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Burns RT, Orzel J, Wadensweiler P, Kenne K, Nakastuka H, Kovacevic N, Aswani Y, Ann Gormley E, Padamanabhan P, Powell CR, Vollstedt A, Takacs E. Radiation exposure during sacral neuromodulation lead placement: Multi-institutional descriptive study. Neurourol Urodyn 2024; 43:595-603. [PMID: 38318969 DOI: 10.1002/nau.25408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Fluoroscopy has significantly improved lead placement and decreased surgical time for implantable sacral neuromodulation (SNM). There is a paucity of data regarding radiation and safety of fluoroscopy during SNM procedures. Our study aims to characterize fluoroscopy time and dose used during SNM surgery across multiple institutions and assess for predictors of increased fluoroscopy time and radiation dose. METHODS Electronic medical records were queried for SNM procedures (Stage 1 and full implant) from 2016 to 2021 at four academic institutions. Demographic, clinical, and intraoperative data were collected, including fluoroscopy time and radiation dose in milligray (mGy). The data were entered into a centralized REDCap database. Univariate and multivariate analysis were performed to assess for predictive factors using STATA/BE 17.0. RESULTS A total of 664 procedures were performed across four institutions. Of these, 363 (54.6%) procedures had complete fluoroscopy details recorded. Mean surgical time was 58.8 min. Of all procedures, 79.6% were performed by Female Pelvic Medicine and Reconstructive Surgery specialists. There was significant variability in fluoroscopy time and dose based on surgical specialty and institution. Most surgeons (76.4%) were considered "low volume" implanters. In a multivariate analysis, bilateral finder needle testing, surgical indication, surgeon volume, and institution significantly predicted increased fluoroscopy time and radiation dose (p < 0.05). CONCLUSIONS There is significant variability in fluoroscopy time and radiation dose utilized during SNM procedures, with differences across institutions, surgeons, and subspecialties. Increased radiation exposure can have harmful impacts on the surgical team and patient. These findings demonstrate the need for standardized fluoroscopy use during SNM procedures.
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Affiliation(s)
- Ramzy T Burns
- Department of Urology, Indiana University, Indianapolis, Indiana, USA
| | - Joanna Orzel
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Paul Wadensweiler
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kimberly Kenne
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Yashant Aswani
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - E Ann Gormley
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Charles R Powell
- Department of Urology, Indiana University, Indianapolis, Indiana, USA
| | - Annah Vollstedt
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Elizabeth Takacs
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Zhang Q, Zhang YH, Hao LL, Xu XH, Wu GF, Lin L, Xu XL, Qi L, Tian S. A numerical study on the siphonic effect of enhanced external counterpulsation at lower extremities with a coupled 0D-1D closed-loop personalized hemodynamics model. J Biomech 2024; 166:112057. [PMID: 38520934 DOI: 10.1016/j.jbiomech.2024.112057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/05/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
Enhanced external counterpulsation (EECP) is a treatment and rehabilitation approach for ischemic diseases, including coronary artery disease. Its therapeutic benefits are primarily attributed to the improved blood circulation achieved through sequential mechanical compression of the lower extremities. However, despite the crucial role that hemodynamic effects in the lower extremity arteries play in determining the effectiveness of EECP treatment, most studies have focused on the diastole phase and ignored the systolic phase. In the present study, a novel siphon model (SM) was developed to investigate the interdependence of several hemodynamic parameters, including pulse wave velocity, femoral flow rate, the operation pressure of cuffs, and the mean blood flow changes in the femoral artery throughout EECP therapy. To verify the accuracy of the SM, we coupled the predicted afterload in the lower extremity arteries during deflation using SM with the 0D-1D patient-specific model. Finally, the simulation results were compared with clinical measurements obtained during EECP therapy to verify the applicability and accuracy of the SM, as well as the coupling method. The precision and reliability of the previously developed personalized approach were further affirmed in this study. The average waveform similarity coefficient between the simulation results and the clinical measurements during the rest state exceeded 90%. This work has the potential to enhance our understanding of the hemodynamic mechanisms involved in EECP treatment and provide valuable insights for clinical decision-making.
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Affiliation(s)
- Qi Zhang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China
| | - Ya-Hui Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Li-Ling Hao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China.
| | - Xuan-Hao Xu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Gui-Fu Wu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Ling Lin
- Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Xiu-Li Xu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China.
| | - Lin Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China.
| | - Shuai Tian
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China.
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Cohen SL, Feizullayeva C, Wang JJ, Chan N, McCandlish JA, Cronin PP, Barish MA, O'Connell W, Sanelli PC. Maternal and Fetal Radiation-Induced Cancer Risk From Computed Tomography Pulmonary Angiography During Pregnancy: A Retrospective Cohort Study Across a Multihospital Integrated Health Care Network. J Comput Assist Tomogr 2024; 48:257-262. [PMID: 38271533 DOI: 10.1097/rct.0000000000001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Computed tomography pulmonary angiogram (CTPA) is important to evaluate suspected pulmonary embolism in pregnancy but has maternal/fetal radiation risks. The objective of this study was to estimate maternal and fetal radiation-induced cancer risk from CTPA during pregnancy. METHODS Simulation modeling via the National Cancer Institute's Radiation Risk Assessment Tool was used to estimate excess cancer risks from 17 organ doses from CTPA during pregnancy, with doses determined by a radiation dose indexing monitoring system. Organ doses were obtained from a radiation dose indexing monitoring system. Maternal and fetal cancer risks per 100,000 were calculated for male and female fetuses and several maternal ages. RESULTS The 534 CTPA examinations had top 3 maternal organ doses to the breast, lung, and stomach of 17.34, 15.53, and 9.43 mSv, respectively, with a mean uterine dose of 0.21 mSv. The total maternal excess risks of developing cancer per 100,000 were 181, 151, 121, 107, 94.5, 84, and 74.4, respectively, for a 20-, 25-, 30-, 35-, 40-, 45-, and 50-year-old woman undergoing CTPA, compared with baseline cancer risks of 41,408 for 20-year-old patients. The total fetal excess risks of developing cancer per 100,000 were 12.3 and 7.3 for female and male fetuses, respectively, when compared with baseline cancer risks of 41,227 and 48,291. DISCUSSION Excess risk of developing cancer from CTPA was small relative to baseline cancer risk for pregnant patients and fetuses, decreased for pregnant patients with increasing maternal age, and was greater for female fetuses than male fetuses.
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Affiliation(s)
| | | | | | - Nicholas Chan
- Department of Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Paul P Cronin
- Department of Radiology and Imaging Science, Emory University Hospital, Atlanta, GA
| | - Matthew A Barish
- Department of Diagnostic Radiology, North Shore University Hospital/Northwell Health, Manhasset, NY
| | - William O'Connell
- Department of Diagnostic Radiology, North Shore University Hospital/Northwell Health, Manhasset, NY
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Ahmed AM, Musa A, Medani A, Mahmoud M, Osman H, Elsamani M, Kajoak S, Alghamdi SS, Tajaldeen A, Hanfi MY, Khandaker MU. Establishment of a local diagnostic reference level for computed tomography chest and abdomen in two different cities in Saudi Arabia. Appl Radiat Isot 2024; 204:111147. [PMID: 38113663 DOI: 10.1016/j.apradiso.2023.111147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/04/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND AIM Spiral computed tomography (CT) scans, which are considered a high-contrast resolution, quick and cross-sectional imaging technique, have grown in popularity as a result of technological advancements. However, these advancements have brought with them the potential for significantly increased radiation doses to the patient. Consequently, many organizations recommended optimization and establishing diagnostic reference levels. The aim of the current study was to assess CT radiation dose and propose a local diagnostic reference level (LDRL) for the adult trunk [chest and abdomen] using CT dose parameters such as CT dose index volume (CTDIvol) and dose length product (DLP) as well as to compare the practices for aforementioned examinations between two hospitals in Taif and Abha cities in Saudi Arabia. MATERIALS AND METHODS Data from 428 patients (216 for abdomen and 212 for chest) who were examined in two hospitals in Taif and Abha City in Saudi Arabia from December 2022 to March 2023, are used in this study. The data for hospitals in Taif and Abha are presented as 'T' and 'A' throughout this manuscript. The parameters of exposure and slice thickness were recorded in a specially designed data sheet together with the gender, age and patients morphometric. Microsoft Excel version 2010 was used to analyze results and plot the figures. The LDRL was achieved from the third quartile of CTDIvol and DLP for each hospital and examination. RESULTS The average DLP (mGy-cm) and CTDIvol (mGy) for the chest and abdomen were 243 mGy cm, 5.8 mGy and 549 mGy cm, 8.6 mGy respectively. The average effective dose (ED) for chest and abdomen were 5.10 and 21.10 mSv, respectively. The proposed LDRL for the chest and abdomen were 6.9 mGy (CTDIvol), 375 mGy-cm (DLP), 7.8 mGy (CTDIvol), and 747 (DLP) mGy-cm, respectively. CONCLUSION Hospital 'A' irradiated patients with a higher dose for the abdomen exam than Hospital 'T', but both hospitals agreed on the amount of radiation dose received by patients for chest imaging. The proposed LDRL for two examinations was less than the DRL obtained from the literature.
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Affiliation(s)
- Amna Mohamed Ahmed
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Alamin Musa
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Afaf Medani
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mustafa Mahmoud
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Hamid Osman
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, 21944, Taif, Saudi Arabia.
| | - Mohammed Elsamani
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, 21944, Taif, Saudi Arabia
| | - Samih Kajoak
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, 21944, Taif, Saudi Arabia
| | - Salem Saeed Alghamdi
- Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Saudi Arabia
| | - Abdulrahman Tajaldeen
- Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Saudi Arabia
| | - Mohamed Y Hanfi
- Nuclear Materials Authority, P.O. Box 530 El-Maadi, Cairo, Egypt; Ural Federal University, St. Mira, 19, Yekaterinburg, 620002, Russia
| | - Mayeen Uddin Khandaker
- Applied Physics and Radiation Technologies Group, CCDCU, School of Engineering and Technology, Sunway University, Bandar Sunway, 47500, Malaysia; Daffodil International University, Daffodil Smart City, Birulia, Savar, Dhaka, 1216, Bangladesh
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Crooijmans J, Singh S, Naqshband M, Bruikman CS, Pinto-Sietsma SJ. Premature atherosclerosis: An analysis over 39 years in the Netherlands. Implications for young individuals in high-risk families. Atherosclerosis 2023; 384:117267. [PMID: 37758605 DOI: 10.1016/j.atherosclerosis.2023.117267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/16/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
Cardiovascular disease (CVD), especially atherosclerotic cardiovascular disease (ASCVD), is one of the most important disease problems in the world accounting for an estimated 18.6 million deaths globally. Although older individuals are more often affected, ASCVD event at a young age is of particular importance because of more healthy years lost. Therefore, it is important to identify young individuals correctly at risk of ASCVD events in an early stage. Unfortunately, current risk score algorithms underestimate ASCVD event risk at a younger age. Both coronary artery calcium scoring (CACs) and family history of premature ASCVD (FH-PASCVD) have emerged as reliable screening tools to be able to identify individuals at risk for ASCVD events. Positive FH-PASCVD is associated with higher absolute CAC scores in first-degree 'healthy' family members and the proportion of individuals above the CACs percentile threshold to warrant treatment is also higher as compared to the general population. Therefore, a positive FH-PASCVD identifies so-called high-risk families and adding CAC scoring within these families identifies individuals at increased risk for ASCVD events. In individuals from high-risk families with an elevated CAC score, ASCVD events can be prevented when treated with statins and aspirin. Therefore, we suggest assessing FH-PASCVD in young 'healthy' individuals as a first screening step and subsequently performing CAC scoring to be able to start treatment at an early stage, since not only the lower is better, but also the earlier is better.
