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Chatterjee AR, Malhotra A, Curl P, Andre JB, Perez-Carrillo GJG, Smith EB. Traumatic Cervical Cerebrovascular Injury and the Role of CTA: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023. [PMID: 37791730 DOI: 10.2214/ajr.23.29783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Traumatic cerebrovascular injury (CVI) involving the cervical carotid and vertebral arteries is rare but can lead to stroke, hemodynamic compromise, and mortality in the absence of early diagnosis and treatment. The diagnosis of both blunt CVI (BCVI) and penetrating CVI is based on cerebrovascular imaging. The most commonly used screening criteria for BCVI include the expanded Denver criteria and the Memphis criteria, each providing varying thresholds for subsequent imaging. Neck CTA has supplanted catheter-based digital subtraction angiography as the preferred screening modality for CVI in patients with trauma. This AJR Expert Panel Narrative Review describes the current state of CTA-based cervical imaging in trauma. We review the most common screening criteria for BCVI, discuss BCVI grading scales that are based on neck CTA, describe the diagnostic performance of CTA in the context of other imaging modalities and evolving treatment strategies, and provide a practical guide for neck CTA implementation.
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Affiliation(s)
- Arindam Rano Chatterjee
- Associate Professor of Radiology, Neurosurgery, and Neurology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis
| | - Ajay Malhotra
- Professor, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
| | - Patti Curl
- Assistant Professor, Department of Radiology, Neuroradiology Section, University of Washington School of Medicine, Seattle WA
| | - Jalal B Andre
- Associate Professor, Department of Radiology, Neuroradiology Section, University of Washington School of Medicine, 1959 NE Pacific St., NW011, Seattle, WA 98195
| | - Gloria J Guzman Perez-Carrillo
- Associate Professor of Radiology, Neuroradiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis
| | - Elana B Smith
- Associate Professor, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201
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Waelti S, Fischer T, Griessinger J, Cip J, Dietrich TJ, Ditchfield M, Allmendinger T, Messerli M, Markart S. Ultra-low-dose computed tomography for torsion measurements of the lower extremities in children and adolescents. Insights Imaging 2022; 13:118. [PMID: 35838922 PMCID: PMC9287501 DOI: 10.1186/s13244-022-01257-w] [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: 04/04/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantifying femoral and tibial torsion is crucial in the preoperative planning for derotation surgery in children and adolescents. The use of an ultra-low-dose computed tomography (CT) protocol might be possible for modern CT scanners and suitable for reliable torsion measurements even though the bones are not completely ossified. METHODS This is a retrospective review of 77 children/adolescents (mean age 12.7 years) who underwent a lower extremity CT for torsion measurements on a 64-slice scanner. A stepwise dose reduction (70%, 50%, 30% of the original dose) was simulated. Torsion measurements were performed on all image datasets, and image noise, interrater agreement and subjective image quality were evaluated. Effective radiation dose of each original scan was estimated. As proof of concept, 24 children were scanned with an ultra-low-dose protocol, adapted from the 30% dose simulation, and the intra-class correlation coefficient (ICC) was determined. Ethics approval and informed consent were given. RESULTS Torsion measurements at the simulated 30% dose level had equivalent interrater agreement compared to the 100% dose level (ICC ≥ 0.99 for all locations and dose levels). Image quality of almost all datasets was rated excellent, regardless of dose. The mean sum of the effective dose of the total torsion measurement was reduced by simulation from 0.460/0.490 mSv (boys/girls) at 100% dose to 0.138/0.147 mSv at 30%. The ICC of the proof-of-concept group was as good as that of the simulated 30% dose level. CONCLUSION Pediatric torsion measurements of the lower extremities can be performed using an ultra-low-dose protocol without compromising diagnostic confidence.
