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1
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Tran NA, Potter CA, Bay C, Sodickson AD. Change in Emergency Department Length of Stay following Routine Adoption of Dual-Energy CT to Differentiate Intracranial Hemorrhage from Calcification. AJNR Am J Neuroradiol 2025; 46:950-955. [PMID: 39694615 DOI: 10.3174/ajnr.a8610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 10/18/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND AND PURPOSE Dual-energy CT (DECT) is an advanced CT technique that has been shown to improve accuracy in distinguishing between intracranial hemorrhage and calcification, which is often challenging on conventional CT and therefore may warrant repeat imaging in the emergency department (ED) to document stability and exclude enlarging intracranial hemorrhage. We hypothesized that implementation of a DECT head protocol in the ED would decrease the need for repeat imaging and therefore reduce overall ED length of stay (LOS). MATERIALS AND METHODS This is a retrospective study comparing ED LOS over a 1-year period before (July 1, 2016 to June 30, 2017) and after (July 1, 2018 to June 30, 2019) implementing a DECT head protocol, for patients scanned for headache, trauma, or fall who were found to have indeterminate intracranial hyperdensities on conventional images, and were subsequently discharged home from the ED (excluding patients who were admitted, taken to the operating room, or left against medical advice). Additional clinical information regarding ED time course and management were also reviewed, including data on time to CT scan, CT report, and if applicable, time to repeat head CT and neurosurgical consultation. RESULTS There was no significant difference in patient demographics and CT indications between the pre-DECT and post-DECT cohorts. There was a small but statistically significant difference in mean baseline ED LOS in the initial cohorts of 20 minutes (P = .002). After the inclusion of only intracranial indeterminate hyperdensities, there was a larger statistically significant difference in ED LOS, with mean pre-DECT LOS of 421 minutes and mean post-DECT LOS of 272 minutes, resulting in mean LOS reduction of 149 minutes (P = .003). The increased ED LOS correlated with increased frequency of neurosurgical consultation and repeat head CT for the findings of indeterminate intracranial hyperdensities. CONCLUSIONS ED LOS was significantly longer in the pre-DECT cohort, which was partly attributable to neurosurgical consultation and repeat head CT performed for indeterminate intracranial hyperdensities.
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Affiliation(s)
- Ngoc-Anh Tran
- From the Department of Radiology (N.-A.T.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Christopher A Potter
- Department of Radiology, Division of Emergency Radiology (C.A.P., A.D.S.), Brigham and Women's Hospital, Boston, Massachusetts
- Department of Radiology, Division of Neuroradiology (C.A.P.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Camden Bay
- Department of Radiology, Division of Statistics (C.B.), Brigham and Women's Hospital, Boston, Massachusetts
| | - Aaron D Sodickson
- Department of Radiology, Division of Emergency Radiology (C.A.P., A.D.S.), Brigham and Women's Hospital, Boston, Massachusetts
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2
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Li R, Wang D. KBA-PDNet: A primal-dual unrolling network with kernel basis attention for low-dose CT reconstruction. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2025; 33:591-607. [PMID: 40026009 DOI: 10.1177/08953996241308759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2025]
Abstract
Computed tomography (CT) image reconstruction is faced with challenge of balancing image quality and radiation dose. Recent unrolled optimization methods address low-dose CT image quality issues using convolutional neural networks or self-attention mechanisms as regularization operators. However, these approaches have limitations in adaptability, computational efficiency, or preservation of beneficial inductive biases. They also depend on initial reconstructions, potentially leading to information loss and error propagation. To overcome these limitations, Kernel Basis Attention Primal-Dual Network (KBA-PDNet) is proposed. The method unrolls multiple iterations of the proximal primal-dual optimization process, replacing traditional proximal operators with Kernel Basis Attention (KBA) modules. This design enables direct training from raw measurement data without relying on preliminary reconstructions. The KBA module achieves adaptability by learning and dynamically fusing kernel bases, generating customized convolution kernels for each spatial location. This approach maintains computational efficiency while preserving beneficial inductive biases of convolutions. By training end-to-end from raw projection data, KBA-PDNet fully utilizes all original information, potentially capturing details lost in preliminary reconstructions. Experiments on simulated and clinical datasets demonstrate that KBA-PDNet outperforms existing approaches in both image quality and computational efficiency.
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Affiliation(s)
- Rongfeng Li
- School of Smart Technology, Chongqing Preschool Education College, Chongqing 404047, China
| | - Dalin Wang
- School of Smart Technology, Chongqing Preschool Education College, Chongqing 404047, China
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3
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Song A, Yang W, Wang J, Cai Y, Cai L, Pang N, Yu R, Liu Z, Yang C, Jiang F. Application of ATR-FTIR spectroscopy and multivariate statistical analysis in cancer diagnosis. SLAS Technol 2025; 31:100253. [PMID: 39900180 DOI: 10.1016/j.slast.2025.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/22/2025] [Accepted: 01/30/2025] [Indexed: 02/05/2025]
Abstract
Lung cancer is one of the most prevalent and lethal malignant tumors worldwide. Currently, clinical diagnosis primarily relies on chest X-ray examinations, histopathological analysis, and the detection of tumor markers in blood. However, each of these methods has inherent limitations. The current study aims to explore novel diagnostic approaches for lung cancer by employing attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy in conjunction with multiple machine learning models. Fourier transform infrared spectroscopy can detect subtle differences in the material structures that reflect the carcinogenic process between lung cancer tissues and normal tissues. By applying principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) to analyze infrared spectral data, these subtle differences can be amplified. The study revealed that the combination of spectral bands within the 3500-3000 cm-1 and 1600-1500 cm-1 ranges is particularly significant for differentiating between the two groups. Three classification models-Support Vector Machine (SVM), k-Nearest Neighbor (kNN), and Linear Discriminant Analysis (LDA)-were constructed for spectral analysis of various band combinations. The results indicated that in detecting lung cancer samples, the combination of the 3500-3000 cm-1 and 1600-1500 cm-1 bands offers significant advantages. The analysis of the receiver operating characteristic (ROC) curve demonstrated that the area under the curve (AUC) exceeded 0.95 for all models, with the LDA model achieving an accuracy rate of 99.4% in identifying lung cancer patients compared to healthy individuals. The findings suggest that the integration of ATR-FTIR spectroscopy with multiple machine learning models represents a promising auxiliary diagnostic method for clinical lung cancer diagnosis, enabling detection at the molecular level.
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Affiliation(s)
- Ao Song
- Jiangsu Key Laboratory of Regional Resource Exploitation and Medicinal Research, Huaiyin Institute of Technology, Huai'an 223003, China; Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China
| | - Wanli Yang
- Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China
| | - Jun Wang
- Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China
| | - Yisa Cai
- Jiangsu Key Laboratory of Regional Resource Exploitation and Medicinal Research, Huaiyin Institute of Technology, Huai'an 223003, China; Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China
| | - Lizheng Cai
- Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China; Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Nan Pang
- Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China
| | - Ruihua Yu
- Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China
| | - Zhikun Liu
- Jiangsu Key Laboratory of Regional Resource Exploitation and Medicinal Research, Huaiyin Institute of Technology, Huai'an 223003, China.
| | - Chao Yang
- Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China.
| | - Feng Jiang
- Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China.