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Affiliation(s)
- Juliette Crooijmans
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Sandeep Singh
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Massih Naqshband
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Caroline S Bruikman
- Department of Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Sara-Joan Pinto-Sietsma
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
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Lin WC, Chen CM, Westphalen AC, Lin TY, Chang CH, Chen LK, Lin CW, Yeh CC, Yu J, Jeng LB, Chen JH. Non-Contrast-Enhanced MR Arteriography of Potential Living-Related Liver Donor: Using Contrast Enhanced CT Arteriography as Standard Reference. J Magn Reson Imaging 2023; 58:894-904. [PMID: 36573963 DOI: 10.1002/jmri.28571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Contrast-enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the primary modalities to assess donors' vessels before transplant surgery. Radiation and contrast medium are potentially harmful to donors. PURPOSE To compare the image quality and visualization scores of hepatic arteries on CTA and balanced steady-state free-precession (bSSFP) non-contrast-enhanced MRA (NC-MRA), and to evaluate if bSSFP NC-MRA can potentially be a substitute for CTA. STUDY TYPE Prospective. POPULATION Fifty-six consecutive potential living-related liver donors (30.9 ± 8.4 years; 31 men). FIELD STRENGTH/SEQUENCE 1.5T; four bSSFP NC-MRA sequences: respiratory-triggered (Inhance inflow inversion recovery [IFIR]) and three breath-hold (BH); and CTA. ASSESSMENT The artery-to-liver contrast (Ca-l) was quantified. Three radiologists independently assigned visualization scores using a four-point scale to potential origins, segments, and branches of the hepatic arteries, determined the anatomical variants based on Hiatt's classification, and assessed the image quality of NC-MRA sequences. STATISTICAL TESTS Fleiss' kappa to evaluate the readers' agreement. Repeat measured ANOVA or Friedman test to compare Ca-l of each NC-MRA. Friedman test to compare overall image quality and visualization scores; post hoc analysis using Wilcoxon signed-rank test. P-value <0.05 was considered statistically significant. RESULTS Inhance IFIR Ca-l was significantly higher than all BH bSSFP Ca-l (0.56 [0.45-0.64] vs. 0.37 [0.29-0.47] to 0.41 [0.23-0.51]). Overall image quality score of BH bSSFP TI1200 was significantly higher than other NC-MRA (4 [4-4] vs. 4 [3 to 4-4]). The median visualization scores of almost all arteries on CTA were significantly higher than on NC-MRA (4 [3 to 4-4] vs. 1 [1-2] to 4 [4-4]). The median visualization scores were all 4 [4-4 ] on Inhance IFIR with >92.3% observed scores ≥3, except the segment 4 branch (3 [1-4], 53.6%). The identification rates of arterial variants were 92.9%-97% on Inhance IFIR. DATA CONCLUSIONS Although CTA is superior to the NC-MRA, all NC-MRA depict the donor arterial anatomy well. Inhance IFIR can potentially be an alternative image modality for CTA to evaluate the arterial variants of living donors. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Wei-Ching Lin
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
- Department of Biomedical Imaging and Radiological Science, School of Medicine, China Medical University, Taichung, Taiwan
- AI Innovation Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ming Chen
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Antonio Carlos Westphalen
- Departments of Radiology, Urology and Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Tzu-Yang Lin
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Chia Hao Chang
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Li-Kuang Chen
- Department of Family and Community Medicine, University of California, San Francisco, California, USA
| | - Chia-Wei Lin
- Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
- Department of Surgery, Asia University Hospital, Taichung, Taiwan
| | - Jiaxin Yu
- AI Innovation Center, China Medical University Hospital, Taichung, Taiwan
| | - Long-Bin Jeng
- Department of Surgery, Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Jeon-Hor Chen
- Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- Department of Radiological Sciences, University of California, Irvine, California, USA
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Dieckmeyer M, Sollmann N, Kupfer K, Löffler MT, Paprottka KJ, Kirschke JS, Baum T. Computed Tomography of the Head : A Systematic Review on Acquisition and Reconstruction Techniques to Reduce Radiation Dose. Clin Neuroradiol 2023; 33:591-610. [PMID: 36862232 PMCID: PMC10449676 DOI: 10.1007/s00062-023-01271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/24/2023] [Indexed: 03/03/2023]
Abstract
In 1971, the first computed tomography (CT) scan was performed on a patient's brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New technological developments, broader availability, and the clinical success of CT led to a steady growth in examination numbers. Most frequent indications for non-contrast CT (NCCT) of the head include the assessment of ischemia and stroke, intracranial hemorrhage and trauma, while CT angiography (CTA) has become the standard for first-line cerebrovascular evaluation; however, resulting improvements in patient management and clinical outcomes come at the cost of radiation exposure, increasing the risk for secondary morbidity. Therefore, radiation dose optimization should always be part of technical advancements in CT imaging but how can the dose be optimized? What dose reduction can be achieved without compromising diagnostic value, and what is the potential of the upcoming technologies artificial intelligence and photon counting CT? In this article, we look for answers to these questions by reviewing dose reduction techniques with respect to the major clinical indications of NCCT and CTA of the head, including a brief perspective on what to expect from current and future developments in CT technology with respect to radiation dose optimization.
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Affiliation(s)
- Michael Dieckmeyer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Karina Kupfer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian T. Löffler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Karolin J. Paprottka
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Huang ZH, Liu YY, Wu WJ, Huang KW. Design and Validation of a Deep Learning Model for Renal Stone Detection and Segmentation on Kidney-Ureter-Bladder Images. Bioengineering (Basel) 2023; 10:970. [PMID: 37627855 PMCID: PMC10452034 DOI: 10.3390/bioengineering10080970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Kidney-ureter-bladder (KUB) imaging is used as a frontline investigation for patients with suspected renal stones. In this study, we designed a computer-aided diagnostic system for KUB imaging to assist clinicians in accurately diagnosing urinary tract stones. The image dataset used for training and testing the model comprised 485 images provided by Kaohsiung Chang Gung Memorial Hospital. The proposed system was divided into two subsystems, 1 and 2. Subsystem 1 used Inception-ResNetV2 to train a deep learning model on preprocessed KUB images to verify the improvement in diagnostic accuracy with image preprocessing. Subsystem 2 trained an image segmentation model using the ResNet hybrid, U-net, to accurately identify the contours of renal stones. The performance was evaluated using a confusion matrix for the classification model. We conclude that the model can assist clinicians in accurately diagnosing renal stones via KUB imaging. Therefore, the proposed system can assist doctors in diagnosis, reduce patients' waiting time for CT scans, and minimize the radiation dose absorbed by the body.
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Affiliation(s)
- Zih-Hao Huang
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 807618, Taiwan; (Z.-H.H.); (Y.-Y.L.); (W.-J.W.)
| | - Yi-Yang Liu
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 807618, Taiwan; (Z.-H.H.); (Y.-Y.L.); (W.-J.W.)
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
| | - Wei-Juei Wu
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 807618, Taiwan; (Z.-H.H.); (Y.-Y.L.); (W.-J.W.)
| | - Ko-Wei Huang
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung City 807618, Taiwan; (Z.-H.H.); (Y.-Y.L.); (W.-J.W.)
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Jeyasugiththan J, Karunarathna S, Satharasinghe D, Hishaam U, Pallewatte A. Evaluation of radiation dose in multi-slice computed tomography protocols of head and neck regions. Radiat Prot Dosimetry 2023:ncad142. [PMID: 37103965 DOI: 10.1093/rpd/ncad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/01/2023] [Accepted: 04/05/2022] [Indexed: 06/19/2023]
Abstract
In head and neck computed tomography (CT) imaging, the optimisation of radiation dose is crucial due to the presence of radio-sensitive organs. This study aimed to evaluate the radiation dose in multi-slice CT for head and neck examinations. Volume CT dose index, dose length product and effective dose (E) were assessed for 10 head and neck CT scans performed on 292 adult patients (mean age 49.2 ± 15.9 y). The study resulted in median E values of 0.82, 1.62, 2.43, 0.93, 1.70, 0.83, 3.55, 6.25, 2.19 and 5.26 mSv, respectively, for sinuses (non-contrast (NC)), sinuses (NC) and contrast-enhanced (CE), petrous bone (PTB)/internal auditory meatus (IAM) (NC + CE), PTB/IAM (NC), orbit (NC + CE), orbit (NC), brain with the orbit (NC), brain CT angiography (CTA) subtraction, neck (NC) and brain/neck (NC). Furthermore, the overall radiation doses of this institution were found to be below the values suggested by similar studies. However, optimisation of the dose is required for brain CTA.
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Affiliation(s)
| | - Sanjaya Karunarathna
- Department of Nuclear Science, Faculty of Science, University of Colombo, Colombo 00300, Sri Lanka
- Department of Radiology, National Hospital of Sri Lanka, Colombo 00700, Sri Lanka
| | - Duminda Satharasinghe
- Department of Nuclear Science, Faculty of Science, University of Colombo, Colombo 00300, Sri Lanka
| | - Urshella Hishaam
- Department of Nuclear Science, Faculty of Science, University of Colombo, Colombo 00300, Sri Lanka
| | - Aruna Pallewatte
- Department of Radiology, National Hospital of Sri Lanka, Colombo 00700, Sri Lanka
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Radaideh K, Al-radaideh A, Ramli RM, Saleh A, Alshayeb R. Establishment of national diagnostic dose reference levels (DRLs) for routine computed tomography examinations in Jordan. Polish Journal of Medical Physics and Engineering 2023; 29:26-34. [DOI: 10.2478/pjmpe-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abstract
Background: Dose reference levels (DRLs) are used as indicators as well as guidance for dose optimization and to ensure justification of appropriate dose for a given clinical indication. The main aims of this study were to establish local DRLs for each CT imaging protocol as a reference point to evaluate the radiation dose indices and to compare our DRLs with those established in other countries and against the internationally reported guidelines.
