely to be considered appropriate than those requested by the Otolaryngology department. Patients with a diagnosis suspicion of tumour pathology were more likely to have a requested imaging test classified as appropriate (aOR: 7.12; 95% CI: 3.25-15.61). The cumulative effective dose was 877.8 mSv, of which 40% corresponded to tests classified as inappropriate. CONCLUSIONS A high percentage of imaging tests are considered as inappropriate in the field of otolaryngology, with a relevant frequency of associated effective radiation dose. Type of department, the diagnostic suspicion and the type of imaging tests were variables associated to the inappropriateness of the test.
Collapse
Affiliation(s)
| | - Elena Ronda
- CIBERESP, Madrid, Spain.
- Public Health Research Group, University of Alicante, Carretera San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain.
| | | | - Blanca Lumbreras
- CIBERESP, Madrid, Spain
- Department of Public Health, History of Science and Gynaecology, Miguel Hernandez University, Elche, Spain
| |
Collapse
|
10
|
Is It Possible to Replace Conventional Radiography (CR) with a Dose Neutral Computed Tomography (CT) of the Cervical Spine in Emergency Radiology—An Experimental Cadaver Study. Diagnostics (Basel) 2022; 12:diagnostics12081872. [PMID: 36010222 PMCID: PMC9406668 DOI: 10.3390/diagnostics12081872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/11/2022] Open
Abstract
The purpose of this experimental study on recently deceased human cadavers was to investigate whether (I) the radiation exposure of the cervical spine CT can be reduced comparable to a dose level of conventional radiography (CR); and (II) whether and which human body parameters can be predictive for higher dose reduction potential (in this context). Materials and Methods: Seventy serial CT scans of the cervical spine of 10 human cadavers undergoing postmortem virtual autopsy were taken using stepwise decreasing upper limits of the tube current (300 mAs, 150 mAs, 110 mAs, 80 mAs, 60 mAs, 40 mAs, and 20 mAs) at 120 kVp. An additional scan acquired at a fixed tube current of 300 mAs served as a reference. Images were reconstructed with filtered back projection and the upper (C1-4) and lower (C4-7) cervical spine were evaluated by three blinded readers for image quality, regarding diagnostic value and resolution of anatomical structures according to a semiquantitative three-point-scale. Dose values and individual physical parameters were recorded. The relationship of diagnostic IQ, dose reduction level, and patients’ physical parameters were investigated. The high-contrast resolution of the applied CT protocols was tested in an additional phantom study. Results: The IQ of the upper cervical spine was diagnostic at 1.69 ± 0.58 mGy (CTDI) corresponding to 0.20 ± 0.07 mSv (effective dose) in all cadavers. IQ of the lower cervical spine was diagnostic at 4.77 ± 1.86 mGy corresponding to 0.560 ± 0.21 mSv (effective dose) in seven cadavers and at 2.60 ± 0.93 mGy corresponding to 0.31 ± 0.11 mSv in four cadavers. Significant correlation was detected for BMI (0.8366; p = 0.002548) and the anteroposterior (a.p.) chest diameter (0.8363; p = 0.002566), shoulder positioning (0.79799; p = 0.00995), and radiation exposure. Conclusions: Conventional radiography can be replaced with a nearly dose-neutral CT scan of the cervical spine.
Collapse
|
11
|
Ahmed SS, Onyambu CK, Omamo E, Odhiambo A. Appropriateness of imaging modality choice by doctors at the Kenyatta National Hospital's Accident and Emergency Department. SA J Radiol 2022; 26:2367. [PMID: 35812704 PMCID: PMC9257894 DOI: 10.4102/sajr.v26i1.2367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Clinical imaging guidelines assist doctors in selecting the most appropriate radiological investigation(s) according to the patient's clinical presentation and also help to avoid unnecessary radiation exposure. Objectives This study aimed to determine the appropriateness of choice of imaging procedures requested by the doctors in the Accident and Emergency Department (A&E) of Kenyatta National Hospital (KNH). Method Request forms sent to the KNH Radiology Department from the A&E Department from 01 July 2019 to 31 October 2019 were captured digitally. The request forms were de-identified to ensure confidentiality of patients and requesting doctors. Only the demographic data, clinical summary and radiological examination requested were extracted. Results A total of 1053 imaging request forms were captured and analysed using the American College of Radiology (ACR) appropriateness criteria. Adequate clinical summary was provided in 81.3% of the request forms. Appropriate imaging requests were 51.9% whilst inappropriate imaging requests were 34.6%. The clinical scenarios of 13.6% of the imaging requests were not found in the ACR database. Imaging modalities using ionising radiation formed the bulk of the inappropriate investigations at 72.8%. Of these, CT scan had the highest individual inappropriate requests of 49.3%. Only 18.4% of female patients in the reproductive age group had a documented last menstrual period. Conclusion Imaging modalities using ionising radiation had the highest percentage of inappropriate radiological requests, especially CT scans requested in the trauma setting. In addition, some clinical scenarios were not captured in the ACR appropriateness criteria, hence the need for local imaging guidelines.
Collapse
Affiliation(s)
- Salman S Ahmed
- Department of Diagnostic Imaging & Radiation Medicine, Faculty of Radiology, University of Nairobi, Nairobi, Kenya
| | - Callen K Onyambu
- Department of Diagnostic Imaging & Radiation Medicine, Faculty of Radiology, University of Nairobi, Nairobi, Kenya
| | - Eunice Omamo
- Department of Radiology, Kenyatta National Hospital, Nairobi, Kenya
| | - Alfred Odhiambo
- Department of Radiology, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
12
|
Krenzlin H, Keric N, Ringel F, Kantelhardt SR. Intermodal Detection of Lumbar Instability in Degenerative Spondylolisthesis is Superior to Functional Radiographs. Front Surg 2022; 9:860865. [PMID: 36034353 PMCID: PMC9407032 DOI: 10.3389/fsurg.2022.860865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/10/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose In this study, we compare different imaging modalities to find the most sensitive and efficient way of detecting instability in lumbar spondylolisthesis. Methods Patients presenting with spondylolisthesis from June 01, 2018 to May 31, 2020 with functional radiographs and either CT scans or MRI images were included in our single-center retrospective cohort study. The amount of translation, in millimeters, was measured on supine MRI images, CT scans, and radiographs of inclination while sitting, standing, or prone and reclination while standing using the Meyerding technique. The amount of translation was compared among the different modalities. Results A total of 113 patients with spondylolisthesis on 125 vertebral levels were included in this study. The mean patient age was 73.52 ± 12.59 years; 69 (60.5%) patients were females. The most affected level was L4/5 (62.4%), followed by L3/4 (16%) and L5/S1 (13.6%). The average translations measured on supine CT were 4.13 ± 5.93 mm and 4.42 ± 3.49 mm on MRI (p = 0.3 for the difference between MRI and CT). The difference of inclination while sitting radiograph to slice imaging was 3.37 ± 3.64 mm (p < 0.0001), inclination while standing to slice imaging was 2.67 ± 3.03 mm (p < 0.0001), reclination while standing to slice imaging was 1.6 ± 3.15 mm (p = 0.03), and prone to slice imaging was 2.19 ± 3.02 mm (p = 0.03). Conclusion We found that a single radiograph in either inclination, reclination, or prone position compared to a CT scan or an MRI image in supine position can detect instability in spondylolisthesis more efficiently than comparison of functional radiographs in any position.
Collapse
|
13
|
DeNunzio G, Evans T, Beebe ME, Browning J, Koivisto J. Craniocervical Junction Visualization and Radiation Dose Consideration Utilizing Cone Beam Computed Tomography for Upper Cervical Chiropractic Clinical Application a Literature Review. Dose Response 2022; 20:15593258221107515. [PMID: 35719850 PMCID: PMC9201332 DOI: 10.1177/15593258221107515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To highlight the detail obtained on a Cone Beam Computed Tomography (CBCT) scan of the craniocervical junction and its usefulness to Chiropractors who specialize in the upper cervical spine. A review of the dose considerations to patients vs radiography in a chiropractic clinical setting and to review the effective radiation dose to the patient. Methods A review of studies discussing cervical biomechanics, neurovascular structures, and abnormal radiographic findings, was discussed in relation to chiropractic clinical relevance. Further studies were evaluated demonstrating radiation dose to the patient from radiographs compared to CBCT. Results Incidental and abnormal findings of the craniocervical junction were shown to have superior visualization with CBCT compared to radiography. The radiation dose to the patient for similar imaging protocols to the craniocervical junction and cervical spine was equal or less utilizing CBCT when compared to radiographs. Conclusions The use of CBCT for visualization of the craniocervical junction and cervical spine in the chiropractic clinical setting allows for adjunctive visualization of the osseous structures which is germane to clinical protocol. Further with CBCT the effective dose to the patient is equal or less than similar imaging protocols utilizing radiographs to evaluate the craniocervical junction.