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4
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Shao W, Yang K, Lou L, Lin X, Qu L, Zhuo W, Liu H. Evolved size-specific dose estimates for patient-specific organ doses from chest CT scans based on hybrid patient size vectors. Phys Eng Sci Med 2025:10.1007/s13246-025-01522-4. [PMID: 39992545 DOI: 10.1007/s13246-025-01522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 02/05/2025] [Indexed: 02/25/2025]
Abstract
This study aims to develop a neural network-based method for predicting patient-specific organ doses from chest CT scans, utilizing hybrid patient size vectors for enhanced computational efficiency, accuracy, and generality. A dataset of 705 chest CT scans was retrospectively analyzed to construct predictive models for organ dose estimation. The proposed approach employs high dimensional hybrid vectors to represent patient size, combining muti-slice parameters regarding lateral dimension, anteroposterior dimension, and water-equivalent diameter (Dw). These vectors are used to train fully-connected neural networks, which are designed to correlate high-dimensional patient size features with reference organ doses obtained from Monte Carlo simulations. The performance of the neural networks was evaluated using separate test cohorts, with metrics such as mean absolute percentage error (MAPE) and coefficient of determination (R²) to evaluate predictive accuracy and generality. For the left lung, right lung, heart, and spinal cord, the trained neural networks respectively achieve MAPE values of 2.94%, 2.79%, 7.04%, and 6.76%, and R² values of 0.98, 0.99, 0.93, and 0.91. The maximal discrepancy between reference and predicted values is less than 10% for the left and right lungs, and less than 20% for the heart and spinal cord. With 5-fold cross-validation, the maximal perturbation does not exceed 1% in MAPE and 0.05 in R². By incorporating hybrid patient size vectors, the neural network models achieve superior accuracy in organ dose estimation compared with traditional size specific dose estimates, paving the way for online swift organ dose screening in clinical practice.
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Affiliation(s)
- Wencheng Shao
- Institute of Radiation Medicine, Fudan University, Shanghai, China
| | - Ke Yang
- ShanDong Center for Disease Control and Prevention, Jinan, China
| | - Lizhi Lou
- AnQiu People's Hospital, Shandong, China
| | - Xin Lin
- Institute of Radiation Medicine, Fudan University, Shanghai, China
| | - Liangyong Qu
- Department of Radiology, Shanghai Zhongye Hospital, Shanghai, China
| | - Weihai Zhuo
- Institute of Radiation Medicine, Fudan University, Shanghai, China.
| | - Haikuan Liu
- Institute of Radiation Medicine, Fudan University, Shanghai, China.
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5
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Fujii R, Sugimura M, Kurita M. [Comparison of CT-like Images Using MRI]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2025; 81:n/a. [PMID: 40058843 DOI: 10.6009/jjrt.25-1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
PURPOSE The objective of this study was to quantitatively evaluate and compare the image contrast and image quality of several recently developed CT-like images (oZTEo, LAVA, MERGE). METHODS Using a self-made phantom created with a GE Healthcare (Milwaukee, WI, USA) MRI Pioneer 3.0T and pig leg bone, along with four types of tissue-mimicking phantoms, we compared cortical bone, contrast-to-noise ratio (CNR), signal change ratio of the tissue-simulating phantom, and visual evaluation. RESULTS CR and CNR were lowest in the order of MERGE, LAVA, and oZTEo. The signal change ratio of background signal and visual evaluation were highest in the order of oZTEo, LAVA, and MERGE. CONCLUSION In comparing CT-like images using MRI, the bone cortex could be visualized in white using black-and-white inversion in all CT-like images, and fracture lines could also be visualized. By capturing CT-like images tailored to the characteristics of each imaging sequence, it is expected that the number of examinations that can be completed using MRI alone will increase, further enhancing the usefulness of MRI.
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6
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Khan R, Shah MA, Wahab S, Khan RA. Size-Specific Dose Estimate and Effective Dose for Pediatric Computed Tomography. J Med Phys 2025; 50:173-183. [PMID: 40256187 PMCID: PMC12005660 DOI: 10.4103/jmp.jmp_55_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 12/05/2024] [Accepted: 12/06/2024] [Indexed: 04/22/2025] Open
Abstract
The purpose of this study is to present the multivariate analysis of the size-specific dose estimate (SSDE) and E in pediatric computed tomography (CT) imaging. Pediatric patients scheduled for CT scans of the head, thorax, and abdomen from July 2022 to February 2024 were included in the prospective study. The water-equivalent diameter (D w), SSDE, and E were computed for each examination using the dose report of CT console display computed tomography dose index (CTD1 vol) and dose length product (DLP). The correlation between SSDE and E on CTD1 vol, D w, Area ROI, body mass index, Size⁄(LAT+AP), age, fsize , and HU mean in the region of interest was examined using the multivariate statistical analysis with 95% level of significance (P < 0.05). The relationship between D w and Size⁄(LAT+AP), Size⁄(LAT+AP), and fsize versus age was investigated using linear regression analysis. The mean values of SSDE for noncontrast head CT and contrast-enhanced CT were found 71.36 mGy and 97.38 mGy, respectively. While as, the mean SSDE for contrast-enhanced thorax CT was observed to be 5.82 mGy, which is less than the mean SSDE of 6.40 mGy for noncontrast thorax CT imaging. The range of the SSDE for contrast-enhanced abdomen CT is 2.05 mGy to 22.13 mGy with a mean SSDE of around 5.71 mGy and for noncontrast abdomen imaging, mean value of SSDE was 5.58 mGy. The mean value of "E" for noncontrast thorax CT imaging was observed to be 2.7 mSv with minimum and maximum 1.17 mSv to 10.10 mSv respectively, which less than the mean effective dose is of 3.64 mSv observed for contrast enhanced thorax CT imaging. The multivariate analysis suggests that SSDE is significantly correlated with CTD1 vol, D w, and E is found significantly dependent on DLP for both contrast enhanced and noncontrast imaging with p < 0.05. A strong positive correlation was found between D w and Size⁄(LAT+AP), form linear regression analysis. The SSDE is crucial for radiologists evaluating pediatric CT scans and is now an international standard expected to be widely adopted. The strong positive correlation between D w versus Size⁄(LAT+AP), indicates that Size⁄(LAT+AP),can be used as surrogate in estimate SSDE when D w calculation is not feasible for pediatric CT imaging.
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Affiliation(s)
- Rukhsar Khan
- Department of Radiodiagnosis, Faculty of Medicine, J. N Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mudasir Ashraf Shah
- Department of Radiodiagnosis, Faculty of Medicine, J. N Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Shagufta Wahab
- Department of Radiodiagnosis, Faculty of Medicine, J. N Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Rizwan Ahmad Khan
- Paediatric Surgery, Faculty of Medicine, J. N Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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7
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Kang S, Skapek S, Krishnan S, Gambhir SS, Zeng Y, Zhou Q, Zaman R. A Novel Approach to Harnessing Acoustic A-Lines to Detect Circulating Tumor Cells in Flowing Blood. NANO LETTERS 2024; 24:15615-15622. [PMID: 39556103 DOI: 10.1021/acs.nanolett.4c03982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2024]
Abstract
Circulating tumor cells (CTCs) are associated with tumor burden and treatment response and, as hallmarks of the initiation of tumor dissemination, can predict the likelihood of metastatic progression before widespread tumors can be detected by standard anatomic imaging. However, early diagnosis of recurrence through the detection of CTCs is limited by their low prevalence in blood and the limited sensitivity of existing technologies. To address these challenges, we investigated the use of ultrasound and targeted microbubbles (MBs) for early CTC detection. While MBs have been used in cardiovascular/molecular tumor imaging, there is limited research on their acoustic properties when bound to CTCs. We developed a hydrophone system for detecting characteristic A-lines from CTCs encapsulating MBs. Our study is the first to identify distinctive characteristics in the acoustic frequency response of MBs bound to different cancer CTCs using in vitro suspensions and in vivo mice that will benefit metastatic cancer detection and management.
