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Dalah EZ, Al Mazrouei NK, Al Ali ZA. Establishing the Diagnostic Reference Levels for Common Dubai Health Adult Nuclear Medicine Examinations. Life (Basel) 2025; 15:649. [PMID: 40283203 PMCID: PMC12028678 DOI: 10.3390/life15040649] [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: 02/10/2025] [Revised: 04/03/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025] Open
Abstract
Nuclear medicine (NM) procedures are performed using unsealed radioactive sources that are administered to patients, resulting in both internal and external exposure for patients and staff alike. Optimization is mainly concerned with ensuring the use of the lowest sufficient level of radiation to perform a procedure while maintaining adequate image quality. Diagnostic reference levels (DRLs) have been proven effective in aiding optimization in clinical practice. This dose review aims to establish an inclusive DRL system for the common adult NM procedures performed at Dubai Health. Our defined DRLs will focus on both the administered radiopharmaceuticals and the radiation dose metrics derived from hybrid computed tomography (CT). Dose surveys for 1439 adult nuclear medicine procedures performed over twelve months were collected and retrospectively analyzed. DRLs were obtained for a total of eight scintigraphy procedures, four hybrid positron emission tomography procedures with CT (denoted PET/CT), and five target sites for CT hybrid single-photon emission tomography with CT (denoted as SPECT/CT). Our derived DRLs for the scintigraphy, hybrid SPECT/CT and PET/CT procedures are within the reported national DRLs, except for the CT dose of the hybrid SPECT/CT for the neck, abdomen and chest/abdomen sites and the 18F PSMA administered activity. A fixed activity dose was administered for a scintigraphy procedure that is weight dependent. This patient dose review serves as a foundational effort aiming to optimize radiation safety and standardize diagnostic practices in NM. Further research is needed to enhance adherence to safety benchmarks.
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Affiliation(s)
- Entesar Z. Dalah
- Central Diagnostic Imaging Department, Dubai Health, Dubai P.O. Box 2727, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University, Dubai Health, Dubai P.O. Box 2727, United Arab Emirates
| | - Najlaa K. Al Mazrouei
- Medical Physics Department, Dubai Hospital, Dubai Health, Dubai P.O. Box 2727, United Arab Emirates
| | - Zahra A. Al Ali
- Nuclear Medicine Center, Dubai Hospital, Dubai Health, Dubai P.O. Box 2727, United Arab Emirates
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Gautam S, Sharma A, Paruthi C, Ghasi RG, Bhardwaj K. Comparison of image quality of split-bolus computed tomography versus dual-phase computed tomography in abdominal trauma. Pol J Radiol 2025; 90:e151-e160. [PMID: 40321708 PMCID: PMC12049156 DOI: 10.5114/pjr/200756] [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: 09/20/2024] [Accepted: 02/03/2025] [Indexed: 05/08/2025] Open
Abstract
Purpose To compare the image quality in single-pass split-bolus abdominal computed tomography (CT) and conventional biphasic CT in abdominal trauma patients. Material and methods Sixty-six consecutive abdominal trauma patients referred for CT were randomised into 2 groups: the study group (n = 33), scanned using the split-bolus technique; and the control group (n = 33), scanned using the conventional biphasic technique. CT image quality was analysed subjectively by 2 observers based on a 5-point Likert scale. The images were also analysed quantitatively for attenuation values achieved by region of interest (ROI) placements in major arteries, veins, and solid organs. In addition, the radiation dose in terms of the dose length product (DLP) was compared between the 2 groups. Results The image quality in both groups ranged from good to excellent in most cases. There was no statistically significant difference in subjective image quality in both the groups as assessed by Likert score. Attenuation values in solid organs and major venous structures were significantly higher in the split-bolus group (p < 0.001). Arterial attenuation values were significantly higher in the control group (p < 0.001), but diagnostic levels were achieved in all patients. There was a reduction of 31.1% in DLP in the split-bolus group. Conclusions The split-bolus technique offers comparable image quality and higher solid organ and venous enhancement than conventional biphasic protocol at a reduced radiation dose.
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Affiliation(s)
- Shubham Gautam
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anuradha Sharma
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Charu Paruthi
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rohini Gupta Ghasi
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Krishna Bhardwaj
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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O'Regan PW, Harold-Barry A, O'Mahony AT, Crowley C, Joyce S, Moore N, O'Connor OJ, Henry MT, Ryan DJ, Maher MM. Ultra-low-dose chest computed tomography with model-based iterative reconstruction in the analysis of solid pulmonary nodules: A prospective study. World J Radiol 2024; 16:668-677. [PMID: 39635307 PMCID: PMC11612801 DOI: 10.4329/wjr.v16.i11.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 10/10/2024] [Accepted: 11/12/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Incidental pulmonary nodules are an increasingly common finding on computed tomography (CT) scans of the thorax due to the exponential rise in CT examinations in everyday practice. The majority of incidental pulmonary nodules are benign and correctly identifying the small number of malignant nodules is challenging. Ultra-low-dose CT (ULDCT) has been shown to be effective in diagnosis of respiratory pathology in comparison with traditional standard dose techniques. Our hypothesis was that ULDCT chest combined with model-based iterative reconstruction (MBIR) is comparable to standard dose CT (SDCT) chest in the analysis of pulmonary nodules with significant reduction in radiation dose. AIM To prospectively compare ULDCT chest combined with MBIR with SDCT chest in the analysis of solid pulmonary nodules. METHODS A prospective cohort study was conducted on adult patients (n = 30) attending a respiratory medicine outpatient clinic in a tertiary referral university hospital for surveillance of previously detected indeterminate pulmonary nodules on SDCT chest. This study involved the acquisition of a reference SDCT chest followed immediately by an ULDCT chest. Nodule identification, nodule characterisation, nodule measurement, objective and subjective image quality and radiation dose were compared between ULDCT with MBIR and SDCT chest. RESULTS One hundred solid nodules were detected on ULDCT chest and 98 on SDCT chest. There was no significant difference in the characteristics of correctly identified nodules when comparing SDCT chest to ULDCT chest protocols. Signal-to-noise ratio was significantly increased in the ULDCT chest in all areas except in the paraspinal muscle at the maximum cardiac diameter level (P < 0.001). The mean subjective image quality score for overall diagnostic acceptability was 8.9/10. The mean dose length product, computed tomography volume dose index and effective dose for the ULDCT chest protocol were 5.592 mGy.cm, 0.16 mGy and 0.08 mSv respectively. These were significantly less than the SDCT chest protocol (P < 0.001) and represent a radiation dose reduction of 97.6%. CONCLUSION ULDCT chest combined with MBIR is non-inferior to SDCT chest in the analysis of previously identified solid pulmonary nodules and facilitates a large reduction in radiation dose.
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Affiliation(s)
- Patrick W O'Regan
- Department of Radiology, School of Medicine, University College Cork, Cork T12 AK54, Ireland
| | | | | | - Claire Crowley
- Department of Radiology, Mercy University Hospital, Cork T12WE28, Ireland
| | - Stella Joyce
- Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
| | - Niamh Moore
- Department of Radiology, School of Medicine, University College Cork, Cork T12 AK54, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
| | - Michael T Henry
- Department of Respiratory Medicine, Cork University Hospital, Cork T12 DC4A, Ireland
| | - David J Ryan
- Department of Radiology, School of Medicine, University College Cork, Cork T12 AK54, Ireland
| | - Michael M Maher
- Department of Radiology, School of Medicine, University College Cork, Cork T12 AK54, Ireland
- Department of Radiology, Cork University Hospital, Cork T12 DC4A, Ireland
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Bastian S, André E, Jesús FL, Doreen K, Yvonne K, Michael T, Rahel A KH, Tilo N. Assessing Environmental Sustainability in Dual-Energy CT: Exploring Energy Consumption and Ecological-Economic Impact in Low Utilization Times. Acad Radiol 2024; 31:4528-4537. [PMID: 38806373 DOI: 10.1016/j.acra.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/05/2024] [Accepted: 05/05/2024] [Indexed: 05/30/2024]
Abstract
RATIONALE AND OBJECTIVES Within global sustainable resource management efforts, reducing healthcare energy consumption is of public concern. This study aims to analyze the energy consumption of three Dual-Energy computed tomography (DECT) scanners and to predict the power consumption based on scan acquisition parameters. MATERIALS AND METHODS This study consisted of two parts assessing three DECT scanners: one Dual-Source and two Single-Source DECT. In Part A, the energy consumption for various single- and DECT scans with different acquisition parameters using a chest phantom was measured. The measurements were compared to the calculated power consumption. In Part B, the energy consumption baselines during nonutilization states of the DECT devices: idle (ready to scan), low-power (incomplete shutdown), and system-off mode (complete shutdown) were measured. Descriptive statistics were used. RESULTS The phantom study revealed a positive correlation between measured and calculated energy consumption (r2 =0.82), except for single-source split-filter DECT acquisitions, indicating a relationship between scan parameters and energy consumption. The baseline study results showed a mean energy consumption of 2.6kWh/hour ± 1.34kWh in idle, 0.89kWh/hour ± 0.42kWh in low-power, and < 0.01kWh/hour ± 0.003kWh in the system-off state. The potential total annual CO2 savings for the assessed DECT scanners amounted to 3767kg CO2 (low power) and 5868kg CO2 (system off) compared to the idle state. Time-related calculations indicated energy savings starting after 5 min in low-power- and after 2 min in the system-off state. Therefore, switching off the scanner, even during shorter periods of non-utilization, can be efficient. CONCLUSION Our results emphasize a positive correlation between scan parameters and energy consumption in DECT. Complete shutdown of DECT devices can have a significant ecological-economic impact.
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Affiliation(s)
- Schulz Bastian
- Kantonsspital Baden AG, Department of Radiology, affiliated Hospital for Research and Teaching of the Faculty of Medicine of the University of Zurich, Im Ergel 1, 5404 Baden, Switzerland (S.B., E.A., K.H.R., N.T.); University of Zurich, Department of Forensic Medicine Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland (S.B., T.M.)
| | - Euler André
- Kantonsspital Baden AG, Department of Radiology, affiliated Hospital for Research and Teaching of the Faculty of Medicine of the University of Zurich, Im Ergel 1, 5404 Baden, Switzerland (S.B., E.A., K.H.R., N.T.)
| | - Fernández León Jesús
- Siemens Healthineers AG, Siemensstrasse 3, 91301 Forchheim, Germany (F.L.J., K.D.)
| | - Kraft Doreen
- Siemens Healthineers AG, Siemensstrasse 3, 91301 Forchheim, Germany (F.L.J., K.D.)
| | - Käser Yvonne
- PhysMed Consulting GmbH, Uetikon am See 8707, Switzerland (K.Y.)
| | - Thali Michael
- University of Zurich, Department of Forensic Medicine Zurich, Winterthurerstrasse 190/52, 8057 Zurich, Switzerland (S.B., T.M.)
| | - Kubik-Huch Rahel A
- Kantonsspital Baden AG, Department of Radiology, affiliated Hospital for Research and Teaching of the Faculty of Medicine of the University of Zurich, Im Ergel 1, 5404 Baden, Switzerland (S.B., E.A., K.H.R., N.T.)
| | - Niemann Tilo
- Kantonsspital Baden AG, Department of Radiology, affiliated Hospital for Research and Teaching of the Faculty of Medicine of the University of Zurich, Im Ergel 1, 5404 Baden, Switzerland (S.B., E.A., K.H.R., N.T.).
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Açıkgöz G. Investigating the Effects of Tube Current and Tube Voltage on Patient Dose in Computed Tomography Examinations with Principial Component Analysis and Cluster Analysis: Phantom Study. HEALTH PHYSICS 2024; 127:513-519. [PMID: 38787573 DOI: 10.1097/hp.0000000000001830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT The aim of this study was to investigate the effects of tube current and tube voltage choices on patient dose in adult and pediatric CT protocols by qualitative analysis using Principal Component Analysis (PCA), cluster analysis, and statistical analysis.Dose length product (DLP), Effective mAs (Eff. mAs), and volume-weighted CT dose index (CTDIvol) dose descriptors were obtained from 16 adult and pediatric head phantom CT examinations. Different tube voltage and tube current values were selected in both pediatric head and adult head CT imaging protocols, and PCA and cluster analysis were applied to the data obtained for qualitative analysis of the relationship between CTDIvol, Eff. mAs and Total DLP values. The two principial components (PC) with the highest values among those obtained as a result of the PCA method were used. PC1 was 70.97%, and PC2 was 28.03%. In the cluster analysis, it was observed that the values obtained from pediatric and adult phantom CT scans were classified into two different clusters. The correlation coefficient for adult patients was r = 0.998, and for pediatric patients, the correlation coefficient was r = 0.947. When the obtained clusters were examined, the degree of closeness or distance of the variables could be observed. In the study, as a result of the analysis of CTDIvol, Eff. mAs and Total DLP data based on manufacturer data at different kV and mA values with PCA and cluster analysis, it was shown that pediatric patients could be exposed to more radiation than the adult patients.