Collapse
Affiliation(s)
- Greg DeNunzio
- Sweere Center for Clinical Biomechanics and Applied Ergonomics, Northwestern Health Sciences University, Bloomington, MI, USA
| | - Tyler Evans
- Private Practice, Arete Chiropractic, Portsmouth, NH, USA
| | - Mychal E Beebe
- Private Practice, Arete Chiropractic, Portsmouth, NH, USA
| | | | | |
Collapse
|
14
|
Marando M, Fusi-Schmidhauser T, Tamburello A, Grazioli Gauthier L, Rigamonti E, Argentieri G, Puligheddu C, Pagnamenta A, Valenti A, Pons M, Gianella P. 1-year radiological, functional and quality-of-life outcomes in patients with SARS-CoV-2 pneumonia - A prospective observational study. NPJ Prim Care Respir Med 2022; 32:8. [PMID: 35241685 PMCID: PMC8894490 DOI: 10.1038/s41533-022-00273-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
All over the world, SARS-CoV-2 pneumonia is causing a significant short and medium-term morbidity and mortality, with reported persisting symptoms, radiological and lung alterations up to 6 months after symptoms onset. Nevertheless, the 1-year impact on affected patients is still poorly known. In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. They underwent a 3-month and 1-year follow-ups. At 1 year, 38 patients underwent functional follow-up through lung function tests and six minutes walking test and submitted SF-12 and SGRQ questionnaires about health-related quality of life. At 1 year most of the patients showed a persistence of the radiological and functional abnormalities and a reduction of the health-related quality of life. Thirty patients (96.8%) still presented some residual abnormalities on CT scans (31 patients at 3 months), though with a general reduction of the lesional load in all lung lobes. Twenty patients (52.6%) had persisting lung function tests impairment, with an overall improvement of DLCO. As concerning the functional status, lowest SpO2 during 6MWT increased significantly. Finally, 19 patients (50%) reported a pathological St. George’s Respiratory Questionnaire, and respectively 12 (31.6%) and 11 (28.9%) patients a pathological Short Form Survey-12 in physical and mental components. At 1-year follow-up SARS-CoV-2 pneumonia survivors still present a substantial impairment in radiological and functional findings and in health-related quality of life, despite showing a progressive recovery.
Collapse
Affiliation(s)
- Marco Marando
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tanja Fusi-Schmidhauser
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Adriana Tamburello
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| | - Lorenzo Grazioli Gauthier
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Elia Rigamonti
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Gianluca Argentieri
- IIMSI - Radiology Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Carla Puligheddu
- IIMSI - Radiology Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alberto Pagnamenta
- Department of intensive care, Ospedale Regionale di Mendrisio, Ente Ospedaliero Cantonale, Mendrisio, Switzerland.,Clinical Trial Unit, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Antonio Valenti
- Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Marco Pons
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Division of Pneumology, University of Geneva, Geneva, Switzerland
| | - Pietro Gianella
- Department of Internal Medicine, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland.,Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| |
Collapse
|
15
|
Grynko O, Thibault T, Pineau E, Reznik A. The X-ray Sensitivity of an Amorphous Lead Oxide Photoconductor. SENSORS 2021; 21:s21217321. [PMID: 34770626 PMCID: PMC8588227 DOI: 10.3390/s21217321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022]
Abstract
The photoconductor layer is an important component of direct conversion flat panel X-ray imagers (FPXI); thus, it should be carefully selected to meet the requirements for the X-ray imaging detector, and its properties should be clearly understood to develop the most optimal detector design. Currently, amorphous selenium (a-Se) is the only photoconductor utilized in commercial direct conversion FPXIs for low-energy mammographic imaging, but it is not practically feasible for higher-energy diagnostic imaging. Amorphous lead oxide (a-PbO) photoconductor is considered as a replacement to a-Se in radiography, fluoroscopy, and tomosynthesis applications. In this work, we investigated the X-ray sensitivity of a-PbO, one of the most important parameters for X-ray photoconductors, and examined the underlying mechanisms responsible for charge generation and recombination. The X-ray sensitivity in terms of electron–hole pair creation energy, W±, was measured in a range of electric fields, X-ray energies, and exposure levels. W± decreases with the electric field and X-ray energy, saturating at 18–31 eV/ehp, depending on the energy of X-rays, but increases with the exposure rate. The peculiar dependencies of W± on these parameters lead to a conclusion that, at electric fields relevant to detector operation (~10 V/μm), the columnar recombination and the bulk recombination mechanisms interplay in the a-PbO photoconductor.
Collapse
Affiliation(s)
- Oleksandr Grynko
- Chemistry and Materials Science Program, Lakehead University, Thunder Bay, ON P7B 5E1, Canada
- Correspondence:
| | - Tristen Thibault
- Physics Department, Lakehead University, Thunder Bay, ON P7B 5E1, Canada; (T.T.); (E.P.); (A.R.)
| | - Emma Pineau
- Physics Department, Lakehead University, Thunder Bay, ON P7B 5E1, Canada; (T.T.); (E.P.); (A.R.)
| | - Alla Reznik
- Physics Department, Lakehead University, Thunder Bay, ON P7B 5E1, Canada; (T.T.); (E.P.); (A.R.)
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON P7B 6V4, Canada
| |
Collapse
|
16
|
Bai L, Zhou J, Shen C, Cai S, Guo Y, Huang X, Jia G, Niu G. Assessment of radiation doses and image quality of multiple low-dose CT exams in COVID-19 clinical management. CHINESE JOURNAL OF ACADEMIC RADIOLOGY 2021; 4:257-261. [PMID: 34642650 PMCID: PMC8498979 DOI: 10.1007/s42058-021-00083-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE The Corona Virus Disease 2019 (COVID-19) was first reported in December 2019 from an outbreak of unexplained pneumonia in Wuhan (Hubei, China) that subsequently spread rapidly around the world. Because of the public health emergency, chest CT has been widely used for sensitive detection and diagnosis, monitoring the changes of lesions and also for treatment evaluation. The purpose of this study was to investigate radiation dose and image quality of chest CT scans received by COVID-19 patients and to evaluate the oncogenic risk of multiple chest CT examinations. METHODS A retrospective review of 33 patients with RT-PCR confirmed COVID-19 infection was performed from January 31, 2020 to February 19, 2020. The date of each CT exam and respective radiation dose for each exam was recorded for all patients. Multiple pulmonary CT scans were obtained during diagnosis and treatment procedure. Scan frequency, total scan times, radiation dose, and image quality were determined. RESULTS Thirty-three patients (15 males and 18 females, age 21-82 years) with confirmed COVID-19 pneumonia underwent a total of 143 chest CT scans. The number of CT scans per patient was 4 ± 1, with a range of 2-6. The time interval between two consecutive chest CT scans was 3 ± 1 days. The average effective dose from a single chest CT scan was 1.21 ± 0.10 mSv, with a range of 1.02-1.44 mSv. The average cumulative effective dose per patient was 5.25 ± 1.52 mSv, with a range of 2.24-7.48 mSv. The maximum cumulative effective dose was 7.48 mSv for six CT examinations during COVID-19 treatment. Based on subjective image quality analysis, the visual scoring of CT findings was 11.23 ± 1.35 points out of 15 points. CONCLUSIONS The frequency, total number and image quality of chest CT scans should be reviewed carefully to guarantee minimally required CT scans during the COVID-19 management.
Collapse
Affiliation(s)
- Lu Bai
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 Shaanxi China
| | - Jie Zhou
- Department of Radiology, Xi’an Chest Hospital, Xi’an, Shaanxi China
| | - Cong Shen
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 Shaanxi China
| | - Shubo Cai
- Department of Radiology, Xi’an Chest Hospital, Xi’an, Shaanxi China
| | - Youmin Guo
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 Shaanxi China
| | - Xunan Huang
- School of Computer Science and Technology, Xidian University, No. 2 South Taibai Rd, Xi’an, 710071 Shaanxi China
| | - Guang Jia
- School of Computer Science and Technology, Xidian University, No. 2 South Taibai Rd, Xi’an, 710071 Shaanxi China
| | - Gang Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 Shaanxi China
| |
Collapse
|
17
|
Zak L, Tiefenboeck TM, Wozasek GE. Computed Tomography in Limb Salvage and Deformity Correction-3D Assessment, Indications, Radiation Exposure, and Safety Considerations. J Clin Med 2021; 10:3781. [PMID: 34501227 PMCID: PMC8432111 DOI: 10.3390/jcm10173781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
Computed tomography (CT) is an essential tool in orthopedic surgery but is known to be a method with that entails radiation exposure. CT increases the risk of developing fatal cancer, which should not be underestimated. However, patients with bone defects and/or deformities must frequently undergo numerous investigations during their treatment. CT is used for surgical planning, evaluating callus maturation, alignment measurement, length measurement, torsion measurement, and angiography. This study explores the indications in CT scans for limb lengthening and deformity correction and estimates the effective radiation dose. These results should help avoid unnecessary radiation exposure by narrowing the examination field and by providing explicit scanning indications. For this study, 19 posttraumatic patients were included after the bone reconstruction of 21 lower limbs. All patients underwent CT examinations during or after treatment with an external ring fixator. The mean effective dose was 3.27 mSv, with a mean cancer risk of 1:117,014. The effective dose depended on the location and indication of measurement, with a mean dose of 0.04 mSv at the ankle up to 6.8 mSv (or higher) for vascular depictions. CT evaluation, with or without 3D reconstruction, is a crucial tool in complex bone reconstruction and deformity treatments. Therefore, strict indications are necessary to reduce radiation exposure-especially in young patients-without compromising the management of their patients.
