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Amoakon JP, Mylavarapu G, Amin RS, Naren AP. Pulmonary Vascular Dysfunctions in Cystic Fibrosis. Physiology (Bethesda) 2024; 39:0. [PMID: 38501963 DOI: 10.1152/physiol.00024.2023] [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: 11/16/2023] [Revised: 01/26/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Abstract
Cystic fibrosis (CF) is an inherited disorder caused by a deleterious mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Given that the CFTR protein is a chloride channel expressed on a variety of cells throughout the human body, mutations in this gene impact several organs, particularly the lungs. For this very reason, research regarding CF disease and CFTR function has historically focused on the lung airway epithelium. Nevertheless, it was discovered more than two decades ago that CFTR is also expressed and functional on endothelial cells. Despite the great strides that have been made in understanding the role of CFTR in the airway epithelium, the role of CFTR in the endothelium remains unclear. Considering that the airway epithelium and endothelium work in tandem to allow gas exchange, it becomes very crucial to understand how a defective CFTR protein can impact the pulmonary vasculature and overall lung function. Fortunately, more recent research has been dedicated to elucidating the role of CFTR in the endothelium. As a result, several vascular dysfunctions associated with CF disease have come to light. Here, we summarize the current knowledge on pulmonary vascular dysfunctions in CF and discuss applicable therapies.
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Affiliation(s)
- Jean-Pierre Amoakon
- Department of Systems Biology and Physiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Pulmonary Medicine and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Goutham Mylavarapu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Raouf S Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Anjaparavanda P Naren
- Department of Systems Biology and Physiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Pulmonary Medicine and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, United States
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
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O’Regan PW, Stevens NE, Logan N, Ryan DJ, Maher MM. Paediatric Thoracic Imaging in Cystic Fibrosis in the Era of Cystic Fibrosis Transmembrane Conductance Regulator Modulation. Children (Basel) 2024; 11:256. [PMID: 38397368 PMCID: PMC10888261 DOI: 10.3390/children11020256] [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] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Cystic fibrosis (CF) is one of the most common progressive life-shortening genetic conditions worldwide. Ground-breaking translational research has generated therapies that target the primary cystic fibrosis transmembrane conductance regulator (CFTR) defect, known as CFTR modulators. A crucial aspect of paediatric CF disease is the development and progression of irreversible respiratory disease in the absence of clinical symptoms. Accurate thoracic diagnostics have an important role to play in this regard. Chest radiographs are non-specific and insensitive in the context of subtle changes in early CF disease, with computed tomography (CT) providing increased sensitivity. Recent advancements in imaging hardware and software have allowed thoracic CTs to be acquired in paediatric patients at radiation doses approaching that of a chest radiograph. CFTR modulators slow the progression of CF, reduce the frequency of exacerbations and extend life expectancy. In conjunction with advances in CT imaging techniques, low-dose thorax CT will establish a central position in the routine care of children with CF. International guidelines regarding the choice of modality and timing of thoracic imaging in children with CF are lagging behind these rapid technological advances. The continued progress of personalised medicine in the form of CFTR modulators will promote the emergence of personalised radiological diagnostics.
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Affiliation(s)
- Patrick W. O’Regan
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, T12 AK54 Cork, Ireland
| | - Niamh E. Stevens
- Department of Surgery, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - Niamh Logan
- Department of Medicine, Mercy University Hospital, T12 WE28 Cork, Ireland
| | - David J. Ryan
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, T12 AK54 Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, T12 DC4A Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, T12 AK54 Cork, Ireland
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3
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West ME, Spielberg DR, Roach DJ, Willmering MM, Bdaiwi AS, Cleveland ZI, Woods JC. Short-term structural and functional changes after airway clearance therapy in cystic fibrosis. J Cyst Fibros 2023; 22:926-932. [PMID: 36740542 DOI: 10.1016/j.jcf.2023.01.017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Airway clearance therapy (ACT) with a high-frequency chest wall oscillation (HFCWO) vest is a common but time-consuming treatment. Its benefit to quality of life for cystic fibrosis (CF) patients is well established but has been questioned recently as new highly-effective modulator therapies begin to change the treatment landscape. 129Xe ventilation MRI has been shown to be very sensitive to lung obstruction in mild CF disease, making it an ideal tool to identify and quantify subtle, regional changes. METHODS 20 CF patients (ages 20.7 ± 5.1 years) refrained from performing ACT before arriving for a single-day visit. Multiple-breath washout (MBW), spirometry, Xe MRI, and ultrashort echo-time (UTE) MRI were obtained twice-before and after patients performed ACT using their prescribed HFCWO vests (average 4.7 ± 0.5 h). UTE MRIs were scored for structural abnormalities, and standard functional metrics were obtained from MBW, spirometry, and Xe MRI-FEV1,pp, LCI2.5, and VDPN4, respectively. RESULTS Spirometry and Xe MRI detected significant improvements in lung function post-ACT. 15/20 patients showed improvements from a baseline median of 92% FEV1,pp. Similarly, 16/20 patients showed improvements in Xe MRI from a baseline median of 15.2% VDPN4. Average individual changes were +2.6% in FEV1,pp and -1.3% in VDPN4, but without spatial correlations to easily-identifiable causative structural defects (e.g. mucus plugs or bronchiectasis) on UTE MRI. CONCLUSIONS Lung function improved after a single instance of HFCWO-vest ACT and was detectable by spirometry and Xe MRI. The only common structural abnormalities were mucus plugs, which corresponded to ventilation defects, but ventilation defects were often present without visible abnormalities.
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Affiliation(s)
- Michael E West
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States
| | - David R Spielberg
- Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, Illinois, 60611, United States
| | - David J Roach
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States
| | - Matthew M Willmering
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States
| | - Abdullah S Bdaiwi
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, 45229, United States
| | - Zackary I Cleveland
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, 45229, United States; Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, 45229, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, 45229, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Department of Physics, University of Cincinnati, Cincinnati, OH, 45229, United States.
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Sheahan KP, O'Mahony AT, Morrissy D, Ibrahim H, Crowley C, Waldron MG, Sokol-Randell D, McMahon A, Maher MM, O'Connor OJ, Plant BJ. Replacing Plain Radiograph with ultra-low dose CT thorax in cystic fibrosis (CF) in the era of CFTR modulation and its impact on cumulative effective dose. J Cyst Fibros 2023; 22:715-721. [PMID: 37400300 DOI: 10.1016/j.jcf.2023.06.006] [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: 10/17/2022] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Medical radiation exposure is of increasing concern in patients with cystic fibrosis (PWCF) due to improving life expectancy. We aimed to assess and quantify the cumulative effective dose (CED) in PWCF in the context of CFTR-modulator therapy and the advancement of dose reduction techniques. METHODS We performed a retrospective observational study in a single University CF centre over a 11-year period. We included PWCF, aged over 18 years who exclusively attended our institution. Relevant clinical data (demographics, transplantation history and modulator status) and radiological data (modality, quantity, and radiation exposure measured as CED) were collected. For those on modulator therapy the quantified imaging and radiation data was dichotomised into pre-and-post therapy periods. RESULTS The study included 181 patients: 139 on CFTR modulator therapy, 15 transplant recipients and 27 with neither exposure. 82% of patients received <25 mSv over the study period. Mean study duration was 6.9 ± 2.6 years pre-modulation and 4.2 ± 2.6 years post-modulation. Pre-modulation CT contributed 9.6% of total chest imaging (n = 139/1453) and 70.9% of the total CED. Post-modulation CT use increased contributing 42.7% of chest imaging (n = 444/1039) and comprised 75.8% of CED. Annual CED was 1.55 mSv pre and 1.36 mSv post modulation (p = 0.41). Transplant recipients had an annual CED of 64 ± 36.1mSv. CONCLUSION Chest CT utilisation for PWCF is rising in our institution, replacing chest radiography amidst CFTR-modulation. Despite the increasing use of CT, no significant radiation dose penalty was observed with a reduction in mean annual CED, primarily due to the influence of CT dose reduction strategies.
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Affiliation(s)
- Kevin P Sheahan
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | | | - David Morrissy
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork Ireland
| | - Hisham Ibrahim
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork Ireland
| | - Claire Crowley
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | | | | | - Aisling McMahon
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Barry J Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork Ireland
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Behrendt L, Smith LJ, Voskrebenzev A, Klimeš F, Kaireit TF, Pöhler GH, Kern AL, Gonzalez CC, Dittrich AM, Marshall H, Schütz K, Hughes PJC, Ciet P, Tiddens HAWM, Wild JM, Vogel-Claussen J. A dual center and dual vendor comparison study of automated perfusion-weighted phase-resolved functional lung magnetic resonance imaging with dynamic contrast-enhanced magnetic resonance imaging in patients with cystic fibrosis. Pulm Circ 2022; 12:e12054. [PMID: 35514781 PMCID: PMC9063970 DOI: 10.1002/pul2.12054] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/17/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
For sensitive diagnosis and monitoring of pulmonary disease, ionizing radiation-free imaging methods are of great importance. A noncontrast and free-breathing proton magnetic resonance imaging (MRI) technique for assessment of pulmonary perfusion is phase-resolved functional lung (PREFUL) MRI. Since there is no validation of PREFUL MRI across different centers and scanners, the purpose of this study was to compare perfusion-weighted PREFUL MRI with the well-established dynamic contrast-enhanced (DCE) MRI across two centers on scanners from two different vendors. Sixteen patients with cystic fibrosis (CF) (Center 1: 10 patients; Center 2: 6 patients) underwent PREFUL and DCE MRI at 1.5T in the same imaging session. Normalized perfusion-weighted values and perfusion defect percentage (QDP) values were calculated for the whole lung and three central slices (dorsal, central, ventral of the carina). Obtained parameters were compared using Pearson correlation, Spearman correlation, Bland-Altman analysis, Wilcoxon signed-rank test, and Wilcoxon rank-sum test. Moderate-to-strong correlations between normalized perfusion-weighted PREFUL and DCE values were found (posterior slice: r = 0.69, p < 0.01). Spatial overlap of PREFUL and DCE QDP maps showed an agreement of 79.4% for the whole lung. Further, spatial overlap values of Center 1 were not significantly different to those of Center 2 for the three central slices (p > 0.07). The feasibility of PREFUL MRI across two different centers and two different vendors was shown in patients with CF and obtained results were in agreement with DCE MRI.