Materials and methods: 2000 CT dose reports of different adult imaging protocols from January 2021 until April 2022 were collected retrospectively at different hospitals in Jordan. Data were collected from CT scans that were performed using different types and models of CT scanners and included four adult non-enhanced, helical CT imaging protocols; Head, Chest, Abdomen-Pelvis, and Chest-Abdomen-Pelvis.
Results: The average doses of CTDIvol, DLP, and effective dose were (65.11 mGy, 1232.71 mGy·cm, 2.83 mSv) for the head scan, (16.6 mGy, 586.6 mGy·cm, 8.21 mSv) for the chest scan, (17.91 mGy, 929.9 mGy·cm, 13.9 mSv) for the abdomen-pelvis scan, and (19.3 mGy, 1152 mGy·cm, 17.25 mSv) for the chest-abdomen-pelvis scan. In comparison with results from different international studies, DLP values measured in the present study were lower for the chest-abdomen-pelvis and abdomen-pelvis CT scans, and higher for the head CT and chest CT scans.
Conclusions: It is very important that each country establishes its own DRLs and compares them with those reported by other countries, especially the developed ones. It is also important that these levels are regularly updated.
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De Monte F, Sapignoli S, Laura Cortinovis A, Di Maggio A, Nardin M, Pizzirani E, Scagliori E, Volpe A, Paiusco M, Roggio A. Effectiveness of body size stratification for patient exposure optimization in Computed Tomography. Eur J Radiol 2023; 163:110804. [PMID: 37043885 DOI: 10.1016/j.ejrad.2023.110804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE To establish size-dependent DRL and to estimate the effectiveness of the size-dependent DRLs over size-independent DRLs for a CT exposure optimization process. METHODS The study included 16,933 adult CT body examinations of the most common CT protocols. Acquisitions were included following an image quality assessment. Patients were grouped into five different classes by means of the water equivalent diameter (Dw): 21 ≤ Dw < 25, 25 ≤ Dw < 29, 29 ≤ Dw < 33,33 ≤ Dw < 37 (in cm). CTDIvol, DLP, DLPtot. and SSDE median values were provided both for the sample as a whole (size-independent approach) and for each Dw class (size-dependent approach). The performance of the two approaches in classifying sub-optimal examinations was evaluated through the confusion matrix and Matthews Correlation Coefficient (MCC) metric. The 75th percentile of the CTDIvol distribution was arbitrarily chosen as a threshold level above which the acquisitions are considered sub-optimal. RESULTS CTDIvol, DLP, DLPtot and SSDE typical values (median values) are statistically different across Dw groups. The confusion matrix analysis suggests that size-independent DRL could not mark potential suboptimal protocols for small and large patients. The agreement between the size-dependent and size-independent methods is strong only for the most populous classes (MCC > 0.7). For small and large patients size-independent approach fails to identify as sub-optimal around 20 % of the acquisition (MCC≪0.2). CONCLUSIONS It was proven by means of the confusion matrix and MCC metric that stratifying DRLs by patient size, size-dependent DRL can be a powerful strategy in order to improve the dose optimization process shown that a size-independent DRL fails to identify sub-optimal examinations for small and large patients.
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Manava P, Galster M, Ammon J, Singer J, Lell MM, Rieger V. Optimized Camera-Based Patient Positioning in CT: Impact on Radiation Exposure. Invest Radiol 2023; 58:126-30. [PMID: 35926075 DOI: 10.1097/RLI.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate whether a 3-dimensional (3D) camera can outperform highly trained technicians in precision of patient positioning and whether this transforms into a reduction in patient exposure. MATERIALS AND METHODS In a single-center study, 3118 patients underwent computer tomography (CT) scans of the chest and/or abdomen on a latest generation single-source CT scanner supported with an automated patient positioning system by 3D camera. One thousand five hundred fifty-seven patients were positioned laser-guided by a highly trained radiographer (camera off) and 1561 patients with 3D camera (camera on) guidance. Radiation parameters such as effective dose, organ doses, CT dose index, and dose length product were analyzed and compared. Isocenter accuracy and table height were evaluated between the 2 groups. RESULTS Isocenter positioning was significantly improved with the 3D camera ( P < 0.001) as compared with visual laser-guided positioning. Absolute table height differed significantly ( P < 0.001), being higher with camera positioning (165.6 ± 16.2 mm) as compared with laser-guided positioning (170.0 ± 20.4 mm). Radiation exposure decreased using the 3D camera as indicated by dose length product (321.1 ± 266.6 mGy·cm; camera off: 342.0 ± 280.7 mGy·cm; P = 0.033), effective dose (3.3 ± 2.7 mSv; camera off: 3.5 ± 2.9; P = 0.053), and CT dose index (6.4 ± 4.3 mGy; camera off: 6.8 ± 4.6 mGy; P = 0.011). Exposure of radiation-sensitive organs such as colon ( P = 0.015) and red bone marrow ( P = 0.049) were also lower using the camera. CONCLUSIONS The introduction of a 3D camera improves patient positioning in the isocenter of the scanner, which results in a lower and also better balanced dose reduction for the patients.
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Liu YY, Huang ZH, Huang KW. Deep Learning Model for Computer-Aided Diagnosis of Urolithiasis Detection from Kidney-Ureter-Bladder Images. Bioengineering (Basel) 2022; 9. [PMID: 36551017 DOI: 10.3390/bioengineering9120811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Kidney-ureter-bladder (KUB) imaging is a radiological examination with a low cost, low radiation, and convenience. Although emergency room clinicians can arrange KUB images easily as a first-line examination for patients with suspicious urolithiasis, interpreting the KUB images correctly is difficult for inexperienced clinicians. Obtaining a formal radiology report immediately after a KUB imaging examination can also be challenging. Recently, artificial-intelligence-based computer-aided diagnosis (CAD) systems have been developed to help clinicians who are not experts make correct diagnoses for further treatment more effectively. Therefore, in this study, we proposed a CAD system for KUB imaging based on a deep learning model designed to help first-line emergency room clinicians diagnose urolithiasis accurately. A total of 355 KUB images were retrospectively collected from 104 patients who were diagnosed with urolithiasis at Kaohsiung Chang Gung Memorial Hospital. Then, we trained a deep learning model with a ResNet architecture to classify KUB images in terms of the presence or absence of kidney stones with this dataset of pre-processed images. Finally, we tuned the parameters and tested the model experimentally. The results show that the accuracy, sensitivity, specificity, and F1-measure of the model were 0.977, 0.953, 1, and 0.976 on the validation set and 0.982, 0.964, 1, and 0.982 on the testing set, respectively. Moreover, the results demonstrate that the proposed model performed well compared to the existing CNN-based methods and was able to detect urolithiasis in KUB images successfully. We expect the proposed approach to help emergency room clinicians make accurate diagnoses and reduce unnecessary radiation exposure from computed tomography (CT) scans, along with the associated medical costs.
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Tamam N, Sulieman A, Omer H, Toufig H, Alsaadi M, Salah H, Mattar EH, Khandaker MU, Bradley D. Assessment of breast dose and cancer risk for young females during CT chest and abdomen examinations. Appl Radiat Isot 2022; 190:110452. [DOI: 10.1016/j.apradiso.2022.110452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/01/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
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Dieckmeyer M, Sollmann N, Kupfer K, Löffler MT, Paprottka KJ, Kirschke JS, Baum T. Computed Tomography of the Spine. Clin Neuroradiol 2022. [DOI: 10.1007/s00062-022-01227-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022]
Abstract
AbstractThe introduction of the first whole-body CT scanner in 1974 marked the beginning of cross-sectional spine imaging. In the last decades, the technological advancement, increasing availability and clinical success of CT led to a rapidly growing number of CT examinations, also of the spine. After initially being primarily used for trauma evaluation, new indications continued to emerge, such as assessment of vertebral fractures or degenerative spine disease, preoperative and postoperative evaluation, or CT-guided interventions at the spine; however, improvements in patient management and clinical outcomes come along with higher radiation exposure, which increases the risk for secondary malignancies. Therefore, technical developments in CT acquisition and reconstruction must always include efforts to reduce the radiation dose. But how exactly can the dose be reduced? What amount of dose reduction can be achieved without compromising the clinical value of spinal CT examinations and what can be expected from the rising stars in CT technology: artificial intelligence and photon counting CT? In this article, we try to answer these questions by systematically reviewing dose reduction techniques with respect to the major clinical indications of spinal CT. Furthermore, we take a concise look on the dose reduction potential of future developments in CT hardware and software.
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Almaasfeh S, Salahudeen A, Salih M, Abukonna A. Estimation of effective and organ dose from chest CT. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nolan JE, Sundet AD, Kagan BD, Lake TJ, Krag MH, Lunardini DJ. The positive prediction of single photon emission computed tomography/ computed tomography (SPECT/CT) in the outcome of intervention for cervical facet pain. Spine J 2022; 22:1622-1627. [PMID: 35537654 DOI: 10.1016/j.spinee.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/28/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have reported that magnetic resonance imaging (MRI) and computed tomography (CT) do not predict response to facet blocks. However, single photon emission computed tomography (SPECT) uptake within facet joints has been shown to correlate with pain relief after intervention in the lumbar spine. There is minimal data regarding the predictive value of single photon emission computed tomography/computed tomography (SPECT/CT) for neck pain. PURPOSE The aim of this study was to evaluate the utility of SPECT/CT in patients with axial neck pain for the identification of specific facet joints that would benefit from diagnostic and therapeutic facet joint steroid injections and/or medial branch block/RFA treatments. STUDY DESIGN A retrospective cohort study. PATIENT SAMPLE One hundred seventy-nine patients at a single institution pain center with neck pain and a SPECT/CT scan between 2009 and 2015. One hundred twelve patients had no prior intervention at the level of interest and met inclusion criteria. OUTCOME MEASURES Pain reduction at 50% and 80% thresholds within 24 hours of facet intervention. Concordance of facet intervention with the focus of maximal uptake on SPECT/CT scan. METHODS All patients were referred to our institution's Center for Pain Medicine and were treated with facet interventions. The site of facet intervention was determined by pain center providers based on their clinical examination and interpretation of images. Groups were formed based on whether the facet intervention included the level of maximal uptake on SPECT/CT scan. A positive response to intervention was defined at both 50% and 80% thresholds for reduction in pain within 24 hours of facet injection with steroid and local anesthetic or medial branch block with local anesthetic only. These were the facet interventions used for our data collection. A Chi-square statistic was used to analyze categorical data and a Student's t-test was used to analyze non-categorical data. SPSS (IBM Corp. IBM SPSS Version 24.0) was used for all analyses. RESULTS Of our 112 patients, Group 1 consisted of 89 with an intervention occurring at the level with increased uptake on SPECT/CT. Group 2 consisted of 23 patients with an intervention at a level without uptake on SPECT/CT. Demographic data did not significantly differ between cohorts. A Chi-square test of independence demonstrated that intervention at a level concordant with SPECT/CT was significantly correlated with self-reported pain relief thresholds of both 50% and 80% (p=.0002). CONCLUSIONS Facet interventions based on SPECT/CT scan uptake were more successful in pain reduction than those which were not. This suggests a role for SPECT/CT in diagnosing therapeutic targets for neck pain.