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Affiliation(s)
- Güneş Açıkgöz
- Hatay Mustafa Kemal University Vocational School of Health Services, Hatay/Turkey. Güneş Açıkgöz, Hatay MKÜ: Hatay Mustafa Kemal Universitesi, Serinyol HMKU campus, Hatay 31100 (ORCID: 0000-0001-9118-3153 )
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Žatkuliaková V, Števík M, Vorčák M, Sýkora J, Trabalková Z, Broocks G, Meyer L, Fiehler J, Zeleňák K. Comparison of doses received from non-contrast enhanced brain CT examinations between two CT scanners. Heliyon 2024; 10:e37043. [PMID: 39295996 PMCID: PMC11408143 DOI: 10.1016/j.heliyon.2024.e37043] [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: 02/07/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/21/2024] Open
Abstract
Objectives Medical devices based on X-ray imaging, such as computed tomography, are considered notable sources of artificial radiation. The aim of this study was to compare the computed tomography dose volume index, the dose length product, and the effective dose of the brain non-contrast enhanced examination on two CT scanners to determine the current state in terms of radiation doses, compare doses to the reference values, and possibly optimize the examination. Materials and methods Data from January 2020 to the second half of 2021 were retrospectively obtained by accessing dose reports from the Picture Archiving and Communication System (PACS). Data were collected and analyzed in Microsoft Excel. The effective dose was estimated using the dose-length product parameter and the normalized conversion factor for a given anatomical region. For statistical analysis, a two-sample t-test was used. Results The first data set consists of 200 patients (100 and 100 for older and newer CT scanners) regardless of the scan technique; the average CTDIvol and DLP for the older CT scanner were 57.61 ± 2.89 mGy and 993.28 ± 146.18 mGy cm, and for the newer CT scanner, 43.66 ± 11.15 mGy and 828.14 ± 130.06 mGy cm. The second data set consists of 100 patients (50 for the older CT scanner and 50 for the newer CT scanner) for a sequential scan; the average CTDIvol and DLP for the older CT scanner were 58.63 ± 3.33 mGy and 949.42 ± 80.87 mGy.cm, and for the newer CT, 57.25 ± 3.4 mGy and 942.13 ± 73.05 mGy cm. The third data set consists of 40 patients (20 and 20 for older and newer CT scanners) for the helical scan - the average CTDIvol and DLP for the older CT scanner were 54.6 ± 0 mGy and 1252.2 ± 52.11 mGy.cm, and for the newer CT, 37.18 ± 2.52 mGy and 859.66 ± 72.04 mGy cm. The difference between the older and newer CT scanners in terms of dose reduction was approximately 30 % in favor of the newer scanner for noncontrast enhanced brain examinations performed using the helical scan technique. Conclusion A non-contrast enhanced brain examination scanned with newer CT equipment was associated with a lower radiation burden on the patient.
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Affiliation(s)
- Veronika Žatkuliaková
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin University Hospital, Martin, Slovakia
| | - Martin Števík
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin University Hospital, Martin, Slovakia
| | - Martin Vorčák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin University Hospital, Martin, Slovakia
| | - Ján Sýkora
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin University Hospital, Martin, Slovakia
| | - Zuzana Trabalková
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin University Hospital, Martin, Slovakia
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin University Hospital, Martin, Slovakia
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Jaruvongvanich V, Muangsomboon K, Teerasamit W, Suvannarerg V, Komoltri C, Thammakittiphan S, Lornimitdee W, Ritsamrej W, Chaisue P, Pongnapang N, Apisarnthanarak P. Optimizing computed tomography image reconstruction for focal hepatic lesions: Deep learning image reconstruction vs iterative reconstruction. Heliyon 2024; 10:e34847. [PMID: 39170325 PMCID: PMC11336302 DOI: 10.1016/j.heliyon.2024.e34847] [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: 03/07/2024] [Revised: 05/27/2024] [Accepted: 07/17/2024] [Indexed: 08/23/2024] Open
Abstract
Background Deep learning image reconstruction (DLIR) is a novel computed tomography (CT) reconstruction technique that minimizes image noise, enhances image quality, and enables radiation dose reduction. This study aims to compare the diagnostic performance of DLIR and iterative reconstruction (IR) in the evaluation of focal hepatic lesions. Methods We conducted a retrospective study of 216 focal hepatic lesions in 109 adult participants who underwent abdominal CT scanning at our institution. We used DLIR (low, medium, and high strength) and IR (0 %, 10 %, 20 %, and 30 %) techniques for image reconstruction. Four experienced abdominal radiologists independently evaluated focal hepatic lesions based on five qualitative aspects (lesion detectability, lesion border, diagnostic confidence level, image artifact, and overall image quality). Quantitatively, we measured and compared the level of image noise for each technique at the liver and aorta. Results There were significant differences (p < 0.001) among the seven reconstruction techniques in terms of lesion borders, image artifacts, and overall image quality. Low-strength DLIR (DLIR-L) exhibited the best overall image quality. Although high-strength DLIR (DLIR-H) had the least image noise and fewest artifacts, it also had the lowest scores for lesion borders and overall image quality. Image noise showed a weak to moderate positive correlation with participants' body mass index and waist circumference. Conclusions The optimal-strength DLIR significantly improved overall image quality for evaluating focal hepatic lesions compared to the IR technique. DLIR-L achieved the best overall image quality while maintaining acceptable levels of image noise and quality of lesion borders.
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Affiliation(s)
- Varin Jaruvongvanich
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kobkun Muangsomboon
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanwarang Teerasamit
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Voraparee Suvannarerg
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chulaluk Komoltri
- Division of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sastrawut Thammakittiphan
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wimonrat Lornimitdee
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Witchuda Ritsamrej
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Parinya Chaisue
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Napapong Pongnapang
- Department of Radiological Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Piyaporn Apisarnthanarak
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Leão RV, Zelada SRB, Lobo CFT, da Silva AGM, Godoy-Santos AL, Gobbi RG, Helito PVP, Helito CP. Assessment of knee instability in ACL-injured knees using weight-bearing computed tomography (WBCT): a novel protocol and preliminary results. Skeletal Radiol 2024; 53:1611-1619. [PMID: 38185734 DOI: 10.1007/s00256-024-04562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To propose a protocol for assessing knee instability in ACL-injured knees using weight-bearing computed tomography (WBCT). MATERIALS AND METHODS We enrolled five patients with unilateral chronic ACL tears referred for WBCT. Bilateral images were obtained in four positions: bilateral knee extension, bilateral knee flexion, single-leg stance with knee flexion and external rotation, and single-leg stance with knee flexion and internal rotation. The radiation dose, time for protocol acquisition, and patients' tolerance of the procedure were recorded. A blinded senior radiologist assessed image quality and measured the anterior tibial translation (ATT) and femorotibial rotation (FTR) angle in the ACL-deficient and contralateral healthy knee. RESULTS All five patients were male, aged 23-30 years old. The protocol resulted in a 16.2 mGy radiation dose and a 15-min acquisition time. The procedure was well-tolerated, and patient positioning was uneventful, providing good-quality images. In all positions, the mean ATT and FTR were greater in ACL-deficient knees versus the healthy knee, with more pronounced differences observed in the bilateral knee flexion position. Mean lateral ATT in the flexion position was 9.1±2.8 cm in the ACL-injured knees versus 4.0±1.8 cm in non-injured knees, and mean FTR angle in the bilateral flexion position was 13.5°±7.7 and 8.6°±4.6 in the injured and non-injured knees, respectively. CONCLUSION Our protocol quantitatively assesses knee instability with WBCT, measuring ATT and FTR in diverse knee positions. It employs reasonable radiation, is fast, well-tolerated, and yields high-quality images. Preliminary findings suggest ACL-deficient knees show elevated ATT and FTR, particularly in the 30° flexion position.
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Affiliation(s)
- Renata Vidal Leão
- Hospital Sírio-Libanês, Institute of Radiology, R. Ovidio Pires de Campos, 65, São Paulo, 05403-911, Brazil.
| | - Sandro Ricardo Benites Zelada
- Knee Group, Institute of Orthopaedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Riccardo Gomes Gobbi
- Knee Group, Institute of Orthopaedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Camilo Partezani Helito
- Knee Group, Institute of Orthopaedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Feldle P, Grunz JP, Huflage H, Kunz AS, Ergün S, Afat S, Gruschwitz P, Görtz L, Pennig L, Bley TA, Conrads N. Influence of helical pitch and gantry rotation time on image quality and file size in ultrahigh-resolution photon-counting detector CT. Sci Rep 2024; 14:9358. [PMID: 38653758 DOI: 10.1038/s41598-024-59729-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
The goal of this experimental study was to quantify the influence of helical pitch and gantry rotation time on image quality and file size in ultrahigh-resolution photon-counting CT (UHR-PCCT). Cervical and lumbar spine, pelvis, and upper legs of two fresh-frozen cadaveric specimens were subjected to nine dose-matched UHR-PCCT scan protocols employing a collimation of 120 × 0.2 mm with varying pitch (0.3/1.0/1.2) and rotation time (0.25/0.5/1.0 s). Image quality was analyzed independently by five radiologists and further substantiated by placing normed regions of interest to record mean signal attenuation and noise. Effective mAs, CT dose index (CTDIvol), size-specific dose estimate (SSDE), scan duration, and raw data file size were compared. Regardless of anatomical region, no significant difference was ascertained for CTDIvol (p ≥ 0.204) and SSDE (p ≥ 0.240) among protocols. While exam duration differed substantially (all p ≤ 0.016), the lowest scan time was recorded for high-pitch protocols (4.3 ± 1.0 s) and the highest for low-pitch protocols (43.6 ± 15.4 s). The combination of high helical pitch and short gantry rotation times produced the lowest perceived image quality (intraclass correlation coefficient 0.866; 95% confidence interval 0.807-0.910; p < 0.001) and highest noise. Raw data size increased with acquisition time (15.4 ± 5.0 to 235.0 ± 83.5 GByte; p ≤ 0.013). Rotation time and pitch factor have considerable influence on image quality in UHR-PCCT and must therefore be chosen deliberately for different musculoskeletal imaging tasks. In examinations with long acquisition times, raw data size increases considerably, consequently limiting clinical applicability for larger scan volumes.
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Affiliation(s)
- Philipp Feldle
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology, University of Wuerzburg, Koellikerstraße 6, 97070, Wuerzburg, Germany
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str 3, 72076, Tuebingen, Germany
| | - Philipp Gruschwitz
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany
| | - Lukas Görtz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany
| | - Nora Conrads
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Wuerzburg, Germany.
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Issahaku S, Boadu M, Inkoom S, Hasford F, Sackey TA. Establishment and utilisation of national diagnostic reference level for adult computed tomography examinations in Ghana. RADIATION PROTECTION DOSIMETRY 2024; 200:564-571. [PMID: 38453140 DOI: 10.1093/rpd/ncae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
The International Atomic Energy Agency, as part of the new regional project (RAF/9/059), recommend the establishment of diagnostic reference levels (DRLs) in Africa. In response to this recommendation, this project was designed to establish and utilise national DRLs of routine computed tomography (CT) examinations. These were done by estimating CT dose index and dose length product (DLP) from a minimum of 20 patient dose report of the most frequently used procedures using 75th percentile distribution of the median values. In all, 22 centres that formed 54% of all CT equipment in the country took part in this study. Additionally, a total of 2156 adult patients dose report were randomly selected, with a percentage distribution of 60, 12, 21 and 7% for head, chest, abdomen-pelvis and lumber spine, respectively. The established DRL for volume CT dose index were 60.0, 15.7, 20.5 and 23.8 mGy for head, chest, abdomen-pelvis and lumber spine, respectively. While the established DRL for DLP were 962.9, 1102.8, 1393.5 and 824.6 mGy-cm for head, chest, abdomen-pelvis, and lumber spine, respectively. These preliminary results were comparable with data from 16 other African countries, European Commission and the International Commission on Radiological Protection. Hence, this study would serve as a baseline for the establishment of a more generalised regional and national adult DRLs for Africa and other developing countries.