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Affiliation(s)
- Lea Behrendt
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Laurie J Smith
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Andreas Voskrebenzev
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Filip Klimeš
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Till F Kaireit
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Gesa H Pöhler
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Agilo L Kern
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Cristian Crisosto Gonzalez
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Anna-Maria Dittrich
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany.,Department for Pediatric Pulmonology, Allergology and Neonatology Hannover Medical School Hannover Germany
| | - Helen Marshall
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Katharina Schütz
- Department for Pediatric Pulmonology, Allergology and Neonatology Hannover Medical School Hannover Germany
| | - Paul J C Hughes
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Pierluigi Ciet
- Department of Pediatric Pulmonology and Allergology Sophia Children's Hospital, Erasmus MC Rotterdam The Netherlands
| | - Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology Sophia Children's Hospital, Erasmus MC Rotterdam The Netherlands.,Department of Radiology and Nuclear medicine Erasmus MC Rotterdam The Netherlands
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Jens Vogel-Claussen
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
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Ciet P, Bertolo S, Ros M, Casciaro R, Cipolli M, Colagrande S, Costa S, Galici V, Gramegna A, Lanza C, Lucca F, Macconi L, Majo F, Paciaroni A, Parisi GF, Rizzo F, Salamone I, Santangelo T, Scudeller L, Saba L, Tomà P, Morana G. State-of-the-art review of lung imaging in cystic fibrosis with recommendations for pulmonologists and radiologists from the "iMAging managEment of cySTic fibROsis" (MAESTRO) consortium. Eur Respir Rev 2022; 31:31/163/210173. [PMID: 35321929 DOI: 10.1183/16000617.0173-2021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Imaging represents an important noninvasive means to assess cystic fibrosis (CF) lung disease, which remains the main cause of morbidity and mortality in CF patients. While the development of new imaging techniques has revolutionised clinical practice, advances have posed diagnostic and monitoring challenges. The authors aim to summarise these challenges and make evidence-based recommendations regarding imaging assessment for both clinicians and radiologists. STUDY DESIGN A committee of 21 experts in CF from the 10 largest specialist centres in Italy was convened, including a radiologist and a pulmonologist from each centre, with the overall aim of developing clear and actionable recommendations for lung imaging in CF. An a priori threshold of at least 80% of the votes was required for acceptance of each statement of recommendation. RESULTS After a systematic review of the relevant literature, the committee convened to evaluate 167 articles. Following five RAND conferences, consensus statements were developed by an executive subcommittee. The entire consensus committee voted and approved 28 main statements. CONCLUSIONS There is a need for international guidelines regarding the appropriate timing and selection of imaging modality for patients with CF lung disease; timing and selection depends upon the clinical scenario, the patient's age, lung function and type of treatment. Despite its ubiquity, the use of the chest radiograph remains controversial. Both computed tomography and magnetic resonance imaging should be routinely used to monitor CF lung disease. Future studies should focus on imaging protocol harmonisation both for computed tomography and for magnetic resonance imaging. The introduction of artificial intelligence imaging analysis may further revolutionise clinical practice by providing fast and reliable quantitative outcomes to assess disease status. To date, there is no evidence supporting the use of lung ultrasound to monitor CF lung disease.
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Affiliation(s)
- Pierluigi Ciet
- Radiology and Nuclear Medicine Dept, Erasmus MC, Rotterdam, The Netherlands .,Pediatric Pulmonology and Allergology Dept, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.,Depts of Radiology and Medical Science, University of Cagliari, Cagliari, Italy
| | - Silvia Bertolo
- Radiology Dept, Ca'Foncello S. Maria Hospital, Treviso, Italy
| | - Mirco Ros
- Dept of Pediatrics, Ca'Foncello S. Maria Hospital, Treviso, Italy
| | - Rosaria Casciaro
- Dept of Pediatrics, IRCCS Institute "Giannina Gaslini", Cystic Fibrosis Centre, Genoa, Italy
| | - Marco Cipolli
- Regional Reference Cystic Fibrosis center, University hospital of Verona, Verona, Italy
| | - Stefano Colagrande
- Dept of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence- Careggi Hospital, Florence, Italy
| | - Stefano Costa
- Dept of Pediatrics, Gaetano Martino Hospital, Messina, Italy
| | - Valeria Galici
- Cystic Fibrosis Centre, Dept of Paediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Andrea Gramegna
- Respiratory Disease and Adult Cystic Fibrosis Centre, Internal Medicine Dept, IRCCS Ca' Granda, Milan, Italy.,Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Cecilia Lanza
- Radiology Dept, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Francesca Lucca
- Regional Reference Cystic Fibrosis center, University hospital of Verona, Verona, Italy
| | - Letizia Macconi
- Radiology Dept, Tuscany Reference Cystic Fibrosis Centre, Meyer Children's Hospital, Florence, Italy
| | - Fabio Majo
- Dept of Pediatrics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Giuseppe Fabio Parisi
- Pediatric Pulmonology Unit, Dept of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesca Rizzo
- Radiology Dept, IRCCS Institute "Giannina Gaslini", Cystic Fibrosis Center, Genoa, Italy
| | | | - Teresa Santangelo
- Dept of Radiology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Luigia Scudeller
- Clinical Epidemiology, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | - Luca Saba
- Depts of Radiology and Medical Science, University of Cagliari, Cagliari, Italy
| | - Paolo Tomà
- Dept of Radiology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Morana
- Radiology Dept, Ca'Foncello S. Maria Hospital, Treviso, Italy
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7
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FitzMaurice TS, Nazareth DS. Incidence of breast cancer in people with cystic fibrosis: A cause for concern? J Cyst Fibros 2021; 21:890. [PMID: 34866012 DOI: 10.1016/j.jcf.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Simon FitzMaurice
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Foundation Trust; Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Dilip S Nazareth
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Foundation Trust; Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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8
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McCormick JP, Skehan SJ, McArdle N, McCormick PA. Increasing radiation exposure from computed tomography in liver transplant recipients over time. Ir J Med Sci 2021. [PMID: 34714492 DOI: 10.1007/s11845-021-02821-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate changes in radiation exposure from computed tomography (CT) among patients undergoing liver transplantation in our unit over a 10-year period. METHODS We evaluated 134 elective patients, without hepatocellular carcinoma or cholangiocarcinoma who underwent transplantation in 2007-2008 and 2017-2018. CT scans performed in our hospital up to 2 years pre transplant and 1 year post transplant were evaluated. RESULTS There was an increase in mean estimated effective radiation dose per patient in 2017-2018 compared to 2007-2008 (77.8 mSv ± 6.2 vs 56.7 mSv ± 5.9, p < 0.05). This change was mainly due to an increased number of pre-transplant CT scans per patient (2.9 ± 0.3 vs 1.4 ± 0.14, p = 0.0001). High radiation dose scan protocols were more frequently used in 2017-2018, with 4-phase liver CT accounting for a larger proportion of scans both pre-transplant (61% vs 43%, p = 0.004) and post-transplant (29% vs 13%, p = 0.002). A greater proportion of patients were exposed to > 100 mSv of ionising radiation in the 2017-2018 patients (29% vs 11%, p < 0.01). These figures are likely to be a significant under-estimate as they exclude other imaging modalities and CT scans performed at other institutions. CONCLUSION Radiation exposure from diagnostic imaging has increased among liver transplant recipients at our institution over the last decade. This appears to be due to an increase in the number of CT scans performed, and a shift towards higher dose scan protocols.
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9
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Stahl M, Steinke E, Graeber SY, Joachim C, Seitz C, Kauczor HU, Eichinger M, Hämmerling S, Sommerburg O, Wielpütz MO, Mall MA. Magnetic Resonance Imaging Detects Progression of Lung Disease and Impact of Newborn Screening in Preschool Children with Cystic Fibrosis. Am J Respir Crit Care Med 2021; 204:943-953. [PMID: 34283704 DOI: 10.1164/rccm.202102-0278oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Previous cross-sectional studies demonstrated that chest magnetic resonance imaging (MRI) is sensitive to detect early lung disease in infants and preschool children with cystic fibrosis (CF) without radiation exposure. However, the ability of MRI to detect progression of lung disease and the impact of early diagnosis in preschool children with CF remains unknown. OBJECTIVES To investigate the potential of MRI to detect progression of early lung disease and impact of early diagnosis by CF newborn screening (NBS) in preschool children with CF. METHODS Annual MRI was performed from diagnosis over four years in a cohort of 96 preschool children with CF (age 0-4 yr) that were concurrently diagnosed based on NBS (n=28) or clinical symptoms (n=68). MRI scans were evaluated using a dedicated morphofunctional score and the relationship between longitudinal MRI scores and respiratory symptoms, pulmonary exacerbations, upper airway microbiology and mode of diagnosis were determined. MEASUREMENTS AND MAIN RESULTS The MRI global score increased in the total cohort of children with CF during preschool years (P<0.001) which was associated with cough, pulmonary exacerbations (P<0.0001), and detection of Staphylococcus aureus and Haemophilus influenzae (P<0.05). MRI-defined abnormalities in lung morphology, especially airway wall thickening/bronchiectasis, were lower in NBS compared to clinically diagnosed children with CF throughout the observation period (P<0.01). CONCLUSIONS MRI detected progression of early lung disease and benefits of early diagnosis by NBS in preschool children with CF. These findings support MRI as sensitive outcome measure for diagnostic monitoring and early intervention trials in preschool children with CF.
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Affiliation(s)
- Mirjam Stahl
- Charité Universitätsmedizin Berlin, 14903, Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Berlin, Germany.,German Center for Lung Research (DZL), associated partner site, Berlin, Germany.,University of Heidelberg, Department of Translational Pulmonology, Heidelberg, Germany.,German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Eva Steinke
- Charité Universitätsmedizin Berlin, 14903, Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Berlin, Germany.,University of Heidelberg, Department of Translational Pulmonology, Heidelberg, Germany.,University of Heidelberg, Department of Pediatrics, Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Heidelberg, Germany.,German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Simon Y Graeber
- Charite Universitatsmedizin Berlin, 14903, Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Berlin, Germany.,German Center for Lung Research (DZL), associated partner site, Berlin, Germany.,University of Heidelberg, Department of Translational Pulmonology, Heidelberg, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Cornelia Joachim
- University of Heidelberg, Department of Pediatrics, Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Heidelberg, Germany.,German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Christoph Seitz
- University of Heidelberg, 9144, Department of Pediatrics, Division of Neonatology, Heidelberg, Germany.,Pediatric Practice , Medical Biometrics Advisor, Bad Saulgau, Germany
| | - Hans-Ulrich Kauczor
- University of Heidelberg, 9144, Department of Translational Pulmonology, Heidelberg, Germany.,German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany.,University of Heidelberg, 9144, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Monika Eichinger
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany.,University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany.,Thoraxklinik at University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Heidelberg, Germany
| | - Susanne Hämmerling
- University of Heidelberg, 9144, Department of Pediatrics, Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Heidelberg, Germany
| | - Olaf Sommerburg
- University of Heidelberg, 9144, Department of Translational Pulmonology, Heidelberg, Germany.,University of Heidelberg, 9144, Department of Pediatrics, Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Heidelberg, Germany.,German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Mark O Wielpütz
- German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany.,University of Heidelberg, 9144, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany.,German Cancer Research Center (DKFZ), Department of Radiology, Heidelberg, Germany
| | - Marcus A Mall
- Charité Universitätsmedizin Berlin, 14903, Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Berlin, Germany.,German Center for Lung Research (DZL), associated partner site, Berlin, Germany.,University of Heidelberg, Department of Translational Pulmonology, Heidelberg, Germany.,Berlin Institute of Health (BIH), Berlin, Germany;
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10
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Abstract
This review summarises the current knowledge about recurrent radiological imaging and associated cumulative doses to patients. The recent conservative estimates are for around 0.9 million patients globally who cumulate radiation doses above 100 mSv, where evidence exists for cancer risk elevation. Around one in five is estimated to be under the age of 50. Recurrent imaging is used for managing various health conditions and chronic diseases such as malignancies, trauma, end-stage kidney disease, cardiovascular diseases, Crohn's disease, urolithiasis, cystic pulmonary disease. More studies are needed from different parts of the world to understand the magnitude and appropriateness. The analysis identified areas of future work to improve radiation protection of individuals who are submitted to frequent imaging. These include access to dose saving imaging technologies; improved imaging strategies and appropriateness process; specific optimisation tailored to the clinical condition and patient habitus; wider utilisation of the automatic exposure monitoring systems with an integrated option for individual exposure tracking in standardised patient-specific risk metrics; improved training and communication. The integration of the clinical and exposure history data will support improved knowledge about radiation risks from low doses and individual radiosensitivity. The radiation protection framework will need to respond to the challenge of recurrent imaging and high individual doses. The radiation protection perspective complements the clinical perspective, and the risk to benefit analysis must account holistically for all incidental and long-term benefits and risks for patients, their clinical history and specific needs. This is a step toward the patient-centric health care.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
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11
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Abstract
Millions of patients benefit from medical imaging every single day. However, we have entered an unprecedented era in imaging practices wherein 1 out of 125 patients can be exposed to effective dose >50 mSv from a single CT exam and 3 out of 10,000 patients undergoing CT exams could potentially receive cumulative effective doses > 100 mSv in a single day. Recurrent imaging with CT, fluoroscopically guided interventions, and hybrid imaging modalities such as positron emission tomography/computed tomography (PET/CT) is more prevalent today than ever before. Presently, we do not know the cumulative doses that patients may be receiving across all imaging modalities combined. Furthermore, patients with diseases with longer life expectancies are being exposed to high doses of radiation enabling radiation effects to manifest over a longer time period. The emphasis in the past on improving justification of imaging and optimization of technique and practice has proved useful. While that must continue, the current situation requires imaging device manufacturers to urgently develop imaging technologies that are safer for patients as high doses have been observed in patients where imaging has been justified through clinical decision-support and optimized by keeping doses below the national benchmark doses. There is a need to have a critical look at the fundamental principles of radiation protection as cumulative doses are likely to increase in the coming years.