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Affiliation(s)
- John E Nolan
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Alec D Sundet
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Benjamin D Kagan
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - Tiffini J Lake
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; Department of Anesthesiology, University of Vermont Medical Center, West Pavilion Level 2, 111 Colchester Ave, Burlington, VT 05401, USA
| | - Martin H Krag
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA
| | - David J Lunardini
- Department of Orthopaedics & Rehabilitation Robert T. Stafford Hall, University of Vermont Medical Center, 4th Floor, 95 Carrigan Drive, Burlington, VT 05405, USA; The Robert Larner, M.D. College of Medicine at The University of Vermont Given Medical Building, E-126, 89 Beaumont Ave, Burlington, VT 05405, USA.
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Elshami W, Abuzaid M, Joseph DZ, Tekin HO, Ghonim H. Development of acceptable quality radiation dose levels for common computed tomography examinations: A focused multicenter study in United Arab Emirates. Front Public Health 2022; 10:964104. [PMID: 36211693 PMCID: PMC9538773 DOI: 10.3389/fpubh.2022.964104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose Diagnostic Reference Level (DRL) is a practical tool for radiation dose optimization, yet it does not indicate the patient size or image quality. The Acceptable Quality Dose (AQD) introduced to address the limitations of the DRLs and it is based on image quality, radiation dose, and patient weight. The aim of this study is to establish the AQD for adult patients' undergoing Computed Tomography (CT) examinations (Head, chest, abdomen). Methods This study is conducted in the four main hospitals at the Ministry of Health and Prevention. Patient information and exposure parameters were extracted. All the acceptable images are scored for their quality assessments. Data is classified as seven weight groups, <50, 50-59, 60-69, 70-79, 80-89, 90-99, and ≥100 kg. The mean ± SD, median, and 75th are calculated for the CTDIvol and DLP for each weight group per examination. Results Out of 392, 358 CT examinations are scored with acceptable quality. The median CTDIvol values for the weight groups are obtained as 24.6, 25.4, 25.4, 25.0, 26.0, 27.0, and 29.0 mGy. Moreover, median DLP values are obtained as 576.7, 601.0, 616.5, 636.1, 654.0, 650.0, 780.0, and 622.5 mGy.cm, respectively, for head CT without Contrast Media (CM). Similar calculation for head CT with (CM), chest without CM, abdomen without CM, and chest and abdomen (with and without CM) CTs are presented. Conclusion Images with bad, unacceptable and higher than necessary qualities contribute to increasing patient dose and increasing the DRLs. The AQD for the selected examinations were lower than the proposed DRLs in the United Arab Emirates. The integration of image quality and patients size in the assessment of the AQD values provide effective model to compare radiation dose indices within facility and compare with others. The obtained results may be useful in terms of improving dose and the diagnostic quality in the national and international levels.
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Affiliation(s)
- Wiam Elshami
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates,*Correspondence: Wiam Elshami
| | - Mohamed Abuzaid
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Dlama Z. Joseph
- Department of Radiology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - H. O. Tekin
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates,Computer Engineering Department, Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, Turkey
| | - Hatem Ghonim
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Kawashima H, Ichikawa K, Takata T, Seto I. Comparative Assessment of Noise Properties for Two Deep Learning CT Image Reconstruction Techniques and Filtered Back Projection. Med Phys 2022; 49:6359-6367. [PMID: 36047991 DOI: 10.1002/mp.15918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Two deep-learning image reconstruction (DLIR) techniques from two different CT vendors have recently been introduced into clinical practice. PURPOSE To characterize the noise properties of two DLIR techniques with different training methods, using a phantom containing a simple uniform and a complex non-uniform region. METHODS A water-bath phantom with a diameter of 300 mm was used as a base phantom. A textured phantom with a diameter of 128 mm, which was made of two materials, one equivalent to water and the other being 12 mg/mL diluted iodine, irregularly mixed to create a complex texture (non-uniform region), was placed in the base phantom. Thirty repeated phantom scans were performed using two CT scanners (GE, Revolution CT with Apex Edition; Canon, Aquilion One PRISM Edition) at two dose levels (CTDI: 5 and 15 mGy). Images were reconstructed with each CT system's filtered back projection (FBP) and DLIR [GE, TrueFidelity (TF); Canon, Advanced intelligent Clear-IQ Engine Body Sharp (AC)] for three process strengths. For basic characteristics of noise, the standard deviation (SD) and noise power spectrum (NPS) were measured for the uniform (water) region. A noise magnitude map was generated by calculating the inter-image SD at each pixel position across the 30 images. Then, a noise reduction map (NRM), which visualizes the relative differences in noise magnitude between FBP and DLIR, was calculated. The NRM values ranged from 0.0 to 1.0. A low NRM value represents a less aggressive noise reduction. The histograms of the NRM value were analyzed for the uniform and non-uniform regions. RESULTS The reduction in noise magnitude compared with FBP tended to be greater with AC (45%-85%) than with TF (32%-65%). The average NPS frequencies of TF and AC were almost comparable to those of FBP, except for the low-dose condition and the high noise reduction strength for AC. The NRM values of TF and AC were higher in the uniform region than in the non-uniform region. In the non-uniform region, TF's average NRM values (0.21-0.48) tended to be lower than AC's (0.39-0.78). The histograms for TF showed a small overlap between the uniform and the non-uniform regions; in contrast, those for AC showed a greater overlap. This difference seems to indicate that TF processes the uniform and non-uniform regions more differently than AC does. CONCLUSION This study has revealed a distinct difference in characteristics between the two DLIR techniques: TF tends to offer less aggressive noise reduction in non-uniform regions and preserve the original signals, whereas AC tends to prioritize noise filtering over edge-preservation, especially at the low-dose condition and with the high noise reduction strength. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hiroki Kawashima
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Katsuhiro Ichikawa
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | | | - Issei Seto
- Department of Radiological Technology, Mitsubishi Kyoto Hospital
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Sulieman A, Tamam N, Elnour A, Alkhorayef M, Babikir E, Al-Mohammed H, Abuhadi N, Khandaker MU, A.Bradley D. Effective radiation dose and radiogenic cancer risk during contrast enhanced abdominal computed tomography examinations. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Almujally A, Tamam N, Sulieman A, Doung TT, Omer H, Abuhadi N, Salah H, Mattar E, Khandaker MU, Bradley D. Evaluation of paediatric computed tomography imaging for brain, abdomen procedures. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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22
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Osman H, Alosaimi M, Alghamdi F, Aljuaid A, Alqurashi M, Aldajani S, Faizo NL, Alamri S, Althobaiti YS, Khandaker MU, Suleiman A. Evaluation of CT dose and establishment of local DRLs for abdomen and pelvis examinations in hospitals in Taif City, Saudi Arabia. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Buono M, Capussela T, Loffredo F, Di Pasquale MA, Serra M, Quarto M. Dose-Tracking Software: A Retrospective Analysis of Dosimetric Data in CT Procedures. Health Phys 2022; 122:548-555. [PMID: 35244621 DOI: 10.1097/hp.0000000000001524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT The increasing use of ionizing radiation in healthcare is causing growing alarm about radiation protection of patients and the doses they receive during procedures. Radiation dose assessment for patients in radiodiagnostic procedures is the subject of interest in view of the recent Italian D.Lgs 31 July 2020, n. 101 (Decreto Legislativo 31 luglio 2020, n. 101) and one of its most important focuses is the prescription to provide patient exposure information as an integral part of the examination report. Dose monitoring systems are therefore essential for the collection of the dosimetric data. In order to analyse potential and critical issues of these software, different systems, adopted at the Antonio Cardarelli Hospital in Naples, were employed. Data extracted from the DoseWatch software (GE Healthcare) and Gray Detector (EL.CO. S.r.l. Healthcare Solutions, Italy) and relating to several protocols adopted for computed tomography (CT), were retrospectively analysed for the purpose of identifying critical issues in the data acquisition and recording phase, comparing with Italian nationwide diagnostic reference levels (DRLs), as provided for in regulatory provisions for radiation safety. Multiphase examinations were also included in this study. Once the distributions of volumetric CT Dose Index (CTDIvol) and dose-length product (DLP) were determined for each acquisition phase and total DLP (DLPtot) for each examination, the 25th, 50th and 75th percentiles were calculated for each distribution and then compared with the relevant Italian nationwide DRLs. In addition, to improve protocol optimization and dose reduction the magnitude of the CT acquisition settings chosen in each procedure was evaluated. In conclusion, these systems allow accurate analysis of radiation dose according to equipment and protocol over time. For the application of optimization measures, a constant use of the dose tracking software is required, which can be translated into actions on scan parameters and prospective data analysis.
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Affiliation(s)
- Mauro Buono
- School of Specialization in Medical Physics, University of Naples Federico II, Naples
| | | | - Filomena Loffredo
- Advanced Biomedical Science Department, University of Naples Federico II, Naples, Italy
| | | | - Marcello Serra
- School of Specialization in Medical Physics, University of Naples Federico II, Naples
| | - Maria Quarto
- Advanced Biomedical Science Department, University of Naples Federico II, Naples, Italy
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Martin CJ, Barnard M. How much should we be concerned about cumulative effective doses in medical imaging? J Radiol Prot 2022; 42:011514. [PMID: 34673564 DOI: 10.1088/1361-6498/ac31c1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Abstract
The International Atomic Energy Agency issued a statement calling for action to strengthen the radiation protection of patients undergoing recurrent imaging. This followed reports of patients receiving cumulative effective doses over 100 mSv from multiple computed tomography examinations. In order to evaluate excess risks of cancer incidence among UK patients, data from an exposure management system covering three hospitals within one trust have been studied over 5½ years. Cumulative effective doses for 105 757 patients, from whom 719 (0.68%) received effective dose over 100 mSv, have been analysed using age and sex specific risk factors for stochastic effects. Two cancers might be expected to be initiated in the patients receiving over 100 mSv, while five might be expected to develop cancer among patients receiving 50-100 mSv. However, the calculations ignore health conditions for which the patients are being treated that may shorten their lives, and rely on the linear-no-threshold dose-effect model which is a subject of debate, so they are likely to overestimate cancer incidence. If health of the patients receiving >100 mSv is taken into account, the risk of mortality from cancer initiated by medical exposure might be the order of 1 in 2000. Recommendations on further strengthening of optimisation should be applied to imaging procedures for all patients with special focus on those performed on children and adolescents.