Collapse
Affiliation(s)
- Lukas Zak
- Department of Orthopedics and Trauma-Surgery, Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (T.M.T.); (G.E.W.)
| | | | | |
Collapse
|
18
|
Abbeyquaye D, Inkoom S, Hammond NB, Fletcher JJ, Botwe BO. PATIENT DOSE ASSESSMENT AND OPTIMISATION OF PELVIC RADIOGRAPHY WITH COMPUTED RADIOGRAPHY SYSTEMS. RADIATION PROTECTION DOSIMETRY 2021; 195:41-49. [PMID: 34320643 DOI: 10.1093/rpd/ncab111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
Digital radiography systems can reduce radiation dose, this capability was harnessed to explore dose and image quality (IQ) optimisation strategies. Entrance surface dose (ESD), effective dose (ED) and organ doses were determined by the indirect method for patients undergoing pelvic anteroposterior X-ray examinations with computed radiography systems. The IQ of patients' radiographs was assessed in terms of signal-to-noise ratio (SNR). An anthropomorphic phantom was exposed with varying tube potential (kVp), tube current-time product (mAs), and focus-to-detector distance (FDD) to determine phantom-entrance dose for the optimisation studies. SNR of each phantom radiograph was determined. Patients' mean ESD of 2.38 ± 0.60 mGy, ED of 0.25 ± 0.07 mSv and SNR of 8.5 ± 2.2 were obtained. After optimisation, entrance dose was reduced by 29.2% with 5 cm increment in FDD, and 5 kVp reduction in tube potential. kVp and/or mAs reduction with an increment in FDD reduced entrance dose without adversely compromising radiographic-IQ.
Collapse
Affiliation(s)
- D Abbeyquaye
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, Atomic Energy Campus, P.O. Box AE 1, Atomic Energy-Accra, Ghana
- Department of Biomedical Engineering Technology, Faculty of Health and Allied Sciences, Koforidua Technical University, P.O. Box KF-981, Koforidua, Ghana
| | - S Inkoom
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, Atomic Energy Campus, P.O. Box AE 1, Atomic Energy-Accra, Ghana
- Radiation Protection and Consultancy Centre, Radiation Protection Institute, Ghana Atomic Energy Commission, P.O. Box LG 80, Legon-Accra, Ghana
| | - N B Hammond
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, Atomic Energy Campus, P.O. Box AE 1, Atomic Energy-Accra, Ghana
- Department of Nuclear Medicine, National Centre for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - J J Fletcher
- Department of Medical Physics, School of Nuclear and Allied Sciences, University of Ghana, Atomic Energy Campus, P.O. Box AE 1, Atomic Energy-Accra, Ghana
- Department of Applied Physics, Faculty of Applied Sciences, University for Development Studies, Navrongo Campus, Upper East Region, P.O. Box TL 1350, Tamale, Ghana
| | - B O Botwe
- Department of Radiography, School of Biomedical and Allied Health Science, College of Health Sciences, University of Ghana, P.O. Box KB143, Korle-Bu Campus, Accra, Ghana
| |
Collapse
|
19
|
Frank M, Urban T, Willer K, Noichl W, De Marco F, Schick R, Gleich B, Schegerer A, Lechel U, Meyer P, Mohr J, Koehler T, Yaroshenko A, Maack I, Pralow T, Proksa R, Renger B, Noël P, Fingerle A, Pfeiffer D, Rummeny E, Herzen J, Pfeiffer F. Dosimetry on first clinical dark-field chest radiography. Med Phys 2021; 48:6152-6159. [PMID: 34314019 DOI: 10.1002/mp.15132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the dose characteristic for patient examinations at the first clinical X-ray dark-field chest radiography system and to determine whether the effective patient dose is within a clinically acceptable dose range. METHODS A clinical setup for grating-based dark-field chest radiography was constructed and commissioned, operating at a tube voltage of 70 kVp. Thermoluminescent dosimeter (TLD) measurements were conducted using an anthropomorphic phantom modeling the reference person to obtain a conversion coefficient relating dose area product (DAP) to effective patient dose at the dark-field system. For 92 patients, the DAP values for posterior-anterior measurements were collected at the dark-field system. Using the previously determined conversion coefficient, the effective dose was calculated. RESULTS A reference person, modeled by an anthropomorphic phantom, receives an effective dose of 35 µSv. For the examined patients, a mean effective dose of 39 µSv was found. CONCLUSIONS The effective dose at the clinical dark-field radiography system, generating both attenuation and dark-field images, is within the range of reported standard dose values for chest radiography.
Collapse
Affiliation(s)
- Manuela Frank
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Theresa Urban
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Konstantin Willer
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Wolfgang Noichl
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Fabio De Marco
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Rafael Schick
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Alexander Schegerer
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany
| | - Ursula Lechel
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany
| | - Pascal Meyer
- Karlsruhe Institute of Technology, Institute of Microstructure Technology, Eggenstein-Leopoldshafen, Germany
| | - Juergen Mohr
- Karlsruhe Institute of Technology, Institute of Microstructure Technology, Eggenstein-Leopoldshafen, Germany
| | | | | | - Ingo Maack
- Philips Medical Systems DMC GmbH, Hamburg, Germany
| | | | | | - Bernhard Renger
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Peter Noël
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Alexander Fingerle
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, School of Natural Sciences and Munich School of BioEngineering, Technical University of Munich, Garching, Germany.,Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, München, Germany
| |
Collapse
|
20
|
Nachit M, Lanthier N, Rodriguez J, Neyrinck AM, Cani PD, Bindels LB, Hiel S, Pachikian BD, Trefois P, Thissen JP, Delzenne NM. A dynamic association between myosteatosis and liver stiffness: Results from a prospective interventional study in obese patients. JHEP Rep 2021; 3:100323. [PMID: 34355155 PMCID: PMC8321935 DOI: 10.1016/j.jhepr.2021.100323] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022] Open
Abstract
Background & Aims Retrospective cross-sectional studies linked sarcopenia and myosteatosis with metabolic dysfunction-associated fatty liver disease (MAFLD). Here, we wanted to clarify the dynamic relationship between sarcopenia, myosteatosis, and MAFLD. Methods A cohort of 48 obese patients was randomised for a dietary intervention consisting of 16 g/day of inulin (prebiotic) or maltodextrin (placebo) supplementation. Before and after the intervention, we evaluated liver steatosis and stiffness with transient elastography (TE); we assessed skeletal muscle index (SMI) and skeletal muscle fat index (SMFI) (a surrogate for absolute fat content in muscle) using computed tomography (CT) and bioelectrical impedance analysis (BIA). Results At baseline, sarcopenia was uncommon in patients with MAFLD (4/48, 8.3%). SMFI was higher in patients with high liver stiffness than in those with low liver stiffness (640.6 ± 114.3 cm2/ Hounsfield unit [HU] vs. 507.9 ± 103.0 cm2/HU, p = 0.001). In multivariate analysis, SMFI was robustly associated with liver stiffness even when adjusted for multiple confounders (binary logistic regression, p <0.05). After intervention, patients with inulin supplementation lost weight, but this was not associated with a decrease in liver stiffness. Remarkably, upon intervention (being inulin or maltodextrin), patients who lowered their SMFI, but not those who increased SMI, had a 12.7% decrease in liver stiffness (before = 6.36 ± 2.15 vs. after = 5.55 ± 1.97 kPa, p = 0.04). Conclusions Myosteatosis, but not sarcopenia, is strongly and independently associated with liver stiffness in obese patients with MAFLD. After intervention, patients in which the degree of myosteatosis decreased reduced their liver stiffness, irrespective of body weight loss or prebiotic treatment. The potential contribution of myosteatosis to liver disease progression should be investigated. Clinical Trials registration number NCT03852069. Lay summary The fat content in skeletal muscles (or myosteatosis) is strongly associated with liver stiffness in obese patients with MAFLD. After a dietary intervention, patients in which the degree of myosteatosis decreased also reduced their liver stiffness. The potential contribution of myosteatosis to liver disease progression should be investigated. Low-radiation CT scan enables muscle evaluation (quantity and composition). Muscle mass is not low in patients with MAFLD and high liver stiffness. In contrast, myosteatosis is strongly associated with liver stiffness. Lower myosteatosis after dietary intervention is associated with improved MAFLD.