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12
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Pennati F, Walkup LL, Chhabra A, Towe C, Myers K, Aliverti A, Woods JC. Quantitative inspiratory-expiratory chest CT to evaluate pulmonary involvement in pediatric hematopoietic stem-cell transplantation patients. Pediatr Pulmonol 2021; 56:1026-1035. [PMID: 33314762 PMCID: PMC8721603 DOI: 10.1002/ppul.25223] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/11/2020] [Accepted: 12/06/2020] [Indexed: 12/18/2022]
Abstract
Pulmonary complications following allogeneic hematopoietic stem-cell transplantation (HSCT) are a significant source of morbidity and complications may arise from a myriad of infectious and noninfectious sources. These complications may occur soon or many months post-transplantation and can have a broad range of outcomes. Surveillance for pulmonary involvement in the pediatric HSCT population can be challenging due to poor compliance with clinical pulmonary function testing, primarily spirometry, and there may be a role for clinical imaging to provide an additional means of monitoring, particularly in the era of clinical low-dose computed tomography (CT) protocols. In this single-site, retrospective study, a review of our institution's radiological and HSCT databases was conducted to assess the utility of a quantitative CT algorithm to describe ventilation abnormalities on high-resolution chest CT scans of pediatric HSCT patients. Thirteen non-contrast enhanced chest CT examinations acquired both in inspiration and expiration, from 12 deceased HSCT patients (median age at HSCT 10.4 years, median days of CT 162) were selected for the analysis. Also, seven age-matched healthy controls (median age 15.5) with non-contrast-enhanced inspiration-expiration chest CT were selected for comparison. We report that, compared to healthy age-matched controls, HSCT patients had larger percentages of poorly ventilated (median, 13.5% vs. 2.3%, p < .001) and air trapped (median 12.3% vs. 0%, p < .001) regions of lung tissue, suggesting its utility as a potential screening tool. Furthermore, there was wide variation within individual HSCT patients, supporting the use of multivolume CT and quantitative analysis to describe and phenotype post-transplantation lung involvement.
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Affiliation(s)
- Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Laura L Walkup
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Anuj Chhabra
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christopher Towe
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kasiani Myers
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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13
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Joyce S, Carey BW, Moore N, Mullane D, Moore M, McEntee MF, Plant BJ, Maher MM, O'Connor OJ. Computed tomography in cystic fibrosis lung disease: a focus on radiation exposure. Pediatr Radiol 2021; 51:544-553. [PMID: 33743038 DOI: 10.1007/s00247-020-04706-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/03/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Abstract
Thoracic computed tomography (CT) is the imaging reference method in the diagnosis, assessment and management of lung disease. In the setting of cystic fibrosis (CF), CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography, and findings correlate with clinical outcomes. Better understanding of the aetiology of CF lung disease indicates that even asymptomatic infants with CF can have irreversible pulmonary pathology. Surveillance and early diagnosis of lung disease in CF are important to preserve lung parenchyma and to optimise long-term outcomes. CF is associated with increased cumulative radiation exposure due to the requirement for repeated imaging from a young age. Radiation dose optimisation, important for the safe use of CT in children with CF, is best achieved in a team environment where paediatric radiologists work closely with paediatric respiratory physicians, physicists and radiography technicians to achieve the best patient outcomes. Despite the radiation doses incurred, CT remains a vital imaging tool in children with CF. Radiologists with special interests in CT dose optimisation and respiratory disease are key to the appropriate use of CT in paediatric imaging. Paediatric radiologists strive to minimise radiation dose to children whilst providing the best possible assessment of lung disease.
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Affiliation(s)
- Stella Joyce
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Brian W Carey
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Niamh Moore
- Department of Radiography, University College Cork, Cork, Ireland
| | - David Mullane
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Michael Moore
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Mark F McEntee
- Department of Radiography, University College Cork, Cork, Ireland
| | - Barry J Plant
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Medicine, Cork University Hospital, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland.,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.,APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland. .,Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland. .,APC Microbiome Institute, University College Cork, Cork, Ireland.
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14
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Marcu LG, Chau M, Bezak E. How much is too much? Systematic review of cumulative doses from radiological imaging and the risk of cancer in children and young adults. Crit Rev Oncol Hematol 2021; 160:103292. [DOI: 10.1016/j.critrevonc.2021.103292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/20/2021] [Accepted: 02/27/2021] [Indexed: 01/18/2023] Open
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15
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Sommerburg O, Wielpütz MO, Trame JP, Wuennemann F, Opdazaite E, Stahl M, Puderbach MU, Kopp-Schneider A, Fritzsching E, Kauczor HU, Baumann I, Mall MA, Eichinger M. Magnetic Resonance Imaging Detects Chronic Rhinosinusitis in Infants and Preschool Children with Cystic Fibrosis. Ann Am Thorac Soc 2020; 17:714-23. [PMID: 32142375 DOI: 10.1513/AnnalsATS.201910-777OC] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Chronic rhinosinusitis (CRS) contributes to disease burden of patients with cystic fibrosis (CF). However, its onset and progression in infants and preschool children with CF remain poorly understood.Objectives: To determine the prevalence and extent of CRS in young children with CF using magnetic resonance imaging (MRI).Methods: MRI was performed in sedation in 67 infants and preschool children with CF (mean age 2.3 ± 2.1 yr; range 0-6 yr) and 30 non-CF control subjects (3.5 ± 2.0 yr; range 0-6 yr). Paranasal sinus dimensions and structural abnormalities, including mucosal swelling; mucopyoceles; and nasal polyps of the maxillary, frontal, sphenoid, and ethmoid sinuses; and, in addition, medial maxillary sinus wall deformation, were assessed using a dedicated CRS MRI scoring system.Results: Pneumatization and dimensions of paranasal sinuses did not differ between the two groups. MRI detected an increased prevalence of mucosal swelling (83% vs. 17%; P < 0.001), mucopyoceles (75% vs. 2%; P < 0.001), polyps (26% vs. 7%; P < 0.001), and maxillary sinus wall deformation (68% vs. 2%; P < 0.001) in infants and preschool children with CF compared with age-matched control subjects. Furthermore, the extent of these abnormalities was also increased with a MRI sum score of 22.9 ± 10.9 in CF compared with 4.5 ± 7.6 in non-CF control subjects (P < 0.001).Conclusions: MRI detected normal dimensions of paranasal sinuses, and a high prevalence and severity of paranasal sinus abnormalities due to CRS in infants and preschool children with CF without radiation exposure. Our results support the development of MRI for sensitive noninvasive diagnosis and monitoring of CRS in young children with CF, and as outcome measures for clinical trials.Clinical trial registered with www.clinicaltrials.gov (NCT00760071).
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16
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Moloney F, Kavanagh RG, Ronan NJ, Grey TM, Joyce S, Ryan DJ, Moore N, O'Connor OJ, Plant BJ, Maher MM. Ultra-low-dose thoracic CT with model-based iterative reconstruction (MBIR) in cystic fibrosis patients undergoing treatment with cystic fibrosis transmembrane conductance regulators (CFTR). Clin Radiol 2021; 76:393.e9-393.e17. [PMID: 33468311 DOI: 10.1016/j.crad.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023]
Abstract
AIM To assess the utility of a volumetric low-dose computed tomography (CT) thorax (LDCTT) protocol at a dose equivalent to a posteroanterior (PA) and lateral chest radiograph for surveillance of cystic fibrosis (CF) patients. MATERIALS AND METHODS A prospective study was undertaken of 19 adult patients with CF that proceeded to LDCTT at 12 and 24 months following initiation of ivacaftor. A previously validated seven-section, low-dose axial CT protocol was used for the 12-month study. A volumetric LDCTT protocol was developed for the 24-month study and reconstructed with hybrid iterative reconstruction (LD-ASIR) and pure iterative reconstruction (model-based IR [LD-MBIR]). Radiation dose was recorded for each scan. Image quality was assessed quantitatively and qualitatively, and disease severity was assessed using a modified Bhalla score. Statistical analysis was performed and p-values of <0.05 were considered statistically significant. RESULTS Volumetric LD-MBIR studies were acquired at a lower radiation dose than the seven-section studies (0.08 ± 0.01 versus 0.10 ± 0.02 mSv; p=0.02). LD-MBIR and seven-section ASIR images had significantly lower levels of image noise compared with LD-ASIR images (p<0.0001). Diagnostic acceptability scores and depiction of bronchovascular structures were found to be acceptable for axial and coronal LD-MBIR images. LD-MBIR images were superior to LD-ASIR images for all qualitative parameters assessed (p<0.0001). No significant change was observed in mean Bhalla score between 1-year and 2-year studies (p=0.84). CONCLUSIONS The use of a volumetric LDCTT protocol (reconstructed with pure IR) enabled acquisition of diagnostic quality CT images, which were considered extremely useful for surveillance of CF patients, at a dose equivalent to a PA and lateral chest radiograph.