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Affiliation(s)
- Shu Kang
- Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, Texas 75235, United States
| | - Stephen Skapek
- Department of Pediatrics, Division of Hematology/Oncology, Duke University School of Medicine, Durham, North Carolina 27710, United States
| | - Sunil Krishnan
- Lilian L. Smith Department of Neurosurgery, UT Health Science Center, Houston, Texas 77054, United States
| | - Sanjiv S Gambhir
- Department of Radiology, Stanford University School of Medicine, Stanford, California 94304, United States
| | - Yushun Zeng
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Qifa Zhou
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Raiyan Zaman
- Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, Texas 75235, United States
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8
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Alghamdi AS, Aldhaheri RW. A Low-Cost, Portable, Multi-Cancer Screening Device Based on a Ratio Fluorometry and Signal Correlation Technique. BIOSENSORS 2024; 14:482. [PMID: 39451695 PMCID: PMC11506725 DOI: 10.3390/bios14100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 10/02/2024] [Accepted: 10/05/2024] [Indexed: 10/26/2024]
Abstract
The autofluorescence of erythrocyte porphyrins has emerged as a potential method for multi-cancer early detection (MCED). With this method's dependence on research-grade spectrofluorometers, significant improvements in instrumentation are necessary to translate its potential into clinical practice, as with any promising medical technology. To fill this gap, in this paper, we present an automated ratio porphyrin analyzer for cancer screening (ARPA-CS), a low-cost, portable, and automated instrument for MCED via the ratio fluorometry of porphyrins. The ARPA-CS aims to facilitate cancer screening in an inexpensive, rapid, non-invasive, and reasonably accurate manner for use in primary clinics or at point of care. To accomplish this, the ARPA-CS uses an ultraviolet-excited optical apparatus for ratio fluorometry that features two photodetectors for detection at 590 and 630 nm. Additionally, it incorporates a synchronous detector for the precision measurement of signals based on the Walsh-ordered Walsh-Hadamard transform (WHT)w and circular shift. To estimate its single-photodetector capability, we established a linear calibration curve for the ARBA-CS exceeding four orders of magnitude with a linearity of up to 0.992 and a low detection limit of 0.296 µg/mL for riboflavin. The ARPA-CS also exhibited excellent repeatability (0.21%) and stability (0.60%). Moreover, the ratio fluorometry of three serially diluted standard solutions of riboflavin yielded a ratio of 0.4, which agrees with that expected based on the known emission spectra of riboflavin. Additionally, the ratio fluorometry of the porphyrin solution yielded a ratio of 49.82, which was ascribed to the predominant concentration of protoporphyrin IX in the brown eggshells, as confirmed in several studies. This study validates this instrument for the ratio fluorometry of porphyrins as a biomarker for MCED. Nevertheless, large and well-designed clinical trials are necessary to further elaborate more on this matter.
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Affiliation(s)
| | - Rabah W. Aldhaheri
- Department of Electrical and Computer Engineering, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
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9
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Shahid S, Ahmad M, Abqari S, Shah MA, Masood SY. Radiation dose in cardiac CT for preoperative diagnosis of children with congenital heart disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2024; 55:192. [DOI: 10.1186/s43055-024-01368-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 09/19/2024] [Indexed: 05/16/2025] Open
Abstract
Abstract
Background
One of the most common congenital conditions detected globally, congenital heart diseases, and CT techniques provide a high-quality and thorough presentation of heart anatomy, thoracic vasculature, and extracardiac structures, and hence, it is becoming a more popular non-invasive diagnostic imaging method for congenital heart disease. The drawbacks with CT imaging are the radiation exposure from repeated scans is also rising, especially in young patients. The present study is aimed to evaluate the radiation dose in gated and non-gated cardiac CT for preoperative diagnosis of pediatric patients with congenital heart diseases.
Results
A total of 111 pediatric patients with mean age of 7.47 years were prospectively included in the study. The mean value of “Effective dose (E)” for gated CT at $$100\;{\text{kV}}_{{\text{p}}}$$
100
kV
p
was found to be $$4.71\;{\text{mSv}}$$
4.71
mSv
which is higher than mean “E” of $$3.95\;{\text{mSv}}$$
3.95
mSv
observed for gated CT at $$80\;{\text{kV}}_{{\text{p}}}$$
80
kV
p
. The average value of “E” for non-gated technique was observed less than that of gated technique at both $$100\;{\text{kV}}_{{\text{p}}}$$
100
kV
p
and $$80\;{\text{kV}}_{{\text{p}}}$$
80
kV
p
. The multiple regression analysis shows that “E” is significantly dependent on $${\text{DLP}}\left( {{\text{mGy}}\;{\text{cm}}} \right)$$
DLP
mGy
cm
for both gated and non-gated techniques at 95% level of significance $$\left( {p < 0.05} \right)$$
p
<
0.05
. The Student’s t-test verifies that the mean value of “E” for both the techniques at $$100\;{\text{kV}}_{{\text{p}}}$$
100
kV
p
and $$80\;{\text{kV}}_{{\text{p}}}$$
80
kV
p
are significantly different at 95% level of significance $$\left( {p < 0.05} \right)$$
p
<
0.05
.
Conclusions
The effective dose received by pediatric patients is much higher when using ECG-gated acquisition with an average value of $$4.71\;{\text{mSv}}$$
4.71
mSv
and $$3.95\;{\text{mSv}}$$
3.95
mSv
at $$100\;{\text{kV}}_{{\text{p}}}$$
100
kV
p
, and at $$80\;{\text{kV}}_{{\text{p}}}$$
80
kV
p
respectively. Because low-voltage X-rays are more sensitive to high atomic number iodinated contrast media, the mean “E” for non-gated cardiac CT imaging at $$80\;{\text{kV}}_{{\text{p}}}$$
80
kV
p
is $$2.26\;{\text{mSv}}$$
2.26
mSv
, and results in significant reduction of effective dose.
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Berg J, Frix AN, Henket M, Gester F, Winandy M, Canivet P, Njock MS, Thys M, Desir C, Meunier P, Louis R, Malchair F, Guiot J. Long Term Evaluation of Quantitative Cumulative Irradiation in Patients Suffering from ILDs. Diagnostics (Basel) 2024; 14:2136. [PMID: 39410540 PMCID: PMC11476226 DOI: 10.3390/diagnostics14192136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/30/2024] [Accepted: 09/06/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND Interstitial lung diseases (ILDs) are an heterogeneous group of infiltrating lung pathologies, for which prompt diagnosis and continuous assessment are of paramount importance. While chest CT is an established diagnostic tool for ILDs, there are no formal guidelines on the follow-up regimen, leaving the frequency and modality of follow-up largely at the clinician's discretion. METHODS The study retrospectively evaluated the indication of chest CT in a cohort of 129 ILD patients selected from the ambulatory care polyclinic at University Hospital of Liège. The aim was to determine whether the imagining acquisition had a true impact on clinical course and follow-up. We accepted three different situations for justifying the indication of the CTs: clinical deterioration, a decrease in pulmonary function tests (at least a 10% drop in a parameter), and monitoring for oncological purposes. The other indications, mainly routine follow-up, were classified as "non-justified". Radiation dose output was evaluated with Computed Tomography Dose Index (CTDI) and Dose Length Product (DLP). RESULTS The mean number of CT scans per patient per year was 1.7 ± 0.4, determining irradiation in CTDI (mGy)/year of 34.9 ± 64.9 and DLP in (mGy*cm)/year of 1095 ± 1971. The percentage of justified CT scans was 57 ± 32%, while the scans justified a posteriori were 60 ± 34%. Around 40% of the prescribed monitoring CT scans had no impact on the management of ILD and direct patient care. CONCLUSIONS Our study identifies a trend of overuse in chest CT scans at follow-up (up to 40%), outside those performed for clinical exacerbation or oncological investigation. In the particular case of ILD exacerbation, CT scan value remains high, underlying the benefit of this strategy.