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Affiliation(s)
- Colin J Martin
- Department of Clinical Physics and Bioengineering, University of Glasgow, Gartnaval Royal Hospital, Glasgow, United Kingdom
| | - Michael Barnard
- Department of Radiation Physics and Protection, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Wang Y, Tancredi DJ, Miglioretti DL. Marginal indirect standardization using latent clustering on multiple hospitals. Stat Med 2021; 41:554-566. [PMID: 34866217 DOI: 10.1002/sim.9272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 11/07/2022]
Abstract
A method was introduced in 2018 of performing indirect standardization for hospital profiling when only the marginal distributions of confounding variables are observed for the index hospital but the full joint covariate distribution is available for the reference hospitals (Wang et al, J Am Stat Assoc 2018; 114:662-630). The method constructs a synthetic comparison hospital using a weighted combination of reference hospitals, with weights assumed to follow a Dirichlet distribution with equal concentration parameters. In this article, we propose a novel method that improves upon the approach in a previous study (Wang et al, J Am Stat Assoc 2018; 114:662-630), by assuming the existence of latent classes among reference hospitals to allow for unequal Dirichlet concentration parameters. The latent class memberships, and thus the hospital weights, are informed by hospital-level characteristics. Our new method results in less biased point estimates and narrower uncertainty intervals for the standardized incidence ratio compared with the existing approach. We show the superiority of our novel methods in an application to a study on prevalence of high-radiation computed tomography exams, as well as in a simulation of the same medical context.
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Affiliation(s)
- Yifei Wang
- Phili R. Lee Institute for Health Policy Studies, University of California, San Francisco, California
- Department of Statistics, University of California, Davis, California
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, California
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, California
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Suliman II, Bashier EH, Awad M, Ahmed I, Mohamed S, Ahmed NA. NATIONAL DIAGNOSTIC REFERENCE LEVELS AND ACHIEVABLE DOSES FOR STANDARD CT EXAMINATIONS IN SUDAN. Radiat Prot Dosimetry 2021; 196:1-9. [PMID: 34415339 DOI: 10.1093/rpd/ncab123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/14/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
Radiation doses were determined to propose national diagnostic reference levels (NDRLs) and achievable doses (ADs) for computed tomography (CT) examinations in Sudan. Doses were estimated from retrospectively collected scan parameters for 1336 CT examinations of adult patients from 14 Sudanese hospitals using CT Expo 2.5 software. ADs and NDRLs were set at the 50th and 75th percentile of the hospital median dose distribution, respectively. The proposed CTDIvol (mGy) ADs ranged from: 10 (chest) to 64 (head), and that of the dose-length product (DLP; mGy.cm) ranged from 366 (chest) to 1225 (head). The proposed CTDIvol (mGy) NDRLs ranged from 15 kidney-ureter-bladder (KUB) to 79 (head), whereas that of the DLP (mGy.cm) ranged from 690 (chest) to 1490 (head). Current doses fell within the upper range of the doses presented in the literature emphasizing the need for implementation of the current ADs and NDRLs for CT to enhance patient protection and dose optimization in Sudan.
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Affiliation(s)
- I I Suliman
- Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Department of Physics, Riyadh 11642, Saudi Arabia
- Sudan Atomic Energy Commission, Radiation and Nuclear Safety Institute, PO Box 3001, Khartoum, Sudan
| | - Einas H Bashier
- Sudan Atomic Energy Commission, Radiation and Nuclear Safety Institute, PO Box 3001, Khartoum, Sudan
| | - Mustafa Awad
- Sudan Atomic Energy Commission, Radiation and Nuclear Safety Institute, PO Box 3001, Khartoum, Sudan
| | - Ibrahim Ahmed
- Sudan Atomic Energy Commission, Radiation and Nuclear Safety Institute, PO Box 3001, Khartoum, Sudan
| | - Suhair Mohamed
- Sudan Atomic Energy Commission, Radiation and Nuclear Safety Institute, PO Box 3001, Khartoum, Sudan
| | - Nada A Ahmed
- Sudan Atomic Energy Commission, Radiation and Nuclear Safety Institute, PO Box 3001, Khartoum, Sudan
- Taibah University, Faculty of Science, P.O. Box 344, Al-Madinah, Saudi Arabia
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Salah H, Rabbaa M, Abuljoud M, Sulieman A, Alkhorayef M, Tamam N, Bradley D. Evaluation of patients radiation dose in computed tomography paranasal sinuses in children. Radiat Phys Chem Oxf Engl 1993 2021; 188:109695. [DOI: 10.1016/j.radphyschem.2021.109695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Alzimami K, Sulieman A, Omer H, Jambi LK, Alfuraih A, Al Hossain N, Babikir E, Alkhorayef M, Khandaker MU, Bradley D. Evaluation of pediatric radiation doses in computed tomography procedures in the Kingdom of Saudi Arabia. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sundararajan SH, Cox M, Sedora-Roman N, Ranganathan S, Hurst R, Pukenas B. Image-Guided Percutaneous Calvarial Biopsy with Low-Dose CT-Fluoroscopy: Technique, Safety, and Utility in 12 Patients. Cardiovasc Intervent Radiol 2022; 45:134-6. [PMID: 34561738 DOI: 10.1007/s00270-021-02974-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
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Cohen SL, Wang JJ, Chan N, Austin McCandlish J, Feizullayeva C, Cronin PP, Barish M, O'Connell W, Sanelli P. CT pulmonary angiography in pregnancy: Specific conversion factors to estimate effective radiation dose from dose length product: A retrospective cross-sectional study across a multi-hospital integrated healthcare network. Eur J Radiol 2021; 143:109908. [PMID: 34481118 DOI: 10.1016/j.ejrad.2021.109908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/28/2021] [Accepted: 08/08/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Effective dose describes radiation-related cancer risk from CT scans and is estimated using a readily available conversion factor (k-factor), which varies by body part and study type. To purpose of this study is to determine the specific k-factor for CTPA in pregnant patients and its predictive factors. METHODS This retrospective cross-sectional study evaluates CTPA in pregnancy across a multihospital integrated healthcare network from January 2012 to April 2017. Patient and CTPA-related data were obtained from the electronic health record and a radiation dose index monitoring system. Each patient's effective dose was determined by patient-specific Monte-Carlo simulation with Cristy phantoms and divided by patient dose-length-product to determine the k-factor. K-factor for pregnant patients was compared to the k-factor for adults of standard physique with a one-sample t-test. Bivariate and multivariable analyses were performed for patient and CT predictors of k-factor. RESULTS A total of 534 patients were included. The mean k-factor for all patients was 0.0249 (mSv·mGy-1·cm-1), 78% greater than k-factor of 0.014 (p < 0.001) suggested for the general adult population. Multivariable analysis demonstrated lower k-factors with increasing pitch (p = 0.0002), patient size (p < 0.001), and scan length (p < 0.0001). The 120 kVp (p < 0.001) and 140 kVp (p = 0.0028) analyses showed a larger k-factor than 80 and 100 kVp studies combined. CONCLUSIONS Specific k-factor for CTPA in pregnant patients is greater than the previously used generic chest CT k-factor and should be used to estimate the effective dose for CTPA exams in pregnancy.
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Affiliation(s)
- Stuart L Cohen
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States.
| | - Jason J Wang
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Nicholas Chan
- Department of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - John Austin McCandlish
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States; Georgia Institute of Technology, Atlanta, GA, United States
| | - Chinara Feizullayeva
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
| | - Paul P Cronin
- Emory University Hospital Department Of Radiology and Imaging Science, Atlanta, GA, United States
| | - Matthew Barish
- North Shore University Hospital/Northwell Health, Department of Radiology, Manhasset, NY, United States
| | - William O'Connell
- North Shore University Hospital/Northwell Health, Department of Radiology, Manhasset, NY, United States
| | - Pina Sanelli
- Imaging Clinical Effectiveness and Outcomes Research (ICEOR), Department of Radiology, Northwell Health, Manhasset, NY, United States; Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, United States
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Zewdu M, Kadir E, Tesfaye M, Berhane M. ESTABLISHING LOCAL DIAGNOSTIC REFERENCE LEVELS FOR ROUTINE COMPUTED TOMOGRAPHY EXAMINATIONS IN JIMMA UNIVERSITY MEDICAL CENTER SOUTH WEST ETHIOPIA. Radiat Prot Dosimetry 2021; 193:200-206. [PMID: 33866377 DOI: 10.1093/rpd/ncab028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/18/2020] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
The main purpose of this study was to determine local diagnostic reference level (LDRL) for Routine Computed Tomography (CT) examination in, Jimma University Medical Center (JUMC) South West Ethiopia. Retrospective study was conducted to determine LDRL for routine CT examination in JUMC. We have considered CTDIvol and DLP as dosimetric quantity based on the recommended guidelines to determine LDRLs by different international legal Authorities. The 75th percentile values of the calculated CTDIvol and DLP were proposed as LDRL. LDRL was obtained as CTDIvol, 42.97mGy, 7.76mGy, 14.32mGy, and 10.86mGy for routine brain CT, routine chest CT, routine thoraco-lumbar CT and routine abdomen CT examination respectively. Similarly the determined LDRL from DLP was 1364.15mGycm, 368.96mGycm, 853.18mGycm, and 1568.96mGycm for brain, chest, thoraco-lumbar and abdomen examination respectively. The LDRL obtained for DLP was higher compared with international DRLs; it can be reduced by coordinating effort between radiologists, technologists and medical physicist.
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Affiliation(s)
- Mesfin Zewdu
- Medical Physicist, Jimma University Radiology Department, PO Box 378, Jimma, Ethiopia
| | - Elias Kadir
- Medical Physicist, Jimma University Radiology Department, PO Box 378, Jimma, Ethiopia
| | - Million Tesfaye
- Medical Physicist, Jimma University Radiology Department, PO Box 378, Jimma, Ethiopia
| | - Melkamu Berhane
- Medical Physicist, Jimma University Radiology Department, PO Box 378, Jimma, Ethiopia
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Kharita MH, AlNaemi H, Kini V, Alkhazzam S, Rehani MM. Development of image quality related reference doses called acceptable quality doses (AQD) in paediatric CT exams in Qatar. Eur Radiol 2021; 31:3098-3105. [PMID: 33175202 PMCID: PMC8043894 DOI: 10.1007/s00330-020-07375-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/10/2020] [Accepted: 10/05/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To describe first experience of integrating assessment of image quality in paediatric X-ray computed tomography (CT) with analysis of the radiation dose indices to develop reference doses called acceptable quality dose (AQD). METHODS Image quality was scored by the radiologists at a tertiary care hospital in Qatar on a scale of 0 to 4 using the recently published scoring criteria. The patients undergoing head, chest and abdomen CT were divided in different weight groups as follows: < 5 kg, 5-< 15 kg, 15-< 30 kg, 30-< 50 kg, 50-< 80 kg and > 80 kg. The images that were clinically acceptable (score of 3) were included for assessment of median values of CTDIvol and DLP to obtain AQDs in different weight groups. RESULTS After initial training in image quality scoring of CT images of 49 patients by three radiologists, the study on 715 patients indicated 665 studies (93%) were clinically acceptable as per scoring criteria. The median CTDIvol values for the above weight groups were 16, 20, 22, 22, 27 and 27 mGy and the median DLP values for these weight groups were 271, 377, 463, 486, 568 and 570 mGy cm, respectively, for head CT. Similar values are presented for chest and abdomen CTs. CONCLUSIONS The first ever experience of starting with image quality assessment and integrating it with analysis of dose indices to obtain AQD values shall provide a workable model for others and values for comparison within the facility and in other facilities leading to optimisation. KEY POINTS • The first study to integrate image quality assessment with analysis of patient dose indices shows feasibility for routine practice in other centres. • The values of acceptable quality dose (AQD) were provided for head, chest and abdomen CT of children divided into weight groups rather than age. They shall act as reference values for future studies. • Verification of our findings on proportional increase in exposure parameters (CTDIvol and DLP) with weight by other investigators shall be helpful.