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Affiliation(s)
- Stephan Waelti
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland. .,Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Tim Fischer
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Jennifer Griessinger
- Radiation Protection and Medical Physics, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Johannes Cip
- Department of Orthopedic Surgery, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Tobias Johannes Dietrich
- Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Michael Ditchfield
- Department of Diagnostic Imaging, Monash Children's Hospital, Clayton, Australia
| | - Thomas Allmendinger
- Diagnostic Imaging, Computed Tomography, Siemens Healthcare, Forchheim, Germany
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Markart
- Department of Radiology and Nuclear Medicine, Children's Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006, St. Gallen, Switzerland.,Department of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Lorenzana DJ, Solomon J, French RJ, McCrum E, Jonkergouw F, Anakwenze OA, Lassiter T, Samei E, Klifto CS. Comparison of Simulated Low-Dose and Conventional-Dose CT for Preoperative Planning in Shoulder Arthroplasty. J Bone Joint Surg Am 2022; 104:1004-1014. [PMID: 35648067 DOI: 10.2106/jbjs.20.01916] [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: 02/01/2023]
Abstract
BACKGROUND Shoulder computed tomography (CT) is commonly utilized in preoperative planning for total shoulder arthroplasty. Conventional-dose shoulder CT may expose patients to more ionizing radiation than is necessary to provide high-quality images for this procedure. The purpose of this study was to evaluate the utility of simulated low-dose CT images for preoperative planning using manual measurements and common preoperative planning software. METHODS Eighteen shoulder CT scans obtained for preoperative arthroplasty planning were used to generate CT images as if they had been acquired at reduced radiation dose (RD) levels of 75%, 50%, and 25% using a simulation technique that mimics decreased x-ray tube current. This technique was validated by quantitative comparison of simulated low-dose scans of a cadaver with actual low-dose scans. Glenoid version, glenoid inclination, and humeral head subluxation were measured using 2 commercially available software platforms and were also measured manually by 3 physicians. These measurements were then analyzed for agreement across RD levels for each patient. Tolerances of 5° of glenoid version, 5° of glenoid inclination, and 10% humeral head subluxation were used as equivalent for preoperative planning purposes. RESULTS At all RD levels evaluated, the preoperative planning software successfully segmented the CT images. Semiautomated software measurement of 25% RD images was within tolerances in 99.1% of measurements; for 50% RD images, within tolerances in 96.3% of measurements; and for 75% RD images, within tolerances in 100% of measurements. Manual measurements of 25% RD images were within these tolerances in 95.1% of measurements; for 50% RD images, in 98.8% of measurements; and for 75% RD images, in 99.4% of measurements. CONCLUSIONS Simulated low-dose CT images were sufficient for reliable measurement of glenoid version, glenoid inclination, and humeral head subluxation by preoperative planning software as well as by physician-observers. These findings suggest the potential for substantial reduction in RD in preoperative shoulder CT scans without compromising surgical planning. CLINICAL RELEVANCE The adoption of low-dose techniques in preoperative shoulder CT may lower radiation exposure for patients undergoing shoulder arthroplasty, without compromising image quality.
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Affiliation(s)
- Daniel J Lorenzana
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Justin Solomon
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Robert J French
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Erin McCrum
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | | | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Tally Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ehsan Samei
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Martens B, Bosschee JGA, Van Kuijk SMJ, Jeukens CRLPN, Brauer MTH, Wildberger JE, Mihl C. Finding the optimal tube current and iterative reconstruction strength in liver imaging; two needles in one haystack. PLoS One 2022; 17:e0266194. [PMID: 35390018 PMCID: PMC8989341 DOI: 10.1371/journal.pone.0266194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/15/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
The aim of the study was to find the lowest possible tube current and the optimal iterative reconstruction (IR) strength in abdominal imaging.
Material and methods
Reconstruction software was used to insert noise, simulating the use of a lower tube current. A semi-anthropomorphic abdominal phantom (Quality Assurance in Radiology and Medicine, QSA-543, Moehrendorf, Germany) was used to validate the performance of the ReconCT software (S1 Appendix). Thirty abdominal CT scans performed with a standard protocol (120 kVref, 150 mAsref) scanned at 90 kV, with dedicated contrast media (CM) injection software were selected. There were no other in- or exclusion criteria. The software was used to insert noise as if the scans were performed with 90, 80, 70 and 60% of the full dose. Consequently, the different scans were reconstructed with filtered back projection (FBP) and IR strength 2, 3 and 4. Both objective (e.g. Hounsfield units [HU], signal to noise ratio [SNR] and contrast to noise ratio [CNR]) and subjective image quality were evaluated. In addition, lesion detection was graded by two radiologists in consensus in another 30 scans (identical scan protocol) with various liver lesions, reconstructed with IR 3, 4 and 5.
Results
A tube current of 60% still led to diagnostic objective image quality (e.g. SNR and CNR) when IR strength 3 or 4 were used. IR strength 4 was preferred for lesion detection. The subjective image quality was rated highest for the scans performed at 90% with IR 4.