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Affiliation(s)
- Julien Berg
- Department of Respiratory Medicine, University Hospital of Liège, 4000 Liège, Belgium (M.W.); (M.-S.N.)
| | - Anne-Noelle Frix
- Department of Respiratory Medicine, University Hospital of Liège, 4000 Liège, Belgium (M.W.); (M.-S.N.)
| | - Monique Henket
- Department of Respiratory Medicine, University Hospital of Liège, 4000 Liège, Belgium (M.W.); (M.-S.N.)
| | - Fanny Gester
- Department of Respiratory Medicine, University Hospital of Liège, 4000 Liège, Belgium (M.W.); (M.-S.N.)
| | - Marie Winandy
- Department of Respiratory Medicine, University Hospital of Liège, 4000 Liège, Belgium (M.W.); (M.-S.N.)
| | - Perrine Canivet
- Department of Radiology, University Hospital of Liège, 4000 Liège, Belgium
| | - Makon-Sébastien Njock
- Department of Respiratory Medicine, University Hospital of Liège, 4000 Liège, Belgium (M.W.); (M.-S.N.)
| | - Marie Thys
- Department of Biostatistics and Medico-Economic Information, University Hospital of Liège, 4000 Liège, Belgium
| | - Colin Desir
- Department of Radiology, University Hospital of Liège, 4000 Liège, Belgium
| | - Paul Meunier
- Department of Radiology, University Hospital of Liège, 4000 Liège, Belgium
| | - Renaud Louis
- Department of Respiratory Medicine, University Hospital of Liège, 4000 Liège, Belgium (M.W.); (M.-S.N.)
| | - Francoise Malchair
- Department of Clinical Science, University of Liège, 4000 Liège, Belgium
| | - Julien Guiot
- Department of Respiratory Medicine, University Hospital of Liège, 4000 Liège, Belgium (M.W.); (M.-S.N.)
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11
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Kim H, Ryu SM, Keum JS, Oh SI, Kim KN, Shin YH, Jeon IH, Koh KH. Clinical validation of enhanced CT imaging for distal radius fractures through conditional Generative Adversarial Networks (cGAN). PLoS One 2024; 19:e0308346. [PMID: 39150966 PMCID: PMC11329132 DOI: 10.1371/journal.pone.0308346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/22/2024] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND/PURPOSE Distal radius fractures (DRFs) account for approximately 18% of fractures in patients 65 years and older. While plain radiographs are standard, the value of high-resolution computed tomography (CT) for detailed imaging crucial for diagnosis, prognosis, and intervention planning, and increasingly recognized. High-definition 3D reconstructions from CT scans are vital for applications like 3D printing in orthopedics and for the utility of mobile C-arm CT in orthopedic diagnostics. However, concerns over radiation exposure and suboptimal image resolution from some devices necessitate the exploration of advanced computational techniques for refining CT imaging without compromising safety. Therefore, this study aims to utilize conditional Generative Adversarial Networks (cGAN) to improve the resolution of 3 mm CT images (CT enhancement). METHODS Following institutional review board approval, 3 mm-1 mm paired CT data from 11 patients with DRFs were collected. cGAN was used to improve the resolution of 3 mm CT images to match that of 1 mm images (CT enhancement). Two distinct methods were employed for training and generating CT images. In Method 1, a 3 mm CT raw image was used as input with the aim of generating a 1 mm CT raw image. Method 2 was designed to emphasize the difference value between the 3 mm and 1 mm images; using a 3 mm CT raw image as input, it produced the difference in image values between the 3 mm and 1 mm CT scans. Both quantitative metrics, such as peak signal-to-noise ratio (PSNR), mean squared error (MSE), and structural similarity index (SSIM), and qualitative assessments by two orthopedic surgeons were used to evaluate image quality by assessing the grade (1~4, which low number means high quality of resolution). RESULTS Quantitative evaluations showed that our proposed techniques, particularly emphasizing the difference value in Method 2, consistently outperformed traditional approaches in achieving higher image resolution. In qualitative evaluation by two clinicians, images from method 2 showed better quality of images (grade: method 1, 2.7; method 2, 2.2). And more choice was found in method 2 for similar image with 1 mm slice image (15 vs 7, p = 201). CONCLUSION In our study utilizing cGAN for enhancing CT imaging resolution, the authors found that the method, which focuses on the difference value between 3 mm and 1 mm images (Method 2), consistently outperformed.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Dongjak-gu, Seoul, Republic of Korea
| | - Seung Min Ryu
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | | | | | | | - Young Ho Shin
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Zeng SL, Grier AJ, Langdell HC, Blevins KM, Tian WM, French RJ, Mithani SK, Hammert WC, Klifto CS. Comparison of Low-Dose Computed Tomography Versus Conventional-Dose Computed Tomography in the Evaluation of Distal Radius Fractures. Hand (N Y) 2024:15589447241232016. [PMID: 38450618 PMCID: PMC11571514 DOI: 10.1177/15589447241232016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Distal radius fractures (DRFs) are common upper extremity fractures and often require surgical fixation when they are intraarticular. Preoperative computed tomography (CT) has emerged as a surgical planning tool to evaluate intraarticular DRFs. Although CT affords additional details, patients receive higher radiation doses than standard radiographs. We aim to develop a low-dose CT (LDCT) protocol, relative to the institutional standard-dose CT wrist for intraarticular DRFs although providing adequate detail for surgical decision-making. METHODS A single-institution prospective study was conducted on patients with intraarticular DRFs who underwent closed reduction and below-elbow splinting who otherwise would undergo wrist CT. Observations were defined as total measurements taken, with each view undergoing 44 measurements. Patients underwent 2 scans with a standard dose and a 10× dose reduction. Articular step and gap measurements were recorded in the sagittal and coronal images. RESULTS A total of 11 patients were enrolled (7 women and 4 men). The mean age was 55 years (SD = 20.1). There were a total of 4 reviewers: 1 attending surgeon, 2 resident physicians, and 1 student. When comparing LDCT and conventional-dose CT (CDCT), there were no significant differences in step and gap measurements across all reviewers. CONCLUSION This study demonstrated that LDCT provides comparable imaging quality for surgical planning as a CDCT without significant diagnostic decay in the setting of DRFs. This comes with the added benefit of a 10-fold reduction in radiation exposure. These results suggest that LDCT is an opportunity to reduce effective radiation in patients although providing beneficial preoperative imaging.
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Affiliation(s)
| | - A. Jordan Grier
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Hannah C. Langdell
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Kier M. Blevins
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Suhail K. Mithani
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
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Mahmoudi G, Toolee H, Maskani R, Jokar F, Mokfi M, Hosseinzadeh A. COVID-19 and cancer risk arising from ionizing radiation exposure through CT scans: a cross-sectional study. BMC Cancer 2024; 24:298. [PMID: 38443829 PMCID: PMC10916077 DOI: 10.1186/s12885-024-12050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The surge in the utilization of CT scans for COVID-19 diagnosis and monitoring during the pandemic is undeniable. This increase has brought to the forefront concerns about the potential long-term health consequences, especially radiation-induced cancer risk. This study aimed to quantify the potential cancer risk associated with CT scans performed for COVID-19 detection. METHODS In this cross-sectional study data from a total of 561 patients, who were referred to the radiology center at Imam Hossein Hospital in Shahroud, was collected. CT scan reports were categorized into three groups based on the radiologist's interpretation. The BEIR VII model was employed to estimate the risk of radiation-induced cancer. RESULTS Among the 561 patients, 299 (53.3%) were males and the average age of the patients was 49.61 ± 18.73 years. Of the CT scans, 408 (72.7%) were reported as normal. The average age of patients with normal, abnormal, and potentially abnormal CT scans was 47.57 ± 19.06, 54.80 ± 16.70, and 58.14 ± 16.60 years, respectively (p-value < 0.001). The average effective dose was 1.89 ± 0.21 mSv, with 1.76 ± 0.11 mSv for males and 2.05 ± 0.29 mSv for females (p-value < 0.001). The average risk of lung cancer was 3.84 ± 1.19 and 9.73 ± 3.27 cases per 100,000 patients for males and females, respectively. The average LAR for all cancer types was 10.30 ± 6.03 cases per 100,000 patients. CONCLUSIONS This study highlights the critical issue of increased CT scan usage for COVID-19 diagnosis and the potential long-term consequences, especially the risk of cancer incidence. Healthcare policies should be prepared to address this potential rise in cancer incidence and the utilization of CT scans should be restricted to cases where laboratory tests are not readily available or when clinical symptoms are severe.