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Affiliation(s)
- Mohammad Hassan Kharita
- Hamad Medical Corporation, Occupational Health and Safety, Radiation Safety Section, Doha, Qatar.
| | - Huda AlNaemi
- Hamad Medical Corporation, Occupational Health and Safety, Radiation Safety Section, Doha, Qatar
| | - Vishwanatha Kini
- Hamad Medical Corporation, Occupational Health and Safety, Radiation Safety Section, Doha, Qatar
| | - Shady Alkhazzam
- Hamad Medical Corporation, Occupational Health and Safety, Radiation Safety Section, Doha, Qatar
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Sulieman A, Adam H, Elnour A, Tamam N, Alhaili A, Alkhorayef M, Alghamdi S, Khandaker MU, Bradley D. Patient radiation dose reduction using a commercial iterative reconstruction technique package. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.108996] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Atlı E, Uyanık SA, Öğüşlü U, Çevik Cenkeri H, Yılmaz B, Gümüş B. Radiation doses from head, neck, chest and abdominal CT examinations: an institutional dose report. Diagn Interv Radiol 2021; 27:147-151. [PMID: 33475510 PMCID: PMC7837727 DOI: 10.5152/dir.2020.19560] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to obtain typical values for head, neck, chest, and abdominal computed tomography (CT) examinations from routine patients in 2018, and to review our data with national and international diagnostic reference levels (DRLs). METHODS Single-phase head, neck, chest, and abdominal CT scans of adults performed in 64-slice CT in 2018 were included in this study. Radiation dose parameters of CT scans were obtained from the picture archiving and communication system of our hospital. Volumetric CT dose index (CTDIvol) and dose length product (DLP) values were recorded. Effective dose (ED) and scan length was calculated. A 16 cm diameter phantom is referenced for head CT, and 32 cm diameter phantom is referenced for neck, chest, and abdominal CT. Descriptive statistics of the variables were given according to the normality testing. RESULTS Median CTDIvol value was 53 mGy for the head, 13.1 mGy for the neck, 8.3 mGy for the chest, and 8.6 mGy for the abdomen. Median DLP value was 988 mGy.cm for the head, 299 mGy.cm for the neck, 314 mGy.cm for the chest, and 457 mGy.cm for the abdomen. Median ED value was 2.07 mSv for the head, 1.76 mSv for the neck, 4.4 mSv for the chest, and 6.8 mSv for the abdomen. Considering national DRLs, median CTDIvol values of head, chest, and abdomen were lower, whereas median DLP and ED values of head and chest were higher. For the abdomen, the median DLP and ED values were lower. CONCLUSION Overall radiation dose parameters obtained in this study points out the need for optimization of head CT examinations in our institution.
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Affiliation(s)
- Eray Atlı
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Sadık Ahmet Uyanık
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Umut Öğüşlü
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Halime Çevik Cenkeri
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Birnur Yılmaz
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
| | - Burçak Gümüş
- From the Department of Radiology (E.A. ), Okan University Hospital, İstanbul, Turkey
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Sun R, Ammari S, Bockel S, Achkar S, Merad M, Dercle L, Rivera S, Chargari C, Deutsch E. Optimization of Patient Management During the COVID-19 Pandemic: Chest CT Scan and PCR as Gatekeepers of the Radiation Therapy Workflow. Front Oncol 2020; 10:556334. [PMID: 33312944 PMCID: PMC7708327 DOI: 10.3389/fonc.2020.556334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Roger Sun
- Gustave Roussy, Département de Radiothérapie, INSERM 1030, Université Paris-Saclay, Villejuif, France
| | - Samy Ammari
- Gustave Roussy, Département d'Imagerie Médicale, Université Paris-Saclay, Villejuif, France
| | - Sophie Bockel
- Gustave Roussy, Département de Radiothérapie, INSERM 1030, Université Paris-Saclay, Villejuif, France
| | - Samir Achkar
- Gustave Roussy, Département de Radiothérapie, INSERM 1030, Université Paris-Saclay, Villejuif, France
| | - Mansouria Merad
- Gustave Roussy, Département d'Oncologie Médicale, Université Paris-Saclay, Villejuif, France
| | - Laurent Dercle
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Sofia Rivera
- Gustave Roussy, Département de Radiothérapie, INSERM 1030, Université Paris-Saclay, Villejuif, France
| | - Cyrus Chargari
- Gustave Roussy, Département de Radiothérapie, INSERM 1030, Université Paris-Saclay, Villejuif, France
| | - Eric Deutsch
- Gustave Roussy, Département de Radiothérapie, INSERM 1030, Université Paris-Saclay, Villejuif, France
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Ghetti C, Ortenzia O, Maddalo M, Altabella L, Sverzellati N. Dosimetric and radiation cancer risk evaluation of high resolution thorax CT during COVID-19 outbreak. Phys Med 2020; 80:119-124. [PMID: 33171381 PMCID: PMC7604119 DOI: 10.1016/j.ejmp.2020.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/12/2020] [Accepted: 10/22/2020] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The aim of this work was to evaluate the dosimetric impact of high-resolution thorax CT during COVID-19 outbreak in the University Hospital of Parma. In two months we have performed a huge number of thorax CT scans collecting effective and equivalent organ doses and evaluating also the lifetime attributable risk (LAR) of lung and other major cancers. MATERIALS AND METHOD From February 24th to April 28th, 3224 high-resolution thorax CT were acquired. For all patients we have examined the volumetric computed tomography dose index (CTDIvol), the dose length product (DLP), the size-specific dose estimate (SSDE) and effective dose (E103) using a dose tracking software (Radimetrics Bayer HealthCare). From the equivalent dose to organs for each patient, LAR for lung and major cancers were estimated following the method proposed in BEIR VII which considers age and sex differences. RESULTS Study population included 3224 patients, 1843 male and 1381 female, with an average age of 67 years. The average CTDIvol, SSDE and DLP, and E103 were 6.8 mGy, 8.7 mGy, 239 mGy·cm and 4.4 mSv respectively. The average LAR of all solid cancers was 2.1 cases per 10,000 patients, while the average LAR of leukemia was 0.2 cases per 10,000 patients. For both male and female the organ with a major cancer risk was lung. CONCLUSIONS Despite the impressive increment in thoracic CT examinations due to COVID-19 outbreak, the high resolution low dose protocol used in our hospital guaranteed low doses and very low risk estimation in terms of LAR.
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Affiliation(s)
- C Ghetti
- Department of Medical Physics, University Hospital of Parma, Italy
| | - O Ortenzia
- Department of Medical Physics, University Hospital of Parma, Italy.
| | - M Maddalo
- Department of Medical Physics, University Hospital of Parma, Italy
| | - L Altabella
- Department of Medical Physics, University Hospital of Parma, Italy
| | - N Sverzellati
- Department of Medicine and Surgery, Division of Radiology, University of Parma, Italy
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Al-Senan R, Brown K, Erdman M, King S. The uncertainty of thyroid dose estimate in chest CT. Biomed Phys Eng Express 2020; 6. [DOI: 10.1088/2057-1976/abb8f3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022]
Abstract
Abstract
Dose to the thyroid from helical chest CT can vary significantly due to the random tube start point, pitch factor, thyroid position relative to the isocenter, and beam width. We used optically stimulated luminescence dosimeters (OSLDs) and an adult anthropomorphic phantom to investigate the uncertainty of thyroid dose estimate. Maximum gap or overlap in the helical beam was estimated using the above factors. Using the maximum gap/overlap over the thyroid, different possible scenarios were simulated and the degree of missed thyroid tissue by the primary beam was estimated. Results showed a variation of >30% in the average thyroid dose, and >50% if a single dosimeter was used to determine dose to the thyroid. Furthermore, measured doses were compared to those calculated by Monte Carlo simulation software, which automatically matches the anatomy of the localizer radiograph with the stylized computational phantom used for dose calculation. The difference was significant: the dose given by the Monte Carlo software was ∼50% lower than the average dose measured with the phantom in all three chest protocols. In addition, the software does not take the effect of the random tube start angle into account.
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Yang CC. Evaluation of Impact of Factors Affecting CT Radiation Dose for Optimizing Patient Dose Levels. Diagnostics (Basel) 2020; 10:E787. [PMID: 33028021 PMCID: PMC7600150 DOI: 10.3390/diagnostics10100787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 11/16/2022] Open
Abstract
The dose metrics and factors influencing radiation exposure for patients undergoing head, chest, and abdominal computed tomography (CT) scans were investigated for optimization of patient dose levels. The local diagnostic reference levels (DRLs) of adult CT scans performed in our hospital were established based on 28,147 consecutive examinations, including 5510 head scans, 9091 chest scans, and 13,526 abdominal scans. Among the six CT scanners used in our hospital, four of them are 64-slice multi-detector CT units (MDCT64), and the other two have detector slices higher than 64 (MDCTH). Multivariate analysis was conducted to evaluate the effects of body size, kVp, mAs, and pitch on volume CT dose index (CTDIvol). The local DRLs expressed in terms of the 75th percentile of CTDIvol for the head, chest, and abdominal scans performed on MDCT64 were 59.32, 9.24, and 10.64 mGy, respectively. The corresponding results for MDCTH were 57.90, 7.67, and 9.86 mGy. In regard to multivariate analysis, CTDIvol showed various dependence on the predictors investigated in this study. All regression relationships have coefficient of determination (R2) larger than 0.75, indicating a good fit to the data. Overall, the research results obtained through our workflow could facilitate the modification of CT imaging procedures once the local DRLs are unusually high compared to the national DRLs.