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Affiliation(s)
- Shiraz Issahaku
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Mary Boadu
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Stephen Inkoom
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Francis Hasford
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
| | - Theophilus A Sackey
- Ghana Atomic Energy Commission, Medical Radiation Physics Center, Box LG 80, Legon, Accra, Ghana
- University of Ghana, Department of Medical Physics, Box LG 80, Legon, Accra, Ghana
- Korle-Bu Teaching Hospital, Department of Radiology, PMB, Accra, Ghana
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Smith-Bindman R, Kang T, Chu PW, Wang Y, Stewart C, Das M, Duong PA, Cervantes L, Lamba R, Lee RK, MacLeod F, Kasraie N, Neill R, Pike P, Roehm J, Schindera S, Chung R, Delman BN, Jeukens CRLPN, Starkey LJ, Szczykutowicz TP. Large variation in radiation dose for routine abdomen CT: reasons for excess and easy tips for reduction. Eur Radiol 2024; 34:2394-2404. [PMID: 37735276 PMCID: PMC10957641 DOI: 10.1007/s00330-023-10076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To characterize the use and impact of radiation dose reduction techniques in actual practice for routine abdomen CT. METHODS We retrospectively analyzed consecutive routine abdomen CT scans in adults from a large dose registry, contributed by 95 hospitals and imaging facilities. Grouping exams into deciles by, first, patient size, and second, size-adjusted dose length product (DLP), we summarized dose and technical parameters and estimated which parameters contributed most to between-protocols dose variation. Lastly, we modeled the total population dose if all protocols with mean size-adjusted DLP above 433 or 645 mGy-cm were reduced to these thresholds. RESULTS A total of 748,846 CTs were performed using 1033 unique protocols. When sorted by patient size, patients with larger abdominal diameters had increased dose and effective mAs (milliampere seconds), even after adjusting for patient size. When sorted by size-adjusted dose, patients in the highest versus the lowest decile in size-adjusted DLP received 6.4 times the average dose (1680 vs 265 mGy-cm) even though diameter was no different (312 vs 309 mm). Effective mAs was 2.1-fold higher, unadjusted CTDIvol 2.9-fold, and phase 2.5-fold for patients in the highest versus lowest size-adjusted DLP decile. There was virtually no change in kV (kilovolt). Automatic exposure control was widely used to modulate mAs, whereas kV modulation was rare. Phase was the strongest driver of between-protocols variation. Broad adoption of optimized protocols could result in total population dose reductions of 18.6-40%. CONCLUSION There are large variations in radiation doses for routine abdomen CT unrelated to patient size. Modification of kV and single-phase scanning could result in substantial dose reduction. CLINICAL RELEVANCE Radiation dose-optimization techniques for routine abdomen CT are routinely under-utilized leading to higher doses than needed. Greater modification of technical parameters and number of phases could result in substantial reduction in radiation exposure to patients. KEY POINTS • Based on an analysis of 748,846 routine abdomen CT scans in adults, radiation doses varied tremendously across patients of the same size and optimization techniques were routinely under-utilized. • The difference in observed dose was due to variation in technical parameters and phase count. Automatic exposure control was commonly used to modify effective mAs, whereas kV was rarely adjusted for patient size. Routine abdomen CT should be performed using a single phase, yet multi-phase was common. • kV modulation by patient size and restriction to a single phase for routine abdomen indications could result in substantial reduction in radiation doses using well-established dose optimization approaches.
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Affiliation(s)
- Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
| | - Taewoon Kang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Philip W Chu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Yifei Wang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Carly Stewart
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Marco Das
- Department of Diagnostic and Interventional Radiology, Helios Hospital Duisburg, An Der Abtei 7-11, 47166, Duisburg, Germany
| | - Phuong-Anh Duong
- Department of Radiology, New York University Langone, 6 Ohio Drive, Lake Success, NY, 11042, USA
| | - Luisa Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62Nd Avenue, Miami, FL, 33155, USA
| | - Ramit Lamba
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Ryan K Lee
- Department of Radiology, Ground Floor, Einstein Healthcare Network, 5501 Old York Road, Levy Bldg, Philadelphia, PA, 19141, USA
| | - Fiona MacLeod
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Nima Kasraie
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Rebecca Neill
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Pavlina Pike
- Huntsville Hospital, 101 Sivley Rd SW, Huntsville, AL, 35801, USA
| | | | - Sebastian Schindera
- Institute of Radiology, Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Robert Chung
- Department of Demography, University of California Berkeley, 310 Social Sciences Building, Berkeley, CA, 94720-2120, USA
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029-6574, USA
| | - Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25 6229 HX, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - L Jay Starkey
- Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Tokyo, 104-8560, Chuo City, Japan
| | - Timothy P Szczykutowicz
- Departments of Radiology, Medical Physics, and Biomedical Engineering, University of Wisconsin Madison, Madison, WI, USA
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12
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O'Regan PW, Dewhurst C, O'Mahony AT, O'Regan C, O'Leary V, O'Connor G, Ryan D, Maher MM, Young R. Split-bolus single-phase versus single-bolus split-phase CT acquisition protocols for staging in patients with testicular cancer: A retrospective study. Radiography (Lond) 2024; 30:628-633. [PMID: 38330895 DOI: 10.1016/j.radi.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Computed tomography (CT) imaging has become indispensable in the management of medical oncology patients. Risks associated with high cumulative effective dose (CED) are relevant in testicular cancer patients. Split-bolus protocols, whereby the contrast medium injection is divided into two, followed by combining the required phase images in a single scan acquisition has been shown to provide images of comparable image quality and less radiation dose compared to single-bolus split-phase CT for various indications. We retrospectively evaluated the performance of split-bolus and single-bolus protocols in patients having follow-up CT imaging for testicular cancer surveillance. METHODS 45 patients with testicular cancer undergoing surveillance CT imaging of the thorax, abdomen, and pelvis who underwent split-bolus and single-bolus protocols were included. Quantitative image quality analysis was conducted by placing region of interests in pre-defined anatomical sub-structures within the abdominal cavity. The signal-to-noise ratio (SNR) and radiation dose in the form of dose length product (DLP) and effective dose (ED) were recorded. RESULTS The DLP and ED for the single-bolus, split-phase acquisition was 506 ± 89 mGy cm and 7.59 ± 1.3 mSv, respectively. For the split-bolus, single-phase acquisition, 397 ± 94 mGy∗cm and 5.95 ± 1.4 mSv, respectively (p < 0.000). This represented a 21.5 % reduction in radiation dose exposure. The SNR for liver, muscle and fat for the single-bolus were 7.4, 4.7 and 8, respectively, compared to 5.5, 3.8 and 7.4 in the split-bolus protocol (p < 0.001). CONCLUSION In a testicular cancer patient cohort undergoing surveillance CT imaging, utilization of a split-bolus single-phase acquisition CT protocol enabled a significant reduction in radiation dose whilst maintaining subjective diagnostic acceptability. IMPLICATIONS FOR PRACTICE Use of split-bolus, single-phase acquisition has the potential to reduce CED in surveillance of testicular cancer patients.
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Affiliation(s)
- P W O'Regan
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - C Dewhurst
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - A T O'Mahony
- Department of Radiology, Cork University Hospital/Mercy University Hospital, Cork, Ireland.
| | - C O'Regan
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - V O'Leary
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - G O'Connor
- Department of Radiology, Mercy University Hospital, Cork, Ireland.
| | - D Ryan
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - M M Maher
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - R Young
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College, Cork, Ireland.
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Prabsattroo T, Wachirasirikul K, Tansangworn P, Punikhom P, Sudchai W. The Dose Optimization and Evaluation of Image Quality in the Adult Brain Protocols of Multi-Slice Computed Tomography: A Phantom Study. J Imaging 2023; 9:264. [PMID: 38132682 PMCID: PMC10743697 DOI: 10.3390/jimaging9120264] [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: 10/16/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Computed tomography examinations have caused high radiation doses for patients, especially for CT scans of the brain. This study aimed to optimize the radiation dose and image quality in adult brain CT protocols. Images were acquired using a Catphan 700 phantom. Radiation doses were recorded as CTDIvol and dose length product (DLP). CT brain protocols were optimized by varying parameters such as kVp, mAs, signal-to-noise ratio (SNR) level, and Clearview iterative reconstruction (IR). The image quality was also evaluated using AutoQA Plus v.1.8.7.0 software. CT number accuracy and linearity had a robust positive correlation with the linear attenuation coefficient (µ) and showed more inaccurate CT numbers when using 80 kVp. The modulation transfer function (MTF) showed a higher value in 100 and 120 kVp protocols (p < 0.001), while high-contrast spatial resolution showed a higher value in 80 and 100 kVp protocols (p < 0.001). Low-contrast detectability and the contrast-to-noise ratio (CNR) tended to increase when using high mAs, SNR, and the Clearview IR protocol. Noise decreased when using a high radiation dose and a high percentage of Clearview IR. CTDIvol and DLP were increased with increasing kVp, mAs, and SNR levels, while the increasing percentage of Clearview did not affect the radiation dose. Optimized protocols, including radiation dose and image quality, should be evaluated to preserve diagnostic capability. The recommended parameter settings include kVp set between 100 and 120 kVp, mAs ranging from 200 to 300 mAs, SNR level within the range of 0.7-1.0, and an iterative reconstruction value of 30% Clearview to 60% or higher.
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Affiliation(s)
- Thawatchai Prabsattroo
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (K.W.); (P.T.); (P.P.)
| | - Kanokpat Wachirasirikul
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (K.W.); (P.T.); (P.P.)
| | - Prasit Tansangworn
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (K.W.); (P.T.); (P.P.)
| | - Puengjai Punikhom
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (K.W.); (P.T.); (P.P.)
| | - Waraporn Sudchai
- Nuclear Technology Service Center, Thailand Institute of Nuclear Technology, Nakhon Nayok 26120, Thailand;
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14
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Lāce E, Mohammadian R, Āboltiņš A, Sosārs D, Apine I. Trade-off between the radiation parameters and image quality using iterative reconstruction techniques in head computed tomography: a phantom study. Acta Radiol 2023; 64:2618-2626. [PMID: 37469141 DOI: 10.1177/02841851231185347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Iterative reconstruction techniques (IRTs) are commonly used in computed tomography (CT) and help to reduce image noise. PURPOSE To determine the minimum radiation dose while preserving image quality in head CT using IRTs. MATERIAL AND METHODS The anthropomorphic phantom was used to scan nine head CT image series with varied radiation parameters. CT dose parameters, including volume CT dose index (CTDIvol [in mGy]) and dose length product (DLP [in mGy/cm]), were recorded for each scan series. Different noise levels (iDoseL1-6) were used in IRT reconstructions for soft and bone tissues. In total, 15 measurements were taken from five regions of interest (ROI) with an area of 10 mm2. The signal-to-noise ratio (SNR) and noise values obtained at different ROIs were compared among various reconstruction methods with repeated measures of statistical analysis. RESULTS In the head CT scan, applying IRT iDoseL5 had the lowest noise and highest SNR for soft tissue (P < 0.05), and increased iDose can decrease CT dose by 54.6% without compromising image quality. While for bone tissue reconstruction, no clear association was found between the level of iDose and noise. However, when CTDIvol is >20 mGy, iDoseL4 is slightly superior to other reconstruction methods (P < 0.065). CONCLUSION Using IRTs in head CTs reduces radiation dose while maintaining image quality. IDoseL5 provided optimal balance for soft tissue.