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Affiliation(s)
- Golshan Mahmoudi
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Heidar Toolee
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Reza Maskani
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Farzaneh Jokar
- School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Milad Mokfi
- School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ali Hosseinzadeh
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran.
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Mataac M, Rehani MM. Is a one percent occurrence of high-dose patients significant? Eur J Radiol 2024; 172:111340. [PMID: 38309214 DOI: 10.1016/j.ejrad.2024.111340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
Risk-free society is utopian. We come across risks in everyday life, and we use probabilities to get a feel of how risky a situation is. Risk probability numbers of around 1% are comforting, but an intercomparison of numbers among various low risks in popular situations can be enlightening. In this article, we compare risks of complications or death in several surgeries and risks in commercial air travel with risks for patients getting cumulative effective dose (CED) of 100 mSv or more, as the latter is a hot and controversial topic currently. The analysis shows that many common surgeries are a few tens or hundreds of times less risky than the risk from a 100 mSv dose, even though the former often frightens us more. Despite there being a much higher chance of developing cancer from radiation than being involved in a commercial plane accident, there is much less emphasis on patient radiation safety than aviation safety. Further, a look at the system of control on prescription drugs indicates that there is much to learn for policy planning. This analysis may help the International Commission on Radiological Protection (ICRP) in their review of recommendations.
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15
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Erçen Diken Ö, Kaya Ş, Bektaş Aksoy H, Ekici A, Çapraz A, Tabaru A, Şengören Dikiş Ö, Arpağ H, Yildiz H, Kiliç T, Özdemir T, Gülhan PY, Arslan S, Ogan N, Doğan C, Tutar Ü, Başlilar Ş, Esendağli D, Kirkil G, Doğan ÖT, Toru Erbay Ü, Ayvaci A, Tosun M, Uğur Chousein EG, Niksarlioğlu EY, Olcay SS, Özkisa T, Hocanli İ, Karadağ M, Özçelik N, Oktay N, Şentürk E, Arslan S, Pekcan Özyurt S, Cerit A, Nennicioğlu Y, Atilla N, Üney İH, Elverişli MF, Berk S, Baha A, Erik N, Ölmez H, Kaçmaz B, Erzurumluoğlu H, Demirdöğen Çetinoğlu E, Özlü T. Pulmonary Physician Consultancy in Emergency Services in Turkiye (PuPCEST) - a cross-sectional multicenter study. Medicine (Baltimore) 2024; 103:e37165. [PMID: 38335404 PMCID: PMC10860966 DOI: 10.1097/md.0000000000037165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.
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Affiliation(s)
- Özlem Erçen Diken
- University of Health Sciences, Adana City Training and Research Hospital, Department of Chest Disease, Adana, Turkiye
| | - Şerife Kaya
- University of Pamukkkale, Department of Chest Disease, Pamukkale, Turkiye
| | - Hayriye Bektaş Aksoy
- Samsun Training and Research Hospital, Department of Chest Disease, Samsun, Turkiye
| | - Aydanur Ekici
- University of Kirikkale, Department of Chest Disease, Kirikkale, Turkiye
| | - Aylin Çapraz
- University of Amasya, Department of Chest Disease, Amasya, Turkiye
| | - Ali Tabaru
- University of Ömer Halisdemir, Department of Chest Disease, Niğde, Turkiye
| | - Özlem Şengören Dikiş
- University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Department of Chest Disease, Bursa, Turkiye
| | - Hüseyin Arpağ
- University of Kahramanmaraş, Department of Chest Disease, Kahramanmaraş, Turkiye
| | - Hanifi Yildiz
- Universitesi of Yüzüncü Yil, Department of Chest Disease, Van, Turkiye
| | - Talat Kiliç
- University of İnönü, Department of Chest Disease, Malatya, Turkiye
| | - Tarkan Özdemir
- Abdurrahman Yurtaslan Ankara Onkoloji Training and Research Hospital, Department of Chest Disease, Ankara, Turkiye
| | | | - Sulhattin Arslan
- University of Cumhuriyet, Department of Chest Disease, Sivas, Turkiye
| | - Nalan Ogan
- University of Ufuk, Department of Chest Disease, Ankara, Turkiye
| | - Canan Doğan
- Isparta City Training and Research Hospital, Department of Chest Disease, Isparta, Turkiye
| | - Ümit Tutar
- Samsun Chest Disease and Thoracic Surgery Hospital, Samsun, Turkiye
| | - Şeyma Başlilar
- University of Health Sciences, İstanbul Ümraniye Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | | | - Gamze Kirkil
- University of Firat, Department of Chest Disease, Elaziğ, Turkiye
| | - Ömer Tamer Doğan
- University of Cumhuriyet, Department of Chest Disease, Sivas, Turkiye
| | - Ümran Toru Erbay
- University of Dumlupinar, Department of Chest Disease, Kütahya, Turkiye
| | - Aysun Ayvaci
- Kanuni Sultan Süleyman Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | - Mustafa Tosun
- University of Erzincan, Department of Chest Disease, Erzincan, Turkiye
| | - Efsun Gonca Uğur Chousein
- Yediküle Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | - Elif Yelda Niksarlioğlu
- Yediküle Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | | | - Tuncer Özkisa
- Gülhane Training and Research Hospital, Department of Chest Disease, Ankara, Turkiye
| | - İclal Hocanli
- University of Harran, Department of Chest Disease, Burdur, Turkiye
| | - Mehmet Karadağ
- University of Uludağ, Department of Chest Disease, Bursa, Turkiye
| | - Neslihan Özçelik
- Kaçkar State Hospital, Department of Chest Disease, Rize, Turkiye
| | - Nuray Oktay
- İzzet Baysal State Hospital, Department of Chest Disease, Bolu, Turkiye
| | - Elvan Şentürk
- University of Karadeniz Teknik, Farabi Hospital, Department of Chest Disease, Trabzon, Turkiye
| | - Sertaç Arslan
- University of Hitit, Department of Chest Disease, Çorum, Turkiye
| | | | - Ahu Cerit
- University of Kirikkale, Department of Chest Disease, Kirikkale, Turkiye
| | - Yasemin Nennicioğlu
- University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Department of Chest Disease, Bursa, Turkiye
| | - Nurhan Atilla
- University of Kahramanmaraş, Department of Chest Disease, Kahramanmaraş, Turkiye
| | | | | | - Serdar Berk
- University of Cumhuriyet, Department of Chest Disease, Sivas, Turkiye
| | - Ayşe Baha
- University of Ufuk, Department of Chest Disease, Ankara, Turkiye
| | - Nur Erik
- University of Health Sciences, İstanbul Ümraniye Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | - Hasan Ölmez
- University of Erzincan, Department of Chest Disease, Erzincan, Turkiye
| | - Berat Kaçmaz
- Gülhane Training and Research Hospital, Department of Chest Disease, Ankara, Turkiye
| | | | | | - Tevfik Özlü
- University of Karadeniz Teknik, Farabi Hospital, Department of Chest Disease, Trabzon, Turkiye
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Lin JAJ, Li PH, Liao CH, Hsieh CH, Kuo YC, Hsu TA, Chu YY, Fu CY. Evaluation of Concomitant Facial Fracture in Traumatic Brain Injury Patients-Simplification and External Validation of a Prediction Model. Ann Plast Surg 2024; 92:S27-S32. [PMID: 38285992 DOI: 10.1097/sap.0000000000003774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Patients with traumatic brain injuries (TBIs) often experience concurrent facial bone fractures. In 2021, a prediction model with 10 variables was published and precisely predicted concomitant facial fractures in TBI patients. Herein, external validation and simplification of this model was performed. METHODS Traumatic brain injury patients treated at a major referral trauma center were retrospectively reviewed for 1 year. The original prediction model (published in 2021), which was developed from a rural level II trauma center, was applied for external validation. A new and simplified model from our level I trauma center was developed and backwardly validated by rural level II trauma center data. RESULTS In total, 313 TBI patients were enrolled; 101 (32.3%) had concomitant facial fractures. When the previous prediction model was applied to the validation cohort, it achieved acceptable discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.713 and good precision, with a Brier score of 0.083. A new and simplified model with 6 variables (age, tooth rupture, epistaxis, facial lesion, eye injury, and intracranial hemorrhage) was created with excellent discrimination (AUC = 0.836) and good precision (Brier score of 0.055). The backward validation of this new model also showed excellent discrimination in the cohort used to develop the original model (AUC = 0.875). CONCLUSION The original model provides an acceptable and reproducible prediction of concomitant facial fractures among TBI patients. A simplified model with fewer variables and the same accuracy could be applied in the emergency department and at higher- and lower-level trauma centers.