Conclusion
A tube current reduction of 10–40% is possible in case IR 4 is used, leading to the highest image quality (10%) or still diagnostic image quality (40%), shown by a pairwise comparison in the same patients.
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Affiliation(s)
- Bibi Martens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | | | - Sander M. J. Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Cécile R. L. P. N. Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maikel T. H. Brauer
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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Huang K, Rhee DJ, Ger R, Layman R, Yang J, Cardenas CE, Court LE. Impact of slice thickness, pixel size, and CT dose on the performance of automatic contouring algorithms. J Appl Clin Med Phys 2021; 22:168-174. [PMID: 33779037 PMCID: PMC8130223 DOI: 10.1002/acm2.13207] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/12/2020] [Accepted: 01/30/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To investigate the impact of computed tomography (CT) image acquisition and reconstruction parameters, including slice thickness, pixel size, and dose, on automatic contouring algorithms. Methods Eleven scans from patients with head‐and‐neck cancer were reconstructed with varying slice thicknesses and pixel sizes. CT dose was varied by adding noise using low‐dose simulation software. The impact of these imaging parameters on two in‐house auto‐contouring algorithms, one convolutional neural network (CNN)‐based and one multiatlas‐based system (MACS) was investigated for 183 reconstructed scans. For each algorithm, auto‐contours for organs‐at‐risk were compared with auto‐contours from scans with 3 mm slice thickness, 0.977 mm pixel size, and 100% CT dose using Dice similarity coefficient (DSC), Hausdorff distance (HD), and mean surface distance (MSD). Results Increasing the slice thickness from baseline value of 3 mm gave a progressive reduction in DSC and an increase in HD and MSD on average for all structures. Reducing the CT dose only had a relatively minimal effect on DSC and HD. The rate of change with respect to dose for both auto‐contouring methods is approximately 0. Changes in pixel size had a small effect on DSC and HD for CNN‐based auto‐contouring with differences in DSC being within 0.07. Small structures had larger deviations from the baseline values than large structures for DSC. The relative differences in HD and MSD between the large and small structures were small. Conclusions Auto‐contours can deviate substantially with changes in CT acquisition and reconstruction parameters, especially slice thickness and pixel size. The CNN was less sensitive to changes in pixel size, and dose levels than the MACS. The results contraindicated more restrictive values for the parameters should be used than a typical imaging protocol for head‐and‐neck.
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Affiliation(s)
- Kai Huang
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dong Joo Rhee
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rachel Ger
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rick Layman
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Winkelmann MT, Afat S, Walter SS, Stock E, Schwarze V, Brendlin A, Kolb M, Artzner CP, Othman AE. Diagnostic Performance of Different Simulated Low-Dose Levels in Patients with Suspected Cervical Abscess Using a Third-Generation Dual-Source CT Scanner. Diagnostics (Basel) 2020; 10:diagnostics10121072. [PMID: 33322074 PMCID: PMC7764070 DOI: 10.3390/diagnostics10121072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 01/02/2023] Open
Abstract
The aim of this study was to investigate the effects of dose reduction on diagnostic accuracy and image quality of cervical computed tomography (CT) in patients with suspected cervical abscess. Forty-eight patients (mean age 45.5 years) received a CT for suspected cervical abscess. Low-dose CT (LDCT) datasets with 25%, 50%, and 75% of the original dose were generated with a realistic simulation. The image data were reconstructed with filtered back projection (FBP) and with advanced modeled iterative reconstruction (ADMIRE) (strengths 3 and 5). A five-point Likert scale was used to assess subjective image quality and diagnostic confidence. The signal-to-noise ratio (SNR) of the sternocleidomastoid muscle and submandibular gland and the contrast-to-noise ratio (CNR) of the sternocleidomastoid muscle and submandibular glandular fat were calculated to assess the objective image quality. Diagnostic accuracy was calculated for LDCT using the original dose as the reference standard. The prevalence of cervical abscesses was high (72.9%) in the cohort; the mean effective dose for all 48 scans was 1.8 ± 0.8 mSv. Sternocleidomastoid and submandibular SNR and sternocleidomastoid muscle fat and submandibular gland fat CNR increased with higher doses and were significantly higher for ADMIRE compared to FBP, with the best results in ADMIRE 5 (all p < 0.001). Subjective image quality was highest for ADMIRE 5 at 75% and lowest for FBP at 25% of the original dose (p < 0.001). Diagnostic confidence was highest for ADMIRE 5 at 75% and lowest for FBP at 25% (p < 0.001). Patient-based diagnostic accuracy was high for all LDCT datasets, down to 25% for ADMIRE 3 and 5 (sensitivity: 100%; specificity: 100%) and lower for FBP at 25% dose reduction (sensitivity: 88.6-94.3%; specificity: 92.3-100%). The use of a modern dual-source CT of the third generation and iterative reconstruction allows a reduction in the radiation dose to 25% (0.5 mSv) of the original dose with the same diagnostic accuracy for the assessment of neck abscesses.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Saif Afat
