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Keenen TL, Demirel S, Gheen A, Casabarro B, Fleishman D. Intraoperative Fluoroscopy Radiation Using OEC 9900 Elite C-arm: Risk and Method for Decreasing Exposure. HEALTH PHYSICS 2023; 124:380-390. [PMID: 36880954 DOI: 10.1097/hp.0000000000001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
ABSTRACT The use of intraoperative fluoroscopy in surgery produces scattered radiation that can expose all operating room personnel to measurable and, in some cases, substantial radiation doses. The goal of this work is to assess and document potential radiation doses to various staff positions in a simulated standard operating room environment. Adult-sized mannequins wearing standard lead protective aprons were placed at seven positions around large and small BMI cadavers. Doses were recorded in real time at thyroid level with Bluetooth-enabled dosimeters for a variety of fluoroscope settings and imaging views. A total of 320 images were acquired, resulting in 2,240 dosimeter readings from the seven mannequins. Doses were compared to cumulative air kerma (CAK) calculations provided by the fluoroscope. There was a strong correlation between the CAK and the recorded scattered radiation doses ( P < 0.001). Radiation doses could be reduced by manipulating C-arm manual technique settings [e.g., turning off the automatic exposure control (AEC) and using pulse (PULSE) or low dose (LD) settings]. Staff position and patient size also affected the recorded doses. The highest radiation doses were recorded across all settings for the mannequin positioned immediately adjacent to the C-arm x-ray tube. The larger BMI cadaver generated greater scattered radiation than the smaller BMI cadaver for all views and settings. This work provides suggestions for reducing exposure to operating room personnel beyond standard techniques of reducing beam-on time, increasing the distance from the radiation source, and use of shielding. Simple changes in C-arm settings (turning AEC off, avoiding DS setting, use of PULSE or LD settings) can markedly reduce dose to staff.
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Affiliation(s)
- Timothy L Keenen
- Oregon Health and Sciences University, Dept of Orthopedics and Rehabilitation, Portland, OR
| | | | | | - Benjamin Casabarro
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd., Indianapolis, IN 46202
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Zou YR, Gan ZQ, Zhao LX. Clear aligner treatment for a four-year-old patient with anterior cross-bite and facial asymmetry: A case report. World J Clin Cases 2022; 10:5088-5096. [PMID: 35801017 PMCID: PMC9198868 DOI: 10.12998/wjcc.v10.i15.5088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/09/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clear aligners have been widely used to treat malocclusions from crowding, extraction cases to orthodontic-orthognathic cases, and practitioners are exploring the border of it. For the first time, clear aligners were used to early intervene anterior cross-bite and facial asymmetry.
CASE SUMMARY This case report described a four-year-old child presented with anterior cross-bite and facial asymmetry associated with functional mandibular shift, who had undergone a failed treatment with conventional appliances. The total treatment time was 18 weeks, and a stable outcome was obtained.
CONCLUSION The increasing need in early treatment highlights the need for clinicians to thoroughly investigate for the patient regarding clinical manifestation as well as patient compliance. We hope that our case will be contemplated by clinicians when seeking for treatment alternatives.
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Affiliation(s)
- Yi-Ran Zou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zi-Qi Gan
- Department of Orthodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, Guangdong Province, China
| | - Li-Xing Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
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Oakley PA, Harrison DE. X-Ray Hesitancy: Patients' Radiophobic Concerns Over Medical X-rays. Dose Response 2020; 18:1559325820959542. [PMID: 32994755 PMCID: PMC7503016 DOI: 10.1177/1559325820959542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
All too often the family physician, orthopedic surgeon, dentist or chiropractor is met with radiophobic concerns about X-ray imaging in the clinical setting. These concerns, however, are unwarranted fears based on common but ill-informed and perpetuated ideology versus current understanding of the effects of low-dose radiation exposures. Themes of X-ray hesitancy come in 3 forms: 1. All radiation exposures are harmful (i.e. carcinogenic); 2. Radiation exposures are cumulative; 3. Children are more susceptible to radiation. Herein we address these concerns and find that low-dose radiation activates the body's adaptive responses and leads to reduced cancers. Low-dose radiation is not cumulative as long as enough time (e.g. 24 hrs) passes prior to a repeated exposure, and any damage is repaired, removed, or eliminated. Children have more active immune systems; the literature shows children are no more affected than adults by radiation exposures. Medical X-rays present a small, insignificant addition to background radiation exposure that is not likely to cause harm. Doctors and patients alike should be better informed of the lack of risks from diagnostic radiation and the decision to image should rely on the best evidence, unique needs of the patient, and the expertise of the physician-not radiophobia.