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Affiliation(s)
- F Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland
| | - R G Kavanagh
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland
| | - N J Ronan
- Cork Cystic Fibrosis Centre, Cork University Hospital, Wilton, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - T M Grey
- Department of Radiology, School of Medicine, University College Cork, Ireland
| | - S Joyce
- Department of Radiology, School of Medicine, University College Cork, Ireland.
| | - D J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland
| | - N Moore
- Department of Radiography, University College Cork, Ireland
| | - O J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland; APC Microbiome, University College Cork, Ireland
| | - B J Plant
- Cork Cystic Fibrosis Centre, Cork University Hospital, Wilton, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - M M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland; Department of Radiology, School of Medicine, University College Cork, Ireland; APC Microbiome, University College Cork, Ireland
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17
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Clark AR, Her EJ, Metcalfe R, Byrnes CA. Could automated analysis of chest X-rays detect early bronchiectasis in children? Eur J Pediatr 2021; 180:3171-3179. [PMID: 33909156 PMCID: PMC8080192 DOI: 10.1007/s00431-021-04061-8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 10/25/2022]
Abstract
Non-cystic fibrosis bronchiectasis is increasingly described in the paediatric population. While diagnosis is by high-resolution chest computed tomography (CT), chest X-rays (CXRs) remain a first-line investigation. CXRs are currently insensitive in their detection of bronchiectasis. We aim to determine if quantitative digital analysis allows CT features of bronchiectasis to be detected in contemporaneously taken CXRs. Regions of radiologically (A) normal, (B) severe bronchiectasis, (C) mild airway dilation and (D) other parenchymal abnormalities were identified in CT and mapped to corresponding CXR. An artificial neural network (ANN) algorithm was used to characterise regions of classes A, B, C and D. The algorithm was then tested in 13 subjects and compared to CT scan features. Structural changes in CT were reflected in CXR, including mild airway dilation. The areas under the receiver operator curve for ANN feature detection were 0.74 (class A), 0.71 (class B), 0.76 (class C) and 0.86 (class D). CXR analysis identified CT measures of abnormality with a better correlation than standard radiological scoring at the 99% confidence level.Conclusion: Regional abnormalities can be detected by digital analysis of CXR, which may provide a low-cost and readily available tool to indicate the need for diagnostic CT and for ongoing disease monitoring. What is Known: • Bronchiectasis is a severe chronic respiratory disorder increasingly recognised in paediatric populations. • Diagnostic computed tomography imaging is often requested only after several chest X-ray investigations. What is New: • We show that a digital analysis of chest X-ray could provide more accurate identification of bronchiectasis features.
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Affiliation(s)
- Alys R. Clark
- grid.9654.e0000 0004 0372 3343Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Emily Jungmin Her
- grid.1012.20000 0004 1936 7910Department of Physics, University of Western Australia, Perth, Australia
| | - Russell Metcalfe
- grid.414057.30000 0001 0042 379XStarship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Catherine A. Byrnes
- grid.414057.30000 0001 0042 379XStarship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand ,grid.9654.e0000 0004 0372 3343Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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18
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Bo YMD, Peng HMD, Yukun LMD, Mingbo ZMD. Feasibility and Efficacy of the Segmental Localization of Lumbar Vertebrae by Ultrasound vs X-ray Examination: A Prospective Comparative Study. Advanced Ultrasound in Diagnosis and Therapy 2021. [DOI: 10.37015/audt.2021.200062] [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: 11/06/2022] Open
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19
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Pennati F, Borzani I, Moroni L, Russo MC, Faelli N, Aliverti A, Colombo C. Longitudinal Assessment of Patients With Cystic Fibrosis Lung Disease With Multivolume Noncontrast
MRI
and Spirometry. J Magn Reson Imaging 2020; 53:1570-1580. [DOI: 10.1002/jmri.27461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano Milan Italy
| | - Irene Borzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Pediatric Radiology Milan Italy
| | - Laura Moroni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Università degli Studi di Milano, Centro Fibrosi Cistica Milan Italy
| | - Maria Chiara Russo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Università degli Studi di Milano, Centro Fibrosi Cistica Milan Italy
| | - Nadia Faelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Università degli Studi di Milano, Centro Fibrosi Cistica Milan Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria Politecnico di Milano Milan Italy
| | - Carla Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Università degli Studi di Milano, Centro Fibrosi Cistica Milan Italy
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20
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Woods JC, Wild JM, Wielpütz MO, Clancy JP, Hatabu H, Kauczor HU, van Beek EJ, Altes TA. Current state of the art MRI for the longitudinal assessment of cystic fibrosis. J Magn Reson Imaging 2020; 52:1306-1320. [PMID: 31846139 PMCID: PMC7297663 DOI: 10.1002/jmri.27030] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 07/29/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
Pulmonary MRI can now provide high-resolution images that are sensitive to early disease and specific to inflammation in cystic fibrosis (CF) lung disease. With specificity and function limited via computed tomography (CT), there are significant advantages to MRI. Many of the modern MRI techniques can be performed throughout life, and can be employed to understand changes over time, in addition to quantification of treatment response. Proton density and T1 /T2 contrast images can be obtained within a single breath-hold, providing depiction of structural abnormalities and active inflammation. Modern radial and/or spiral ultrashort echo-time (UTE) techniques rival CT in resolution for depiction and quantification of structure, for both airway and parenchymal abnormalities. Contrast perfusion MRI techniques are now utilized routinely to visualize changes in pulmonary and bronchial circulation that routinely occur in CF lung disease, and noncontrast techniques are moving closer to clinical translation. Functional information can be obtained from noncontrast proton images alone, using techniques such as Fourier decomposition. Hyperpolarized-gas MRI, increasingly using 129 Xe, is now becoming more widespread and has been demonstrated to have high sensitivity to early airway obstruction in CF via ventilation MRI. The sensitivity of 129 Xe MRI promises future use in personalized medicine, management of early CF lung disease, and in future clinical trials. By combining structural and functional techniques, with or without hyperpolarized gases, regional structure-function relationships can be obtained, giving insight into the pathophysiology of disease and improved clinical management. This article reviews the modern MRI techniques that can routinely be employed for CF lung disease in nearly any large medical center. Level of Evidence: 4 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019.
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Affiliation(s)
- Jason C. Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital and University of Cincinnati; Cincinnati OH, USA
| | - Jim M. Wild
- Department of Radiology, University of Sheffield, Sheffield UK
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC) Heidelberg, German Center for lung Research (DZL), Heidelberg, Germany
| | - John P. Clancy
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital and University of Cincinnati; Cincinnati OH, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC) Heidelberg, German Center for lung Research (DZL), Heidelberg, Germany
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Talissa A Altes
- Department of Radiology, University of Missouri, Columbia, MO, USA
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21
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Leutz-Schmidt P, Eichinger M, Sommerburg O, Stahl M, Triphan SMF, Gehlen S, Kauczor HU, Puderbach MU, Mall MA, Wielpütz MO. [Magnetic resonance imaging of the lungs in cystic fibrosis]. Radiologe 2020; 60:813-22. [PMID: 32728856 DOI: 10.1007/s00117-020-00723-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CLINICAL ISSUE Disease severity and mortality in patients with cystic fibrosis (CF) is mainly determined by (progressive) pulmonary lung disease. Early diagnosis and therapy are important and of prognostic value to conserve lung function. STANDARD RADIOLOGICAL METHODS Primary imaging techniques for lung imaging are x‑ray and computed tomography (CT) to monitor disease severity and regional distribution. METHODICAL INNOVATIONS Radiation-free imaging techniques such as magnetic resonance imaging (MRI) have gained interest over the last decade in order to prevent radiation damage. PERFORMANCE The main findings of CF lung disease are airway wall thickening, bronchiectasis, and mucus plugging, which are found in up to 60% of preschool age children. Pleural abnormalities and consolidations are often associated with pulmonary exacerbation. Young CF patients often show a mosaic pattern as functional changes and also perfusion defects can be seen from birth in 50% of CF patients by contrast-enhanced perfusion imaging, and in up to 90% of adult patients, with varying degrees of severity. Dilated bronchial arteries indicate an increased risk for hemoptysis. ACHIEVEMENTS Proton MRI is the sole imaging technique that can show structural and functional lung changes in one examination. Structured assessment using a scoring system helps to systematically grade the extent and severity of all CF-associated changes. CONCLUSIONS Lung MRI for cystic fibrosis has been recently established as a clinical standard examination and is routinely performed at experienced centers. More recently, it has also been used as an endpoint within the framework of clinical studies.
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22
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Bischoff A, Weinheimer O, Eichinger M, Stahl M, Sommerburg O, Kauczor HU, Mall MA, Wielpütz MO. [Cystic fibrosis and computed tomography of the lungs]. Radiologe 2020; 60:791-801. [PMID: 32621155 DOI: 10.1007/s00117-020-00713-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
With its high detail of morphological changes in lung parenchyma and airways as well as the possibilities for three-dimensional reconstruction, computed tomography (CT) represents a solid tool for the diagnosis and follow-up in patients suffering from cystic fibrosis (CF). Guidelines for standardized CT image acquisition in CF patients are still missing. In the mostly younger CF patients, an important issue is the well-considered use of radiation in CT imaging. The use of intravenous contrast agent is mainly restricted to acute emergency diagnostics. Typical morphological findings in CF lung disease are bronchiectasis, mucus plugging, or signs of decreased ventilation (air trapping) which can be detected with CT even in early stages. Various scoring systems that have become established over time are used to grade disease severity and for structured follow-up, e.g., in clinical research studies. With the technical development of CT, a number of postprocessing software tools were developed to help clinical reporting and overcome interreader differences for a standardized quantification. As an imaging modality free of ionizing radiation, magnetic resonance imaging (MRI) is becoming increasingly important in the diagnosis and follow-up of CF patients and is already frequently a substitute for CT for long-term follow-up at numerous specialized centers.
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Joyce S, O'Connor OJ, Maher MM, McEntee MF. Strategies for dose reduction with specific clinical indications during computed tomography. Radiography (Lond) 2020; 26 Suppl 2:S62-S68. [PMID: 32682731 DOI: 10.1016/j.radi.2020.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/24/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022]
Abstract
Increasing integration of computed tomography (CT) into routine patient care has escalated concerns regarding associated radiation exposure. Specific patient cohorts, particularly those with cystic fibrosis (CF) and Crohn's disease, have repeat exposures and thus have an increased risk of high lifetime cumulative effective dose exposures. Thoracic CT is the gold standard imaging method in the diagnosis, assessment and management of pulmonary disease. In the setting of CF, CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography. Furthermore, in specific cases of Crohn's disease, CT demonstrates diagnostic superiority over magnetic resonance imaging (MRI) for radiological evaluation. Low dose CT protocols have proven beneficial in the evaluation of CF, Crohn's disease and renal calculi, and in the follow up of testicular cancer patients. For individuals with chronic conditions warranting frequent radiological follow up, the focus must continue to be the incorporation of appropriate CT use into patient care. This is of particular importance for the paediatric population who are most susceptible to potential radiation induced malignancy. CT technological developments continue to focus on radiation dose optimisation. This article aims to highlight these advancements, which prioritise the acquisition of diagnostically satisfactory images with the least amount of radiation possible.
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Affiliation(s)
- S Joyce
- Department of Radiology, University College Cork, Cork, Ireland.
| | - O J O'Connor
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M M Maher
- Department of Radiology, University College Cork, Cork, Ireland; Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - M F McEntee
- Discipline of Diagnostic Radiography, University College Cork, Cork, Ireland
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Leutz-Schmidt P, Eichinger M, Stahl M, Sommerburg O, Biederer J, Kauczor HU, Puderbach MU, Mall MA, Wielpütz MO. Ten years of chest MRI for patients with cystic fibrosis : Translation from the bench to clinical routine. Radiologe 2019; 59:10-20. [PMID: 31172247 DOI: 10.1007/s00117-019-0553-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite recent advances in our knowledge about the pathophysiology and treatment of cystic fibrosis (CF), pulmonary involvement remains the most important determinant of morbidity and mortality in patients with CF. Since lung function testing may not be sensitive enough for subclinical disease progression, and because young children may have normal spirometry results over a longer period of time, imaging today plays an increasingly important role in clinical routine and research for the monitoring of CF lung disease. In this regard, chest magnetic resonance imaging (MRI) could serve as a radiation-free modality for structural and functional lung imaging. METHODS Our research agenda encompassed the entire process of development, implementation, and validation of appropriate chest MRI protocols for use with infant and adult CF patients alike. RESULTS After establishing a general MRI protocol for state-of-the-art clinical 1.5-T scanners based on the available sequence technology, a semiquantitative scoring system was developed followed by cross-validation of the method against the established modalities of computed tomography, radiography, and lung function testing. Cross-sectional studies were then set up to determine the sensitivity of the method for the interindividual variation of the disease and for changes in disease severity after treatment. Finally, the MRI protocol was implemented at multiple sites to be validated in a multicenter setting. CONCLUSION After more than a decade, lung MRI has become a valuable tool for monitoring CF in clinical routine application and as an endpoint for clinical studies.