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Affiliation(s)
- Ching-Ching Yang
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Medical Research, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung 80708, Taiwan
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Garba I, Zarb F, McEntee MF, Fabri SG. Computed tomography diagnostic reference levels for adult brain, chest and abdominal examinations: A systematic review. Radiography (Lond) 2021; 27:673-81. [PMID: 32948454 DOI: 10.1016/j.radi.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/16/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Radiation dose variation within and among Computed Tomography (CT) centres is commonly reported. This work systematically reviewed published articles on adult Diagnostic Reference Levels (DRLs) for the brain, chest and abdomen to determine the causes and extent of variation. A systematic literature search and review was performed in selected databases containing leading journals in radiography, radiology and medical physics using carefully defined search terms related to CT and DRLs. The quality of the included articles was determined using the Effective Public Health Practise Project tool for quantitative studies. KEY FINDINGS The 54 articles reviewed include: 45 studies using human data, 8 studies using phantom data, and one study with both human and phantom data. The main comparator in between studies was the dose indices used in reporting DRLs. DRL variations of up to a factor of 2 for the same procedure were noted in phantom studies, and up to a factor of 3 in human studies. Sources of variation include the type of scanner, the age of the scanner, differences in protocols, variations in patients, as well as variations in study design. Different combinations of dose indices were reported: volume computed tomography dose index (CTDIvol) and dose length product (DLP) (59%); DLP only (11%); weighted computed tomography dose index (CTDIw) and DLP (9%); CTDIvol only (7%); CTDIvol, DLP and effective dose (ED) (6%); CTDIw only (4%); CTDIvol, DLP and size specific dose estimate (SSDE) (1%) and CTDIw, CTDIvol and DLP (1%). The use of different dose indices limited dose comparison between studies. CONCLUSION The study noted a 2-3 fold variation in DRLs between studies for the same procedure. The causes of variation are reported and include study design, scanner technology and the use of different dose indices. IMPLICATIONS FOR PRACTICE There is a need for standardisation of CT DRLs in line with the International Commission on Radiological Protection recommendations to reduce dose variation and facilitate dose comparison.
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Georgiades CS. Another Milestone for Cryoablation on Its Way to Becoming the Standard of Care for Stage T1A Renal Cell Carcinoma. Radiology 2020; 296:696-697. [PMID: 32639195 DOI: 10.1148/radiol.2020202037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christos S Georgiades
- From the Department of Radiology, Johns Hopkins Hospital, 1800 Orleans St, Zayed s7203, Baltimore, MD 21287
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Tang S, Zhang G, Chen Z, Liu X, Fan X, Liu D, He L. Application of multiple injections of contrast agent in head and neck CT arteriovenous angiography in children: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19773. [PMID: 32282739 PMCID: PMC7220194 DOI: 10.1097/md.0000000000019773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the application value of multiple injections of contrast agent in head and neck CT arteriovenous angiography in children. METHODS A total of 100 children aged 6 to 7 years who needed head and neck CT arteriovenous angiography were prospectively selected. They were randomly divided into a control group and a research group, with 50 children in each group. The same scanning parameters and reconstruction methods were used. The right median cubital vein was injected intravenously with the contrast agent Omnipaque (350 mg I/ml). For children in the control group, a bolus of undiluted contrast agent (dose was 2 ml/kg, upper limit was 50 ml) was injected 1 time. The arterial phase and vein phase of the head and neck vessels were scanned. For children in the research group, a contrast agent bolus diluted with saline to a concentration of 20% was first injected (dose was 1 ml/kg, upper limit was 25 ml), and then an undiluted contrast agent bolus (dose was 1 ml/kg, upper limit was 25 ml) was injected. Thresholds were used to trigger the scanning of the head and neck arterial phases. The CT image quality of the head and neck arteries and veins, radiation dose and contrast agent dose were compared between the 2 groups. RESULTS Subjective evaluation of CT image quality of arteries: there were 47 cases of 4 points and 3 cases of 3 points in the control group and 34 cases of 4 points and 16 cases of 3 points in the research group. Subjective evaluation of CT image quality of veins: there were 47 cases of 4 points and 3 cases of 3 points in the control group and 5 cases of 4 points, 42 cases of 3 points and 3 cases of 2 points in the research group. The CT value of brain arterial vessel enhancement was higher in the control group than the research group, and the difference was statistically significant (P < .05). The CT value of vein enhancement was higher in the control group than the research group, and the difference was statistically significant (P < .05). The X-ray dose in the research group was 51% lower than that in the control group; the contrast agent dose in the research group was 44% lower than that in the control group. CONCLUSION For the head and neck enhanced CT examination of children, the method of first bolus injection of 20% diluted contrast agent and later bolus injection of undiluted contrast agent can clearly demonstrate the head and neck arteries and veins one time, reducing the X-ray dose and contrast agent dose, which has clinical practical value in the enhanced CT examination of children with head and neck disease.
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Affiliation(s)
| | - Guanping Zhang
- National Clinical Research Center for Child Health and Disorders
| | - Zhuo Chen
- Department of Radiology
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xianfan Liu
- Ministry of Education Key Laboratory of Child Development and Disorders
| | - Xiao Fan
- China International Science and Technology Cooperation base of Child development and Critical Disorders
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Abstract
STUDY DESIGN A prospective, case-based, observational study. OBJECTIVES To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery. METHODS In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation. RESULTS AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0.28 mm) resulted in a reliable AR representation with a close matching of visualized objects and reality, distinctly supporting anatomical orientation in the surgical field. Flexible AR visualization applying either the microscope HUD or video superimposition, including the ability to selectively activate objects of interest, as well as different display modes allowed a smooth integration in the surgical workflow, without disturbing the actual procedure. On average, 7.1 ± 4.6 objects were displayed visualizing target and risk structures reliably. CONCLUSIONS Microscope-based AR can be applied successfully to various kinds of spinal procedures. AR improves anatomical orientation in the surgical field supporting the surgeon, as well as it offers a potential tool for education.
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Affiliation(s)
- Barbara Carl
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Miriam Bopp
- Department of Neurosurgery, University Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Benjamin Saß
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Mirza Pojskic
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | | | - Christopher Nimsky
- Department of Neurosurgery, University Marburg, Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
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Mikayama R, Shirasaka T, Yabuuchi H, Sakai Y, Kojima T, Kondo M, Yoshikawa H, Kato T. Effect of scan mode and focal spot size in airway dimension measurements for ultra-high-resolution computed tomography of chronic obstructive pulmonary disease: A COPDGene phantom study. Phys Med 2020; 70:102-108. [DOI: 10.1016/j.ejmp.2019.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 11/29/2022] Open
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Rastogi S, Singh R, Borse R, Valkovic Zujic P, Segota D, Diklic A, Jurkovic S, Ali A, Mohammed Kharita H, Al-naemi HM, Alkalbani J, Al-rasbi A, Gershan V, Galic S, Yusuf M, Avramova-cholakova S, Zulkipli IMBH, Shein N, Teferi S, Rehani MM, Vassileva J, Kalra MK. Use of Multiphase CT Protocols in 18 Countries: Appropriateness and Radiation Doses. Can Assoc Radiol J 2021; 72:381-7. [DOI: 10.1177/0846537119888390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To assess the frequency, appropriateness, and radiation doses associated with multiphase computed tomography (CT) protocols for routine chest and abdomen–pelvis examinations in 18 countries. Materials and Methods: In collaboration with the International Atomic Energy Agency, multi-institutional data on clinical indications, number of scan phases, scan parameters, and radiation dose descriptors (CT dose–index volume; dose–length product [DLP]) were collected for routine chest (n = 1706 patients) and abdomen–pelvis (n = 426 patients) CT from 18 institutions in Asia, Africa, and Europe. Two radiologists scored the need for each phase based on clinical indications (1 = not indicated, 2 = probably indicated, 3 = indicated). We surveyed 11 institutions for their practice regarding single-phase and multiphase CT examinations. Data were analyzed with the Student t test. Results: Most institutions use multiphase protocols for routine chest (10/18 institutions) and routine abdomen–pelvis (10/11 institutions that supplied data for abdomen–pelvis) CT examinations. Most institutions (10/11) do not modify scan parameters between different scan phases. Respective total DLP for 1-, 2-, and 3-phase routine chest CT was 272, 518, and 820 mGy·cm, respectively. Corresponding values for 1- to 5-phase routine abdomen–pelvis CT were 400, 726, 1218, 1214, and 1458 mGy cm, respectively. For multiphase CT protocols, there were no differences in scan parameters and radiation doses between different phases for either chest or abdomen–pelvis CT ( P = 0.40-0.99). Multiphase CT examinations were unnecessary in 100% of routine chest CT and in 63% of routine abdomen–pelvis CT examinations. Conclusions: Multiphase scan protocols for the routine chest and abdomen–pelvis CT examinations are unnecessary, and their use increases radiation dose.
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Xu J, Wang X, Xiao H, Xu J. Size-Specific Dose Estimates Based on Water-Equivalent Diameter and Effective Diameter in Computed Tomography Coronary Angiography. Med Sci Monit 2019; 25:9299-9305. [PMID: 31808424 PMCID: PMC6911303 DOI: 10.12659/msm.917980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine the difference in size-specific dose estimates (SSDEs), separately based on effective diameter (deff) and water equivalent diameter (dw) of the central slice of the scan range in computed tomography coronary angiography (CTCA). MATERIAL AND METHODS There were 134 patients who underwent CTCA examination, were electronically retrieved. SSDEs (SSDEdeff and SSDEdw) were calculated using 2 approaches: deff and dw. The median SSDEs and mean absolute relative difference of SSDEs were calculated. Linear regression model was used to assess the absolute relative difference of SSDEs based on the ratio of deff to dw. RESULTS The median values of SSDEdeff and SSDEdw were 18.26 mGy and 20.56 mGy, respectively (P<0.01). The former was about 10.08% smaller than the latter. The mean absolute relative difference of SSDEs was 10.48%, ranging from 0.33% to 24.16%. A considerably positive correlation was found between the absolute relative difference of SSDEs and the ratio of deff to dw (R²=0.9561, r=0.979, P<0.01). CONCLUSIONS The value of SSDEdeff was smaller by an average of about 10.08% than SSDEdw in CTCA, and the absolute relative difference increased linearly with the ratio of effective diameter to water equivalent diameter.
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Affiliation(s)
- Jian Xu
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland)
| | - Xiangquan Wang
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital Of Hangzhou Medical CollegeZhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland)
| | - Huawei Xiao
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland)
| | - Jianguo Xu
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China (mainland)
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Rehani MM, Yang K, Melick ER, Heil J, Šalát D, Sensakovic WF, Liu B. Patients undergoing recurrent CT scans: assessing the magnitude. Eur Radiol 2019; 30:1828-1836. [PMID: 31792585 DOI: 10.1007/s00330-019-06523-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/19/2019] [Accepted: 10/17/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess percent of patients undergoing multiple CT exams that leads to cumulative effective dose (CED) of ≥ 100 mSv and determine their age distribution. METHODS Data was retrieved retrospectively from established radiation dose monitoring systems by setting the threshold value of 100 mSv at four institutions covering 324 hospitals. The number of patients with CED ≥ 100 mSv only from recurrent CT exams during a feasible time period between 1 and 5 years was identified. Age and gender distribution of these patients were assessed to identify the magnitude of patients in the relatively lower age group of ≤ 50 years. RESULTS Of the 2.5 million (2,504,585) patients who underwent 4.8 million (4,819,661) CT exams during the period of between 1 and 5 years, a total of 33,407 (1.33%) patients received a CED of ≥ 100 mSv with an overall median CED of 130.3 mSv and maximum of 1185 mSv. Although the vast majority (72-86%) of patients are > 50 years of age, nearly 20% (13.4 to 28%) are ≤ 50 years. The minimum time to accrue 100 mSv was a single day at all four institutions, an unreported finding to date. CONCLUSIONS We are in an unprecedented era, where patients undergoing multiple CT exams and receiving CED ≥ 100 mSv are not uncommon. While underscoring the need for imaging appropriateness, the consideration of the number and percent of patients with high exposures and related clinical necessities creates an urgent need for the industry to develop CT scanners and protocols with sub-mSv radiation dose, a goal that has been lingering. KEY POINTS • We are in an era where patients undergoing multiple CT exams during a short span of 1 to 5 years are not uncommon and a sizable fraction among them are below 50 years of age. • This leads to cumulative radiation dose to individual patients at which radiation effects are of real concern. • There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering.