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Alsleem H, Davidson R, Al‐Dhafiri B, Alsleem R, Ameer H. Evaluation of radiographers' knowledge and attitudes of image quality optimisation in paediatric digital radiography in Saudi Arabia and Australia: a survey-based study. J Med Radiat Sci 2019; 66:229-237. [PMID: 31697039 PMCID: PMC6920681 DOI: 10.1002/jmrs.366] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Digital radiography (DR) systems enable radiographers to reduce the radiation dose to patients while maintaining optimised image quality. However, concerns still exist about paediatric patients who may be exposed to an increased level of radiation dose which is not needed for clinical practice. The purpose of this study was to evaluate the knowledge, awareness and attitudes, in terms of image quality optimisation of radiographers undertaking paediatric DR in Australia and Saudi Arabia. METHODS A survey-based study was devised and distributed to radiographers from Australia and Saudi Arabia. Questions focused on Australian and Saudi Arabian radiographers' knowledge and attitude of paediatric DR examinations. RESULTS There were 376 participants who responded to the survey from both countries. A major finding showed that most participants lack knowledge in the area of paediatric DR examinations. Most participants from Australia had received no formal training in paediatric digital radiography (79%), whereas nearly half of the participants from Saudi Arabia received no training (45%). Approximately three out of four radiographers from both countries believed that when using DR they did not need to change the way they collimate the beam as DR images can be cropped using post-processing methods. CONCLUSION The finding of this study demonstrates that radiographers from both countries should improve their understanding and clinical use of DR in paediatric imaging. More education and training for both students and clinicians is needed to enhance radiographer performance in digital radiography and improve their clinical practices.
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Affiliation(s)
- Haney Alsleem
- Imam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
- University of CanberraCanberraAustralia
| | | | | | | | - Hussain Ameer
- Imam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
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Irnstorfer N, Unger E, Hojreh A, Homolka P. An anthropomorphic phantom representing a prematurely born neonate for digital x-ray imaging using 3D printing: Proof of concept and comparison of image quality from different systems. Sci Rep 2019; 9:14357. [PMID: 31591433 PMCID: PMC6779877 DOI: 10.1038/s41598-019-50925-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023] Open
Abstract
An anthropomorphic phantom for image optimization in neonatal radiography was developed, and its usability in optimizing image acquisition and processing demonstrated. The phantom was designed to mimic a patient image of a prematurely born neonate. A clinical x-ray (neonate <1 kg) taken with an effective dose of 11 µSv on a needle-crystal storage phosphor system was retrospectively selected from anonymized images as an appropriate template representing a standard case in neonatology imaging. The low dose level used in clinical imaging results in high image noise content. Therefore, the image had to be processed using structure preserving noise reduction. Pixel values were related to printing material thickness to result in a similar attenuation pattern as the original patient including support mattress. A 3D model generating a similar x-ray attenuation pattern on an image detector as a patient was derived accounting for beam hardening and perspective, and printed using different printing technologies. Best printing quality was achieved using a laser stereolithography printer. Phantom images from different digital radiography systems used in neonatal imaging were compared. Effects of technology, image processing, and radiation dose on diagnostic image quality can be assessed for otherwise identical anthropomorphic neonatal images not possible with patient images, facilitating optimization and standardization of imaging parameters and image appearance.
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Affiliation(s)
- Nikolaus Irnstorfer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ewald Unger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Azadeh Hojreh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Peter Homolka
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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Abstract
BACKGROUND There is currently no consensus on the utility of preoperative computed tomography (CT) in nonsyndromic craniosynostosis. This systematic review and meta-analysis examines the evidence available on the necessity of preoperative CT for the treatment of nonsyndromic craniosynostosis. METHODS A comprehensive literature review of the National Library of Medicine (PubMed) database was performed. The following variables were analyzed: concordance of findings between clinical examinations and CT, incidental findings reported on imaging, and the effect of imaging on subsequent management. Concordance between clinical examination/CT and the presence of incidental findings were collected and displayed as descriptive data. The effect of imaging on subsequent diagnosis/management was analyzed by meta-analysis. RESULTS Eleven studies met the inclusion criteria for a total of 728 patients. Overall, physical examination concordance with CT diagnosis was 97.9% (371/379). Overall, incidental findings led to additional imaging/workup in 1.79% of cases (5/278). The results of the meta-analysis revealed that, in the absence of alternative imaging modalities, CT scans significantly altered diagnosis or led to additional investigations in 12 cases (4.8%, 95% confidence interval = 3%-8%). Preoperative CT scans led to additional investigations in 5 cases and detected incomplete/wrong diagnoses in 7 cases. CONCLUSIONS The results of the present meta-analysis support the use of preoperative CT scans for nonsyndromic craniosynostosis in the absence of alternative imaging modalities. The results also suggest that in properly selected patients, alternative imaging modalities may be appropriate, potentially obviating the need for CT scans.