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Affiliation(s)
- Patricia Leutz-Schmidt
- Department of Diagnostic and Interventional Radiology, Subdivision Pulmonary Imaging, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany. .,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital of Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Germany.
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology, Subdivision Pulmonary Imaging, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital of Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Mirjam Stahl
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.,Department of Translational Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.,Department of Translational Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic and Interventional Radiology, Subdivision Pulmonary Imaging, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital of Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Germany.,Faculty of Medicine, University of Latvia, Raina bulvaris 19, LV-1586, Riga, Latvia
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Subdivision Pulmonary Imaging, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital of Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Germany.,Department of Translational Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Michael U Puderbach
- Department of Diagnostic and Interventional Radiology, Subdivision Pulmonary Imaging, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital of Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Hufeland Hospital, Rudolph-Weiss-Straße 1-5, 99947, Bad Langensalza, Germany
| | - Marcus A Mall
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Department of Translational Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, Subdivision Pulmonary Imaging, University Hospital of Heidelberg, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital of Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Germany
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Zhang MB, Yan LT, Li SP, Li YY, Huang P. Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case report. World J Clin Cases 2019; 7:1161-1168. [PMID: 31183348 PMCID: PMC6547327 DOI: 10.12998/wjcc.v7.i10.1161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/01/2019] [Accepted: 03/16/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). Repeated fluoroscopy, with more than 30 shots on average, is inevitable to ensure its accuracy and safety. However, exposure to X-rays may pose a threat to human health. We herein report a case of ultrasound (US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD.
CASE SUMMARY A 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic, his symptoms had aggravated for 1 month, and he was diagnosed with L3-4 and L4-5 disc herniations. He received US-guided PELD with good results: His straight leg elevation increased from 40 to 90 degrees after PELD, and his visual analog scale (VAS) and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD. With the guidance of US, he received only two shots of fluoroscopy (fluoroscopic time: 4.4 s; radiation dose: 3.98 mGy). To our knowledge, this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels.
CONCLUSION US could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.
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Affiliation(s)
- Ming-Bo Zhang
- Department of Ultrasound, General Hospital of Chinese PLA, Beijing 100853, China
| | - Long-Tao Yan
- Department of Pain, China-Japan Friendship Hospital, Beijing 100029, China
| | - Shou-Peng Li
- Department of Ultrasound, General Hospital of Chinese PLA, Beijing 100853, China
| | - Ying-Ying Li
- Department of Ultrasound, General Hospital of Chinese PLA, Beijing 100853, China
| | - Peng Huang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China
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26
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Zhang M, Yan L, Li S, Li Y, Huang P. Ultrasound-guided transforaminal percutaneous endoscopic lumbar discectomy: a new guidance method that reduces radiation doses. Eur Spine J 2019; 28:2543-50. [DOI: 10.1007/s00586-019-05980-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
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Pennati F, Salito C, Borzani I, Cervellin G, Gambazza S, Guarise R, Russo MC, Colombo C, Aliverti A. Quantitative multivolume proton-magnetic resonance imaging in patients with cystic fibrosis lung disease: comparison with clinical indicators. Eur Respir J 2019; 53:13993003.02020-2017. [PMID: 30819810 DOI: 10.1183/13993003.02020-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/03/2019] [Indexed: 11/05/2022]
Abstract
This cross-sectional study aims to verify the relationship between quantitative multivolume proton-magnetic resonance imaging (1H-MRI) and clinical indicators of ventilatory abnormalities in cystic fibrosis (CF) lung disease.Non-enhanced chest MRI, spirometry and multiple breath washout was performed by 28 patients (10-27 years) with CF lung disease. Images acquired at end-inspiration and end-expiration were registered by optical flow to estimate expiratory-inspiratory proton-density change (Δ1H-MRI) as a measure of regional ventilation. Magnetic resonance images were also evaluated using a CF-specific scoring system.Biomarkers of CF ventilation impairment were defined from the Δ1H-MRI as follows: Δ1H-MRI median, Δ1H-MRI quartile coefficient of variation (QCV) and percentage of low-ventilation volume (%LVV). Imaging biomarkers correlated to all the clinical measures of ventilation abnormality, with the strongest correlation between Δ1H-MRI median and forced expiratory volume in 1 s (r2=0.44, p<0.001), Δ1H-MRI QCV and lung clearance index (LCI) (r2=0.51, p<0.001) and %LVV and LCI (r2=0.66, p<0.001). Correlations were also found between imaging biomarkers of ventilation and morphological scoring.The study showed a significant correlation between quantitative multivolume MRI and clinical indicators of CF lung disease. MRI, as a non-ionising imaging technique, may be particularly attractive in CF care for longitudinal evaluation, providing a new imaging biomarker to detect early ventilatory abnormalities.
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Affiliation(s)
- Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Caterina Salito
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Irene Borzani
- Radiologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Cervellin
- Radiologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Gambazza
- U.O.C. Direzione Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Guarise
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Chiara Russo
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carla Colombo
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Perchik JD, Murphy RP, Kelly DM, Sawyer JR. Radiation exposure in adult and pediatric patients with osteogenesis imperfecta. J Orthop 2019; 16:320-324. [PMID: 30976147 DOI: 10.1016/j.jor.2019.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/26/2018] [Revised: 11/30/2018] [Accepted: 03/03/2019] [Indexed: 11/26/2022] Open
Abstract
Diagnostic radiographs, computed tomography (CT), nuclear medicine studies, and intraoperative fluoroscopy durations were analyzed for radiation exposure. Cumulative and yearly effective ionizing radiation doses, cumulative background radiation, and total radiograph studies were compared between pediatric and adult populations. In 24 patients with 1,246 imaging studies (average 5.5 years longitudinal treatment duration), the mean estimated cumulative effective radiation dose per patient was 30.0 mSv (range 2.3-115.0), with an average yearly dose of 4.9 mSv (range 0.4-24.8). Pediatric patients had significantly more radiograph studies per year than adults and greater average yearly effective radiation doses.
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Affiliation(s)
- Jordan D Perchik
- University of Alabama at Birmingham, Department of Radiology, 1670 University Blvd, Birmingham, AL, 35233, USA
| | - Ryan P Murphy
- University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Derek M Kelly
- University of Tennessee, Campbell Clinic Department of Orthopaedic Surgery, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA.,LeBonheur Children's Research Hospital, 848 Adams Avenue, Memphis, TN, 38103, USA
| | - Jeffrey R Sawyer
- University of Tennessee, Campbell Clinic Department of Orthopaedic Surgery, 1211 Union Avenue, Suite 510, Memphis, TN, 38104, USA.,LeBonheur Children's Research Hospital, 848 Adams Avenue, Memphis, TN, 38103, USA
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Perrem L, Rayment JH, Ratjen F. The lung clearance index as a monitoring tool in cystic fibrosis: ready for the clinic? Curr Opin Pulm Med 2018; 24:579-85. [DOI: 10.1097/mcp.0000000000000515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Zha W, Nagle SK, Cadman RV, Schiebler ML, Fain SB. Three-dimensional Isotropic Functional Imaging of Cystic Fibrosis Using Oxygen-enhanced MRI: Comparison with Hyperpolarized 3He MRI. Radiology 2018; 290:229-237. [PMID: 30351258 DOI: 10.1148/radiol.2018181148] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To compare the performance of three-dimensional radial ultrashort echo time (UTE) oxygen-enhanced (OE) MRI with that of hyperpolarized helium 3 (3He) MRI with respect to quantitative ventilation measurements in patients with cystic fibrosis (CF). Materials and Methods In this prospective study conducted from June 2013 to May 2015, 25 participants with CF aged 10-55 years (14 male; age range, 13-55 years; 11 female; age range, 10-37 years) successfully underwent pulmonary function tests, hyperpolarized 3He MRI, and OE MRI. OE MRI used two sequential 3.5-minute normoxic and hyperoxic steady-state free-breathing UTE acquisitions. Seven participants underwent imaging at two separate examinations 1-2 weeks apart to assess repeatability. Regional ventilation was quantified as ventilation defect percentage (VDP) individually from OE MRI and hyperpolarized 3He MRI by using the same automated quantification tool. Bland-Altman analysis, intraclass correlation coefficient (ICC), Spearman correlation coefficient, and Wilcoxon signed-rank test were used to evaluate repeatability. Results In all 24 participants, the global VDP measurements from either OE MRI (ρ = -0.66, P < .001) or hyperpolarized 3He MRI (ρ = -0.75, P < .001) were significantly correlated with the percentage predicted forced expiratory volume in 1 second. VDP reported at OE MRI was 5.0% smaller than (P = .014) but highly correlated with (ρ = 0.78, P < .001) VDP reported at hyperpolarized 3He MRI. Both OE MRI-based VDP and hyperpolarized 3He MRI-based VDP demonstrated good repeatability (ICC = 0.91 and 0.95, respectively; P ≤ .001). Conclusion In lungs with cystic fibrosis, ultrashort echo time oxygen-enhanced MRI showed similar performance compared with hyperpolarized 3He MRI for quantitative measures of ventilation defects and their repeatability. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Wei Zha
- From the Departments of Medical Physics (W.Z., S.K.N., R.V.C., S.B.F.), Radiology (S.K.N., M.L.S., S.B.F.), Pediatrics (S.K.N.), and Biomedical Engineering (S.B.F.), University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Ave, Room 2492, Madison, WI 53792
| | - Scott K Nagle
- From the Departments of Medical Physics (W.Z., S.K.N., R.V.C., S.B.F.), Radiology (S.K.N., M.L.S., S.B.F.), Pediatrics (S.K.N.), and Biomedical Engineering (S.B.F.), University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Ave, Room 2492, Madison, WI 53792
| | - Robert V Cadman
- From the Departments of Medical Physics (W.Z., S.K.N., R.V.C., S.B.F.), Radiology (S.K.N., M.L.S., S.B.F.), Pediatrics (S.K.N.), and Biomedical Engineering (S.B.F.), University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Ave, Room 2492, Madison, WI 53792
| | - Mark L Schiebler
- From the Departments of Medical Physics (W.Z., S.K.N., R.V.C., S.B.F.), Radiology (S.K.N., M.L.S., S.B.F.), Pediatrics (S.K.N.), and Biomedical Engineering (S.B.F.), University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Ave, Room 2492, Madison, WI 53792
| | - Sean B Fain
- From the Departments of Medical Physics (W.Z., S.K.N., R.V.C., S.B.F.), Radiology (S.K.N., M.L.S., S.B.F.), Pediatrics (S.K.N.), and Biomedical Engineering (S.B.F.), University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, 1111 Highland Ave, Room 2492, Madison, WI 53792
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Wielpütz MO, von Stackelberg O, Stahl M, Jobst BJ, Eichinger M, Puderbach MU, Nährlich L, Barth S, Schneider C, Kopp MV, Ricklefs I, Buchholz M, Tümmler B, Dopfer C, Vogel-Claussen J, Kauczor HU, Mall MA. Multicentre standardisation of chest MRI as radiation-free outcome measure of lung disease in young children with cystic fibrosis. J Cyst Fibros 2018; 17:518-527. [DOI: 10.1016/j.jcf.2018.05.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 12/31/2022]
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Chassagnon G, Martin C, Burgel PR, Hubert D, Fajac I, Paragios N, Zacharaki EI, Legmann P, Coste J, Revel MP. An automated computed tomography score for the cystic fibrosis lung. Eur Radiol 2018; 28:5111-5120. [PMID: 29869171 DOI: 10.1007/s00330-018-5516-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 09/08/2017] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To develop an automated density-based computed tomography (CT) score evaluating high-attenuating lung structural abnormalities in patients with cystic fibrosis (CF). METHODS Seventy adult CF patients were evaluated. The development cohort comprised 17 patients treated with ivacaftor, with 45 pre-therapeutic and follow-up chest CT scans. Another cohort of 53 patients not treated with ivacaftor was used for validation. CT-density scores were calculated using fixed and adapted thresholds based on histogram characteristics, such as the mode and standard deviation. Visual CF-CT score was also calculated. Correlations between the CT scores and forced expiratory volume in 1 s (FEV1% pred), and between their changes over time were assessed. RESULTS On cross-sectional evaluation, the correlation coefficients between FEV1%pred and the automated scores were slightly lower to that of the visual score in the development and validation cohorts (R = up to -0.68 and -0.61, versus R = -0.72 and R = -0.64, respectively). Conversely, the correlation to FEV1%pred tended to be higher for automated scores (R = up to -0.61) than for visual score (R = -0.49) on longitudinal follow-up. Automated scores based on Mode + 3 SD and Mode +300 HU showed the highest cross-sectional (R = -0.59 to -0.68) and longitudinal (R = -0.51 to -0.61) correlation coefficients to FEV1%pred. CONCLUSIONS The developed CT-density score reliably quantifies high-attenuating lung structural abnormalities in CF. KEY POINTS • Automated CT score shows moderate to good cross-sectional correlations with FEV 1 %pred . • CT score has potential to be integrated into the standard reporting workflow.