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Sven S Walter
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Eva Stock
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Vincent Schwarze
- Department of Radiology, University Hospital LMU, 81337 Munich, Germany
| | - Andreas Brendlin
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Manuel Kolb
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Christoph P Artzner
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Ahmed E Othman
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
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Diagnostic accuracy of ultra-low-dose CT for torsion measurement of the lower limb. Eur Radiol 2020; 31:3574-3581. [PMID: 33241518 PMCID: PMC8249276 DOI: 10.1007/s00330-020-07528-8] [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: 05/13/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/12/2023]
Abstract
Objectives The study aimed to investigate the diagnostic performance of simulated ultra-low-dose CT (ULD-CT) for torsion measurement of the lower limb. Methods Thirty retrospectively identified patients were included (32.3 ± 14.2 years; 14 women, 16 men). ULD-CT simulations were generated at dose levels of 100%, 10%, 5%, and 1% using two reconstruction methods: standard filtered back projection (FBP) and iterative reconstruction (ADMIRE). Two readers measured the lower limb torsion in all data sets. The readers also captured image noise in standardized anatomical landmarks. All data sets were evaluated regarding subjective diagnostic confidence (DC; 5-point Likert scale). Effective radiation dose of the original data sets and the simulated ULD-CT was compared. Results There was no significant difference of measured lower limb torsion in any simulated dose level compared to the original data sets in both readers. Dose length product (DLP) of the original examinations was 402.1 ± 4.3 mGy cm, which resulted in an effective radiation dose of 4.00 ± 2.12 mSv. Calculated effective radiation dose in ULD-CT at 1% of the original dose was 0.04 mSv. Image noise increased significantly with dose reduction (p < 0.0001) and was dependent on the reconstructional method (p < 0.0001) with less noise using ADMIRE compared to FBP. Both readers rated DC at doses 100%, 10%, and 5% with 5.0/5: there were no ratings worse than 3/5 at 1% dose level. Conclusions The results suggest that radiation dose reduction down to 1% of original CT dose levels may be achieved in CT torsion measurements of the lower limb without compromising diagnostic accuracy. Key Points • Modern CT delivers exceptional high image quality in musculoskeletal imaging, especially for evaluation of osseous structures. • Usually, this high image quality is accompanied by significant radiation exposure to the patient and may not always be required for the intended purpose, e.g., pure delineation of cortical bone of the lower limb. • This study shows the tremendous prospects of radiation dose reduction without compromising diagnostic confidence in CT torsion measurement of the lower limb.
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Erdal BS, Demirer M, Little KJ, Amadi CC, Ibrahim GFM, O’Donnell TP, Grimmer R, Gupta V, Prevedello LM, White RD. Are quantitative features of lung nodules reproducible at different CT acquisition and reconstruction parameters? PLoS One 2020; 15:e0240184. [PMID: 33057454 PMCID: PMC7561205 DOI: 10.1371/journal.pone.0240184] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022] Open
Abstract
Consistency and duplicability in Computed Tomography (CT) output is essential to quantitative imaging for lung cancer detection and monitoring. This study of CT-detected lung nodules investigated the reproducibility of volume-, density-, and texture-based features (outcome variables) over routine ranges of radiation dose, reconstruction kernel, and slice thickness. CT raw data of 23 nodules were reconstructed using 320 acquisition/reconstruction conditions (combinations of 4 doses, 10 kernels, and 8 thicknesses). Scans at 12.5%, 25%, and 50% of protocol dose were simulated; reduced-dose and full-dose data were reconstructed using conventional filtered back-projection and iterative-reconstruction kernels at a range of thicknesses (0.6-5.0 mm). Full-dose/B50f kernel reconstructions underwent expert segmentation for reference Region-Of-Interest (ROI) and nodule volume per thickness; each ROI was applied to 40 corresponding images (combinations of 4 doses and 10 kernels). Typical texture analysis metrics (including 5 histogram features, 13 Gray Level Co-occurrence Matrix, 5 Run Length Matrix, 2 Neighboring Gray-Level Dependence Matrix, and 3 Neighborhood Gray-Tone Difference Matrix) were computed per ROI. Reconstruction conditions resulting in no significant change in volume, density, or texture metrics were identified as "compatible pairs" for a given outcome variable. Our results indicate that as thickness increases, volumetric reproducibility decreases, while reproducibility of histogram- and texture-based features across different acquisition and reconstruction parameters improves. To achieve concomitant reproducibility of volumetric and radiomic results across studies, balanced standardization of the imaging acquisition parameters is required.