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Pedersen CCE, Hardy M, Blankholm AD. An Evaluation of Image Acquisition Techniques, Radiographic Practice, and Technical Quality in Neonatal Chest Radiography. J Med Imaging Radiat Sci 2018; 49:257-264. [DOI: 10.1016/j.jmir.2018.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 11/28/2022]
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Wolter NE, Hernandez K, Irace AL, Davidson K, Perez JA, Larson K, Rahbar R. A Systematic Process for Weaning Children With Aspiration From Thickened Fluids. JAMA Otolaryngol Head Neck Surg 2017; 144:51-56. [PMID: 29121147 DOI: 10.1001/jamaoto.2017.1917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Thickening of fluids is a common strategy for feeding patients with oropharyngeal dysphagia but has known risks and should be stopped once it is safe to do so. Weaning children from thickened fluids safely can be challenging, and novel methods are required. Objective To describe the use of a systematic weaning process (SWP) for children who received thickened liquids owing to oropharyngeal dysphagia and identified risk of aspiration. Design, Setting, and Participants Retrospective case series (2010 to 2015) at a tertiary care center of 50 children with documented aspiration by clinical swallowing assessment, airway evaluation, and videofluoroscopic swallow study with at least 4 months of follow-up. All patients were initially receiving thickened fluids. A 10% reduction in thickness was made every 2 weeks based on clinical symptoms. Caregivers progressed to the next incremental level if there were no signs or symptoms of aspiration. Main Outcomes and Measures Number of patients weaned to a thin-fluid diet. Results Of 50 children (32 [64%] male; median [interquartile range] age, 0.7 [1.0] y at presentation and 1.8 [1.3] y at start of wean) using the SWP, 44 (88%) were able to reduce the amount of thickener used. A successful wean from thickened fluids to thin fluids was completed in 39 (78%). The mean (SD) duration of a successful wean was 0.9 (0.6) years. Five patients tolerated a reduction in thickener but not a full wean to thin fluids. For 6 patients, weaning failed and they continued to receive thickened fluids. Of those whose weaning failed, 2 patients developed pneumonia. Of the 39 successfully weaned patients, 14 (36%) experienced a temporary stall but eventually tolerated thin fluids. Only 2 (5%) developed pneumonia while all other successfully weaned patients (n = 37 [95%]) did not experience any substantial respiratory issues. Overall, 46 (92%) of children required 2 or fewer videofluoroscopic swallow study evaluations. Conclusions and Relevance Patients with oropharyngeal dysphagia and aspiration should be gradually weaned off of thickened fluids. The SWP uses small incremental steps to gradually reduce the amount of thickener. Using this method, most children tolerated a reduction in thickeners and a thin-fluid diet. The SWP presents a safe and effective way of gradually returning children to a more normal diet.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Kayla Hernandez
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandria L Irace
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Kathryn Davidson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Jennifer A Perez
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Kara Larson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
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Rosenblatt SD, Wolter NE, Siegele B, Brodsky JR. Primary parotid lymphoma presenting as a recurrent cystic mass: A case report. Laryngoscope 2017; 128:998-1001. [PMID: 28771798 DOI: 10.1002/lary.26786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 12/29/2022]
Abstract
A 15-year-old boy was diagnosed with a cystic parotid mass, which was initially thought to be a first branchial cleft cyst. The mass was treated with antibiotics and fully resolved on examination and imaging. The mass returned, and a superficial parotidectomy was performed to remove the suspected branchial cleft cyst. Final pathology demonstrated a B-cell lymphoblastic lymphoma. Bilateral bone marrow biopsies and peripheral blood counts were negative for any malignancy. This case demonstrates a rare presentation of primary parotid B-cell lymphoblastic lymphoma that began as a fluctuating cystic parotid mass consistent in appearance with a first branchial cleft cyst. Laryngoscope, 128:998-1001, 2018.