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Affiliation(s)
- Guillaume Chassagnon
- Radiology Department, Groupe Hospitalier Cochin-Hotel Dieu, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.
- Centre for Visual Computing, Ecole Centrale Paris, Grande Voie des Vignes, 92290, Chatenay Malabry, France.
| | - Clémence Martin
- Pulmonary Department and Adult CF Centre, Groupe Hospitalier Cochin-Hotel Dieu, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Pierre-Régis Burgel
- Pulmonary Department and Adult CF Centre, Groupe Hospitalier Cochin-Hotel Dieu, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Dominique Hubert
- Pulmonary Department and Adult CF Centre, Groupe Hospitalier Cochin-Hotel Dieu, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Isabelle Fajac
- Physiology Department, Groupe Hospitalier Cochin-Hotel Dieu, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Nikos Paragios
- Centre for Visual Computing, Ecole Centrale Paris, Grande Voie des Vignes, 92290, Chatenay Malabry, France
| | - Evangelia I Zacharaki
- Centre for Visual Computing, Ecole Centrale Paris, Grande Voie des Vignes, 92290, Chatenay Malabry, France
| | - Paul Legmann
- Radiology Department, Groupe Hospitalier Cochin-Hotel Dieu, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Joel Coste
- Biostatistics and Epidemiology Department, Groupe Hospitalier Cochin-Hotel Dieu, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marie-Pierre Revel
- Radiology Department, Groupe Hospitalier Cochin-Hotel Dieu, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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Ronan NJ, Einarsson GG, Twomey M, Mooney D, Mullane D, NiChroinin M, O'Callaghan G, Shanahan F, Murphy DM, O'Connor OJ, Shortt CA, Tunney MM, Eustace JA, Maher MM, Elborn JS, Plant BJ. CORK Study in Cystic Fibrosis: Sustained Improvements in Ultra-Low-Dose Chest CT Scores After CFTR Modulation With Ivacaftor. Chest 2017; 153:395-403. [PMID: 29037527 DOI: 10.1016/j.chest.2017.10.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [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: 07/23/2017] [Revised: 09/16/2017] [Accepted: 10/02/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact of cystic fibrosis transmembrane conductance regulator modulation on multiple modalities of patient assessment. METHODS Thirty-three patients with the G551D mutation were assessed at baseline and prospectively every 3 months for 1 year after initiation of ivacaftor. Change in ultra-low-dose chest CT scans, blood inflammatory mediators, and the sputum microbiome were assessed. RESULTS Significant improvements in FEV1, BMI, and sweat chloride levels were observed post-ivacaftor treatment. Improvement in ultra-low-dose CT imaging scores were observed after treatment, with significant mean reductions in total Bhalla score (P < .01), peribronchial thickening (P = .035), and extent of mucous plugging (P < .001). Reductions in circulating inflammatory markers, including interleukin (IL)-1β, IL-6, and IL-8 were demonstrated. There was a 30% reduction in the relative abundance of Pseudomonas species and an increase in the relative abundance of bacteria associated with more stable community structures. Posttreatment community richness increased significantly (P = .03). CONCLUSIONS Early and sustained improvements on ultra-low-dose CT scores suggest it may be a useful method of evaluating treatment response. It paralleled improvement in symptoms, circulating inflammatory markers, and changes in the lung microbiota.
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Affiliation(s)
- Nicola J Ronan
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - Gisli G Einarsson
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, Northern Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Denver Mooney
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, Northern Ireland
| | - David Mullane
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland
| | - Muireann NiChroinin
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland
| | - Grace O'Callaghan
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | | | - Desmond M Murphy
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Cathy A Shortt
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland
| | - Michael M Tunney
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, Northern Ireland
| | - Joseph A Eustace
- HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - J Stuart Elborn
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, Northern Ireland; Imperial College and Royal Brompton Hospital, London, England
| | - Barry J Plant
- Cork Cystic Fibrosis Centre, Cork University Hospital, University College Cork, Cork, Ireland; HRB Clinical Research Facility, Cork University Hospital, University College Cork, Cork, Ireland.
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Ward R, Carroll WD, Cunningham P, Ho SA, Jones M, Lenney W, Thompson D, Gilchrist FJ. Radiation dose from common radiological investigations and cumulative exposure in children with cystic fibrosis: an observational study from a single UK centre. BMJ Open 2017; 7:e017548. [PMID: 28827272 PMCID: PMC5724114 DOI: 10.1136/bmjopen-2017-017548] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 11/30/2022] Open
Abstract
OBJECTIVES Cumulative radiation exposure is associated with increased risk of malignancy. This is important in cystic fibrosis (CF) as frequent imaging is required to monitor disease progression and diagnose complications. Previous estimates of cumulative radiation are outdated as the imaging was performed on older equipment likely to deliver higher radiation. Our objectives were to determine the radiation dose delivered to children during common radiological investigations using modern equipment and to identify the number of such investigations performed in a cohort of children with CF to calculate their cumulative radiation exposure. DESIGN, SETTING AND PARTICIPANTS Data including age at investigation and radiation exposure measured as estimated effective dose (EED) were collected on 2827 radiological studies performed on children at one UK paediatric centre. These were combined with the details of all radiological investigations performed on 65 children with CF attending the same centre to enable calculation of each child's cumulative radiation exposure. RESULTS The mean EED for the common radiological investigations varied according to age. The range was 0.01-0.02 mSv for chest X-rays, 0.03-0.11 mSv for abdominal X-rays, 0.57-1.69 mSv for CT chest, 2.9-3.9 mSv for abdominal and pelvic CT, 0.20-0.21 mSv for sinus CT and 0.15-0.52 mSv for fluoroscopy-guided procedures. The mean EED was three to five times higher for helical compared with axial chest CT scans. The mean annual cumulative EED for our cohort of children with CF was 0.15 mSv/year with an estimated cumulative paediatric lifetime EED (0-18 years) of 3.5 mSv. CONCLUSIONS This study provides up-to-date estimations of the radiation exposure when using common radiological investigations. These doses and the estimates of cumulative radiation exposure in children with CF are lower than previously reported. This reflects the reduced EED associated with modern equipment and the use of age-specific scanning protocols.
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Affiliation(s)
- Rebecca Ward
- Academic Department of Child Health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - William D Carroll
- Academic Department of Child Health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - Paula Cunningham
- Department of Radiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Sheng-Ang Ho
- Academic Department of Child Health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Mary Jones
- Department of Radiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Warren Lenney
- Academic Department of Child Health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
| | - David Thompson
- Department of Radiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Francis J Gilchrist
- Academic Department of Child Health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Institute of Applied Clinical Science, Keele University, Keele, UK
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Stahl M, Wielpütz MO, Graeber SY, Joachim C, Sommerburg O, Kauczor HU, Puderbach M, Eichinger M, Mall MA. Comparison of Lung Clearance Index and Magnetic Resonance Imaging for Assessment of Lung Disease in Children with Cystic Fibrosis. Am J Respir Crit Care Med 2017; 195:349-359. [PMID: 27575911 DOI: 10.1164/rccm.201604-0893oc] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Early onset and progression of lung disease in children with cystic fibrosis (CF) indicates that sensitive noninvasive outcome measures are needed for diagnostic monitoring and early intervention clinical trials. The lung clearance index (LCI) and chest magnetic resonance imaging (MRI) were shown to detect early lung disease in CF; however, the relationship between the two measures remains unknown. OBJECTIVES To correlate the LCI with abnormalities detected by MRI and compare the sensitivity of the two techniques to detect responses to therapy for pulmonary exacerbations in children with CF. METHODS LCI determined by age-adapted multiple breath washout techniques and MRI studies were performed in 97 clinically stable children with CF across the pediatric age range (0.2-21.1 yr). Furthermore, LCI (n = 26) or MRI (n = 10) were performed at the time of pulmonary exacerbation and after antibiotic therapy. MRI was evaluated using a dedicated morphofunctional score. MEASUREMENTS AND MAIN RESULTS The LCI correlated with the global MRI score as well as MRI-defined airway wall abnormalities, mucus plugging, and abnormal lung perfusion in infants and toddlers (P < 0.05 to P < 0.001) and in older children (P < 0.001) with CF. LCI and MRI were sensitive to detect response to antibiotic therapy for pulmonary exacerbations. CONCLUSIONS Our results indicate that LCI and MRI may be useful complementary tools for noninvasive monitoring and as quantitative endpoints in early intervention trials in children with CF. In this context, MRI enables detection of disease heterogeneity, including regional mucus plugging associated with abnormal lung perfusion in early CF lung disease. Clinical trial registered with www.clinicaltrials.gov (NCT 02270476).