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Affiliation(s)
- Elīza Lāce
- Department of Radiology, Riga Stradin's University, Riga, Latvia
| | - Reza Mohammadian
- Department of Radiology, Riga Stradin's University, Riga, Latvia
| | - Ainārs Āboltiņš
- Department of Radiology, Children's Clinical University Hospital, Riga, Latvia
| | - Dāvis Sosārs
- Department of Radiology, Children's Clinical University Hospital, Riga, Latvia
| | - Ilze Apine
- Department of Radiology, Riga Stradin's University, Riga, Latvia
- Department of Radiology, Children's Clinical University Hospital, Riga, Latvia
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15
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Eshed I, Diekhoff T, Hermann KGA. Is it time to move on from pelvic radiography as the first-line imaging modality for suspected sacroiliitis? Curr Opin Rheumatol 2023; 35:219-225. [PMID: 36728773 DOI: 10.1097/bor.0000000000000925] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Pelvic radiography in which structural lesions characteristic of sacroiliitis can be detected, is recommended as the first imaging modality when axial spondyloarthritis (axSpA) is suspected clinically. However, cross-sectional modalities like computed tomography (CT) and magnetic resonance imaging (MRI) are superior to radiographs for diagnosing sacroiliitis. Thus, we currently debate the role of radiography as first imaging modality in the diagnostic workup of axSpA. RECENT FINDINGS Diagnosing sacroiliitis on pelvic radiographs is challenging with large interobserver and intraobserver variation. Low-dose CT (ldCT) of the sacroiliac joints (SIJs) was proved to be more sensitive and reliable than radiographs with comparable ionizing radiation exposure. MRI is the preferred modality for detecting early SIJ inflammation, well before structural lesions evolve. New, promising MRI sequences sensitive to cortical bone improve erosion detection, making MRI a one-stop shop for the diagnosis of sacroiliitis. SUMMARY Given the debatable additive value of pelvic radiographs for the detection of sacroiliitis, and the presence of excellent alternatives for imaging the bony cortex of the SIJs such as ldCT and MRI with state-of-the-art sequences sensitive to cortical bone, it is high time to discuss the use of these more accurate modalities instead of radiographs.
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Affiliation(s)
- Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Torsten Diekhoff
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, Germany
| | - Kay Geert A Hermann
- Department of Radiology (CCM), Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin, Germany
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Bohang SAM, Sohaimi N. An Overview on the Alignment of Radiation Protection in Computed Tomography with Maqasid al-Shari'ah in the Context of al-Dharuriyat. Malays J Med Sci 2023; 30:60-72. [PMID: 37425388 PMCID: PMC10325131 DOI: 10.21315/mjms2023.30.3.5] [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: 07/26/2021] [Accepted: 01/08/2022] [Indexed: 07/11/2023] Open
Abstract
The increasing utilisation of computed tomography (CT) in the medical field has raised a greater concern regarding the radiation-induced health effects as CT imposes high radiation risks on the exposed individual. Adherence to radiation protection measures in CT as endorsed by regulatory bodies; justification, optimisation and dose limit, is essential to minimise radiation risks. Islam values every human being and Maqasid al-Shari'ah helps to protect human beings through its sacred principles which aim to fulfil human beings' benefits (maslahah) and prevent mischief (mafsadah). Alignment of the concept of radiation protection in CT within the framework of al-Dharuriyat; protection of faith or religion (din), protection of life (nafs), protection of lineage (nasl), protection of intellect ('aql) and protection of property (mal) is essential. This strengthens the concept and practices of radiation protection in CT among radiology personnel, particularly Muslim radiographers. The alignment provides supplementary knowledge towards the integration of knowledge fields between Islamic worldview and radiation protection in medical imaging, particularly in CT. This paper is hoped to set a benchmark for future studies on the integration of knowledge between the Islamic worldview and radiation protection in medical imaging in terms of other classifications of Maqasid al-Shari'ah; al-Hajiyat and al-Tahsiniyat.
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Affiliation(s)
- Siti Aisyah Munirah Bohang
- Department of Diagnostic Imaging and Radiotherapy, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
| | - Norhanna Sohaimi
- Department of Diagnostic Imaging and Radiotherapy, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
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Kim SH. [Radiologic Diagnosis of Gastrointestinal Bleeding]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:520-535. [PMID: 37325008 PMCID: PMC10265251 DOI: 10.3348/jksr.2022.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/26/2023] [Accepted: 02/19/2023] [Indexed: 06/17/2023]
Abstract
Gastrointestinal (GI) bleeding is not a single disease but a symptom and clinical manifestation of a broad spectrum of conditions in the GI tract. According to its clinical presentation, GI bleeding can be classified into overt, occult, and obscure types. Additionally, it can be divided into upper and lower GI bleeding based on the Treitz ligament. Variable disease entities, including vascular lesions, polyps, neoplasms, inflammation such as Crohn's disease, and heterotopic pancreatic or gastric tissue, can cause GI bleeding. CT and conventional angiographies and nuclear scintigraphy are all radiologic imaging modalities that can be used to evaluate overt bleeding. For the work-up of occult GI bleeding, CT enterography (CTE) can be the first imaging modality. For CTE, an adequate bowel distention is critical for obtaining acceptable diagnostic performance as well as minimizing false positives and negatives. Meckel's scintigraphy can be complementarily useful in cases where the diagnosis of CTE is suboptimal. For the evaluation of obscured GI bleeding, various imaging modalities can be used based on clinical status and providers' preferences.
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Low dose of contrast agent and low radiation liver computed tomography with deep-learning-based contrast boosting model in participants at high-risk for hepatocellular carcinoma: prospective, randomized, double-blind study. Eur Radiol 2023; 33:3660-3670. [PMID: 36934202 DOI: 10.1007/s00330-023-09520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/18/2022] [Accepted: 02/03/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE To investigate the image quality and lesion conspicuity of a deep-learning-based contrast-boosting (DL-CB) algorithm on double-low-dose (DLD) CT of simultaneous reduction of radiation and contrast doses in participants at high-risk for hepatocellular carcinoma (HCC). METHODS Participants were recruited and underwent four-phase dynamic CT (NCT04722120). They were randomly assigned to either standard-dose (SD) or DLD protocol. All CT images were initially reconstructed using iterative reconstruction, and the images of the DLD protocol were further processed using the DL-CB algorithm (DLD-DL). The primary endpoint was the contrast-to-noise ratio (CNR), the secondary endpoint was qualitative image quality (noise, hepatic lesion, and vessel conspicuity), and the tertiary endpoint was lesion detection rate. The t-test or repeated measures analysis of variance was used for analysis. RESULTS Sixty-eight participants with 57 focal liver lesions were enrolled (20 with HCC and 37 with benign findings). The DLD protocol had a 19.8% lower radiation dose (DLP, 855.1 ± 254.8 mGy·cm vs. 713.3 ± 94.6 mGy·cm, p = .003) and 27% lower contrast dose (106.9 ± 15.0 mL vs. 77.9 ± 9.4 mL, p < .001) than the SD protocol. The comparative analysis demonstrated that CNR (p < .001) and portal vein conspicuity (p = .002) were significantly higher in the DLD-DL than in the SD protocol. There was no significant difference in lesion detection rate for all lesions (82.7% vs. 73.3%, p = .140) and HCCs (75.7% vs. 70.4%, p = .644) between the SD protocol and DLD-DL. CONCLUSIONS DL-CB on double-low-dose CT provided improved CNR of the aorta and portal vein without significant impairment of the detection rate of HCC compared to the standard-dose acquisition, even in participants at high risk for HCC. KEY POINTS • Deep-learning-based contrast-boosting algorithm on double-low-dose CT provided an improved contrast-to-noise ratio compared to standard-dose CT. • The detection rate of focal liver lesions was not significantly differed between standard-dose CT and a deep-learning-based contrast-boosting algorithm on double-low-dose CT. • Double-low-dose CT without a deep-learning algorithm presented lower CNR and worse image quality.
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Gobi K, Arunachalam VK, Varatharajaperumal RK, Cherian M, Periaswamy G, Rajesh S. The role of ultra-low-dose computed tomography in the detection of pulmonary pathologies: a prospective observational study. Pol J Radiol 2022; 87:e597-e605. [PMID: 36532248 PMCID: PMC9749781 DOI: 10.5114/pjr.2022.121433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/21/2021] [Indexed: 10/14/2024] Open
Abstract
PURPOSE The aim of the study was to compare the image noise, radiation dose, and image quality of ultra-low-dose computed tomography (CT) and standard CT in the imaging of pulmonary pathologies. MATERIAL AND METHODS This observational study was performed between July 2020 and August 2021. All enrolled patients underwent both ultra-low-dose and standard CTs. The image noise, image quality for normal pulmonary structures, presence or absence of various pulmonary lesions, and radiation dose were recorded for each of the scans. The findings of standard-dose CT were regarded as the gold standard and compared with that of ultra-low-dose CT. RESULTS A total of 124 patients were included in the study. The image noise was higher in the ultra-low-dose CT compared to standard-dose CT. The overall image quality was determined to be diagnostic in 100% of standard CT images and in 96.77% of ultra-low-dose CT images with proportional worsening of the image quality as the body mass index (BMI) range was increased. Ultra-low-dose CT offered higher (> 90%) sensitivity for lesions like consolidation (97%), pleural effusion (95%), fibrosis (92%), and solid pulmonary nodules (91%). The effective radiation dose (mSv) was many times lower in ultra-low-dose CT when compared to standard-dose CT (mean ± SD: 0.50 ± 0.005 vs. 3.99 ± 1.57). CONCLUSIONS The radiation dose of ultra-low-dose chest CT was almost equal to that of a chest X-ray. It could be used for the screening and/or follow-up of patients with solid pulmonary nodules (> 3 mm) and consolidation.
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Affiliation(s)
- K. Gobi
- Kovai Medical Centre and Hospital, Coimbatore, India
| | | | | | | | | | - S. Rajesh
- Kovai Medical Centre and Hospital, Coimbatore, India
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Yoo HJ, Kim YJ, Hong H, Hong SH, Chae HD, Choi JY. Deep learning-based fully automated body composition analysis of thigh CT: comparison with DXA measurement. Eur Radiol 2022; 32:7601-7611. [PMID: 35435440 DOI: 10.1007/s00330-022-08770-y] [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: 11/16/2021] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare volumetric CT with DL-based fully automated segmentation and dual-energy X-ray absorptiometry (DXA) in the measurement of thigh tissue composition. METHODS This prospective study was performed from January 2019 to December 2020. The participants underwent DXA to determine the body composition of the whole body and thigh. CT was performed in the thigh region; the images were automatically segmented into three muscle groups and adipose tissue by custom-developed DL-based automated segmentation software. Subsequently, the program reported the tissue composition of the thigh. The correlation and agreement between variables measured by DXA and CT were assessed. Then, CT thigh tissue volume prediction equations based on DXA-derived thigh tissue mass were developed using a general linear model. RESULTS In total, 100 patients (mean age, 44.9 years; 60 women) were evaluated. There was a strong correlation between the CT and DXA measurements (R = 0.813~0.98, p < 0.001). There was no significant difference in total soft tissue mass between DXA and CT measurement (p = 0.183). However, DXA overestimated thigh lean (muscle) mass and underestimated thigh total fat mass (p < 0.001). The DXA-derived lean mass was an average of 10% higher than the CT-derived lean mass and 47% higher than the CT-derived lean muscle mass. The DXA-derived total fat mass was approximately 20% lower than the CT-derived total fat mass. The predicted CT tissue volume using DXA-derived data was highly correlated with actual CT-measured tissue volume in the validation group (R2 = 0.96~0.97, p < 0.001). CONCLUSIONS Volumetric CT measurements with DL-based fully automated segmentation are a rapid and more accurate method for measuring thigh tissue composition. KEY POINTS • There was a positive correlation between CT and DXA measurements in both the whole body and thigh. • DXA overestimated thigh lean mass by 10%, lean muscle mass by 47%, but underestimated total fat mass by 20% compared to the CT method. • The equations for predicting CT volume (cm3) were developed using DXA data (g), age, height (cm), and body weight (kg) and good model performance was proven in the validation study.
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Affiliation(s)
- Hye Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea
| | - Hee Dong Chae
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea
| | - Ja-Young Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, South Korea.