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Affiliation(s)
- Steven D Rosenblatt
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Nikolaus E Wolter
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts
| | - Bradford Siegele
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Sensakovic WF, O'Dell MC, Letter H, Kohler N, Rop B, Cook J, Logsdon G, Varich L. Image quality and dose differences caused by vendor-specific image processing of neonatal radiographs. Pediatr Radiol 2016; 46:1606-13. [PMID: 27488507 DOI: 10.1007/s00247-016-3663-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/14/2016] [Accepted: 06/23/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Image processing plays an important role in optimizing image quality and radiation dose in projection radiography. Unfortunately commercial algorithms are black boxes that are often left at or near vendor default settings rather than being optimized. OBJECTIVE We hypothesize that different commercial image-processing systems, when left at or near default settings, create significant differences in image quality. We further hypothesize that image-quality differences can be exploited to produce images of equivalent quality but lower radiation dose. MATERIALS AND METHODS We used a portable radiography system to acquire images on a neonatal chest phantom and recorded the entrance surface air kerma (ESAK). We applied two image-processing systems (Optima XR220amx, by GE Healthcare, Waukesha, WI; and MUSICA(2) by Agfa HealthCare, Mortsel, Belgium) to the images. Seven observers (attending pediatric radiologists and radiology residents) independently assessed image quality using two methods: rating and matching. Image-quality ratings were independently assessed by each observer on a 10-point scale. Matching consisted of each observer matching GE-processed images and Agfa-processed images with equivalent image quality. A total of 210 rating tasks and 42 matching tasks were performed and effective dose was estimated. RESULTS Median Agfa-processed image-quality ratings were higher than GE-processed ratings. Non-diagnostic ratings were seen over a wider range of doses for GE-processed images than for Agfa-processed images. During matching tasks, observers matched image quality between GE-processed images and Agfa-processed images acquired at a lower effective dose (11 ± 9 μSv; P < 0.0001). CONCLUSION Image-processing methods significantly impact perceived image quality. These image-quality differences can be exploited to alter protocols and produce images of equivalent image quality but lower doses. Those purchasing projection radiography systems or third-party image-processing software should be aware that image processing can significantly impact image quality when settings are left near default values.
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Affiliation(s)
- William F Sensakovic
- Imaging Administration, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA.
| | - M Cody O'Dell
- Imaging Administration, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA
| | - Haley Letter
- Imaging Administration, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA
| | - Nathan Kohler
- Imaging Administration, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA
| | - Baiywo Rop
- Imaging Administration, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA
| | - Jane Cook
- Imaging Administration, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA
| | - Gregory Logsdon
- Imaging Administration, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA
| | - Laura Varich
- Imaging Administration, Florida Hospital, 601 E. Rollins St., Orlando, FL, 32803, USA
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Zhao P, Hou Y, Liu Q, Ma Y, Guo Q. Radiation dose reduction in cardiovascular CT angiography with iterative reconstruction (AIDR 3D) in a swine model: a model of paediatric cardiac imaging. Clin Radiol 2016; 71:716.e7-716.e14. [DOI: 10.1016/j.crad.2016.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 04/05/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
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European Guidelines for AP/PA chest X-rays: routinely satisfiable in a paediatric radiology division? Eur Radiol 2015; 26:495-505. [DOI: 10.1007/s00330-015-3836-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 04/02/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
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Decoster R, Mol H, Smits D. Post-processing, is it a burden or a blessing? Part 2 CNR saturation as a new hypothesis. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Post-processing, is it a burden or a blessing? Part 1 evaluation of clinical image quality. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To determine the incidence and clinical characteristics of noncontiguous spinal injuries (NCSI) in a pediatric population. The secondary objective is to identify high-risk patients requiring further imaging to rule out NCSI. SUMMARY OF BACKGROUND DATA NCSI can add significant complexity to the diagnosis, management, and outcome of children. There is very little in the pediatric literature examining the nature, associated risk factors, management, and outcomes of NCSI. METHODS All children up to 18 years of age with a spinal injury, as defined by International Classification of Diseases, Ninth Revision codes, at one pediatric trauma hospital were included (n = 211). Data for patient demographics, mechanism of injury, spinal levels involved, extent of neurological injury and recovery, associated injuries, medical complications, treatment, and outcome were recorded. RESULTS Twenty-five (11.8%) of 211 patients had NCSI, with a median age of 13.0 years (interquartile range = 8-15). The most common pattern of injury was a double thoracic noncontiguous injury. Sixteen percent of the cases of NCSI were initially missed, with no clinical deterioration due to missed diagnosis. Associated injuries occurred in 44% of patients with NCSI. Twenty-four percent of patients with multiple NCSI had a neurological injury compared with 9.7% in patients with single-level or contiguous injuries (P = 0.046). CONCLUSION There is a high incidence of children with multiple NCSI who are more likely to experience neurological injuries compared with patients with single-level or contiguous spinal injuries. Patients with a single-level spinal injury on existing imaging with an associated neurological injury should undergo at least plain films of the entire spine to exclude noncontiguous injuries. In patients without neurological injury and a single spinal fracture, radiography showing at least 4 levels above and below the fracture should be performed. All children with spinal injury should have associated injuries carefully excluded.