Collapse
Key Words
- ALM, appendicular lean mass
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- BIA, bioelectrical impedance analysis
- BMI, body mass index
- CAP, controlled attenuation parameter
- CT scan
- CT, computed tomography
- CTDIvol, volume CT dose index
- DEXA, dual-energy X-ray absorptiometry
- DLP, dose–length product
- FFM, fat-free mass
- HT, hypertension
- HU, Hounsfield unit
- HbA1c, haemoglobin A1c
- ITF, inulin-type fructans
- L3, third lumbar level
- Liver
- M0, baseline
- M3, end of the 3-month intervention
- MAFL, metabolic associated fatty liver
- MAFLD, metabolic dysfunction-associated fatty liver disease
- MRI, magnetic resonance imaging
- Muscle fat
- Myosteatosis
- NASH, non-alcoholic steatohepatitis
- PMI, psoas muscle index
- SMD, skeletal muscle density
- SMDpsoas, psoas muscle density
- SMFI, skeletal muscle fat index
- SMFIpsoas, psoas fat index
- SMI, skeletal muscle index
- SMIbw, SMI scaled on body weight
- SMIht2, SMI scaled on height squared
- Sarcopenia
- TE, transient elastography
- γGT, γ-glutamyl transferase
Collapse
Affiliation(s)
- Maxime Nachit
- Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, UCLouvain, Université catholique de Louvain, Brussels, Belgium.,Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Nicolas Lanthier
- Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, UCLouvain, Université catholique de Louvain, Brussels, Belgium.,Service d'Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Julie Rodriguez
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Audrey M Neyrinck
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Patrice D Cani
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Brussels, Belgium.,WELBIO - Walloon Excellence in Life Sciences and BIOtechnology, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Laure B Bindels
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Sophie Hiel
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Barbara D Pachikian
- Centre d'Investigation Clinique en Nutrition, UCLouvain, Université catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Pierre Trefois
- Medical Imaging Department, Cliniques universitaires St-Luc, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Jean-Paul Thissen
- Pole of Endocrinology, Diabetes and Nutrition, Institut de Recherche Expérimentale et Clinique, UCLouvain, Université catholique de Louvain, Brussels, Belgium.,Service d'Endocrinologie, diabétologie et nutrition, Cliniques universitaires Saint-Luc, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| | - Nathalie M Delzenne
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
21
|
The value of L5/S1 vertebral junction projection in diagnostic radiology. J Med Imaging Radiat Sci 2021; 52:356-362. [PMID: 34088644 DOI: 10.1016/j.jmir.2021.05.009] [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: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to compare the diagnostic contribution of the standard lateral and coned lumbar vertebra five and sacral vertebra one (L5/S1) projection in diagnostic radiology for specific pathologies in the digital era. METHODS The study used a retrospective qualitative design through a systematic stepwise process. The steps included a retrospective analysis of lumbar spine radiology reports over 20 months. The objective of this step was to identify the most common lumbar spine pathologies observed among the source population records (N=354). A radiologist identified five different pathologies on standard lateral and coned lateral L5/S1 projections (n=96). Fischer's exact test was performed to examine the significance of the association between the standard lateral and coned lateral L5/S1 projection classifications for each of the top five lumbar spine pathologies separately. RESULTS The five most prevalent lumbar spine pathologies indicated were degenerative disc disease (n=235; 66.4%), disc space narrowing (n=175; 49.4%), osteophytes (n=92; 26.0%), endplate sclerosis 19.21% (n=68; =9.2%) and malalignment (n=61; 17.2%). The Fisher's exact test executed to compare the top five lumbar spine pathologies visible on the standard lateral and coned lateral L5/S1 indicated that except for endplate sclerosis (p=0.0023), no significant difference in additional diagnostic information was observed between the standard lateral and coned lateral L5/S1 projections at α=0.05. CONCLUSION Compared to the standard lateral projection, the coned lateral L5/S1 projection did not contribute statistically significant additional diagnostic information for specific lumbar spine pathologies in the digital era.
Collapse
|
22
|
Argentieri G, Bellesi L, Pagnamenta A, Vanini G, Presilla S, Del Grande F, Marando M, Gianella P. Diagnostic yield, safety, and advantages of ultra-low dose chest CT compared to chest radiography in early stage suspected SARS-CoV-2 pneumonia: A retrospective observational study. Medicine (Baltimore) 2021; 100:e26034. [PMID: 34032725 PMCID: PMC8154470 DOI: 10.1097/md.0000000000026034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To determine the role of ultra-low dose chest computed tomography (uld CT) compared to chest radiographs in patients with laboratory-confirmed early stage SARS-CoV-2 pneumonia.Chest radiographs and uld CT of 12 consecutive suspected SARS-CoV-2 patients performed up to 48 hours from hospital admission were reviewed by 2 radiologists. Dosimetry and descriptive statistics of both modalities were analyzed.On uld CT, parenchymal abnormalities compatible with SARS-CoV-2 pneumonia were detected in 10/12 (83%) patients whereas on chest X-ray in, respectively, 8/12 (66%) and 5/12 (41%) patients for reader 1 and 2. The average increment of diagnostic performance of uld CT compared to chest X-ray was 29%. The average effective dose was, respectively, of 0.219 and 0.073 mSv.Uld CT detects substantially more lung injuries in symptomatic patients with suspected early stage SARS-CoV-2 pneumonia compared to chest radiographs, with a significantly better inter-reader agreement, at the cost of a slightly higher equivalent radiation dose.
Collapse
Affiliation(s)
| | | | | | - Gianluca Vanini
- Internal Medicine Department
- Allergology, Internal Medicine Department
| | | | | | | | - Pietro Gianella
- Internal Medicine Department
- Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| |
Collapse
|
23
|
Pojskić M, Bopp M, Saß B, Kirschbaum A, Nimsky C, Carl B. Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine. Brain Sci 2021; 11:brainsci11050646. [PMID: 34063546 PMCID: PMC8156391 DOI: 10.3390/brainsci11050646] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.
Collapse
Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Correspondence: ; Tel.: +49-64215869848
| | - Miriam Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 35043 Marburg, Germany
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
| | - Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, University of Marburg, 35043 Marburg, Germany;
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 35043 Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, Baldingerstraße, 35043 Marburg, Germany; (M.B.); (B.S.); (C.N.); (B.C.)
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, 65199 Wiesbaden, Germany
| |
Collapse
|
24
|
Gianella P, Rigamonti E, Marando M, Tamburello A, Grazioli Gauthier L, Argentieri G, Puligheddu C, Pagnamenta A, Pons M, Fusi-Schmidhauser T. Clinical, radiological and functional outcomes in patients with SARS-CoV-2 pneumonia: a prospective observational study. BMC Pulm Med 2021; 21:136. [PMID: 33902513 PMCID: PMC8072729 DOI: 10.1186/s12890-021-01509-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND All over the world, SARS-CoV-2 pneumonia is causing a significant short-term morbidity and mortality, but the medium-term impact on lung function and quality of life of affected patients are still unknown. METHODS In this prospective observational study, 39 patients with SARS-CoV-2 pneumonia were recruited from a single COVID-19 hospital in Southern Switzerland. At three months patients underwent radiological and functional follow-up through CT scan, lung function tests, and 6 min walking test. Furthermore, quality of life was assessed through self-reported questionnaires. RESULTS Among 39 patients with SARS-CoV-2 pneumonia, 32 (82% of all participants) presented abnormalities in CT scan and 25 (64.1%) had lung function tests impairment at three months. Moreover, 31 patients (79.5%) reported a perception of poor health due to respiratory symptoms and all 39 patients showed an overall decreased quality of life. CONCLUSIONS Medium-term follow up at three months of patients diagnosed with SARS-CoV-2 pneumonia shows the persistence of abnormalities in CT scans, a significant functional impairment assessed by lung function tests and a decreased quality of life in affected patients. Further studies evaluating the long-term impact are warranted to guarantee an appropriate follow-up to patients recovering from SARS-CoV-2 pneumonia.