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Affiliation(s)
- Barbaros S. Erdal
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Mutlu Demirer
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Kevin J. Little
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Chiemezie C. Amadi
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Gehan F. M. Ibrahim
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Thomas P. O’Donnell
- Siemens Healthineers, Malvern, Pennsylvania, United States of America and Erlangen, Germany
| | - Rainer Grimmer
- Siemens Healthineers, Malvern, Pennsylvania, United States of America and Erlangen, Germany
| | - Vikash Gupta
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Luciano M. Prevedello
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Richard D. White
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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Aissa J, Bölke E, Sawicki LM, Appel E, Thomas C, Heusch P, Sedlmair M, Krzymyk K, Kröpil P, Antoch G, Boos J. Noise insertion in CT for cocaine body packing: where is the limit of extensive dose reduction? Eur J Med Res 2018; 23:59. [PMID: 30526681 PMCID: PMC6284291 DOI: 10.1186/s40001-018-0356-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/29/2018] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate the detection rate and image quality in CT-body-packer-screening at different radiation-dose levels and to determine a dose threshold that enables a reliable detection of incorporated body packs and incidental findings with a maximum of dose saving. Materials and methods We retrospectively included 27 individuals who underwent an abdominal CT with automated exposure control due to suspected body packing. CT images were reconstructed at different radiation-dose levels of 50%, 10, 5% and 1% using iterative reconstructions. All 135 CT reconstructions were evaluated by three independent readers. Reviewers determined the presence of foreign bodies and evaluated the image quality using a 5-point ranking scale. In addition, visualization of incidental findings was assessed. Results A threshold of 5% (effective dose 0.11 ± 0.07 mSv) was necessary to correctly identify all 27 patients with suspected body packing. Extensive noise insertion to a dose level of 1% (0.02 ± 0.01 mSV) led to false-positive solid cocaine findings in three patients. Image quality was comparable between 100 and 50%. The threshold for correct identification of incidental findings was 10% of the initial dose (effective dose 0.21 ± 0.13 mSv). Conclusions Our results indicate that dose of abdominal CT for the detection of intracorporeal cocaine body packets can be markedly reduced to up to 5% of the initial dose while still providing sufficient image quality to detect ingested body packets. However, a minimum effective dose of 0.21 mSv (10% of initial dose) seems to be required to properly identify incidental findings.
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Affiliation(s)
- Joel Aissa
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Elisabeth Appel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Christoph Thomas
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Philipp Heusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Martin Sedlmair
- Computed Tomography, Siemens Healthineers GmbH, Forchheim, Germany
| | - Karl Krzymyk
- Computed Tomography, Siemens Healthineers GmbH, Forchheim, Germany
| | - Patric Kröpil
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.,Department of Radiology, BG Klinikum Duisburg gGmbH, 47249, Duisburg, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Johannes Boos
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
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Advanced Modeled Iterative Reconstruction (ADMIRE) Facilitates Radiation Dose Reduction in Abdominal CT. Acad Radiol 2018; 25:1277-1284. [PMID: 29500115 DOI: 10.1016/j.acra.2018.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to determine the potential degree of radiation dose reduction achievable using Advanced Modeled Iterative Reconstruction (ADMIRE) in abdominal computed tomography (CT) while maintaining image quality. Moreover, this study compared differences in image noise reduction of this iterative algorithm with radiation dose reduction. METHODS Eleven consecutive patients scheduled for abdominal CT were scanned according to our institute's standard protocol (100 kV, 289 reference mAs). Using a proprietary reconstruction software, CT images of these patients were reconstructed as either full-dose weighted filtered back projections or with simulated radiation dose reductions down to 10% of the full-dose level and ADMIRE at either strength 3 or strength 5. Images were marked with arrows pointing on anatomic structures of the abdomen, differing in their contrast to the surrounding tissue. Structures were grouped into high-, medium-, and low-contrast subgroups. In addition, the intrinsic noise of these structures was measured. That followed, image pairs were presented to observers, with five readers assessing image quality using two-alternative-forced-choice comparisons. In total, 3000 comparisons were performed that way. RESULTS Both ADMIRE 3 and 5 decreased noise of the anatomic structures significantly compared to the filtered back projection, with an additional significant difference between ADMIRE 3 and 5. Radiation dose reduction potential for ADMIRE ranged from 29.0% to 53.5%, with no significant differences between ADMIRE 3 and 5 within the contrast subgroups.The potential levels of radiation dose reduction for ADMIRE 3 differed significantly between high-, medium-, and low-contrast structures, whereas for ADMIRE 5, there was only a significant difference between the high- and the medium-contrast subgroups. CONCLUSION Although ADMIRE 5 permits significantly higher noise reduction potential than ADMIRE 3, it does not facilitate higher levels of radiation dose reduction. ADMIRE nonetheless holds remarkable potential for radiation dose reduction, which features a certain dependency on the contrast of the structure of interest. Applying ADMIRE with a strength of 3 in abdominal CT may permit radiation dose reduction of about 30%.