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Lederlin M, Thambo JB, Latrabe V, Corneloup O, Cochet H, Montaudon M, Laurent F. Coronary imaging techniques with emphasis on CT and MRI. Pediatr Radiol 2011; 41:1516-25. [PMID: 22127683 DOI: 10.1007/s00247-011-2222-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 06/06/2011] [Indexed: 01/23/2023]
Abstract
Coronary artery imaging in children is challenging, with high demands both on temporal and spatial resolution due to high heart rates and smaller anatomy. Although invasive conventional coronary angiography remains the benchmark technique, over the past 10 years, CT and MRI have emerged in the field of coronary imaging. The choice of hardware is important. For CT, the minimum requirement is a 64-channel scanner. The temporal resolution of the scanner is most important for optimising image quality and minimising radiation dose. Manufacturers have developed several modes of electrocardiographic (ECG) triggering to facilitate dose reduction. Recent technical advances have opened new possibilities in MRI coronary imaging. As a non-ionising radiation technique, MRI is of great interest in paediatric imaging. It is currently recommended in centres with appropriate expertise for the screening of patients with suspected congenital coronary anomalies. However, MRI is still not feasible in infants. This review describes and discusses the technical requirements and the pros and cons of all three techniques.
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Affiliation(s)
- Mathieu Lederlin
- CHU Bordeaux, Thoracic and Cardiovascular Imaging Department, Hôpital Cardiologique, Avenue de Magellan, Pessac 33600, France.
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Radiation dose for thoracic and coronary step-and-shoot CT using a 128-slice dual-source machine in infants and small children with congenital heart disease. Pediatr Radiol 2011; 41:244-9. [PMID: 20821005 DOI: 10.1007/s00247-010-1804-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 06/15/2010] [Accepted: 07/01/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND For coronary artery visualization, retrospective ECG-gated acquisition by dual-source computed tomography (DSCT) was superior to spiral non-ECG-gated acquisition in a paediatric population of congenital heart disease (CHD) patients. However, retrospective cardiac CT is associated with substantial radiation doses to the patient. Recently, DSCT with end-systolic reconstruction was found to be robust for imaging the coronary arteries in patients with high heart rates. OBJECTIVE To evaluate step-and-shoot DSCT with end-systolic reconstruction for evaluating the heart, coronary arteries and other thoracic structures in young children with CHD. MATERIALS AND METHODS All neonates and children younger than 6 years of age who were referred to our institution for CHD evaluation between September and October 2009 were included in the study. ECG-gated DSCT was performed in sequential prospective mode centred on the systolic phase identified by ECG analysis. To assess the radiation dose, we recorded the dose-length product (DLP) in mGy·cm and the effective dose in mSv estimated from the DLP. Overall image quality was evaluated using a 5-grade scoring system and was assessed by looking at cardiac and vascular structures. The image quality for the proximal and middle segments of the right and left coronary arteries was also evaluated using a 5-grade scale. RESULTS Images of diagnostic quality (grade ≥ 3) were obtained in all 30 children with a mean image quality grade of 4.7 ± 0.6 (range, 3-5). Mean DLP was 5.7 ± 4.8 mGy*cm (range, 1-22 mGy cm) and mean effective radiation dose was 0.26 ± 0.16 mSv (range, 0.05-0.8 mSv). CONCLUSION Prospective ECG-gated thoracic DSCT at end-systole usually provides adequate thoracic and coronary artery image quality in neonates, infants and young children with CHD, independent of heart rate. This new method is associated with lower radiation doses compared to previous literature (mean effective dose, 0.26 mSv).