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21
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Abuzaid MM, Elshami W, Sulieman A, Bradley D. Cumulative radiation exposure, effective and organ dose estimation from multiple head CT scans in stroke patients. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Cao Q, Mao Y, Qin L, Quan G, Yan F, Yang W. Improving image quality and lung nodule detection for low-dose chest CT by using generative adversarial network reconstruction. Br J Radiol 2022; 95:20210125. [PMID: 35994298 PMCID: PMC9815729 DOI: 10.1259/bjr.20210125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/01/2022] [Accepted: 07/21/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To investigate the improvement of two denoising models with different learning targets (Dir and Res) of generative adversarial network (GAN) on image quality and lung nodule detectability in chest low-dose CT (LDCT). METHODS In training phase, by using LDCT images simulated from standard dose CT (SDCT) of 200 participants, Dir model was trained targeting SDCT images, while Res model targeting the residual between SDCT and LDCT images. In testing phase, a phantom and 95 chest LDCT, exclusively with training data, were included for evaluation of imaging quality and pulmonary nodules detectability. RESULTS For phantom images, structural similarity, peak signal-to-noise ratio of both Res and Dir models were higher than that of LDCT. Standard deviation of Res model was the lowest. For patient images, image noise and quality of both two models, were better than that of LDCT. Artifacts of Res model was less than that of LDCT. The diagnostic sensitivity of lung nodule by two readers for LDCT, Res and Dir model, were 72/77%, 79/83% and 72/79% respectively. CONCLUSION Two GAN denoising models, including Res and Dir trained with different targets, could effectively reduce image noise of chest LDCT. The image quality evaluation scoring and nodule detectability of Res denoising model was better than that of Dir denoising model and that of hybrid IR images. ADVANCES IN KNOWLEDGE The GAN-trained model, which learned the residual between SDCT and LDCT images, reduced image noise and increased the lung nodule detectability by radiologists on chest LDCT. This demonstrates the potential for clinical benefit.
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Affiliation(s)
- Qiqi Cao
- Department of Radiology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai Jiao Tong, China
| | - Yifu Mao
- Department of CT reconstruction physics algorithm, Shanghai United Imaging Healthcare Co., Ltd, Shanghai, China
| | - Le Qin
- Department of Radiology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai Jiao Tong, China
| | - Guotao Quan
- Department of CT reconstruction physics algorithm, Shanghai United Imaging Healthcare Co., Ltd, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai Jiao Tong, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai Jiao Tong, China
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Alsleem H, Tajaldeen A, Almutairi A, Almohiy H, Aldaais E, Albattat R, Alsleem M, Abuelhia E, Kheiralla OAM, Alqahtani A, Alghamdi S, Aljondi R, Alharbi R. The Actual Role of Iterative Reconstruction Algorithm Methods in Several Saudi Hospitals As A Tool For Radiation Dose Minimization of Ct Scan Examinations. J Multidiscip Healthc 2022; 15:1747-1757. [PMID: 36016857 PMCID: PMC9398457 DOI: 10.2147/jmdh.s376729] [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: 06/13/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background Iterative reconstruction algorithm (IR) techniques were developed to maintain a lower radiation dose for patients as much as possible while achieving the required image quality and medical benefits. The main purpose of the current research was to assess the level and usage extent of IR techniques in computed tomographic (CT) scan exams. Also, the obligation of practitioners in several hospitals in Saudi Arabia to implement IR in CT exams was assessed. Material and Methodology The recent research was based on two studies: data collection and a survey study. Data on the CT scan examinations were retrospectively collected from CT scanners. The survey was conducted using a questionnaire to evaluate radiographers’ and radiologists’ perceptions about IR and their practices with IR techniques. The statistical analysis results were performed to measure the usage strength level of IR methods. Results and Discussions The IR strength level of 50% was selected for nearly 80% of different CT examinations and patients of different ages and weights. About 46% of the participants had not learned about IR methods during their college studies, and 54% had not received formal training in applying IR techniques. Only 32% of the participants had adequate experience with IR. Half of the participants were not involved in the updating process of the CT protocol. Conclusion The results indicate that the majority of radiographer and radiologist at four different hospitals in Saudi Arabia have no explicit or understandable knowledge of selecting IR strength levels during the CT examination of patients. There is a need for more training in IR applications for both radiologists and radiographers. Training sessions were suggested to support radiographers and radiologists to efficiently utilize IR techniques to optimize image quality. Further studies are required to adjust CT exam protocols effectively to utilize the IR technique.
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Affiliation(s)
- Haney Alsleem
- Department of Radiological Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulrahman Tajaldeen
- Department of Radiological Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Hussain Almohiy
- Radiological Sciences, King Khalid University, Abha, Saudi Arabia
| | - Ebtisam Aldaais
- Department of Radiological Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rayan Albattat
- Medical Imaging Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mousa Alsleem
- College of Dentistry, King Faisal University, Alahsa, Saudi Arabia
| | - Elfatih Abuelhia
- Department of Radiological Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Ahmed Alqahtani
- Radiology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Salem Alghamdi
- Department of Applied Radiologic Technology, University of Jeddah, Jeddah, Saudi Arabia
| | - Rowa Aljondi
- Department of Applied Radiologic Technology, University of Jeddah, Jeddah, Saudi Arabia
| | - Renad Alharbi
- Department of Radiology, Specialized Medical Complex, Jeddah, Saudi Arabia
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Low-Dose Abdominal CT for Evaluating Suspected Appendicitis: Recommendations for CT Imaging Techniques and Practical Issues. Diagnostics (Basel) 2022; 12:diagnostics12071585. [PMID: 35885490 PMCID: PMC9320604 DOI: 10.3390/diagnostics12071585] [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: 05/25/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
A vast disparity exists between science and practice for CT radiation dose. Despite high-level evidence supporting the use of low-dose CT (LDCT) in diagnosing appendicitis, a recent survey showed that many care providers were still concerned that the low image quality of LDCT may lead to incorrect diagnoses. For successful implementation of LDCT practice, it is important to inform and educate the care providers not only of the scientific discoveries but also of concrete guidelines on how to overcome more practical matters. Here, we discuss CT imaging techniques and other practical issues for implementing LDCT practice.
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Uushona V, Boadu M, Nyabanda R, Diagne M, Inkoom S, Issahaku S, Hasford F, Haiduwa P, Koteng A, Omondi B, Diop AY, Gilley DB. ESTABLISHMENT OF REGIONAL DIAGNOSTIC REFERENCE LEVELS IN ADULT COMPUTED TOMOGRAPHY FOR FOUR AFRICAN COUNTRIES: A PRELIMINARY SURVEY. RADIATION PROTECTION DOSIMETRY 2022; 198:414-422. [PMID: 35596952 DOI: 10.1093/rpd/ncac074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/09/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
This preliminary study aims towards the establishment of regional diagnostic reference levels (DRLs) for routine adult computed tomography (CT) examinations. The study was performed on 54 CT facilities from four African countries (Ghana, Kenya, Namibia and Senegal) and the results compared with international DRLs. Data were collected from facilities using a structured questionnaire provided by the International Atomic Energy Agency. Dose descriptors (volume computed tomography dose index [CTDIvol] and dose length product [DLP]) evaluations were performed on CT head and body phantoms for head, chest and abdomen CT examination protocols using standard methods. The estimated dose indices were compared with console-displayed dose values. Experienced radiologists accepted the diagnostic image quality of the images as per departmental imaging requirements. Median CTDIvol and DLP data from each facility were compiled to estimate the typical dose in each country. National DRLs were established based on the 75th percentile of median values, whereas the regional DRLs were based on the median of the national DRLs. Comparison of measured CTDIvol with console values of all facilities in all four countries was within 20% as recommended. The established CTDIvol DRLs for head CT, chest CT and abdomen CT were 60.9 mGy, 15.2 mGy and 15.7 mGy, respectively. Similarly, that of DLP, DRLs were 1259 mGy.cm, 544 mGy.cm and 737 mGy.cm, respectively for head CT, chest CT and abdomen CT. The established DRLs from this study were comparable to DRLs from other countries with some variations. This study would serve as baseline for establishment of a more generalized regional adult CT DRLs for Africa.
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Affiliation(s)
- Vera Uushona
- National Radiation Protection Authority of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - Mary Boadu
- Ghana Atomic Energy Commission, Accra, Ghana
| | - Rose Nyabanda
- Department of Radiology, Kenyatta National Hospital, Nairobi Kenya
| | - Magatte Diagne
- University Teaching Hospital-Senegal, Institut Curie, Hôpital Universitaire le Dantec, BP, Dakar, Senegal
| | | | | | | | - Paulus Haiduwa
- Nuclear Medicine Department, Windhoek Central Hospital, Windhoek, Namibia
| | | | - Bob Omondi
- Department of Radiology, Kenyatta National Hospital, Nairobi Kenya
| | - Adji Yaram Diop
- University Teaching Hospital-Senegal, Institut Curie, Hôpital Universitaire le Dantec, BP, Dakar, Senegal
| | - Debbie Bray Gilley
- Radiation Protection of Patients Unit, Radiation Safety and Monitoring Section, Division of Radiation, Transport and Waste Safety, Department of Nuclear Safety and Security, International Atomic Energy Agency (IAEA), Vienna International Centre, Vienna, Austria
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Dalah EZ, Obaideen A, Anam S, Alzimami K, Jambi LK, Bradley DA. Gender based lung cancer risks for symptomatic coronary artery disease patients undergone cardiac CT. PLoS One 2022; 17:e0265609. [PMID: 35404962 PMCID: PMC9000096 DOI: 10.1371/journal.pone.0265609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 03/04/2022] [Indexed: 11/27/2022] Open
Abstract
We estimate the lifetime attributable risk (LAR) of lung cancer incidence in symptomatic Coronary Artery Disease (CAD) patients receiving enhanced Coronary Computed Tomography Angiography (CCTA) and the unenhanced Computed Tomography Calcium Scoring (CTCS) examination. Retrospective analysis has been made of CCTA and CTCS data collected for 87 confirmed CAD adult patients. Patient effective dose (E) and organ doses (ODs) were calculated using CT-EXPO. Statistical correlation and the differences between E and ODs in enhanced CCTA and unenhanced CTCS were calculated using the Pearson coefficient and Wilcoxon unpaired t-test. Following BEIR VII report guidance, organ-specific LARs for the cohort were estimated using the organ-equivalent dose-to-risk conversion factor for numbers of cases per 100,000 patients exposed to low doses of 0.1 Gy. Significant statistical difference (p<0.0001) is found between E obtained for CTCS and that of CCTA. The scan length was found to be greater in CCTA (17.5 ± 2.9 cm) compared to that for CTCS (15 ± 2 cm). More elevated values of dose were noted for the esophagus (4.2 ± 2.15 mSv) and thymus (9.6 ± 2.54 mSv) for both CTCS and CCTA. CTCS organ doses were lower than that of CCTA. Per 100,000 patients, female cumulative doses are seen to give rise to greater lung cancer LARs compared to that for males, albeit with risk varying significantly, noticeably greater for females, younger patients and combined CCTA and CTCS scans. While scan parameters and tube-modulation methods clearly contribute to patient dose, mAs offers by far the greater contribution.
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Affiliation(s)
- Entesar Zawam Dalah
- Department of Diagnostic Imaging, HQ Dubai Health Authority, Dubai, UAE
- Department of Medical Diagnostic Imaging, University of Sharjah, Sharjah, UAE Radiology
- * E-mail:
| | | | - Sabaa Anam
- Department of Medical Diagnostic Imaging, University of Sharjah, Sharjah, UAE Radiology
| | - Khalid Alzimami
- Department of Radiological Sciences, Applied Medical Sciences College, King Saud University, Riyadh, Saudi Arabia
| | - Layal Khalid Jambi
- Department of Radiological Sciences, Applied Medical Sciences College, King Saud University, Riyadh, Saudi Arabia
| | - David A. Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey, United Kingdom
- Centre for Biomedical Physics, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
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Chyou JY, Sanz J. Chest Computed Tomography Imaging and Cardiac Implantable Electronic Devices. J Cardiovasc Electrophysiol 2022; 33:1341-1343. [DOI: 10.1111/jce.15476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Janice Y Chyou
- Icahn School of Medicine at Mount Sinai, Medicine, CardiologyNew YorkNYUSA
| | - Javier Sanz
- Icahn School of Medicine at Mount Sinai, Medicine, CardiologyNew YorkNYUSA
- Icahn School of Medicine at Mount Sinai, Diagnostic, Molecular and Interventional RadiologyNew YorkNYUSA
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Nair AV, Ramanathan S, Venugopalan P. Chest imaging in pregnant patients with COVID-19: Recommendations, justification, and optimization. Acta Radiol Open 2022; 11:20584601221077394. [PMID: 35284094 PMCID: PMC8905047 DOI: 10.1177/20584601221077394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/16/2022] [Indexed: 01/11/2023] Open
Abstract
Evaluation of COVID-19 related complication is challenging in pregnancy, due to concerns about ionizing radiation risk to mother and the fetus. Although there are instances when diagnostic imaging is clinically warranted for COVID-19 evaluation despite the minimal risks of radiation exposure, often there are concerns raised by the patients and sometimes by the attending physicians. This article reviews the current recommendations on indications of chest imaging in pregnant patients with COVID-19, the dose optimization strategies, and the risks related to imaging exposure during pregnancy. In clinical practice, these imaging strategies are key in addressing the complex obstetrical complications associated with COVID-19 pneumonia.