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Virtual Computed Tomography Colonography: Evaluation of 2D and Virtual 3D Image Quality of Sub-mSv Examinations Enabled by Third-generation Dual Source Scanner Featuring Tin Filtering. Acad Radiol 2018; 25:1046-1051. [PMID: 29371121 DOI: 10.1016/j.acra.2017.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/04/2017] [Accepted: 12/17/2017] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate two- and three-dimensional (2D and 3D) image quality of sub-milliSievert (mSv) computed tomography (CT) colonography utilizing a third-generation dual source CT scanner featuring a tin filter. METHODS We retrospectively evaluated 26 consecutive patients who underwent third-generation dual source CT colonography, nine with the standard-dose clinical-scan protocol (SDP) and 17 with a low-dose protocol (LDP) featuring a tin filter. Radiation dose was evaluated by volume computed tomography dose index (CTDIvol), dose length product (DLP), effective dose (E), and size-specific dose estimate. Objective image quality was evaluated utilizing signal-to-noise ratio (SNR) derived from standardized placed regions of interest on the transverse 2D images and the ratio of SNR/CTDIvol (normalized SNR). Two radiologists in consensus assessed subjective image quality of the virtual 3D images. RESULTS There were no significant differences in subjective image quality (P = .661). All examinations were rated "excellent" or "good" for diagnostic confidence. The mean total for DLP/E was 143.4 ± 29.8 mGy/3.00 ± 0.40 mSv in the SDP and therefore significantly higher than in the LDP with 36.9 ± 8.7 mGy/0.75 ± 0.16 mSv (P < .001). The SNR was 8.9 ± 2.1 in the SDP and 4.9 ± 0.8 in the LDP. CONCLUSIONS Third-generation dual source CT featuring a tin filter enables consistent sub-mSv colonography without substantially impairing image quality.
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Ellmann S, Kammerer F, Allmendinger T, Brand M, Janka R, Hammon M, Lell MM, Uder M, Kramer M. Dose reduction potential of iterative reconstruction algorithms in neck CTA-a simulation study. Dentomaxillofac Radiol 2016; 45:20160228. [PMID: 27461784 DOI: 10.1259/dmfr.20160228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES This study aimed to determine the degree of radiation dose reduction in neck CT angiography (CTA) achievable with Sinogram-affirmed iterative reconstruction (SAFIRE) algorithms. METHODS 10 consecutive patients scheduled for neck CTA were included in this study. CTA images of the external carotid arteries either were reconstructed with filtered back projection (FBP) at full radiation dose level or underwent simulated dose reduction by proprietary reconstruction software. The dose-reduced images were reconstructed using either SAFIRE 3 or SAFIRE 5 and compared with full-dose FBP images in terms of vessel definition. 5 observers performed a total of 3000 pairwise comparisons. RESULTS SAFIRE allowed substantial radiation dose reductions in neck CTA while maintaining vessel definition. The possible levels of radiation dose reduction ranged from approximately 34 to approximately 90% and depended on the SAFIRE algorithm strength and the size of the vessel of interest. In general, larger vessels permitted higher degrees of radiation dose reduction, especially with higher SAFIRE strength levels. With small vessels, the superiority of SAFIRE 5 over SAFIRE 3 was lost. CONCLUSIONS Neck CTA can be performed with substantially less radiation dose when SAFIRE is applied. The exact degree of radiation dose reduction should be adapted to the clinical question, in particular to the smallest vessel needing excellent definition.