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Sinnott B, Ron E, Schneider AB. Exposing the thyroid to radiation: a review of its current extent, risks, and implications. Endocr Rev 2010; 31:756-73. [PMID: 20650861 PMCID: PMC3365850 DOI: 10.1210/er.2010-0003] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 06/04/2010] [Indexed: 12/26/2022]
Abstract
Radiation exposure of the thyroid at a young age is a recognized risk factor for the development of differentiated thyroid cancer lasting for four decades and probably for a lifetime after exposure. Medical radiation exposure, however, occurs frequently, including among the pediatric population, which is especially sensitive to the effects of radiation. In the past, the treatment of benign medical conditions with external radiation represented the most significant thyroid radiation exposures. Today, diagnostic medical radiation represents the largest source of man-made radiation exposure. Radiation exposure related to the use of computerized tomography is rising exponentially, particularly in the pediatric population. There is direct epidemiological evidence of a small but significant increased risk of cancer at radiation doses equivalent to computerized tomography doses used today. Paralleling the increasing use of medical radiation is an increase in the incidence of papillary thyroid cancer. At present, it is unclear how much of this increase is related to increased detection of subclinical disease from the increased utilization of ultrasonography and fine-needle aspiration, how much is due to a true increase in thyroid cancer, and how much, if any, can be ascribed to medical radiation exposure. Fortunately, the amount of radiation exposure from medical sources can be reduced. In this article we review the sources of thyroid radiation exposure, radiation risks to the thyroid gland, strategies for reducing radiation exposure to the thyroid, and ways that endocrinologists can participate in this effort. Finally, we provide some suggestions for future research directions.
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Affiliation(s)
- Bridget Sinnott
- Section of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois at Chicago, 1819 West Polk Street (MC 640), Chicago, Illinois 60612, USA
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Paul JF, Rohnean A, Sigal-Cinqualbre A. Multidetector CT for congenital heart patients: what a paediatric radiologist should know. Pediatr Radiol 2010; 40:869-75. [PMID: 20432005 DOI: 10.1007/s00247-010-1614-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 01/30/2010] [Indexed: 11/28/2022]
Abstract
Multidetector CT (MDCT) is increasingly used for imaging congenital heart disease (CHD) patients in addition to echocardiography, due to its ability to provide high quality three-dimensional images, giving a comprehensive evaluation of complex heart malformations. Using 4-slice or 16-slice CT, diagnostic information in CHD patients is limited to extra-cardiac anatomy, mainly the pulmonary arteries, aorta and venous connections. Due to high heart rates in babies however, coronary evaluation and intra-cardiac analysis were not reliable with the first generations of MDCT. Larger detector size with 64-slice CT and faster acquisition time, up to 75 ms for one slice, has progressively improved coronary and intra-cardiac visualization. Because radiation dose is the main concern, especially in children, every attempt to minimize dose whilst preserving image quality is important: the ALARA concept should always be applied in this population. The 80 kVp setting is now well accepted as a standard for more and more radiological teams involved in CT of children. Different acquisition strategies are now possible for childhood coronary imaging, using retrospective or even prospective gating. Using the latest technology, sub-mSv acquisitions are now attainable for scanning a whole thorax, providing a complete analysis of any 3-D cardiac malformation, including coronary artery course visualisation. This review will describe how technological developments have improved image quality with continuous reduction of radiation dose.
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Affiliation(s)
- Jean-François Paul
- Radiology Unit, Marie Lannelongue Hospital, 133 Avenue de la Résistance, Plessis-Robinson 92350, France.
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Chida K, Kato M, Kagaya Y, Zuguchi M, Saito H, Ishibashi T, Takahashi S, Yamada S, Takai Y. Radiation dose and radiation protection for patients and physicians during interventional procedure. JOURNAL OF RADIATION RESEARCH 2010; 51:97-105. [PMID: 20339253 DOI: 10.1269/jrr.09112] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although the wide acceptance of interventional radiology (IVR) procedures has led to increasing numbers of interventions being performed, the radiation doses from IVR are higher. Increasing numbers of case reports of patient radiation injury resulting from IVR are being published. Therefore, radiation protection during IVR poses a very important problem. To protect against radiation injury, the evaluation of radiation dose is essential. The radiation dose must be evaluated for each IVR x-ray machine and each laboratory, because it varies greatly. To obtain this information easily, and to ensure practical use of the radiation information, good relationships between interventionists and medical physicists are essential.