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Affiliation(s)
- Mirjam Stahl
- 1 Department of Translational Pulmonology.,2 Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and.,3 Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Mark O Wielpütz
- 4 Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,3 Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.,5 Department of Radiology, German Cancer Research Center, Heidelberg, Germany; and
| | - Simon Y Graeber
- 1 Department of Translational Pulmonology.,2 Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and.,3 Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Cornelia Joachim
- 1 Department of Translational Pulmonology.,2 Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and.,3 Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Olaf Sommerburg
- 1 Department of Translational Pulmonology.,2 Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and.,3 Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- 4 Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany.,3 Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Michael Puderbach
- 5 Department of Radiology, German Cancer Research Center, Heidelberg, Germany; and.,6 Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Eichinger
- 3 Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany.,5 Department of Radiology, German Cancer Research Center, Heidelberg, Germany; and.,6 Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Marcus A Mall
- 1 Department of Translational Pulmonology.,2 Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, and.,3 Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
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Wu R, Liao X, Xia H. Radiation Exposure to the Surgeon During Ultrasound-Assisted Transforaminal Percutaneous Endoscopic Lumbar Discectomy: A Prospective Study. World Neurosurg 2017; 101:658-665.e1. [PMID: 28342919 DOI: 10.1016/j.wneu.2017.03.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/19/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine the radiation dose to the surgeon during ultrasound-assisted transforaminal percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation, and to investigate whether the usage of ultrasonography could reduce the radiation exposure to the surgeon. METHODS The stages of needle insertion and foraminal plasty for transforaminal PELD were performed under ultrasound guidance and confirmed by fluoroscopy according to the standard technique by 2 spinal surgeons separately in 25 transforaminal PELDs (25 levels). The radiation exposure dose of the surgeons' chest above and below the shielding and the fluoroscopy time were recorded. The effective dose and number of possible levels per year within the yearly occupational exposure limit (OEL) were calculated. The radiation dose per level and fluoroscopy time between ultrasound-assisted PELD and fluoroscopy-assisted PELD were compared. RESULTS The mean operation time and fluoroscopy time were 67.6 ± 14.6 minutes and 2.9 ± 0.7 seconds, respectively. The mean effective dose to the surgeons per level was 1.3 ± 0.6 μSv. One surgeon could perform PELDs at 38,462 levels per year without exceeding the OEL for whole-body radiation wearing a lead apron, and 1938 levels per year without using any shielding devices. Ultrasound-assisted PELD had significantly less radiation dose per level at the chest below and above apron, effective dose per level, and fluoroscopy time, compared with fluoroscopy-assisted PELD (all P < 0.05). CONCLUSIONS The method of ultrasound-assisted needle insertion and foraminal plasty in transforaminal PELD can reduce radiation exposure to the surgeons compared with fluoroscopy-assisted PELD.
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Affiliation(s)
- Ruihui Wu
- Department of Orthopedics, Southern Medical University, Guangzhou, P.R. China; Department of Orthopedics, First People's Hospital of Foshan, Foshan, P.R. China
| | - Xuqiang Liao
- Department of Orthopedics, First People's Hospital of Foshan, Foshan, P.R. China
| | - Hong Xia
- Department of Orthopedics, Southern Medical University, Guangzhou, P.R. China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, P.R. China.
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Mall MA, Stahl M, Graeber SY, Sommerburg O, Kauczor HU, Wielpütz MO. Early detection and sensitive monitoring of CF lung disease: Prospects of improved and safer imaging. Pediatr Pulmonol 2016; 51:S49-S60. [PMID: 27662104 DOI: 10.1002/ppul.23537] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 05/29/2016] [Revised: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 12/27/2022]
Abstract
Recent imaging studies using chest computed tomography (CT) in presymptomatic infants and young children with cystic fibrosis (CF) diagnosed by newborn screening presented compelling evidence of early onset and progression of structural lung damage in CF. These data argue persuasively that non-invasive outcome measures for early detection and sensitive monitoring of lung disease applicable in the clinical setting will be instrumental for further improvement of clinical care and the development of early intervention therapies that have the potential to prevent irreversible lung damage. In this context, the use of CT imaging for early detection and long-term monitoring has the disadvantage of the risk to induce malignancies due to cumulating ionizing radiation exposure. More recently, magnetic resonance imaging (MRI) has emerged as an alternative radiation-free imaging technique for quantitative assessment of CF lung disease. In addition to structural lung damage, chest MRI enables non-invasive assessment of abnormalities in lung perfusion and ventilation characteristically associated with mucus plugging in CF lung disease. Here, we review recent developments and the prospects of MRI for improved and safer imaging with a focus on recent studies that support its utility as a sensitive non-invasive outcome measure of early lung disease in young children with CF. Pediatr Pulmonol. 2016;51:S49-S60. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marcus A Mall
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany. .,Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany. .,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.
| | - Mirjam Stahl
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany.,Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Simon Y Graeber
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany.,Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Olaf Sommerburg
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany.,Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Mark O Wielpütz
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
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Abstract
1. CT is superior to pulmonary function tests and chest radiography for the assessment and monitoring of cystic fibrosis (CF)-related lung disease and, also, of pediatric bronchiectasis not caused by CF (hereafter referred to as non-CF bronchiectasis). 2. Low-dose CT protocols that impart radiation doses similar to those used in chest radiography are feasible for the surveillance of patients with bronchiectasis. 3. Chest radiography is still most commonly used as the first-line imaging examination of choice for the assessment of acute complications related to bronchiectasis. 4. Pulmonary MRI, with or without the use of inhaled hyperpolarized gas, can be performed to obtain functional information, and, in dedicated centers, it may yield imaging results comparable to those obtained by CT. 5. Gastrointestinal and pancreaticobiliary manifestations of CF are observed with greater frequency in adults, because of increased life expectancy.
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Moloney F, Fama D, Twomey M, O’Leary R, Houlihane C, Murphy KP, O’Neill SB, O’Connor OJ, Breen D, Maher MM. Cumulative radiation exposure from diagnostic imaging in intensive care unit patients. World J Radiol 2016; 8:419-427. [PMID: 27158429 PMCID: PMC4840200 DOI: 10.4329/wjr.v8.i4.419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/03/2015] [Accepted: 01/31/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To quantify cumulative effective dose of intensive care unit (ICU) patients attributable to diagnostic imaging.
METHODS: This was a prospective, interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center. Demographic and clinical data including age, gender, date of ICU admission, primary reason for ICU admission, APACHE II score, length of stay, number of days intubated, date of death or discharge, and re-admission data was collected on all patients admitted over a 1-year period. The overall radiation exposure was quantified by the cumulative effective radiation dose (CED) in millisieverts (mSv) and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board. Pediatric patients were selected for subgroup-analysis.
RESULTS: A total of 2737 studies were performed in 421 patients. The total CED was 1704 mSv with a median CED of 1.5 mSv (IQR 0.04-6.6 mSv). Total CED in pediatric patients was 74.6 mSv with a median CED of 0.07 mSv (IQR 0.01-4.7 mSv). Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED. Computed tomography (CT) accounted for 16% of all studies performed and contributed 97% of total CED. Trauma patients received a statistically significant higher dose [median CED 7.7 mSv (IQR 3.5-13.8 mSv)] than medical [median CED 1.4 mSv (IQR 0.05-5.4 mSv)] and surgical [median CED 1.6 mSv (IQR 0.04-7.5 mSv)] patients. Length of stay in ICU [OR = 1.12 (95%CI: 1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mSv.
CONCLUSION: Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs. CED should be minimized where feasible, especially in young patients.
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Ferris H, Twomey M, Moloney F, O’Neill SB, Murphy K, O’Connor OJ, Maher M. Computed tomography dose optimisation in cystic fibrosis: A review. World J Radiol 2016; 8:331-341. [PMID: 27158420 PMCID: PMC4840191 DOI: 10.4329/wjr.v8.i4.331] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/15/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
Cystic fibrosis (CF) is the most common autosomal recessive disease of the Caucasian population worldwide, with respiratory disease remaining the most relevant source of morbidity and mortality. Computed tomography (CT) is frequently used for monitoring disease complications and progression. Over the last fifteen years there has been a six-fold increase in the use of CT, which has lead to a growing concern in relation to cumulative radiation exposure. The challenge to the medical profession is to identify dose reduction strategies that meet acceptable image quality, but fulfil the requirements of a diagnostic quality CT. Dose-optimisation, particularly in CT, is essential as it reduces the chances of patients receiving cumulative radiation doses in excess of 100 mSv, a dose deemed significant by the United Nations Scientific Committee on the Effects of Atomic Radiation. This review article explores the current trends in imaging in CF with particular emphasis on new developments in dose optimisation.
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Gergin O, Kawai K, MacDougall RD, Robson CD, Moritz E, Cunningham M, Adil E. Sinus Computed Tomography Imaging in Pediatric Cystic Fibrosis. Otolaryngol Head Neck Surg 2016; 155:160-5. [DOI: 10.1177/0194599816634671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/03/2016] [Indexed: 11/17/2022]
Abstract
Study Objective To evaluate the prevalence of computed tomography (CT) sinus imaging in a pediatric cystic fibrosis (CF) population, determine changes in Lund Mackay (LM) scores over time, and estimate radiation exposure. Study Design Case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods In total, 202 pediatric patients with CF who underwent endoscopic sinus surgery (ESS) were included. The total number of CT scans was calculated for each patient, with specific focus on the indications for and subsequent outcomes of the sinus CT scan subgroup. Results Patients underwent a total of 1718 CT scans, 832 of which were sinus CT scans (mean of 4.2 sinus scans per patient). Disease evaluation (54%) and preoperative planning (35%) were the most common indications. Otolaryngologists were more likely to order imaging for preoperative evaluation, and those scans were more likely to result in surgery compared with those requested by other physicians ( P < .001). Ninety CT scans (10.8%) led to no change in management. There was no significant difference in LM scores between patients admitted to the hospital or prescribed antibiotics and those who were not. There was also no significant change in LM score following ESS after adjusting for age and sex ( P = .23). Conclusion Based on LM scores, all sinus CT scans in patients with CF reveal moderate to severe sinus disease. Effort should be made to minimize radiation exposure in patients with CF by limiting sinus CT scans to the preoperative context or for evaluation of potential sinusitis complications.
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Affiliation(s)
- Ozgul Gergin
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
| | | | - Caroline D. Robson
- Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ethan Moritz
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Michael Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Eelam Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Wielpütz MO, Kauczor HU. Imaging cystic fibrosis lung disease with MRI. Imaging 2016. [DOI: 10.1183/2312508x.10002415] [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: 11/05/2022] Open
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Murphy KP, Crush L, O’Neill SB, Foody J, Breen M, Brady A, Kelly PJ, Power DG, Sweeney P, Bye J, O’Connor OJ, Maher MM, O’Regan KN. Feasibility of low-dose CT with model-based iterative image reconstruction in follow-up of patients with testicular cancer. Eur J Radiol Open 2016; 3:38-45. [PMID: 27069978 PMCID: PMC4811850 DOI: 10.1016/j.ejro.2016.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 10/28/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We examine the performance of pure model-based iterative reconstruction with reduced-dose CT in follow-up of patients with early-stage testicular cancer. METHODS Sixteen patients (mean age 35.6 ± 7.4 years) with stage I or II testicular cancer underwent conventional dose (CD) and low-dose (LD) CT acquisition during CT surveillance. LD data was reconstructed with model-based iterative reconstruction (LD-MBIR). Datasets were objectively and subjectively analysed at 8 anatomical levels. Two blinded clinical reads were compared to gold-standard assessment for diagnostic accuracy. RESULTS Mean radiation dose reduction of 67.1% was recorded. Mean dose measurements for LD-MBIR were: thorax - 66 ± 11 mGy cm (DLP), 1.0 ± 0.2 mSv (ED), 2.0 ± 0.4 mGy (SSDE); abdominopelvic - 128 ± 38 mGy cm (DLP), 1.9 ± 0.6 mSv (ED), 3.0 ± 0.6 mGy (SSDE). Objective noise and signal-to-noise ratio values were comparable between the CD and LD-MBIR images. LD-MBIR images were superior (p < 0.001) with regard to subjective noise, streak artefact, 2-plane contrast resolution, 2-plane spatial resolution and diagnostic acceptability. All patients were correctly categorised as positive, indeterminate or negative for metastatic disease by 2 readers on LD-MBIR and CD datasets. CONCLUSIONS MBIR facilitated a 67% reduction in radiation dose whilst producing images that were comparable or superior to conventional dose studies without loss of diagnostic utility.