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Affiliation(s)
- Stephan Ellmann
- 1 Institute of Radiology, University Hospital Erlangen-Nuernberg, University of Erlangen-Nuernberg, Erlangen, Germany
| | - Ferdinand Kammerer
- 1 Institute of Radiology, University Hospital Erlangen-Nuernberg, University of Erlangen-Nuernberg, Erlangen, Germany
| | - Thomas Allmendinger
- 2 Siemens Healthineers GmbH, CT Division, Siemensstraße 1, Forchheim/Erlangen, Germany
| | - Michael Brand
- 1 Institute of Radiology, University Hospital Erlangen-Nuernberg, University of Erlangen-Nuernberg, Erlangen, Germany
| | - Rolf Janka
- 1 Institute of Radiology, University Hospital Erlangen-Nuernberg, University of Erlangen-Nuernberg, Erlangen, Germany
| | - Matthias Hammon
- 1 Institute of Radiology, University Hospital Erlangen-Nuernberg, University of Erlangen-Nuernberg, Erlangen, Germany
| | - Michael M Lell
- 3 Clinicum Nuernberg, Department of Radiology and Nuclear Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Michael Uder
- 1 Institute of Radiology, University Hospital Erlangen-Nuernberg, University of Erlangen-Nuernberg, Erlangen, Germany
| | - Manuel Kramer
- 1 Institute of Radiology, University Hospital Erlangen-Nuernberg, University of Erlangen-Nuernberg, Erlangen, Germany
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邵 礼, 菅 洪, 陈 广, 梁 蕴, 黄 文. [Recurrence and survival analysis of postoperative patients aged 25 to 59 years with differentiated thyroid carcinoma]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:274-277. [PMID: 28219876 PMCID: PMC6779664 DOI: 10.3969/j.issn.1673-4254.2017.02.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the recurrence and survival of postoperative patients with differentiated thyroid carcinoma (DTC) aged from 25 to 59 years. METHODS We retrospectively analyzed the clinical data of 36 patients with DTC treated in our hospital from 1996 to 2011, and the recurrence and survival status of the patients were recorded. Kaplan-Meier analysis was carried out to analyze factors that affect the patient's survival. RESULTS Nine patients died of recurrence or metastasis, and the interval between the initial surgery and recurrence ranged from 22 to 46 months. The survival time of the 36 patients ranged from 34 to 135 months with a 10-year survival rate of 75.0%. Kaplan-Meier analysis showed that male patients had a significantly shorter mean survival time than female patients (Χ2=3.164, P=0.041); the median survival time of patients aged 45-59 years was obviously shorter than that of patients aged 25-44 years (Χ2=4.622, P=0.032); the postoperative survival in patients with 131I therapy was significantly longer than those who did not receive the therapy (Χ2=4.527, P=0.033), and was not affected by total excision of the thyroid gland (Χ2=0.988, P=0.320). No significant difference was found in the median survival of patients in different clinical stages (Χ2=2.2132, P=0.167). CONCLUSION In young and middle-aged patients with DTC, postoperative recurrence is the most likely in 2 to 4 years after the surgery. Male patients at 45-59 years of age who do not receive 131I treatment are at high risks of tumor recurrence.
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Affiliation(s)
- 礼成 邵
- 佛山市第五人民医院内三科,广东 佛山 528211Third Internal Medical, Foshan Fifth People's Hospital, Foshan 528211, China
| | - 洪健 菅
- 南方医科大学南方医院急诊科,广东 广州 510515Department of Emergency Medicine, Nanfang Hospital,Southern Medical University, Guangzhou 510515, China
| | - 广辉 陈
- 佛山市第五人民医院内三科,广东 佛山 528211Third Internal Medical, Foshan Fifth People's Hospital, Foshan 528211, China
| | - 蕴谊 梁
- 佛山市第五人民医院内三科,广东 佛山 528211Third Internal Medical, Foshan Fifth People's Hospital, Foshan 528211, China
| | - 文柱 黄
- 佛山市第五人民医院内三科,广东 佛山 528211Third Internal Medical, Foshan Fifth People's Hospital, Foshan 528211, China
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