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Affiliation(s)
- Koichi Chida
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University.
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Pantos I, Patatoukas G, Katritsis DG, Efstathopoulos E. Patient radiation doses in interventional cardiology procedures. Curr Cardiol Rev 2009; 5:1-11. [PMID: 20066141 PMCID: PMC2803281 DOI: 10.2174/157340309787048059] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/01/2008] [Accepted: 08/01/2008] [Indexed: 11/22/2022] Open
Abstract
Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography, percutaneous coronary interventions, diagnostic electrophysiology studies and radiofrequency catheter ablation. Patient radiation dose in these procedures can be assessed either by measurements on a series of patients in real clinical practice or measurements using patient-equivalent phantoms. In this article we review the derived doses at non-pediatric patients from 72 relevant studies published during the last 22 years in international scientific literature. Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. Discrepancies of the derived results are patient-, procedure-, physician-, and fluoroscopic equipmentrelated. Nevertheless, interventional cardiology procedures can subject patients to considerable radiation doses. Efforts to minimize patient exposure should always be undertaken.
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Affiliation(s)
- Ioannis Pantos
- Department of Cardiology, Athens Euroclinic, Athens, Greece
- 2 Department of Radiology, Medical Physics Unit, University of Athens, Athens, Greece
| | - Georgios Patatoukas
- 2 Department of Radiology, Medical Physics Unit, University of Athens, Athens, Greece
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23
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Houseni M, Chamroonrat W, Servaes S, Alavi A, Zhuang H. Applications of PET/CT in Pediatric Patients with Fever of Unknown Origin. PET Clin 2008; 3:605-19. [DOI: 10.1016/j.cpet.2009.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Affiliation(s)
- Ana Maria Gaca
- Division of Pediatric Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
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Jimenez RR, Deguzman MA, Shiran S, Karrellas A, Lorenzo RL. CT versus plain radiographs for evaluation of c-spine injury in young children: do benefits outweigh risks? Pediatr Radiol 2008; 38:635-44. [PMID: 18368400 DOI: 10.1007/s00247-007-0728-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Revised: 11/16/2007] [Accepted: 12/06/2007] [Indexed: 10/24/2022]
Abstract
BACKGROUND Various reports support the use of cervical spine (c-spine) CT over conventional radiography in screening of c-spine injury. Interest now exists in diagnostic radiation-induced morbidity. OBJECTIVE To estimate excess relative risk for developing cancer from c-spine high-resolution CT radiation exposure. MATERIALS AND METHODS We conducted a retrospective review of children evaluated for c-spine injury using CT. The study population was divided into three age groups, 0-4 years (group 1), 5-8 years (group 2), and older than 8 years (group 3). Anthropomorphic 1-year-old and 5-year-old phantoms were used to measure radiation at the thyroid during radiography and CT. Excess relative risk for thyroid cancer was estimated using these measurements. RESULTS A total of 557 patients were evaluated with CT. The radiographic method most commonly used was head CT/c-spine CT in 363 (65%). Only 179 children (32%) had any type of prior radiography. The use of c-spine CT exposes the thyroid to 90-200 times more radiation than multiple conventional radiographs. The mean excess relative risk for thyroid cancer after CT was 2.0 for group 1 and 0.6 for group 2. There were no comparison data for group 3. CONCLUSION C-spine CT is associated with a significant exposure to ionizing radiation and increases excess relative risk for thyroid cancer in young children.
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Affiliation(s)
- Ricardo R Jimenez
- Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Rice HE, Frush DP, Farmer D, Waldhausen JH. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg 2007; 42:603-7. [PMID: 17448753 DOI: 10.1016/j.jpedsurg.2006.12.009] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Over the past several years, increasing attention has been focused on the potential for radiation exposure from computed tomography (CT) for inducing the development of cancers. An understanding of these issues is important for the practice of pediatric surgery. METHODS Medline based clinical review of current medical literature of the risks for the induction of cancers by CT. Data includes estimates of cancer risk from computer models, epidemiologic data from survivors of atomic bomb radiation exposure, and consensus opinions from expert panels. RESULTS Review of scientific evidence demonstrates varied opinions, but consensus suggests there may be a potential for an increased risk of cancer from low level radiation exposure such as from CT. These calculations suggest that there may be as high as 1 fatal cancer for every 1000 CT scans performed in a young child. CONCLUSIONS Pediatric surgeons should be aware of the potential risks of CT. Minimizing the radiation risks of CT is a complex endeavor, and will require investments from pediatric surgeons as well as pediatric radiologists.