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Affiliation(s)
| | - Pei-Hua Li
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ying Chu
- From the Department of Plastic and Reconstructive Surgery
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Al-Hayek Y, Spuur K, Davidson R, Hayre C, Currie G, Zheng X. The effect of inappropriate patient centring on CT numbers and radiation dose: A survey of current practices and knowledge. Radiography (Lond) 2023; 30:100-106. [PMID: 39492402 DOI: 10.1016/j.radi.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 11/05/2024]
Abstract
INTRODUCTION Patient positioning is known to impact CT number and patient dose. The aim of this study was to report current practice and the accuracy of the knowledge of radiographers in Australia regarding inappropriate patient centring during CT. METHODS A survey of members of the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) was undertaken. The survey consisted of 36 questions about patient off-centring, CT number accuracy, and radiation dose. The survey was open from May to August 2021 and directed toward diagnostic radiographers with CT experience. Responses were evaluated as correct or incorrect based on evidence-based knowledge and theoretical definitions. RESULTS Among 186 participants, a majority of 75.7 % followed the manufacturer's recommended guidelines for localiser radiographs direction. Despite higher radiation dose to anteriorly located radiosensitive organs, 63.64 % preferred the anterior-posterior (AP) localiser. Only 21.93 % agreed that localiser direction would definitely affect radiation dose if the patient was inappropriately centred. A knowledge-practice disparity is evident as 45.77 % rarely or never reviewed CT numbers post-image acquisition, even though 92.8 % acknowledged their significance on prognosis and clinical decisions. Significant discrepancies in the accuracy of responses were identified; inaccuracies were dependent on CT qualifications (p = 0.0199), experience (p = 0.0397), and workload (p = 0.0360). Knowledge gaps existed regarding factors affecting patient centring and its impact on radiation dose and CT numbers. CONCLUSION This study highlights inconsistent CT practices and knowledge gaps among Australian radiographers. Given the impact of inaccurate positioning on radiation dose and CT number, engagement with continuous professional development programs that focus on the importance of patient positioning and the utilisation of the latest advancements in dose management tools is urgently needed. IMPLICATIONS FOR PRACTICE Where radiographers do not possess the necessary theoretical knowledge and understanding to maximise patient positioning accuracy to optimise dose and CT number accuracy, then patients may receive an unnecessary dose. Inaccurate CT number accuracy may lead to misdiagnosis or inaccurate delivery of treatment.
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Affiliation(s)
- Y Al-Hayek
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia; Department of Medical Imaging, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, 13133, Jordan.
| | - K Spuur
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
| | - R Davidson
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra, ACT, 2601, Australia.
| | - C Hayre
- Department of Health and Care Professions, Faculty of Health and Life Sciences, University of Exeter, Exeter, Devon, EX1 2LU, UK.
| | - G Currie
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
| | - X Zheng
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
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Westmark S, Hessellund T, Hoffmann A, Madsen BB, Jensen TS, Gielen M, Bøggild H, Leutscher PDC. Increasing use of computed tomography scans in the North Denmark Region raises patient safety concern. Eur J Radiol 2023; 166:110997. [PMID: 37499480 DOI: 10.1016/j.ejrad.2023.110997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Use of computed tomography (CT) scans raises safety concern as lifetime cumulative ionising radiation exposure is associated with risk of developing malignancies. This study aimed to investigate use of abdominal CT scans in the Danish health care sector. METHODS Data on abdominal CT scans performed annually in the North Denmark Region between 2005 and 2018 were extracted from the regional registry with emphasis on patients with a medical history of a repeated abdominal CT scan within 28 days. An audit of the medical files was subsequently conducted in 100 randomly selected patient cases to evaluate clinical information being provided, in addition to justification for a repeated abdominal CT scan, and finally if other radiology modalities could have been applied. RESULTS Number of annually performed abdominal CT scans in this demographically stable regional population increased by a factor 4.3 from 15 in 2005 to 65 in 2018 per 1,000 inhabitants. The audit revealed that 31% of the secondabdominal CT scans within a 28 days period were categorized as either doubtful whether justified or not justified. Moreover, 20% of theCT scans were considered replaceable by ultrasonography. CONCLUSIONS Annual performance of abdominal CT scans increased fourfold during the 14 years period. This tendency is probably attributable to changes in the Danish health care sector by which CT scan examination are used more frequently aiming at more accelerated patient investigation flow in conjunction with shorter length of hospitalization stay. Alertness is strongly warranted towards the associated risk of cancer due to life-time cumulative ionising radiation exposure by this strategy.
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Affiliation(s)
- Signe Westmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Thomas Hessellund
- Department of Radiology, Clinic for Diagnostics, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Andreas Hoffmann
- Department of Radiology, Gødstrup Regional Hospital, Gødstrup, Denmark
| | | | - Trine S Jensen
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Mahican Gielen
- Department of Radiology, Clinic for Diagnostics, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Kumari K, Goswami M. Gamma radiation detector selection for CT scanner. Z Med Phys 2023:S0939-3889(23)00088-0. [PMID: 37586961 DOI: 10.1016/j.zemedi.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
Three types of gamma radiation detectors associated with distributed electronics namely, NaI (Tl), HPGe and LaBr3(Ce) are compared primarily focusing on electronic noise and scattering noise. Additionally, detectors of same make, material, size and electronics are also compared. A methodology is proposed to select the most suitable detector for computed tomography (CT) among the available options. Standard deviation parameter is employed to estimate electronic noise without performing CT experiment. Kanpur theorem-1(KT-1) is used to estimate the scattering noise quantitatively after verifying its sensitivity to scattering noise. The impact of scattering noise on CT profiles is evaluated using dice similarity dice coefficient. A good resemblance between KT-1 and dice coefficient is observed. A maximum difference of 56% in scattering noise is observed when five detectors used simultaneously instead of single detector whereas a discrepancy of 85% is observed between different types of radiation detectors. As far as ease of handling, operational and capital cost is concern one has to compromise minimum 12% of accuracy in CT reconstruction if NaI (Tl) detector is used with respect to best alternative available. The proposed methodology can be applied to measurement that require minimal scattering interference data other than CT experiments. The manufacturer can add noise level of detector as a characteristic parameter in the data sheet.