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Affiliation(s)
| | - Subramaniyan Ramanathan
- Department of Clinical Imaging, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Radiology, Weill Cornell Medicine, Doha, Qatar
| | - Prasanna Venugopalan
- Department of Obstetrics and Gynaecology, Travancore Medical College, Kollam, Kerala, India
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29
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Poor practice and governance in Lebanese national diagnostic reference levels of adult head and body computed tomography: A nationwide study. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2021.109888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dalah EZ, Alsuwaidi JS, Hamed MS, Gani AHA, Beevi HAA, Panangatil AG, Funtelar CO, Ferrer AY, Al Hussein SGAB, Albedwawi SA. Challenges experienced in establishing clinical indication based diagnostic reference levels: Pilot study. Eur J Radiol 2022; 148:110046. [DOI: 10.1016/j.ejrad.2021.110046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 11/15/2021] [Indexed: 12/30/2022]
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Arslan S, Onur MR, Sarıkaya Y, Özcan HN, Haliloğlu M, Akata D. Radiation dose levels of thoracic-lumbar spine CT in pediatric trauma patients and assessment of scan parameters for dose optimization. Pediatr Radiol 2022; 52:65-74. [PMID: 34651195 DOI: 10.1007/s00247-021-05170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/05/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND CT is frequently used for assessing spinal trauma in children. OBJECTIVE To establish the local diagnostic reference levels of spine CT examinations in pediatric spinal trauma patients and analyze scan parameters to enable dose optimization. MATERIALS AND METHODS In this retrospective study, we included 192 pediatric spinal trauma patients who underwent spine CT. Children were divided into two age groups: 0-10 years (group 1) and 11-17 years (group 2). Each group was subdivided into thoracic, thoracolumbar and lumbar CT groups. CT acquisition parameters (tube potential, in kilovoltage [kV]; mean tube current-time product, in milliamperes [mAs]; reference mAs; collimated slice width; tube rotation time; pitch; scan length) and radiation dose descriptors (volume CT dose index [CTDIvol] and dose-length product [DLP]) were recorded. The CTDIvol and DLP values of spine CTs obtained with different tube potential and collimated slice width values were compared for each group. RESULTS CTDIvol and DLP values of thoracolumbar spine CTs in group 1 and lumbar spine CTs in group 2 were significantly lower in CTs acquired with low tube potential levels (P<0.05). CTDIvol and DLP values of thoracolumbar spine CTs in both groups and lumbar spine CTs in group 2 acquired with high collimated slice width values were significantly lower than in corresponding CTs acquired with low collimated slice width values (P<0.05). CONCLUSION Pediatric spine CT radiation doses can be notably reduced from the manufacturers' default protocols while preserving image quality.
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Affiliation(s)
- Sevtap Arslan
- Department of Radiology, Hacettepe University School of Medicine, Adnan Saygun St., Ankara, 06230, Turkey.
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University School of Medicine, Adnan Saygun St., Ankara, 06230, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - H Nursun Özcan
- Department of Radiology, Hacettepe University School of Medicine, Adnan Saygun St., Ankara, 06230, Turkey
| | - Mithat Haliloğlu
- Department of Radiology, Hacettepe University School of Medicine, Adnan Saygun St., Ankara, 06230, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Adnan Saygun St., Ankara, 06230, Turkey
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The reliability of CT numbers as absolute values for diagnostic scanning, dental imaging, and radiation therapy simulation: A narrative review. J Med Imaging Radiat Sci 2021; 53:138-146. [PMID: 34911666 DOI: 10.1016/j.jmir.2021.11.007] [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: 07/19/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this review was to examine the reported factors that affect the reliability of Computed Tomography (CT) numbers and their impact on clinical applications in diagnostic scanning, dental imaging, and radiation therapy dose calculation. METHODS A comprehensive search of the literature was conducted using Medline (PubMed), Google Scholar, and Ovid databases which were searched using the keywords CT number variability, CT number accuracy and uniformity, tube voltage, patient positioning, patient off-centring, and size dependence. A narrative summary was used to compile the findings under the overarching theme. DISCUSSION A total of 47 articles were identified to address the aim of this review. There is clear evidence that CT numbers are highly dependent on the energy level applied based on the effective atomic number of the scanned tissue. Furthermore, body size and anatomical location have also indicated an influence on measured CT numbers, especially for high-density materials such as bone tissue and dental implants. Patient off-centring was reported during CT imaging, affecting dose and CT number reliability, which was demonstrated to be dependent on the shaping filter size. CONCLUSION CT number accuracy for all energy levels, body sizes, anatomical locations, and degrees of patient off-centring is observed to be a variable under certain common conditions. This has significant implications for several clinical applications. It is crucial for those involved in CT imaging to understand the limitations of their CT system to ensure radiologists and operators avoid potential pitfalls associated with using CT numbers as absolute values for diagnostic scanning, dental imaging, and radiation therapy dose calculation.
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Ahmed HM, Borg M, Saleem AEA, Ragab A. Multi-detector computed tomography in traumatic abdominal lesions: value and radiation control. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background, The context
A prospective study was conducted involving 81 patients (mean age, 20.79 years) with abdominal trauma who underwent ultrasonography and post-contrast CT on MDCT scanner. The total DLP for each patient was reviewed, and the effective dose was calculated. Purpose of the study to: explore the role of MDCT in assessing traumatic abdominal lesions, demonstrate radiation dose delivered by MDCT, and describe specific CT technical features to minimize radiation.
Results
The spleen was the most commonly injured organ (49.4%) followed by liver (39.5%) and kidney (24.7%). Pancreatic injury occurred in seven patients, whereas only two patients had intestinal injuries. One patient had adrenal injury. Minimal, mild and moderate free intra-peritoneal fluid collection was detected in 21 (25.9%), 47 (58%) and 10 (12.3%) patients, respectively. Only three (3.7%) patients had no collection. One patient had active uncontrolled bleeding and died. Radiation dose was below the detrimental level (calculated effective dose), with optimal image quality.
Conclusions
MDCT is sensitive to all types of traumatic abdominal lesions. Not only in determining the injury, but also in its grading. MDCT has affected the treatment directions, spotting a focus on conservative treatment by raising the diagnostic confidence.
FAST cannot be the sole imaging modality. The individual radiation risk is small but real. Advancements in medical imaging reduce radiation risk.
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Mahesh M. Benchmarking CT Radiation Doses Based on Clinical Indications: Is Subjective Image Quality Enough? Radiology 2021; 302:390-391. [PMID: 34751622 DOI: 10.1148/radiol.2021212624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mahadevappa Mahesh
- From the Department of Radiological Physics, Johns Hopkins University School of Medicine, 601 N Caroline St, Johns Hopkins Outpatient Center Suite 4264, Baltimore, MD 21287-0856
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35
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Kim J, Kim HK. A NOVEL METHOD FOR ESTIMATING PATIENT-SPECIFIC PRIMARY DOSE IN CONE-BEAM COMPUTED TOMOGRAPHY. RADIATION PROTECTION DOSIMETRY 2021; 196:71-84. [PMID: 34487179 DOI: 10.1093/rpd/ncab128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
For the purpose of real-time scan-protocol optimisation and patient-specific dose management in cone-beam computed tomography, we introduce a numerical algorithm that estimates the primary dose distributions in reconstructed images. The proposed algorithm is based on the ray-tracing technique and utilises reconstructed voxel data and scanning protocol. The algorithm is validated with the Monte Carlo (MC) and conventional model-based dose reconstruction methods for the simple cylindrical water and anthropomorphic head phantoms. The algorithm shows good agreement with both methods in terms of the zeroth-order x-ray interactions, which exclude the higher-order x-ray interactions at sites distant from the first interactions, and it consumes a significantly lower computational cost compared with the MC method. The differences between the proposed algorithm and the model-based dose reconstruction method as well as the improvement strategies of the algorithm are discussed in detail.
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Affiliation(s)
- Jinwoo Kim
- Center for Advanced Medical Engineering Research, Pusan National University, Busan 46241, Republic of Korea
| | - Ho Kyung Kim
- Center for Advanced Medical Engineering Research, Pusan National University, Busan 46241, Republic of Korea
- School of Mechanical Engineering, Pusan National University, Busan 46241, Republic of Korea
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Skjøt-Arkil H, Heltborg A, Lorentzen MH, Cartuliares MB, Hertz MA, Graumann O, Rosenvinge FS, Petersen ERB, Østergaard C, Laursen CB, Skovsted TA, Posth S, Chen M, Mogensen CB. Improved diagnostics of infectious diseases in emergency departments: a protocol of a multifaceted multicentre diagnostic study. BMJ Open 2021; 11:e049606. [PMID: 34593497 PMCID: PMC8487181 DOI: 10.1136/bmjopen-2021-049606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The major obstacle in prescribing an appropriate and targeted antibiotic treatment is insufficient knowledge concerning whether the patient has a bacterial infection, where the focus of infection is and which bacteria are the agents of the infection. A prerequisite for the appropriate use of antibiotics is timely access to accurate diagnostics such as point-of-care (POC) testing.The study aims to evaluate diagnostic tools and working methods that support a prompt and accurate diagnosis of hospitalised patients suspected of an acute infection. We will focus on the most common acute infections: community-acquired pneumonia (CAP) and acute pyelonephritis (APN). The objectives are to investigate (1) patient characteristics and treatment trajectory of the different acute infections, (2) diagnostic and prognostic accuracy of infection markers, (3) diagnostic accuracy of POC urine flow cytometry on diagnosing and excluding bacteriuria, (4) how effective the addition of POC analysis of sputum to the diagnostic set-up for CAP is on antibiotic prescriptions, (5) diagnostic accuracy of POC ultrasound and ultralow dose (ULD) computerized tomography (CT) on diagnosing CAP, (6) diagnostic accuracy of specialist ultrasound on diagnosing APN, (7) diagnostic accuracy of POC ultrasound in diagnosing hydronephrosis in patients suspected of APN. METHODS AND ANALYSIS It is a multifaceted multicentre diagnostic study, including 1000 adults admitted with suspicion of an acute infection. Participants will, within the first 24 hours of admission, undergo additional diagnostic tests including infection markers, POC urine flow cytometry, POC analysis of sputum, POC and specialist ultrasound, and ULDCT. The primary reference standard is an assigned diagnosis determined by a panel of experts. ETHICS, DISSEMINATION AND REGISTRATION Approved by Regional Committees on Health Research Ethics for Southern Denmark, Danish Data Protection Agency and clinicaltrials.gov. Results will be presented in peer-reviewed journals, and positive, negative and inconclusive results will be published. TRIAL REGISTRATION NUMBERS NCT04661085, NCT04681963, NCT04667195, NCT04652167, NCT04686318, NCT04686292, NCT04651712, NCT04645030, NCT04651244.