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Affiliation(s)
- Henry E Rice
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Rampado O, Isoardi P, Ropolo R. Quantitative assessment of computed radiography quality control parameters. Phys Med Biol 2006; 51:1577-93. [PMID: 16510964 DOI: 10.1088/0031-9155/51/6/015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Quality controls for testing the performance of computed radiography (CR) systems have been recommended by manufacturers and medical physicists' organizations. The purpose of this work was to develop a set of image processing tools for quantitative assessment of computed radiography quality control parameters. Automatic image analysis consisted in detecting phantom details, defining regions of interest and acquiring measurements. The tested performance characteristics included dark noise, uniformity, exposure calibration, linearity, low-contrast and spatial resolution, spatial accuracy, laser beam function and erasure thoroughness. CR devices from two major manufacturers were evaluated. We investigated several approaches to quantify the detector response uniformity. We developed methods to characterize the spatial accuracy and resolution properties across the entire image area, based on the Fourier analysis of the image of a fine wire mesh. The implemented methods were sensitive to local blurring and allowed us to detect a local distortion of 4% or greater in any part of an imaging plate. The obtained results showed that the developed image processing tools allow us to implement a quality control program for CR with short processing time and with absence of subjectivity in the evaluation of the parameters.
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Affiliation(s)
- O Rampado
- Struttura Complessa Fisica Sanitaria, Azienda Ospedaliera San Giovanni Battista, Corso Bramante 88, 10126 Torino, Italy.
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Chida K, Saito H, Otani H, Kohzuki M, Takahashi S, Yamada S, Shirato K, Zuguchi M. Relationship Between Fluoroscopic Time, Dose–Area Product, Body Weight, and Maximum Radiation Skin Dose in Cardiac Interventional Procedures. AJR Am J Roentgenol 2006; 186:774-8. [PMID: 16498105 DOI: 10.2214/ajr.04.1653] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Real-time maximum dose monitoring of the skin is unavailable on many of the X-ray machines that are used for cardiac intervention procedures. Therefore, some reports have recommended that physicians record the fluoroscopic time for patients undergoing fluoroscopically guided intervention procedures. However, the relationship between the fluoroscopic time and the maximum radiation skin dose is not clear. This article describes the correlation between the maximum radiation skin dose and fluoroscopic time for patients undergoing cardiac intervention procedures. In addition, we examined whether the correlations between maximum radiation skin dose and body weight, fluoroscopic time, and dose-area product (DAP) were useful for estimating the maximum skin dose during cardiac intervention procedures. MATERIALS AND METHODS Two hundred consecutive cardiac intervention procedures were studied: 172 percutaneous coronary interventions and 28 cardiac radiofrequency catheter ablation (RFCA) procedures. The patient skin dose and DAP were measured using Caregraph with skin-dose-mapping software. RESULTS For the RFCA procedures, we found a good correlation between the maximum radiation skin dose and fluoroscopic time (r = 0.801, p < 0.0001), whereas we found a poor correlation between the maximum radiation skin dose and fluoroscopic time for the percutaneous coronary intervention procedures (r = 0.628, p < 0.0001). There was a strong correlation between the maximum radiation skin dose and DAP in RFCA procedures (r = 0.942, p < 0.0001). There was also a significant correlation between the maximum radiation skin dose and DAP (r = 0.724, p < 0.0001) and weight-fluoroscopic time product (WFP) (r = 0.709, p < 0.0001) in percutaneous coronary intervention procedures. CONCLUSION The correlation between the maximum radiation skin dose with DAP is more striking than that with fluoroscopic time in both RFCA and percutaneous coronary intervention procedures. We recommend that physicians record the DAP when it can be monitored and that physicians record the fluoroscopic time when DAP cannot be monitored for estimating the maximum patient skin dose in RFCA procedures. For estimating the maximum patient skin dose in percutaneous coronary intervention procedures, we also recommend that physicians record DAP when it can be monitored and that physicians record WFP when DAP cannot be monitored.
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Affiliation(s)
- Koichi Chida
- Department of Radiological Technology, Tohoku University School of Health Sciences, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
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