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Affiliation(s)
- Kajal Kumari
- Divyadrishti Imaging Laboratory, Department of Physics, IIT Roorkee, Roorkee, India
| | - Mayank Goswami
- Divyadrishti Imaging Laboratory, Department of Physics, IIT Roorkee, Roorkee, India.
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The why, who, how, and what of communicating CT radiation risks to patients and healthcare providers. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1514-1525. [PMID: 36799998 DOI: 10.1007/s00261-022-03778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 02/18/2023]
Abstract
Computed tomography (CT) has witnessed tremendous growth in utilization. Despite its immense benefits, there is a growing concern from the general public and the medical community about the detrimental consequences of ionizing radiation from CT. Anxiety from the perceived risks associated with CT can deter referring physicians from ordering clinically indicated CT scans and patients from undergoing medically necessary exams. This article discusses various strategies for educating patients and healthcare providers on the benefits and risks of CT scanning and salient techniques for effective communication.
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21
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Cao CF, Ma KL, Shan H, Liu TF, Zhao SQ, Wan Y, Jun-Zhang, Wang HQ. CT Scans and Cancer Risks: A Systematic Review and Dose-response Meta-analysis. BMC Cancer 2022; 22:1238. [PMID: 36451138 PMCID: PMC9710150 DOI: 10.1186/s12885-022-10310-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is still uncertainty on whether ionizing radiation from CT scans can increase the risks of cancer. This study aimed to identify the association of cumulative ionizing radiation from CT scans with pertaining cancer risks in adults. METHODS Five databases were searched from their inception to November 15, 2020. Observational studies reporting cancer risks from CT scans in adults were included. The main outcome included quantified cancer risks as cancer case numbers in exposed/unexposed adult participants with unified converted measures to odds ratio (OR) for relative risk, hazard ratio. Global background radiation (2.4 mSv per year) was used as control for lifetime attribution risk (LAR), with the same period from incubation after exposure until survival to 100 years. RESULTS 25 studies were included with a sum of 111,649,943 participants (mean age: 45.37 years, 83.4% women), comprising 2,049,943 actual participants from 6 studies with an average follow-up period as 30.1 years (range, 5 to 80 years); 109,600,000 participants from 19 studies using LAR. The cancer risks for adults following CT scans were inordinately increased (LAR adults, OR, 10.00 [95% CI, 5.87 to 17.05]; actual adults, OR, 1.17 [95%CI, 0.89 to 1.55]; combined, OR, 5.89 [95%CI, 3.46 to 10.35]). Moreover, cancer risks elevated with increase of radiation dose (OR, 33.31 [95% CI, 21.33 to 52.02]), and multiple CT scan sites (OR, 14.08 [95% CI, 6.60 to 30.05]). The risk of solid malignancy was higher than leukemia. Notably, there were no significant differences for age, gender, country, continent, study quality and studying time phrases. CONCLUSIONS Based on 111.6 million adult participants from 3 continents (Asia, Europe and America), this meta-analysis identifies an inordinately increase in cancer risks from CT scans for adults. Moreover, the cancer risks were positively correlated with radiation dose and CT sites. The meta-analysis highlights the awareness of potential cancer risks of CT scans as well as more reasonable methodology to quantify cancer risks in terms of life expectancy as 100 years for LAR. PROSPERO TRIAL REGISTRATION NUMBER CRD42019133487.
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Affiliation(s)
- Chun-Feng Cao
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160, Chongqing, People's Republic of China
| | - Kun-Long Ma
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160, Chongqing, People's Republic of China
| | - Hua Shan
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an, 712046, Shaanxi Province, People's Republic of China
| | - Tang-Fen Liu
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an, 712046, Shaanxi Province, People's Republic of China
| | - Si-Qiao Zhao
- Department of Orthopedics, No.1 Hospital of Xi'an City, Northwestern University, Xi'an, 710002, Shaanxi Province, People's Republic of China
| | - Yi Wan
- Department of Health Services, Fourth Military Medical University, Xi'an, 710032, No.169 West Changle Road, Shaanxi Province, People's Republic of China
| | - Jun-Zhang
- Baoji Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shaanxi Province, People's Republic of China
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an, 712046, Shaanxi Province, People's Republic of China.
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22
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Barros G, Meyer RM, Bass DI, Nistal D, McAvoy M, Clarke JV, Vanent KN, Cruz MJ, Levitt MR. Clinical Utility of Routine Postprocedural Computed Tomography of the Head Following Elective Neuroendovascular Interventions. World Neurosurg 2022; 167:e1426-e1431. [PMID: 36122855 DOI: 10.1016/j.wneu.2022.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little evidence supports acquisition of routine head imaging after uncomplicated elective neurosurgical procedures for patients with unchanged neurological examinations; however, imaging is still performed by some neurointerventionalists. We assessed the clinical utility of routine computed tomography of the head (CTH) following elective neuroendovascular interventions, including aneurysm coiling, aneurysm stent-assisted coiling, aneurysm flow diversion, arteriovenous malformation/fistula embolization, middle meningeal artery embolization for subdural hematoma, extracranial carotid artery stenting, and venous sinus stenting. METHODS Retrospective chart review identified patients undergoing neuroendovascular intervention from 2011 to 2021 at our institution. Demographic, clinical, and radiographic variables, including presenting signs and symptoms, antiplatelets and/or anticoagulant medications, intraprocedural complications, postprocedural CTH findings, and postprocedural neurological examinations, were recorded. Association of clinical variables with an abnormal postprocedural CTH was assessed with univariate analysis. Patients with ruptured vascular pathology, preoperative embolizations, and missing postprocedural CTH images and/or reports were excluded. RESULTS Of 509 procedures identified, 354 were eligible for analysis; 4.8% of patients (17/354) had abnormal findings on postprocedural CTH. Nine patients had intraprocedural complications or new postprocedural neurological deficits that would have prompted imaging regardless of institutional practice. None of the remaining 8 (2.3%) patients required additional procedures. New postprocedural neurological deficit was the only significant predictor of abnormal postprocedural CTH (odds ratio = 6.79; 95% confidence interval, 2.01-20.32; P = 0.0009). CONCLUSIONS In a large cohort of patients undergoing elective neuroendovascular intervention, no patients were identified for whom routine postprocedural CTH alone meaningfully altered their clinical care. Routine CTH is not necessary after uncomplicated elective neuroendovascular interventions performed with careful postprocedural neurological assessment.
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Affiliation(s)
- Guilherme Barros
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - R Michael Meyer
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David I Bass
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Dominic Nistal
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Malia McAvoy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Julian V Clarke
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Kevin N Vanent
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael J Cruz
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA; Department of Radiology, University of Washington, Seattle, Washington, USA; Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA; Stroke & Applied Neurosciences Center, University of Washington, Seattle, Washington, USA.