Collapse
Affiliation(s)
- Pietro Gianella
- Department of Internal Medicine, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland
- Division of Pneumology, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Elia Rigamonti
- Department of Internal Medicine, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Marco Marando
- Department of Internal Medicine, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Adriana Tamburello
- Department of Internal Medicine, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Lorenzo Grazioli Gauthier
- Department of Internal Medicine, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Gianluca Argentieri
- IIMSI - Radiology Department, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Carla Puligheddu
- IIMSI - Radiology Department, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alberto Pagnamenta
- Department of Intensive Care, Intensive Care Unit Ospedale Regionale Di Mendrisio, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Unit of Biostatistics, Bellinzona, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Marco Pons
- Department of Internal Medicine, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland
- Division of Pneumology, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Division of Pneumology, University of Geneva, Geneva, Switzerland
| | - Tanja Fusi-Schmidhauser
- Department of Internal Medicine, Ospedale Regionale Di Lugano, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland
| |
Collapse
|
25
|
Lahham A, Issa A. Evaluation of Radiation Doses in Pediatric Patients Undergoing Conventional Chest X-ray Examination. HEALTH PHYSICS 2021; 120:212-216. [PMID: 32868704 DOI: 10.1097/hp.0000000000001302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
ABSTRACT This work deals with the evaluation of radiation doses from chest x rays for 240 male and female pediatric patients selected randomly from four Palestinian hospitals. The patient population was divided into five age groups: Newborn, 1, 5, 10, and 15 y old. Doses were theoretically calculated by using Monte Carlo based codes: CALDOSE-X5 and PCXMC-2.0. Patients' data and type of radiographic systems used as well as exposure factors were provided by the administrations of the selected hospitals. Absorbed organ doses from AP and PA projections were evaluated for 76 pediatric patients selected from one hospital in East Jerusalem. The highest mean organ dose for these patients was 0.085 mGy to the breast in AP projection. Effective doses were estimated for the five age groups for all patients. The highest average effective dose was found for patients in the age group of 10 y and was about 0.13 mSv, while the lowest average effective dose was found for the 5-y age group, about 0.06 mSv. The mean effective dose for all investigated patients in the five age categories was about 0.08 mSv. Variations in effective doses for the same age group and x-ray examination among involved hospitals are remarkable.
Collapse
Affiliation(s)
- Adnan Lahham
- Center for Radiation Science and Technology, Al-Quds University, P.O. Box 20002, East Jerusalem, Palestine
| | | |
Collapse
|
26
|
Atlı E, Uyanık SA, Öğüşlü U, Çevik Cenkeri H, Yılmaz B, Gümüş B. Radiation doses from head, neck, chest and abdominal CT examinations: an institutional dose report. Diagn Interv Radiol 2021; 27:147-151. [PMID: 33475510 PMCID: PMC7837727 DOI: 10.5152/dir.2020.19560] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to obtain typical values for head, neck, chest, and abdominal computed tomography (CT) examinations from routine patients in 2018, and to review our data with national and international diagnostic reference levels (DRLs). METHODS Single-phase head, neck, chest, and abdominal CT scans of adults performed in 64-slice CT in 2018 were included in this study. Radiation dose parameters of CT scans were obtained from the picture archiving and communication system of our hospital. Volumetric CT dose index (CTDIvol) and dose length product (DLP) values were recorded. Effective dose (ED) and scan length was calculated. A 16 cm diameter phantom is referenced for head CT, and 32 cm diameter phantom is referenced for neck, chest, and abdominal CT. Descriptive statistics of the variables were given according to the normality testing. RESULTS Median CTDIvol value was 53 mGy for the head, 13.1 mGy for the neck, 8.3 mGy for the chest, and 8.6 mGy for the abdomen. Median DLP value was 988 mGy.cm for the head, 299 mGy.cm for the neck, 314 mGy.cm for the chest, and 457 mGy.cm for the abdomen. Median ED value was 2.07 mSv for the head, 1.76 mSv for the neck, 4.4 mSv for the chest, and 6.8 mSv for the abdomen. Considering national DRLs, median CTDIvol values of head, chest, and abdomen were lower, whereas median DLP and ED values of head and chest were higher. For the abdomen, the median DLP and ED values were lower. CONCLUSION Overall radiation dose parameters obtained in this study points out the need for optimization of head CT examinations in our institution.
Collapse
Affiliation(s)
- Eray Atlı
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Sadık Ahmet Uyanık
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Umut Öğüşlü
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Halime Çevik Cenkeri
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Birnur Yılmaz
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Burçak Gümüş
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| |
Collapse
|
27
|
Dose-Area Product–to–Effective Dose Conversion Coefficients for Pelvic Radiography Using a Monte Carlo Program. AJR Am J Roentgenol 2020; 215:679-684. [DOI: 10.2214/ajr.19.22013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
28
|
Sng LH, Arlany L, Toh LC, Loo TY, Ilzam NS, Wong BSS, Lanca L. Initial data from an experiment to implement a safe procedure to perform PA erect chest radiographs for COVID-19 patients with a mobile radiographic system in a "clean" zone of the hospital ward. Radiography (Lond) 2020; 27:48-53. [PMID: 32517970 PMCID: PMC7261440 DOI: 10.1016/j.radi.2020.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 12/14/2022]
Abstract
Introduction With the current Covid-19 pandemic, general wards have been converted into cohort wards for Covid-19 patients who are stable and ambulant. A 2-radiographer mobile radiography team is required to perform bedside Chest X-rays (CXR) for these patients. Hospital guidelines require both radiographers to be in full Personal Protective Equipment (PPE) throughout the image acquisition process and the mobile radiographic unit needs to be disinfected twice after each case. This affects the efficiency of the procedure and an increase usage of limited PPE resources. This study aims to explore the feasibility of performing mobile chest radiography with the mobile radiographic unit in a “clean” zone of the hospital ward. Methods An anthropomorphic body phantom was used during the test. With the mobile radiographic unit placed in a “clean” zone, the phantom and the mobile radiographic unit was segregated by the room door with a clear glass panel. The test was carried out with the room door open and closed. Integrated radiation level and patient dose were measured. A consultant radiologist was invited to review and score all the images acquired using a Barco Medical Grade workstation. The Absolute Visual Grading Analysis (VGA) scoring system was used to score these images. Results A VGA score of 4 was given to all the 40 test images, suggesting that there is no significant differences in the image quality of the images acquired using the 2 different methods. Radiation exposure received by the patient at the highest kV setting through the glass is comparable to the regular CXR on patient without glass panel at 90 kV, suggesting that there is no significant increase in patient dose. Conclusion The result suggests that acquiring CXR with the X-ray beam attenuating through a glass panel is a safe and feasible way of performing CXR for COVID-19 patients in the newly converted COVID wards. This will allow the mobile radiographic unit as well as one radiographer to be completely segregated from the patient. Implications for practice This new method of acquiring CXR in an isolation facility set up requires a 2-Radiographer mobile radiography team, and is applicable only for patients who are generally well and not presented with any mobility issues. It is also important to note that a clear glass panel must be present in the barriers set up for segregation between the “clean” zone and patient zone in order to use this new method of acquiring CXR.
Collapse
Affiliation(s)
- L H Sng
- Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore; Singapore Institute of Technology, 10 Dover Drive, 138683, Singapore.
| | - L Arlany
- Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
| | - L C Toh
- Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
| | - T Y Loo
- Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
| | - N S Ilzam
- Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
| | - B S S Wong
- Sengkang General Hospital, 110 Sengkang East Way, 544886, Singapore
| | - L Lanca
- Singapore Institute of Technology, 10 Dover Drive, 138683, Singapore
| |
Collapse
|
29
|
Masamoto K, Fujibayashi S, Otsuki B, Fukushima Y, Koizumi K, Shimizu T, Shimizu Y, Murata K, Ikeda N, Matsuda S. Cervical spinal computed tomography utilizing model-based iterative reconstruction reduces radiation to an equivalent of three cervical X-rays. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2804-2813. [PMID: 32388669 DOI: 10.1007/s00586-020-06426-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/04/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate radiation dose and image quality of cervical spinal computed tomography scanned with low-radiation dose (LD-CT) utilizing model-based iterative reconstruction (MBIR). METHODS We retrospectively examined 14 patients (65.5 ± 13.9 years) who underwent both standard-radiation-dose CT (SD-CT) reconstructed with hybrid iterative reconstruction and LD-CT of cervical spine. The radiation dose, objective image quality indicator, which includes signal-to-noise and contrast-to-noise, and subjective image quality score of the anatomical landmarks in the SD-CT and LD-CT were statistically compared. In addition, the measurement errors of the length of C3 vertebrae (height, anteroposterior length, inner and outer pedicle diameters) between SD-CT and LD-CT were analyzed. RESULTS Radiation dose of LD-CT was reduced to one-sixth of the dose of SD-CT. The objective image quality indicator of LD-CT was significantly better than that of SD-CT. The subjective image quality of LD-CT was relatively worse than that of SD-CT but generally graded as clinically accepted or higher. There was no remarkable difference between SD-CT and LD-CT in the measurement value of height and anteroposterior length. Inner pedicle diameter was significantly (0.21 ± 0.13 mm) smaller, and outer pedicle diameter was (0.24 ± 0.14 mm) larger on LD-CT than on SD-CT. CONCLUSION Cervical spinal LD-CT that utilized MBIR enabled radical decrease in radiation dose and provided sufficient image quality for clinical use. This scanning protocol can be a good alternative for protecting patients from exposure to unnecessary radiation, especially when a patient requires multiple CT scans.