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Affiliation(s)
- Helene Skjøt-Arkil
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Anne Heltborg
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Internal Medicine, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Morten Hjarnø Lorentzen
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Mariana Bichuette Cartuliares
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Mathias Amdi Hertz
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
| | - Ole Graumann
- Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Eva Rabing Brix Petersen
- Blood Samples, Biochemistry and Immunology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Claus Østergaard
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Thor Aage Skovsted
- Blood Samples, Biochemistry and Immunology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Stefan Posth
- Department of Clinical Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Emergency Department, Odense University Hospital, Odense, Denmark
| | - Ming Chen
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Microbiology, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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Yeoh H, Hong SH, Ahn C, Choi JY, Chae HD, Yoo HJ, Kim JH. Deep Learning Algorithm for Simultaneous Noise Reduction and Edge Sharpening in Low-Dose CT Images: A Pilot Study Using Lumbar Spine CT. Korean J Radiol 2021; 22:1850-1857. [PMID: 34431248 PMCID: PMC8546130 DOI: 10.3348/kjr.2021.0140] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
Objective The purpose of this study was to assess whether a deep learning (DL) algorithm could enable simultaneous noise reduction and edge sharpening in low-dose lumbar spine CT. Materials and Methods This retrospective study included 52 patients (26 male and 26 female; median age, 60.5 years) who had undergone CT-guided lumbar bone biopsy between October 2015 and April 2020. Initial 100-mAs survey images and 50-mAs intraprocedural images were reconstructed by filtered back projection. Denoising was performed using a vendor-agnostic DL model (ClariCT.AI™, ClariPI) for the 50-mAS images, and the 50-mAs, denoised 50-mAs, and 100-mAs CT images were compared. Noise, signal-to-noise ratio (SNR), and edge rise distance (ERD) for image sharpness were measured. The data were summarized as the mean ± standard deviation for these parameters. Two musculoskeletal radiologists assessed the visibility of the normal anatomical structures. Results Noise was lower in the denoised 50-mAs images (36.38 ± 7.03 Hounsfield unit [HU]) than the 50-mAs (93.33 ± 25.36 HU) and 100-mAs (63.33 ± 16.09 HU) images (p < 0.001). The SNRs for the images in descending order were as follows: denoised 50-mAs (1.46 ± 0.54), 100-mAs (0.99 ± 0.34), and 50-mAs (0.58 ± 0.18) images (p < 0.001). The denoised 50-mAs images had better edge sharpness than the 100-mAs images at the vertebral body (ERD; 0.94 ± 0.2 mm vs. 1.05 ± 0.24 mm, p = 0.036) and the psoas (ERD; 0.42 ± 0.09 mm vs. 0.50 ± 0.12 mm, p = 0.002). The denoised 50-mAs images significantly improved the visualization of the normal anatomical structures (p < 0.001). Conclusion DL-based reconstruction may enable simultaneous noise reduction and improvement in image quality with the preservation of edge sharpness on low-dose lumbar spine CT. Investigations on further radiation dose reduction and the clinical applicability of this technique are warranted.
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Affiliation(s)
- Hyunjung Yeoh
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Chulkyun Ahn
- Department of Transdisciplinary Studies, Program in Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Ja-Young Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee-Dong Chae
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hyo Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Transdisciplinary Studies, Program in Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.,Center for Medical-IT Convergence Technology Research, Advanced Institutes of Convergence Technology, Suwon, Korea
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Association between facet joint ankylosis and functional impairment in patients with radiographic axial spondyloarthritis. Semin Arthritis Rheum 2021; 51:1005-1010. [PMID: 34411837 DOI: 10.1016/j.semarthrit.2021.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To investigate the occurrence of facet joint ankylosis in the spine of patients with radiographic axial spondyloarthritis (r-axSpA) using low dose computed tomography (ldCT), and to examine the association between facet joint ankylosis and functional impairment. METHODS A group of 126 patients with r-axSpA was selected from Incheon Saint Mary's axSpA observational cohort and whole spine ldCT data were examined. Facet joint (right and left, C2-S1) ankylosis was scored from 0-46 (total). The presence of facet joint ankylosis was assessed by two readers, each blinded to the patient data. The inter-reader reliability of facet joint ankylosis scoring was assessed using intraclass correlation coefficients (ICCs). The CT Syndesmophyte Score (CTSS) was assessed. Lumbar spinal mobility was evaluated using the modified Schober test. Functional impairment was measured using the Bath AS functional index (BASFI). RESULTS The ICCs of ankylosed facet joint scores at the cervical, thoracic, lumbar and whole spine were 0.84, 0.88, 0.92 and 0.90, respectively. Facet joint ankylosis was most common in the thoracic spine. Scores for the whole spine correlated positively with the ASDAS, mSASSS and the syndesmophyte score. Multivariate analysis revealed that facet joint ankylosis was significantly associated with decreased lumbar motion. For both readers, the scores for the whole spine were independently associated with BASFI after adjusting for syndesmophyte score and disease activity. CONCLUSIONS Facet joint ankylosis in patients with r-axSpA was associated with functional impairment and spinal mobility. Facet joints should be incorporated into a structural damage assessment method.
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Abstract
The CT manifestation of COVID-19 patients is now well known and essentially reflects pathological changes in the lungs. Actually, there is insufficient knowledge on the long-term outcomes of this new disease, and several chest CTs might be necessary to evaluate the outcomes. The aim of this study is to evaluate the radiation dose for chest CT scans in COVID-19 patients compared to a cohort with pulmonary infectious diseases at the same time of the previous year to value if there is any modification of exposure dose. The analysis of our data shows an increase in the overall mean dose in COVID-19 patients compared with non-COVID-19 patients. In our results, the higher dose increase occurs in the younger age groups (+86% range 21–30 years and +67% range 31–40 years). Our results show that COVID-19 patients are exposed to a significantly higher dose of ionizing radiation than other patients without COVID infectious lung disease, and especially in younger age groups, although some authors have proposed the use of radiotherapy in these patients, which is yet to be validated. Our study has limitations: the use of one CT machine in a single institute and a limited number of patients.
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Lenga L, Lange M, Martin SS, Albrecht MH, Booz C, Yel I, Arendt CT, Vogl TJ, Leithner D. Head and neck single- and dual-energy CT: differences in radiation dose and image quality of 2nd and 3rd generation dual-source CT. Br J Radiol 2021; 94:20210069. [PMID: 33914613 PMCID: PMC8173672 DOI: 10.1259/bjr.20210069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare radiation dose and image quality of single-energy (SECT) and dual-energy (DECT) head and neck CT examinations performed with second- and third-generation dual-source CT (DSCT) in matched patient cohorts. METHODS 200 patients (mean age 55.1 ± 16.9 years) who underwent venous phase head and neck CT with a vendor-preset protocol were retrospectively divided into four equal groups (n = 50) matched by gender and BMI: second (Group A, SECT, 100-kV; Group B, DECT, 80/Sn140-kV), and third-generation DSCT (Group C, SECT, 100-kV; Group D, DECT, 90/Sn150-kV). Assessment of radiation dose was performed for an average scan length of 27 cm. Contrast-to-noise ratio measurements and dose-independent figure-of-merit calculations of the submandibular gland, thyroid, internal jugular vein, and common carotid artery were analyzed quantitatively. Qualitative image parameters were evaluated regarding overall image quality, artifacts and reader confidence using 5-point Likert scales. RESULTS Effective radiation dose (ED) was not significantly different between SECT and DECT acquisition for each scanner generation (p = 0.10). Significantly lower effective radiation dose (p < 0.01) values were observed for third-generation DSCT groups C (1.1 ± 0.2 mSv) and D (1.0 ± 0.3 mSv) compared to second-generation DSCT groups A (1.8 ± 0.1 mSv) and B (1.6 ± 0.2 mSv). Figure-of-merit/contrast-to-noise ratio analysis revealed superior results for third-generation DECT Group D compared to all other groups. Qualitative image parameters showed non-significant differences between all groups (p > 0.06). CONCLUSION Contrast-enhanced head and neck DECT can be performed with second- and third-generation DSCT systems without radiation penalty or impaired image quality compared with SECT, while third-generation DSCT is the most dose efficient acquisition method. ADVANCES IN KNOWLEDGE Differences in radiation dose between SECT and DECT of the dose-vulnerable head and neck region using DSCT systems have not been evaluated so far. Therefore, this study directly compares radiation dose and image quality of standard SECT and DECT protocols of second- and third-generation DSCT platforms.
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Affiliation(s)
- Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marvin Lange
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Christophe T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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Lam JP, Alexander LF, Haley WE, Hodge DO, Kofler JM, Morin RL, Thiel DD, Cernigliaro JC. In Vivo Comparison of Radiation Exposure in Third Generation versus Second Generation Dual-Source Dual-Energy CT for Imaging Urinary Calculi. J Endourol 2021; 35:1581-1585. [PMID: 33858196 DOI: 10.1089/end.2021.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate the potential for decreasing radiation dose when utilizing a third generation versus second generation dual-source dual-energy CT scanner, while maintaining diagnostic image quality and acceptable image noise. MATERIALS AND METHODS Retrospective analysis of patients who underwent dual-source dual-energy CT (dsDECT) for clinical suspicion of urolithiasis from 10/2/2017 - 9/5/2018. Patient demographics, body mass index, abdominal diameter, scanning parameters, and CT dose index volume (CTDIvol) were recorded. Image quality was assessed by measuring the attenuation and standard deviation (SD) regions of interest in the aorta and in the bladder. Image noise was determined by averaging the SD at both levels. Patients were excluded if they had not undergone both 3rd and 2nd generation DECT, time between DECT was more than 2 years, or scan parameters were outside standard protocol. RESULTS 117 patients met inclusion criteria. Examinations performed on a 3rd generation DECT had an average CTDIvol 12.3 mGy, while examinations performed on a 2nd generation DECT had an average CTDIvol 13.3 mGy (p<0.001). Average image noise was significantly lower for the 3rd generation DECT (SD=10.3) as compared to the 2nd generation DECT (SD=13.9) (p<0.001). CONCLUSIONS The third generation dsDECT scanners can simultaneously decrease patient radiation dose and decrease image noise as compared to second generation DECT. These reductions in radiation exposure can be particularly important in patients with urinary stone disease who often require repeated imaging to evaluate for stone development and recurrence as well as treatment assessment.
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Affiliation(s)
- Jonathan P Lam
- Mayo Clinic Florida, 23389, Radiology, Jacksonville, Florida, United States;
| | - Lauren F Alexander
- Mayo Clinic Florida, 23389, Radiology, Jacksonville, Florida, United States;
| | - William E Haley
- Mayo Clinic Florida, 23389, Nephrology, Jacksonville, Florida, United States;
| | - David O Hodge
- Mayo Clinic Florida, 23389, Biomedical Statistics and Informatics, Jacksonville, Florida, United States;
| | - James M Kofler
- Mayo Clinic Florida, 23389, Radiology, Jacksonville, Florida, United States;
| | - Richard L Morin
- Mayo Clinic Florida, 23389, Radiology, Jacksonville, Florida, United States;
| | - David D Thiel
- Mayo Clinic Florida, 23389, Urology, Jacksonville, Florida, United States;
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Zhang H, Capaldi D, Zeng D, Ma J, Xing L. Prior-image-based CT reconstruction using attenuation-mismatched priors. Phys Med Biol 2021; 66:064007. [PMID: 33729997 DOI: 10.1088/1361-6560/abe760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prior-image-based reconstruction (PIBR) methods are powerful tools for reducing radiation doses and improving the image quality of low-dose computed tomography (CT). Apart from anatomical changes, prior and current images can also have different attenuations because they originated from different scanners or from the same scanner but with different x-ray beam qualities (e.g., kVp settings, beam filters) during data acquisition. In such scenarios, with attenuation-mismatched priors, PIBR is challenging. In this work, we investigate a specific PIBR method, called statistical image reconstruction, using normal-dose image-induced nonlocal means regularization (SIR-ndiNLM), to address PIBR with such attenuation-mismatched priors and achieve quantitative low-dose CT imaging. We propose two corrective schemes for the original SIR-ndiNLM method, (1) a global histogram-matching approach and (2) a local attenuation correction approach, to account for the attenuation differences between the prior and current images in PIBR. We validate the efficacy of the proposed schemes using images acquired from dual-energy CT scanners to simulate attenuation mismatches. Meanwhile, we utilize different CT slices to simulate anatomical mismatches or changes between the prior and the current low-dose image. We observe that the original SIR-ndiNLM introduces artifacts to the reconstruction when an attenuation-mismatched prior is used. Furthermore, we find that a larger attenuation mismatch between the prior and current images results in more severe artifacts in the SIR-ndiNLM reconstruction. Our two proposed corrective schemes enable SIR-ndiNLM to effectively handle the attenuation mismatch and anatomical changes between the two images and successfully eliminate the artifacts. We demonstrate that the proposed techniques permit SIR-ndiNLM to leverage the attenuation-mismatched prior and achieve quantitative low-dose CT reconstruction from both low-flux and sparse-view data acquisitions. This work permits robust and reliable PIBR for CT data acquired using different beam settings.