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Affiliation(s)
- Madan M Rehani
- Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA, 02114, USA.
| | - Kai Yang
- Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA, 02114, USA
| | - Emily R Melick
- Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA, 02114, USA
| | - John Heil
- Imalogix Research Institute, Bryn Mawr, PA, 19010, USA
| | - Dušan Šalát
- Institute of Radiation Protection, Továrenská 22, 911 05, Trenčín, Slovakia
| | - William F Sensakovic
- AdventHealth, Orlando, FL, USA.,Mayo Clinic Scottsdale, Scottsdale, AZ, 85259, USA
| | - Bob Liu
- Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA, 02114, USA
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Rehani MM, Melick ER, Alvi RM, Doda Khera R, Batool-Anwar S, Neilan TG, Bettmann M. Patients undergoing recurrent CT exams: assessment of patients with non-malignant diseases, reasons for imaging and imaging appropriateness. Eur Radiol 2019; 30:1839-1846. [PMID: 31792584 DOI: 10.1007/s00330-019-06551-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/15/2019] [Accepted: 10/25/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine percent of patients without malignancy and ≤ 40 years of age with high cumulative radiation doses through recurrent CT exams and assess imaging appropriateness. METHODS From the cohort of patients who received cumulative effective dose (CED) of ≥ 100 mSv over a 5-year period, a sub-set was identified with non-malignant disease. The top 50 clinical indications leading to multiple CTs were determined. Clinical decision support (CDS) system scores were analyzed using a widely adopted standard of 1-3 (red) as "not usually appropriate," 4-6 (yellow) "may or may not be appropriate," and 7-9 (green) "usually appropriate." Clinicians reviewed patient records to assess compliance with appropriate use criteria (AUC). RESULTS 9.6% of patients in our series were with non-malignant conditions and 1.4% with age ≤ 40 years. CDS scores (rounded) were 2% red, 38% yellow, 27% green, and 33% unscored CTs. Clinical society guidelines for CT exams, wherever available, were followed in 87.5 to 100% of cases. AUCs were not available for several clinical indications as also referral guidelines for serial CT imaging. More than half of CT exams were unrelated to follow-up of a primary chronic disease. CONCLUSIONS We are faced with a situation wherein patients in age ≤ 40 years require or are thought to require many CT exams over the course of a few years but the radiation risk creates concern. There is a fair number of conditions for which AUC are not available. Suggested solutions include development of CT scanners with lesser radiation dose and further development of appropriateness criteria. KEY POINTS We are faced with a situation wherein patients in age group 0-40 years and with non-malignant diagnosis require or are thought to require many CT exams over the course of a few years. More than half of CT exams were unrelated to follow-up of a primary chronic disease. Imaging guidelines and appropriateness use criteria are not available for many conditions. Wherever available, they are for initial work-up and diagnosis and there is a lack of guidance on serial CT imaging.
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Affiliation(s)
- Madan M Rehani
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Emily R Melick
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Raza M Alvi
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ruhani Doda Khera
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Tomas G Neilan
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michael Bettmann
- Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
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Demb J, Chu P, Yu S, Whitebird R, Solberg L, Miglioretti DL, Smith-Bindman R. Analysis of Computed Tomography Radiation Doses Used for Lung Cancer Screening Scans. JAMA Intern Med 2019; 179:1650-1657. [PMID: 31545340 PMCID: PMC6764003 DOI: 10.1001/jamainternmed.2019.3893] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE The American College of Radiology (ACR) has recognized the importance of minimizing radiation doses used for lung cancer screening (LCS) computed tomography (CT). However, without standard protocols, doses could still be unnecessarily high, reducing screening margin of benefit. OBJECTIVE To characterize LCS CT radiation doses and identify factors explaining variation. DESIGN, SETTING, AND PARTICIPANTS We prospectively collected LCS examination dose metrics, from 2016 to 2017, at US institutions in the University of California, San Francisco International Dose Registry. Institution-level factors were collected through baseline survey. Mixed-effects linear and logistic regression models were estimated using forward variable selection. Results are presented as percentage excess dose and odds ratios (ORs) with 95% confidence intervals (CIs). The analysis was conducted between 2018 and 2019. MAIN OUTCOMES AND MEASURES Log-transformed measures of (1) mean volume CT dose index (CTDIvol, mGy), reflecting the average radiation dose per slice; (2) mean effective dose (ED, mSv), reflecting the total dose received and estimated future cancer risk; (3) proportion of CT scans using radiation doses above ACR benchmarks (CTDIvol >3 mGy, ED >1 mSv); and (4) proportion of CT scans using radiation doses above 75th percentile of registry doses (CTDIvol >2.7 mGy, ED >1.4 mSv). RESULTS Data were collected for 12 529 patients undergoing LCS CT scans performed at 72 institutions. Overall, 7232 participants (58%) were men, and the median age was 65 years (interquartile range [IQR], 60-70). Of 72 institutions, 15 (21%) had median CTDIvol and 47 (65%) had median ED above ACR guidelines. Institutions allowing any radiologists to establish protocols had 44% higher mean CTDIvol (mean dose difference [MDD], 44%; 95% CI, 19%-69%) and 27% higher mean ED (MDD, 27%; 95% CI, 5%-50%) vs those limiting who established protocols. Institutions allowing any radiologist to establish protocols had higher odds of examinations exceeding ACR CTDIvol guidelines (OR, 12.0; 95% CI, 2.0-71.4), and 75th percentile of registry CTDIvol (OR, 19.0; 95% CI, 1.9-186.7) or ED (OR, 8.5; 95% CI, 1.7-42.9). Having lead radiologists establish protocols resulted in lower odds of doses exceeding ACR ED guidelines (OR, 0.01; 95% CI, 0.001-0.1). Employing external vs internal medical physicists was associated with increased odds of exceeding ACR CTDIvol guidelines (OR, 6.1; 95% CI, 1.8-20.8). Having medical physicists establish protocols was associated with decreased odds of exceeding 75th percentile of registry CTDIvol (OR, 0.09; 95% CI, 0.01-0.59). Institutions reporting protocol updates as needed had 27% higher mean CTDIvol (MDD, 27%; 95% CI, 8%-45%). CONCLUSIONS AND RELEVANCE Facilities varied in LCS CT radiation dose distributions. Institutions limiting protocol creation to lead radiologists and having internal medical physicists had lower doses.
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Affiliation(s)
- Joshua Demb
- Moores Cancer Center, University of California, San Diego
| | - Philip Chu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Sophronia Yu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Robin Whitebird
- School of Social Work, University of St Thomas, St Paul, Minnesota
| | - Leif Solberg
- HealthPartners Institute, Minneapolis, Minnesota
| | - Diana L Miglioretti
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis.,Kaiser Permanente Washington Health Research Institute, Seattle
| | - Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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Cohen SL, Wang JJ, Chan N, O’Connell W, Shah R, Sanelli P, Raoof S. Lung Cancer Screening CT. Chest 2019; 156:1214-1222. [DOI: 10.1016/j.chest.2019.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/12/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022] Open
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Carl B, Bopp M, Saß B, Pojskic M, Gjorgjevski M, Voellger B, Nimsky C. Reliable navigation registration in cranial and spine surgery based on intraoperative computed tomography. Neurosurg Focus 2019; 47:E11. [DOI: 10.3171/2019.8.focus19621] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVELow registration errors are an important prerequisite for reliable navigation, independent of its use in cranial or spinal surgery. Regardless of whether navigation is used for trajectory alignment in biopsy or implant procedures, or for sophisticated augmented reality applications, all depend on a correct registration of patient space and image space. In contrast to fiducial, landmark, or surface matching–based registration, the application of intraoperative imaging allows user-independent automatic patient registration, which is less error prone. The authors’ aim in this paper was to give an overview of their experience using intraoperative CT (iCT) scanning for automatic registration with a focus on registration accuracy and radiation exposure.METHODSA total of 645 patients underwent iCT scanning with a 32-slice movable CT scanner in combination with navigation for trajectory alignment in biopsy and implantation procedures (n = 222) and for augmented reality (n = 437) in cranial and spine procedures (347 craniotomies and 42 transsphenoidal, 56 frameless stereotactic, 59 frame-based stereotactic, and 141 spinal procedures). The target registration error was measured using skin fiducials that were not part of the registration procedure. The effective dose was calculated by multiplying the dose length product with conversion factors.RESULTSAmong all 1281 iCT scans obtained, 1172 were used for automatic patient registration (645 initial registration scans and 527 repeat iCT scans). The overall mean target registration error was 0.86 ± 0.38 mm (± SD) (craniotomy, 0.88 ± 0.39 mm; transsphenoidal, 0.92 ± 0.39 mm; frameless, 0.74 ± 0.39 mm; frame-based, 0.84 ± 0.34 mm; and spinal, 0.80 ± 0.28 mm). Compared with standard diagnostic scans, a distinct reduction of the effective dose could be achieved using low-dose protocols for the initial registration scan with mean effective doses of 0.06 ± 0.04 mSv for cranial, 0.50 ± 0.09 mSv for cervical, 4.12 ± 2.13 mSv for thoracic, and 3.37 ± 0.93 mSv for lumbar scans without impeding registration accuracy.CONCLUSIONSReliable automatic patient registration can be achieved using iCT scanning. Low-dose protocols ensured a low radiation exposure for the patient. Low-dose scanning had no negative effect on navigation accuracy.
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Affiliation(s)
- Barbara Carl
- 1Department of Neurosurgery, University of Marburg; and
| | - Miriam Bopp
- 1Department of Neurosurgery, University of Marburg; and
- 2Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Benjamin Saß
- 1Department of Neurosurgery, University of Marburg; and
| | - Mirza Pojskic
- 1Department of Neurosurgery, University of Marburg; and
| | | | | | - Christopher Nimsky
- 1Department of Neurosurgery, University of Marburg; and
- 2Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
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