Collapse
Affiliation(s)
- Kazutaka Masamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yasuhiro Fukushima
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Koizumi
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Norimasa Ikeda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| |
Collapse
|
30
|
Marando M, Tamburello A, Gianella P. False-Negative Nasopharyngeal Swab RT-PCR Assays in Typical COVID-19: Role of Ultra-low-dose Chest CT and Bronchoscopy in Diagnosis. Eur J Case Rep Intern Med 2020; 7:001680. [PMID: 32670990 PMCID: PMC7357997 DOI: 10.12890/2020_001680] [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: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 12/25/2022] Open
Abstract
On 11 March 2020, the WHO declared COVID-19 a pandemic and global health emergency. We describe the clinical features and role of ultra-low-dose chest computed tomography (CT) and bronchoscopy in the diagnosis of coronavirus disease (COVID-19). In our patient, who was highly suggestive clinically and radiologically for COVID-19, we had two false-negative results for nasopharyngeal and oral swab reverse-transcriptase polymerase chain reaction (RT-PCR) assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eventually, we confirmed the diagnosis using bronchoscopy and bronchoalveolar lavage (BAL). LEARNING POINTS Clinical and laboratory findings in COVID-19 are unspecific.Chest CT has a diagnostic sensitivity comparable to nasopharyngeal swab RT-PCR assay but lacks specificity.RT-PCR assays on biological specimens, particularly nasopharyngeal swabs, are considered the diagnostic gold standard.Bronchoscopy and bronchoalveolar lavage can help confirm the diagnosis and should be performed in patients in whom diagnostic-driven treatment for COVID-19, such as tocilizumab or remdesivir, is being considered.
Collapse
Affiliation(s)
- Marco Marando
- General Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Adriana Tamburello
- General Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Pietro Gianella
- General Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Pneumology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| |
Collapse
|
31
|
Abstract
STUDY DESIGN A prospective, case-based, observational study. OBJECTIVES To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery. METHODS In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation. RESULTS AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0.28 mm) resulted in a reliable AR representation with a close matching of visualized objects and reality, distinctly supporting anatomical orientation in the surgical field. Flexible AR visualization applying either the microscope HUD or video superimposition, including the ability to selectively activate objects of interest, as well as different display modes allowed a smooth integration in the surgical workflow, without disturbing the actual procedure. On average, 7.1 ± 4.6 objects were displayed visualizing target and risk structures reliably. CONCLUSIONS Microscope-based AR can be applied successfully to various kinds of spinal procedures. AR improves anatomical orientation in the surgical field supporting the surgeon, as well as it offers a potential tool for education.
Collapse
Affiliation(s)
- Barbara Carl
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Miriam Bopp
- Department of Neurosurgery, University Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Benjamin Saß
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Mirza Pojskic
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | | | - Christopher Nimsky
- Department of Neurosurgery, University Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| |
Collapse
|
32
|
Differences in the clinical management of women and men after detection of a solitary pulmonary nodule in clinical practice. Eur Radiol 2020; 30:4390-4397. [PMID: 32193639 DOI: 10.1007/s00330-020-06791-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To explore differences in the clinical management of men and women in the 5 years after detecting a solitary pulmonary nodule (SPN) by chest radiograph or CT in routine clinical practice. METHODS We followed up 545 men and 347 women with an SPN detected by chest radiograph or CT in a retrospective cohort of 25,422 individuals undergoing routine thoracic imaging in 2010-2011. We compared the frequency of each management strategy (no further test, immediate intervention or follow up) according to sex by means of chi-squared. We estimated the relative risk of women versus men of having been followed up instead of an immediate intervention using multivariate logistic regression. We compared by sex the time between detection of the nodule and lung cancer diagnosis, the time between diagnosis and death by means of Mann-Whitney U test and the cumulative effective dose of radiation in each management strategy by means of t test. RESULTS Women were more likely than men to have follow-up rather than immediate intervention (aRR = 1.8, CI 1.3-2.7, p = 0.002), particularly in those who underwent CT (aRR = 4.2, CI 1.9-9.3, p < 0.001). The median time between SPN detection and lung cancer diagnosis was higher in women (4.2 months, interquartile range (IQR) 5.1) than in men (1.5 months, IQR 16.2). The mean cumulative effective dose was 21.3 mSv, 19.4 mSv in men and 23.9mv in women (p = 0.023). CONCLUSIONS Our results could reflect decisions based on a greater suspicion of lung cancer in men. The incidental detection of SPNs is increasing, and it is necessary to establish clear strategies aimed to reduce variability in their management according to patient's sex. KEY POINTS • After incidental finding of SPN, women were less likely to receive an immediate intervention. • Accumulative radiation was higher in women than in men. • Our results could reflect decisions based on a greater suspicion of lung cancer in men.
Collapse
|
33
|
Suliman II. Estimates of Patient Radiation Doses in Digital Radiography Using DICOM Information at a Large Teaching Hospital in Oman. J Digit Imaging 2020; 33:64-70. [PMID: 30891650 PMCID: PMC7064681 DOI: 10.1007/s10278-019-00199-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In this study, we sought to estimate the patient radiation doses in the digital radiography X-ray examinations conducted in a large hospital. The patient exposure factors and kerma-area product (PKA) were retrospectively recorded via the Digital Imaging and Communications in Medicine (DICOM) header for 547 patients. The entrance surface air kerma (ESAK) was estimated from the measurements of the X-ray tube output and recorded exposure factors, as well as from the console that displayed PKA as an alternative method. Effective doses were estimated from ESAK and PKA values using the appropriate conversion coefficient. In the chest PA, chest LAT, cervical spine AP, cervical spine LAT, abdomen AP, pelvis AP, lumbar spine AP, and lumbar spine LAT, the median ESAK (mGy) was found to be 0.13, 0.27, 0.35, 0.52, 0.70, 1.06, 2.33, and 4.18 mGy, respectively. Median PKA values were 0.10, 0.26, 0.14, 0.17, 0.77, 0.68, 0.81, and 1.11 Gy cm2, respectively. The estimated effective dose from ESAK and PKA values yielded comparable results. The comparison revealed that the ESAK and PKA values fell far below the reported in the literature. The results showed that the information of the DICOM deader is valuable for dosimetry and optimization.
Collapse
Affiliation(s)
- Ibrahim I Suliman
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan.
- Formerly at Medical Physics Section, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al-Khoudh, 123, Muscat, Oman.
- Physics Department, College of Science, Committee on Radiation and Environmental Pollution Protection, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11642, Saudi Arabia.
| |
Collapse
|
34
|
Carl B, Bopp M, Saß B, Pojskic M, Gjorgjevski M, Voellger B, Nimsky C. Reliable navigation registration in cranial and spine surgery based on intraoperative computed tomography. Neurosurg Focus 2019; 47:E11. [DOI: 10.3171/2019.8.focus19621] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVELow registration errors are an important prerequisite for reliable navigation, independent of its use in cranial or spinal surgery. Regardless of whether navigation is used for trajectory alignment in biopsy or implant procedures, or for sophisticated augmented reality applications, all depend on a correct registration of patient space and image space. In contrast to fiducial, landmark, or surface matching–based registration, the application of intraoperative imaging allows user-independent automatic patient registration, which is less error prone. The authors’ aim in this paper was to give an overview of their experience using intraoperative CT (iCT) scanning for automatic registration with a focus on registration accuracy and radiation exposure.METHODSA total of 645 patients underwent iCT scanning with a 32-slice movable CT scanner in combination with navigation for trajectory alignment in biopsy and implantation procedures (n = 222) and for augmented reality (n = 437) in cranial and spine procedures (347 craniotomies and 42 transsphenoidal, 56 frameless stereotactic, 59 frame-based stereotactic, and 141 spinal procedures). The target registration error was measured using skin fiducials that were not part of the registration procedure. The effective dose was calculated by multiplying the dose length product with conversion factors.RESULTSAmong all 1281 iCT scans obtained, 1172 were used for automatic patient registration (645 initial registration scans and 527 repeat iCT scans). The overall mean target registration error was 0.86 ± 0.38 mm (± SD) (craniotomy, 0.88 ± 0.39 mm; transsphenoidal, 0.92 ± 0.39 mm; frameless, 0.74 ± 0.39 mm; frame-based, 0.84 ± 0.34 mm; and spinal, 0.80 ± 0.28 mm). Compared with standard diagnostic scans, a distinct reduction of the effective dose could be achieved using low-dose protocols for the initial registration scan with mean effective doses of 0.06 ± 0.04 mSv for cranial, 0.50 ± 0.09 mSv for cervical, 4.12 ± 2.13 mSv for thoracic, and 3.37 ± 0.93 mSv for lumbar scans without impeding registration accuracy.CONCLUSIONSReliable automatic patient registration can be achieved using iCT scanning. Low-dose protocols ensured a low radiation exposure for the patient. Low-dose scanning had no negative effect on navigation accuracy.