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Affiliation(s)
- Hao Zhang
- Department of Radiation Oncology, Stanford University School of Medicine, California, United States of America. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, United States of America
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de Bakker CMJ, Walker REA, Besler BA, Tse JJ, Manske SL, Martin CR, French SJ, Dodd AE, Boyd SK. A quantitative assessment of dual energy computed tomography-based material decomposition for imaging bone marrow edema associated with acute knee injury. Med Phys 2021; 48:1792-1803. [PMID: 33606278 DOI: 10.1002/mp.14791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study developed methods to quantify and improve the accuracy of dual-energy CT (DECT)-based bone marrow edema imaging using a clinical CT system. Objectives were: (a) to quantitatively compare DECT with gold-standard, fluid-sensitive MRI for imaging of edema-like marrow signal intensity (EMSI) and (b) to identify image analysis parameters that improve delineation of EMSI associated with acute knee injury on DECT images. METHODS DECT images from ten participants with acute knee injury were decomposed into estimated fractions of bone, healthy marrow, and edema based on energy-dependent differences in tissue attenuation. Fluid-sensitive MR images were registered to DECT for quantitative, voxel-by-voxel comparison between the two modalities. An optimization scheme was developed to find attenuation coefficients for healthy marrow and edema that improved EMSI delineation, compared to MRI. DECT method accuracy was evaluated by measuring dice coefficients, mutual information, and normalized cross correlation between the DECT result and registered MRI. RESULTS When applying the optimized three-material decomposition method, dice coefficients for EMSI identified through DECT vs MRI were 0.32 at the tibia and 0.13 at the femur. Optimization of attenuation coefficients improved dice coefficient, mutual information, and cross-correlation between DECT and gold-standard MRI by 48%-107% compared to three-material decomposition using non-optimized parameters, and improved mutual information and cross-correlation by 39%-58% compared to the manufacturer-provided two-material decomposition. CONCLUSIONS This study quantitatively evaluated the performance of DECT in imaging knee injury-associated EMSI and identified a method to optimize DECT-based visualization of complex tissues (marrow and edema) whose attenuation parameters cannot be easily characterized. Further studies are needed to improve DECT-based EMSI imaging at the femur.
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Affiliation(s)
- Chantal M J de Bakker
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Richard E A Walker
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Bryce A Besler
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Justin J Tse
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - C Ryan Martin
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Stephen J French
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Andrew E Dodd
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
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Lu L, Sun SH, Afran A, Yang H, Lu ZF, So J, Schwartz LH, Zhao B. Identifying Robust Radiomics Features for Lung Cancer by Using In-Vivo and Phantom Lung Lesions. Tomography 2021; 7:55-64. [PMID: 33681463 PMCID: PMC7934702 DOI: 10.3390/tomography7010005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
We propose a novel framework for determining radiomics feature robustness by considering the effects of both biological and noise signals. This framework is preliminarily tested in a study predicting the epidermal growth factor receptor (EGFR) mutation status in non-small cell lung cancer (NSCLC) patients. Pairs of CT images (baseline, 3-week post therapy) of 46 NSCLC patients with known EGFR mutation status were collected and a FDA-customized anthropomorphic thoracic phantom was scanned on two vendors' scanners at four different tube currents. Delta radiomics features were extracted from the NSCLC patient CTs and reproducible, non-redundant, and informative features were identified. The feature value differences between EGFR mutant and EGFR wildtype patients were quantitatively measured as the biological signal. Similarly, radiomics features were extracted from the phantom CTs. A pairwise comparison between settings resulted in a feature value difference that was quantitatively measured as the noise signal. Biological signals were compared to noise signals at each setting to determine if the distributions were significantly different by two-sample t-test, and thus robust. Four optimal features were selected to predict EGFR mutation status, Tumor-Mass, Sigmoid-Offset-Mean, Gabor-Energy and DWT-Energy, which quantified tumor mass, tumor-parenchyma density transition at boundary, line-like pattern inside tumor and intratumoral heterogeneity, respectively. The first three variables showed robustness across the majority of studied CT acquisition parameters. The textual feature DWT-Energy was less robust. The proposed framework was able to determine robustness of radiomics features at specific settings by comparing biological signal to noise signal. Identification of robust radiomics features may improve the generalizability of radiomics models in future studies.
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Affiliation(s)
| | | | | | | | | | | | | | - Binsheng Zhao
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA; (L.L.); (S.H.S.); (A.A.); (H.Y.); (Z.F.L.); (J.S.); (L.H.S.)
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Muhammad N, Sabarudin A, Ismail N, Karim M. A systematic review and meta-analysis of radiation dose exposure from computed tomography examination of thorax-abdomen-pelvic regions among paediatric population. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.109148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Appel E, Boos J, Fang J, Zhang D, Wilcox C, Camacho A, Dommaraju S, Brook A, Brook OR. Minimizing Radiation Dose Outliers Through Systematic Analysis, Computed Tomography Technologist Education, and Standardized System Solutions. J Comput Assist Tomogr 2021; 45:78-83. [PMID: 32168081 DOI: 10.1097/rct.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were to systematically analyze causes for radiation dose outliers in emergency department noncontrast head computed tomographies (CTs), to develop and implement standardized system solutions, and audit program success for an extended period of time. METHODS This study was performed in a large, tertiary academic center between January 2015 and September 2017. Four phases of radiation dose data collection with and without prior interventions were performed. Outliers from 5 categories were evaluated for appropriateness in consensus by 2 radiologists and a senior CT technologist. RESULTS A total of 275 ± 15 CTs per period were included. Fifty-seven inappropriate scanning parameters were found in 24 (9%) of 254 CTs during the first analysis, 27 in 21 (7%) of 290 CTs during the second, 11 in 10 (4%) of 276 during the third assessment (P = 0.006). After a year without additional intervention, the number remained stable (14 in 11/281 CTs, 4%). CONCLUSIONS Combining a dose reporting system, individual case analysis, staff education, and implementation of systemic solutions lead to sustained radiation exposure improvement.
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Affiliation(s)
- Elisabeth Appel
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Johannes Boos
- Institute of clinical and interventional Radiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Jieming Fang
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Da Zhang
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Carol Wilcox
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Andrés Camacho
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sujithraj Dommaraju
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Olga R Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
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Stengel D, Mutze S, Güthoff C, Weigeldt M, von Kottwitz K, Runge D, Razny F, Lücke A, Müller D, Ekkernkamp A, Kahl T. Association of Low-Dose Whole-Body Computed Tomography With Missed Injury Diagnoses and Radiation Exposure in Patients With Blunt Multiple Trauma. JAMA Surg 2020; 155:224-232. [PMID: 31940019 PMCID: PMC6990738 DOI: 10.1001/jamasurg.2019.5468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Question Is low-dose whole-body computed tomography with statistical image reconstruction associated with similar rates of missed injuries and accuracy but reduced radiation exposure compared with standard-dose whole-body computed tomography in the primary diagnostic workup of blunt multiple trauma? Findings In this quasi-experimental cohort study of 971 patients with suspected blunt multiple trauma, participants in the standard-dose and low-dose whole-body computed tomography groups had the same risk of missed injury diagnoses. Low-dose scanning markedly reduced exposure to radiation, improved the contrast-to-noise ratio, and showed similar diagnostic accuracy among the investigated anatomical areas and organs when compared with standard-dose scanning. Meaning These findings suggest that low-dose whole-body computed tomography may safely replace standard-dose scanning in the primary diagnostic workup of blunt multiple trauma. Importance Initial whole-body computed tomography (WBCT) for screening patients with suspected blunt multiple trauma remains controversial and a source of excess radiation exposure. Objective To determine whether low-dose WBCT scanning using an iterative reconstruction algorithm does not increase the rate of missed injury diagnoses at the point of care compared with standard-dose WBCT with the benefit of less radiation exposure. Design, Setting, and Participants This quasi-experimental, prospective time-series cohort study recruited 1074 consecutive patients admitted for suspected blunt multiple trauma to an academic metropolitan trauma center in Germany from September 3, 2014, through July 26, 2015, for the standard-dose protocol, and from August 7, 2015, through August 20, 2016, for the low-dose protocol. Five hundred sixty-five patients with suspected blunt multiple trauma prospectively received standard-dose WBCT, followed by 509 patients who underwent low-dose WBCT. Confounding was controlled by segmented regression analysis and a secondary multivariate logistic regression model. Data were analyzed from January 16, 2017, through October 14, 2019. Interventions Standard- or low-dose WBCT. Main Outcomes and Measures The primary outcome was the incidence of missed injury diagnoses at the point of care, using a synopsis of clinical, surgical, and radiological findings as an independent reference test. The secondary outcome was radiation exposure with either imaging strategy. Results Of 1074 eligible patients, 971 (mean [SD] age, 52.7 [19.5] years; 649 men [66.8%]) completed the study. A total of 114 patients (11.7%) had multiple trauma, as defined by an Injury Severity Score of 16 or greater. The proportion of patients with any missed injury diagnosis at the point of care was 109 of 468 (23.3%) in the standard-dose and 107 of 503 (21.3%) in the low-dose WBCT groups (risk difference, −2.0% [95% CI, −7.3% to 3.2%]; unadjusted odds ratio, 0.89 [95% CI, 0.66-1.20]; P = .45). Adjustments for autocorrelation and multiple confounding variables did not alter the results. Radiation exposure, measured by the volume computed tomography dose index, was lowered from a median of 11.7 (interquartile range, 11.7-17.6) mGy in the standard-dose WBCT group to 5.9 (interquartile range, 5.9-8.8) mGy in the low-dose WBCT group (P < .001). Conclusions and Relevance Low-dose WBCT using iterative image reconstruction does not appear to increase the risk of missed injury diagnoses at the point of care compared with standard-dose protocols while almost halving the exposure to diagnostic radiation.
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Affiliation(s)
- Dirk Stengel
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany
| | - Sven Mutze
- Institute of Radiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,Institute for Diagnostic Radiology and Neuroradiology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claas Güthoff
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Moritz Weigeldt
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Konrad von Kottwitz
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Domenique Runge
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Filip Razny
- Institute of Radiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Anna Lücke
- Institute of Radiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Dirk Müller
- Consultant in radiation physics, Hamburg, Germany
| | - Axel Ekkernkamp
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany.,BG Kliniken-Klinikverbund der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany.,Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Thomas Kahl
- Institute of Radiology, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
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Singh R, Wu W, Wang G, Kalra MK. Artificial intelligence in image reconstruction: The change is here. Phys Med 2020; 79:113-125. [DOI: 10.1016/j.ejmp.2020.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 12/19/2022] Open
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Management of Hydrocephalus in Children: Anatomic Imaging Appearances of CSF Shunts and Their Complications. AJR Am J Roentgenol 2020; 216:187-199. [PMID: 33112667 DOI: 10.2214/ajr.20.22888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This article addresses the management of hydrocephalus and the CSF shunts used to treat this entity. CONCLUSION. CSF shunts have a high failure rate. Imaging plays a pivotal role in assessing CSF shunt failure and determining the need for surgical revision. An in-depth knowledge of CSF shunt components, their failure modes, and the corresponding findings on anatomic imaging studies is necessary to ensure timely diagnosis and prevent permanent neurologic damage.
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Gopireddy DR, Mahmoud H, Baig S, Le R, Bhosale P, Lall C. "Renal emergencies: a comprehensive pictorial review with MR imaging". Emerg Radiol 2020; 28:373-388. [PMID: 32974867 DOI: 10.1007/s10140-020-01852-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Superior soft-tissue contrast and high sensitivity of magnetic resonance imaging (MRI) for detecting and characterizing disease may provide an expanded role in acute abdominal and pelvic imaging. Although MRI has traditionally not been exploited in acute care settings, commonly used in biliary obstruction and during pregnancy, there are several conditions in which MRI can go above and beyond other modalities in diagnosis, characterization, and providing functional and prognostic information. In this manuscript, we highlight how MRI can help in further assessment and characterization of acute renal emergencies. Currently, renal emergencies are predominantly evaluated with ultrasound (US) or computed tomography (CT) scanning. US may be limited by various patient factors and technologist experience while CT imaging with intravenous contrast administration can further compromise renal function. With the advent of rapid, robust non-contrast MRI, and magnetic resonance angiography (MRA) imaging studies with short scan times, free-breathing techniques, and lack of ionization radiation, the utility of MRI for renal evaluation might be superior to CT not only in diagnosing an emergent renal process but also by providing functional and prognostic information. This review outlines the clinical manifestations and the key imaging findings for acute renal processes including acute renal infarction, hemorrhage, and renal obstruction, among other entities, to highlight the added value of MRI in evaluating the finer nuances in acute renal emergencies.
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Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, UF College of Medicine-Jacksonville, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA.
| | - Hagar Mahmoud
- Department of Diagnostic Radiology, the University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Saif Baig
- Imaging Informatics and Artificial Intelligence, University of Florida, College Medicine, Gainesville, FL, USA
| | - Rebecca Le
- Jacksonville Center for Clinical Research, University of Florida, Gainesville, FL, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, the University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chandana Lall
- Department of Radiology, UF College of Medicine-Jacksonville, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
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