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Affiliation(s)
- Kevin P. Murphy
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Lee Crush
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Siobhan B. O’Neill
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - James Foody
- Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | - Micheál Breen
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Adrian Brady
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Paul J. Kelly
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Derek G. Power
- Department of Medical Oncology, Cork and Mercy University Hospitals, Cork, Ireland
| | - Paul Sweeney
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Jackie Bye
- General Electric Healthcare Technologies, Herdfordshire, UK
| | - Owen J. O’Connor
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
- Department of Radiology, University College Cork, Cork, Ireland
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Kevin N. O’Regan
- Department of Radiology, Cork University Hospital, Cork, Ireland
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Sanders DB, Li Z, Brody AS. Chest computed tomography predicts the frequency of pulmonary exacerbations in children with cystic fibrosis. Ann Am Thorac Soc 2015; 12:64-9. [PMID: 25474182 DOI: 10.1513/AnnalsATS.201407-338OC] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Abnormalities on chest computed tomography (CT) in children with cystic fibrosis (CF) have been shown to correlate with short-term measures of lung disease. Chest CT scores offer promise as a potential surrogate end point in CF; however, there is limited information available on the ability of chest CT scores to predict future morbidity. OBJECTIVES Determine whether chest CT scores are associated with the rate of pulmonary exacerbations over the next 10 years. METHODS Ten years of follow-up data were obtained from the CF Foundation Patient Registry for 60 children enrolled in the Pulmozyme Early Intervention Trial and who had chest CT scans at baseline. MEASUREMENTS AND MAIN RESULTS Multivariable Poisson regression was used to compare Brody CT scores and the number of pulmonary exacerbations in the following 10 years. At the time of the chest CT, the mean (SD) age was 10.6 (1.7) years. A 1-point increase in the Brody CT score was associated with an increase in the mean (95% confidence interval) rate of pulmonary exacerbations of 1.39 (1.15, 1.67) (P < 0.001). Brody CT scores were more strongly associated with the number of pulmonary exacerbations than FEV1 % predicted at the time of the chest CT (P = 0.037 by chi-square test). CONCLUSIONS There is a significant association between Brody CT scores and the rate of pulmonary exacerbations up to 10 years later. This association is stronger than for FEV1 obtained at the time of the CT, suggesting that chest CT scores offer improved ability to predict future outcomes.
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Addy C, Downey DG, Elborn JS. Improvements in symptomatic treatment strategies for cystic fibrosis: delivering CF care in the 21st century. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2016.1107473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zamiara P, Thomas KE, Connolly BL, Lane H, Marcon MA, Chiu PP. Long-term burden of care and radiation exposure in survivors of esophageal atresia. J Pediatr Surg 2015; 50:1686-90. [PMID: 26091971 DOI: 10.1016/j.jpedsurg.2015.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 01/05/2015] [Revised: 04/29/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) historically have had a high risk of neonatal mortality but the majority of patients are now expected to live into adulthood. However, the long-term burden of care among recent EA/TEF survivors has not been documented. METHODS A single-institution retrospective review of newborns with EA/TEF treated from 2001-2005 was conducted, including initial and total hospitalization length of stay, and number of clinic visits and procedures requiring general anesthesia in the first three years of life. Exposure to and number of radiological studies involving ionizing radiation (IR) were recorded. RESULTS Seventy-one of 78 (91%) patients survived to discharge and 69 were included for analysis. Mean length of initial hospital stay was 51.3 (range 9-390) days. By age 3 years, patients required 4.5 (mean, range 1-23) procedures performed under general anesthesia, attended 13.5 (mean, range 3-40) outpatient visits and were exposed to 17.4 mSv (mean, range 3.0-59.9) of IR from 40 (mean, range 5-165) radiological studies. CONCLUSION Patients with EA/TEF need complex and frequent hospital-based care from infancy to early childhood. Opportunities to critically review clinical services and imaging needs should be explored to improve the experience of patients and their families.
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Affiliation(s)
- Paul Zamiara
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.
| | - Karen E Thomas
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.
| | - Bairbre L Connolly
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.
| | - Hillary Lane
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.
| | - Priscilla P Chiu
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8.
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Lee E, Goo HW, Lee JY. Age- and gender-specific estimates of cumulative CT dose over 5 years using real radiation dose tracking data in children. Pediatr Radiol 2015; 45:1282-92. [PMID: 25801905 DOI: 10.1007/s00247-015-3331-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Received: 11/17/2014] [Revised: 01/23/2015] [Accepted: 02/24/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is necessary to develop a mechanism to estimate and analyze cumulative radiation risks from multiple CT exams in various clinical scenarios in children. OBJECTIVE To identify major contributors to high cumulative CT dose estimates using actual dose-length product values collected for 5 years in children. MATERIALS AND METHODS Between August 2006 and July 2011 we reviewed 26,937 CT exams in 13,803 children. Among them, we included 931 children (median age 3.5 years, age range 0 days-15 years; M:F = 533:398) who had 5,339 CT exams. Each child underwent at least three CT scans and had accessible radiation dose reports. Dose-length product values were automatically extracted from DICOM files and we used recently updated conversion factors for age, gender, anatomical region and tube voltage to estimate CT radiation dose. We tracked the calculated CT dose estimates to obtain a 5-year cumulative value for each child. The study population was divided into three groups according to the cumulative CT dose estimates: high, ≥30 mSv; moderate, 10-30 mSv; and low, <10 mSv. We reviewed clinical data and CT protocols to identify major contributors to high and moderate cumulative CT dose estimates. RESULTS Median cumulative CT dose estimate was 5.4 mSv (range 0.5-71.1 mSv), and median number of CT scans was 4 (range 3-36). High cumulative CT dose estimates were most common in children with malignant tumors (57.9%, 11/19). High frequency of CT scans was attributed to high cumulative CT dose estimates in children with ventriculoperitoneal shunt (35 in 1 child) and malignant tumors (range 18-49). Moreover, high-dose CT protocols, such as multiphase abdomen CT (median 4.7 mSv) contributed to high cumulative CT dose estimates even in children with a low number of CT scans. CONCLUSION Disease group, number of CT scans, and high-dose CT protocols are major contributors to higher cumulative CT dose estimates in children.
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Affiliation(s)
- Eunsol Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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Sullivan CJ, Murphy KP, McLaughlin PD, Twomey M, O'Regan KN, Power DG, Maher MM, O'Connor OJ. Radiation exposure from diagnostic imaging in young patients with testicular cancer. Eur Radiol 2014; 25:1005-13. [PMID: 25500962 DOI: 10.1007/s00330-014-3507-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/30/2014] [Accepted: 11/13/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Risks associated with high cumulative effective dose (CED) from radiation are greater when imaging is performed on younger patients. Testicular cancer affects young patients and has a good prognosis. Regular imaging is standard for follow-up. This study quantifies CED from diagnostic imaging in these patients. METHODS Radiological imaging of patients aged 18-39 years, diagnosed with testicular cancer between 2001 and 2011 in two tertiary care centres was examined. Age at diagnosis, cancer type, dose-length product (DLP), imaging type, and frequency were recorded. CED was calculated from DLP using conversion factors. Statistical analysis was performed with SPSS. RESULTS In total, 120 patients with a mean age of 30.7 ± 5.2 years at diagnosis had 1,410 radiological investigations. Median (IQR) surveillance was 4.37 years (2.0-5.5). Median (IQR) CED was 125.1 mSv (81.3-177.5). Computed tomography accounted for 65.3 % of imaging studies and 98.3 % of CED. We found that 77.5 % (93/120) of patients received high CED (>75 mSv). Surveillance time was associated with high CED (OR 2.1, CI 1.5-2.8). CONCLUSIONS Survivors of testicular cancer frequently receive high CED from diagnostic imaging, mainly CT. Dose management software for accurate real-time monitoring of CED and low-dose CT protocols with maintained image quality should be used by specialist centres for surveillance imaging. KEY POINTS • CT accounted for 98.3 % of CED in patients with testicular cancer. • Median CED in patients with testicular cancer was 125.1 mSv • High CED (>75 mSv) was observed in 77.5 % (93/120) of patients. • Dose tracking and development of low-dose CT protocols are recommended.
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Affiliation(s)
- C J Sullivan
- Department of Radiology, Cork and Mercy University Hospitals, Wilton, Cork, Ireland
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Abstract
Head and neck diseases in children and adolescents present special diagnostic and differential diagnostic challenges to ENT surgeons as well as to radiologists. Both disciplines have to adapt the latest radiological and interventional technologies to the needs of the pediatric patient in order to enable a minimally invasive but successful diagnostic procedure. High quality sonography by an experienced examiner is often the only imaging technique that is necessary in children and adolescents. Radiographs are rarely indicated in pediatric head and neck diseases. MRI, compared to computed tomography, has the advantage of absent radiation exposure. Additionally, due to current advances in high resolution techniques to delineate very small details or in visualization of different tissue characteristics, it has become an integral part of pre- and postoperative imaging. However, children should not be denied an adequate diagnostic procedure even if it includes sedation, intervention, or exposure to radiation. The responsible use of the diagnostic options under consideration of the therapeutic consequences is essential. It is most likely to be successful in a close interdisciplinary cooperation of pediatric ENT specialists and radiologists as well as pediatric anesthesiologists in selected cases. Although benign diseases predominate in children and adolescents, the possibility of malignancy has to be considered in cases of atypical clinical and radiological findings. In many of these young patients, the outcome and the probability of survival are directly associated with the initial diagnostic and therapeutic strategies, which should therefore be in accordance with the current guidelines of pediatric oncology therapy studies. Our collection of clinical cases consists of representative examples of useful diagnostic approaches in common and age specific diagnoses as well as in rare diseases and malformations. It shows the significance of a special knowledge in embryology and normal postnatal development for the differentiation of normal variants from pathological findings. Only in considering the results of imaging studies in their clinical context, it is possible to succeed in detecting a syndrome behind a single malformation or adequately caring for patients with a chronic disease such as cystic fibrosis.
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Affiliation(s)
- Thekla von Kalle
- Institute of Radiology, Olgahospital, Klinikum Stuttgart, Germany,*To whom correspondence should be addressed: Thekla von Kalle, Institute of Radiology, Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174 Stuttgart, Germany, E-mail:
| | - Assen Koitschev
- Department of Otolaryngology, Division of Pediatric Otolaryngology and Otology, Olgahospital, Klinikum Stuttgart, Germany
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