Collapse
Affiliation(s)
- Barbara Carl
- 1Department of Neurosurgery, University of Marburg; and
| | - Miriam Bopp
- 1Department of Neurosurgery, University of Marburg; and
- 2Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Benjamin Saß
- 1Department of Neurosurgery, University of Marburg; and
| | - Mirza Pojskic
- 1Department of Neurosurgery, University of Marburg; and
| | | | | | - Christopher Nimsky
- 1Department of Neurosurgery, University of Marburg; and
- 2Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| |
Collapse
|
35
|
Wachabauer D, Mathis-Edenhofer S, Moshammer H. Medical radiation exposure from radiological and interventional procedures in Austria. Wien Klin Wochenschr 2019; 132:563-571. [DOI: 10.1007/s00508-019-01557-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/05/2019] [Accepted: 09/18/2019] [Indexed: 11/25/2022]
|
36
|
Feasibility of Submillisievert CT of the Skeletal Pelvis Using Iterative Reconstruction: A Human Cadaver Study. AJR Am J Roentgenol 2019; 213:903-911. [PMID: 31287726 DOI: 10.2214/ajr.18.20933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
37
|
Lumbreras B, Salinas JM, Gonzalez-Alvarez I. Cumulative exposure to ionising radiation from diagnostic imaging tests: a 12-year follow-up population-based analysis in Spain. BMJ Open 2019; 9:e030905. [PMID: 31537572 PMCID: PMC6756468 DOI: 10.1136/bmjopen-2019-030905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To calculate each patient's cumulative radiation exposure and the recurrent tests during a 12-year study period, according to sex and age, in routine practice. DESIGN Retrospective cohort study. SETTING A general hospital with a catchment population of 224 751 people, in the Southeast of Spain. PARTICIPANTS Population belonged to the catchment area of that hospital in 2007. We collected all consecutive diagnostic imaging tests undergone by this population until 31 December 2018. We excluded: imaging tests that did not involve radiation exposure. MAIN OUTCOME MEASURES The cumulative effective dose and the recurrent imaging tests by sex and age at entry of study. RESULTS Of the 224 751 people, 154 520 (68.8%) underwent an imaging test. The population had 1 335 752 imaging tests during the period of study: 1 110 077 (83.0%) plain radiography; 156 848 (11.8%) CT; 63 157 (4.8%) fluoroscopy and 5670 (0.4%) interventional radiography. 25.4% of the patients who had a CT, underwent five or more CTs (5.4% in the 0-20 years age group). The median total cumulative effective dose was 2.10 mSv (maximum 3980.30) and 16.30 mSv (maximum 1419.30 mSv) if we considered only doses associated with CT. Women received more effective dose than men (median 2.38 vs median 1.90, p<0.001). A total of 7142 (4.6%) patients received more than 50 mSv, with differences in men and women (p<0.001) and 2.5% of the patients in the 0-20 years age group, if we considered only doses associated with CT. CONCLUSIONS Nearly 5% of patients received doses higher than 50 mSv during the 12-year period of study and 2.5% of the patients in the 0-20 years age group, if we considered only doses associated with CT. The rate of recurrent examinations was high, especially in older patients, but also relevant in the 0-20 years age group.
Collapse
Affiliation(s)
- Blanca Lumbreras
- Department of Public Health, Miguel Hernandez University of Elche, Alicante, Spain
- CIBER en Epidemiología y Salud Pública, Alicante, Spain
| | | | | |
Collapse
|
38
|
The Utility of In-Hospital Postoperative Radiographs Following Surgical Treatment of Traumatic Thoracolumbar Injuries. Clin Spine Surg 2019; 32:E297-E302. [PMID: 31045598 DOI: 10.1097/bsd.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The objective of this study was to assess the utility of routine in-hospital postoperative radiographs for identifying hardware failure following surgical treatment of traumatic thoracolumbar (TL) injuries. BACKGROUND Postoperative radiographs following spine surgery are considered standard of care despite a lack of evidence supporting their utility. Previous studies have concluded that postoperative radiographs following lumbar fusion for degenerative conditions have limited clinical value. MATERIALS AND METHODS A retrospective chart review was performed on patients who underwent surgical treatment of traumatic TL injuries between December 2006 and October 2015 at a level I trauma center. Before discharge, postoperative upright anteroposterior and lateral radiographs were obtained and reviewed by 1 surgeon and 1 radiologist as per protocol. Patients who subsequently underwent revision surgery during their initial hospital stay were identified. These patients were further analyzed to identify the indications for surgery and determine if the results of the radiographs obtained led to the subsequent revision surgery. RESULTS A total of 463 patients were identified who underwent surgical treatment following TL trauma. The rate of revision surgery during the initial hospitalization was 1.3% (6/463). Three patients underwent revision surgery due to worsening neurological status. One patient underwent reoperation because of advance imaging obtained for abdominal trauma. Two patients underwent revision surgery due to abnormal findings on postoperative radiographs. The overall sensitivity and specificity of routine postoperative radiographs was 33.3% and 100%, respectively. CONCLUSIONS In the absence of new clinical signs and symptoms, obtaining routine in-hospital postoperative radiographs following surgical treatment of TL injuries provides minimal value. Clinical assessment should help determine if additional imaging is indicated for the patient. Avoiding unnecessary inpatient tests such as routine postoperative radiograph may offer multitude of benefits including lowering patient radiation exposure, reducing health care costs and better allocation of hospital resources. LEVEL OF EVIDENCE Level III.
Collapse
|
39
|
Delhaas EM, van der Lugt A. Low-Dose Computed Tomography With Two- and Three-Dimensional Postprocessing as an Alternative to Plain Radiography for Intrathecal Catheter Visualization: A Phantom Pilot Study. Neuromodulation 2019; 22:818-822. [PMID: 31087726 PMCID: PMC6852017 DOI: 10.1111/ner.12966] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/27/2019] [Accepted: 04/10/2019] [Indexed: 12/02/2022]
Abstract
Objectives In intrathecal drug delivery, visualization of the device has been performed with plain radiography. However, the visibility of the related structures can be problematic. In troubleshooting, after the contrast material injection via the catheter access port, a computed tomography (CT) scan has been used. In troubleshooting, we also used a non‐contrast CT scan with 2D and 3D reconstructions. With the current phantom study, we aimed to obtain high‐resolution imaging of a poor opaque catheter with the use of a low‐dose single‐energy 2D and 3D CT scan with limited radiation exposure as a substitute for plain radiography. Materials and Methods The catheter was placed into a fatty substance and mounted on an anthropomorphic abdomen phantom followed by CT with varying kVp settings and with added tin beam filtering. Dose levels corrected based on the spinal catheter tip on T8 would result in a calculated effective dose in the range of the mSv's calculated for the plain x‐ray examination. Results Ultimately, Sn100 kVp has the best trade‐off between visibility, artifacts, and noise for a fixed dose. Although 3D VRT imaging was challenging at this low dose level, we could make a full evaluation possible with complementary 2D projections. Conclusions We could correctly identify the catheter and related structures, which supports the investigation of this in vivo and side‐by‐side evaluation with plain radiography. If found superior, then this technique may be able to replace plain radiography, while providing better visualization and acceptable radiation exposure. Conflict of Interest Dr. Delhaas reports personal fees from Medtronic Inc., as a previous consultant, outside the submitted work; Prof. van der Lugt reports grants from GE Healthcare, Siemens, Stryker, Medtronic, and Penumbra outside the submitted work.
Collapse
Affiliation(s)
- Elmar M Delhaas
- Center for Pain Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
40
|
Bevilacqua MU, Hague CJ, Romann A, Sheitt H, Vasilescu DM, Yi TW, Levin A. CT of Kidney Volume in Autosomal Dominant Polycystic Kidney Disease: Accuracy, Reproducibility, and Radiation Dose. Radiology 2019; 291:660-667. [PMID: 30964424 DOI: 10.1148/radiol.2019181830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Total kidney volume (TKV) assessment is valuable in autosomal dominant polycystic kidney disease (ADPKD) but the reference standard method of MRI planimetry requires access to MRI and time-consuming interpretation. Purpose To determine whether accurate TKV measurements comparable to the resource-intensive reference standard of MRI planimetry can be obtained by using alternate methods including dose-reducing CT protocols and time-saving measurement equations. Materials and Methods In this prospective study conducted September 2016 to June 2017, adult participants with ADPKD underwent one MRI and two CT examinations. Low-dose (LD) and ultra-low-dose (ULD) CT examinations were performed with radiation doses 1.4 and 2.6 times lower, respectively, than the authors' institution's standard abdomen and pelvis CT. ULD CT examinations were reconstructed via model-based iterative reconstruction. Three TKV measurement equations were applied to all image sets, and MRI manual planimetry was the reference standard. Spearman correlation with the reference standard, simple linear regression, and root mean square error (RMSE) calculation analyzed accuracy of these methods; intraclass correlation coefficient examined reproducibility. Results Thirty participants (mean age, 41 years; age range, 24-67 years) had a mean TKV of 1368.9 mL ± 1146.13 (standard deviation). The ULD and LD CT protocols had median dose-length product of 58.8 and 115.5 mGy ∙ cm, respectively (P = .01), and CT dose index of 1.2 and 3.9 mGy, respectively (P < .001). All imaging modalities and measurement equations had excellent correlation with the reference standard (r2 > 0.98). RMSE ranged from 80.5 to 157.3 mL (5.9%-11.5% of mean TKV). Intraclass correlation coefficients were greater than 0.98 for all methods. Mean measurement times for the ellipsoid method ranged from 4.6 to 5.2 minutes compared with a mean of 27.7 minutes (range, 14-60 minutes) for manual planimetry. Conclusion Accurate and reproducible total kidney volume measurements comparable to the reference standard of MRI planimetry can be obtained by using a dose-minimizing ultra-low-dose CT protocol and volume measurement based on discrete linear measurements. © RSNA, 2019 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Micheli U Bevilacqua
- From the Division of Nephrology (M.U.B., T.W.Y., A.L.), Department of Radiology (C.J.H., H.S.), and Centre for Heart Lung Innovation (D.M.V.), University of British Columbia, #700 - 1380 Burrard St, Vancouver, BC, Canada V6Z 2H3; and British Columbia Provincial Renal Agency, Vancouver, Canada (M.U.B., A.R., A.L.)
| | - Cameron J Hague
- From the Division of Nephrology (M.U.B., T.W.Y., A.L.), Department of Radiology (C.J.H., H.S.), and Centre for Heart Lung Innovation (D.M.V.), University of British Columbia, #700 - 1380 Burrard St, Vancouver, BC, Canada V6Z 2H3; and British Columbia Provincial Renal Agency, Vancouver, Canada (M.U.B., A.R., A.L.)
| | - Alexandra Romann
- From the Division of Nephrology (M.U.B., T.W.Y., A.L.), Department of Radiology (C.J.H., H.S.), and Centre for Heart Lung Innovation (D.M.V.), University of British Columbia, #700 - 1380 Burrard St, Vancouver, BC, Canada V6Z 2H3; and British Columbia Provincial Renal Agency, Vancouver, Canada (M.U.B., A.R., A.L.)
| | - Hana Sheitt
- From the Division of Nephrology (M.U.B., T.W.Y., A.L.), Department of Radiology (C.J.H., H.S.), and Centre for Heart Lung Innovation (D.M.V.), University of British Columbia, #700 - 1380 Burrard St, Vancouver, BC, Canada V6Z 2H3; and British Columbia Provincial Renal Agency, Vancouver, Canada (M.U.B., A.R., A.L.)
| | - Dragoş M Vasilescu
- From the Division of Nephrology (M.U.B., T.W.Y., A.L.), Department of Radiology (C.J.H., H.S.), and Centre for Heart Lung Innovation (D.M.V.), University of British Columbia, #700 - 1380 Burrard St, Vancouver, BC, Canada V6Z 2H3; and British Columbia Provincial Renal Agency, Vancouver, Canada (M.U.B., A.R., A.L.)
| | - Tae Won Yi
- From the Division of Nephrology (M.U.B., T.W.Y., A.L.), Department of Radiology (C.J.H., H.S.), and Centre for Heart Lung Innovation (D.M.V.), University of British Columbia, #700 - 1380 Burrard St, Vancouver, BC, Canada V6Z 2H3; and British Columbia Provincial Renal Agency, Vancouver, Canada (M.U.B., A.R., A.L.)
| | - Adeera Levin
- From the Division of Nephrology (M.U.B., T.W.Y., A.L.), Department of Radiology (C.J.H., H.S.), and Centre for Heart Lung Innovation (D.M.V.), University of British Columbia, #700 - 1380 Burrard St, Vancouver, BC, Canada V6Z 2H3; and British Columbia Provincial Renal Agency, Vancouver, Canada (M.U.B., A.R., A.L.)
| |
Collapse
|
41
|
Carl B, Bopp M, Saß B, Voellger B, Nimsky C. Implementation of augmented reality support in spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1697-1711. [DOI: 10.1007/s00586-019-05969-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/02/2018] [Accepted: 04/02/2019] [Indexed: 01/07/2023]
|
42
|
|
43
|
Vilar-Palop J, Hernandez-Aguado I, Pastor-Valero M, Vilar J, González-Alvarez I, Lumbreras B. Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis. BMJ Open 2018; 8:e019535. [PMID: 29549204 PMCID: PMC5857681 DOI: 10.1136/bmjopen-2017-019535] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. DESIGN Cross-sectional retrospective study. SETTING Two Spanish public tertiary hospitals. PARTICIPANTS 2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Five outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient's clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category. RESULTS Approximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays. CONCLUSION There was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.
Collapse
Affiliation(s)
| | - Ildefonso Hernandez-Aguado
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Barcelona, Spain
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, Alicante, Spain
| | - María Pastor-Valero
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Barcelona, Spain
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, Alicante, Spain
| | - José Vilar
- Radiology Department, Peset Hospital, Valencia, Spain
| | | | - Blanca Lumbreras
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Barcelona, Spain
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, Alicante, Spain
| |
Collapse
|
44
|
Balonov M, Golikov V, Zvonova I, Chipiga L, Kalnitsky S, Sarycheva S, Vodovatov A. Patient doses from medical examinations in Russia: 2009-2015. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:121-139. [PMID: 29154256 DOI: 10.1088/1361-6498/aa9b99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to evaluate adult patient doses in Russia in the context of patient protection. Effective doses from x-ray and nuclear medicine examinations were assessed using two approaches. The first was based on data collection performed by the authors in hospitals in St. Petersburg and other 17 Russian regions. The second approach was to assess mean doses through the collective dose estimated annually within the federal data bank ESKID. In 2015, 203 million examinations were conducted in Russia, i.e. 1.4 examinations per capita. The number of examinations has increased by 35% over the last 10 years. Patient doses from x-ray examinations are strongly dependent on the imaging modality. Mean dose increases by an order of magnitude with each x-ray modality from dental examinations (0.01-0.1 mSv) to radiography (0.1-1 mSv), fluoroscopy and CT (1-10 mSv) and to interventional examinations (more than 10 mSv). Mean doses for x-ray examinations are comparable with that of foreign countries. Scintigraphy examinations with 99mTc are associated with mean doses of 1-5 mSv. Mean doses from PET/CT whole body examinations are 15-25 mSv with similar contributions from CT and radiopharmaceuticals. In nuclear medicine, patient doses are lower compared to other countries. According to ESKID data the collective dose from medical exposure in Russia has decreased from 140 000 man-Sv in 2000 to 77 000 man-Sv in 2015. Medical exposure contributes about 13% into a total collective dose. The maximum contribution was from CT examinations, i.e. 45% in 2015. A range of mean doses between different hospitals was up to two orders of magnitude for radiography and one order of magnitude for CT. In interventional studies, the scatter of individual doses was significant. Significant variations in doses between hospitals and some regions indicate the potential for optimization with the focus on interventional examinations, CT and nuclear medicine examinations combined with CT.
Collapse
Affiliation(s)
- M Balonov
- Research Institute of Radiation Hygiene, Mira St 8, 197101 St. Petersburg, Russia
| | | | | | | | | | | | | |
Collapse
|