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23
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Morgenstern J, Challen K, Heitz C, Milne WK. Hot off the press: Low-risk, recurrent abdominal pain in the emergency department. Acad Emerg Med 2022; 29:1275-1277. [PMID: 35790050 DOI: 10.1111/acem.14556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 01/25/2023]
Affiliation(s)
| | | | - Corey Heitz
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Abuzaid MM, Elshami W, Sulieman A, Bradley D. Cumulative radiation exposure, effective and organ dose estimation from multiple head CT scans in stroke patients. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Machine Learning Model Drift: Predicting Diagnostic Imaging Follow-Up as a Case Example. J Am Coll Radiol 2022; 19:1162-1169. [PMID: 35981636 DOI: 10.1016/j.jacr.2022.05.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Address model drift in a machine learning (ML) model for predicting diagnostic imaging follow-up using data augmentation with more recent data versus retraining new predictive models. METHODS This institutional review board-approved retrospective study was conducted January 1, 2016, to December 31, 2020, at a large academic institution. A previously trained ML model was trained on 1,000 radiology reports from 2016 (old data). An additional 1,385 randomly selected reports from 2019 to 2020 (new data) were annotated for follow-up recommendations and randomly divided into two sets: training (n = 900) and testing (n = 485). Support vector machine and random forest (RF) algorithms were constructed and trained using 900 new data reports plus old data (augmented data, new models) and using only new data (new data, new models). The 2016 baseline model was used as comparator as is and trained with augmented data. Recall was compared with baseline using McNemar's test. RESULTS Follow-up recommendations were contained in 11.3% of reports (157 or 1,385). The baseline model retrained with new data had precision = 0.83 and recall = 0.54; none significantly different from baseline. A new RF model trained with augmented data had significantly better recall versus the baseline model (0.80 versus 0.66, P = .04) and comparable precision (0.90 versus 0.86). DISCUSSION ML methods for monitoring follow-up recommendations in radiology reports suffer model drift over time. A newly developed RF model achieved better recall with comparable precision versus simply retraining a previously trained original model with augmented data. Thus, regularly assessing and updating these models is necessary using more recent historical data.
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Shi HM, Sun ZC, Ju FH. Understanding the harm of low‑dose computed tomography radiation to the body (Review). Exp Ther Med 2022; 24:534. [PMID: 35911849 DOI: 10.3892/etm.2022.11461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hai-Min Shi
- Department of Gynecology and Obstetrics Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Zhi-Chao Sun
- Department of Medical Imaging, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Fang-He Ju
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310006, P.R. China
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Hattingh HL, Michaleff ZA, Fawzy P, Du L, Willcocks K, Tan KM, Keijzers G. Ordering of computed tomography scans for head and cervical spine: a qualitative study exploring influences on doctors' decision-making. BMC Health Serv Res 2022; 22:790. [PMID: 35717206 PMCID: PMC9206095 DOI: 10.1186/s12913-022-08156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ordering of computed tomography (CT) scans needs to consideration of diagnostic utility as well as resource utilisation and radiation exposure. Several factors influence ordering decisions, including evidence-based clinical decision support tools to rule out serious disease. The aim of this qualitative study was to explore factors influencing Emergency Department (ED) doctors' decisions to order CT of the head or cervical spine. METHODS In-depth semi-structured interviews were conducted with purposively selected ED doctors from two affiliated public hospitals. An interview tool with 10 questions, including three hypothetical scenarios, was developed and validated to guide discussions. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo Release 1.3 to facilitate coding and thematic analysis. RESULTS In total 21 doctors participated in semi-structured interviews between February and December 2020; mean interview duration was 35 min. Data saturation was reached. Participants ranged from first-year interns to experienced consultants. Five overarching emerging themes were: 1) health system and local context, 2) work structure and support, 3) professional practices and responsibility, 4) reliable patient information, and 5) holistic patient-centred care. Mapping of themes and sub-themes against a behaviour change model provided a basis for future interventions. CONCLUSIONS CT ordering is complex and multifaceted. Multiple factors are considered by ED doctors during decisions to order CT scans for head or c-spine injuries. Increased education on the use of clinical decision support tools and an overall strategy to improve awareness of low-value care is needed. Strategies to reduce low-yield CT ordering will need to be sustainable, sophisticated and supportive to achieve lasting change.
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Affiliation(s)
- H Laetitia Hattingh
- Diagnostic and Sub-Specialty Services, Gold Coast Health, Southport, Gold Coast, QLD, 4215, Australia. .,School of Pharmacy and Medical Sciences, Griffith University, Southport, Gold Coast, QLD, 4222, Australia.
| | | | - Peter Fawzy
- Neurosurgery Department, Gold Coast Health, Southport, Gold Coast, QLD, 4215, Australia.,School of Medicine and Health Sciences, Bond University, Gold Coast, QLD, 4226, Australia
| | - Leanne Du
- Medical Imaging, Gold Coast Health, Southport, Gold Coast, QLD, 4215, Australia
| | - Karlene Willcocks
- Diagnostic and Sub-Specialty Services, Gold Coast Health, Southport, Gold Coast, QLD, 4215, Australia
| | - K Meng Tan
- Diagnostic and Sub-Specialty Services, Gold Coast Health, Southport, Gold Coast, QLD, 4215, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Health, Southport, Gold Coast, QLD, 4215, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, 4226, Australia.,School of Medicine, Griffith University, Southport, Gold Coast, QLD, 4222, Australia
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ŞAHMARAN T, AKÇOBAN S. Meslek yüksekokulu öğrencileri ve akademisyenlerin radyasyon bilgi düzeylerinin değerlendirilmesi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Amaç: Bu çalışma bir üniversitenin meslek yüksekokulunda sağlık programlarında öğrenim gören öğrenciler ile bu üniversiteye bağlı meslek yüksekokullarında çalışan akademisyenlerin radyasyon bilgi düzeylerini değerlendirme amacıyla yapıldı.
Yöntem: Tanımlayıcı tipte planlanan araştırma Şubat 2022- Mart 2022 tarihleri arasında, 163 öğrenci ve 100 akademisyen ile tamamlandı. Veri toplama formu olarak “Öğrenci Tanıtıcı Bilgi Formu”, “Akademisyen Tanıtıcı Bilgi Formu” ve “Radyasyon Tutum Ölçeği” kullanıldı. Veriler elektronik ortamda (Google Formlar) online olarak toplandı. Veri analizi SPSS 25.0 paket programında yapıldı. İstatistiksel anlamlılık için p
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Affiliation(s)
- Turan ŞAHMARAN
- HATAY MUSTAFA KEMAL ÜNİVERSİTESİ, KIRIKHAN MESLEK YÜKSEKOKULU
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Ha TN, Kamarova S, Youens D, Wright C, McRobbie D, Doust J, Slavotinek J, Bulsara MK, Moorin R. Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003-2015. BMJ Open 2022; 12:e059242. [PMID: 35649618 PMCID: PMC9161060 DOI: 10.1136/bmjopen-2021-059242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE High use of CT scanning has raised concern due to the potential ionising radiation exposure. This study examined trends of CT during admission to tertiary hospitals and its associations with length of stay (LOS), readmission and mortality. DESIGN Retrospective observational study from 2003 to 2015. SETTING West Australian linked administrative records at individual level. PARTICIPANTS 2 375 787 episodes of tertiary hospital admission in adults aged 18+ years. MAIN OUTCOME MEASURES LOS, 30-day readmissions and mortality stratified by CT use status (any, multiple (CTs to multiple areas during episode), and repeat (repeated CT to the same area)). METHODS Multivariable regression models were used to calculate adjusted rate of CT use status. The significance of changes since 2003 in the outcomes (LOS, 30-day readmission and mortality) was compared among patients with specific CT imaging status relative to those without. RESULTS Between 2003 and 2015, while the rate of CT increased 3.4% annually, the rate of repeat CTs significantly decreased -1.8% annually and multiple CT showed no change. Compared with 2003 while LOS had a greater decrease in those with any CT, 30-day readmissions had a greater increase among those with any CT, while the probability of mortality remained unchanged between the any CT/no CT groups. A similar result was observed in patients with multiple and repeat CT scanning, except for a significant increase in mortality in the recent years in the repeat CT group. CONCLUSION The observed pattern of increase in CT utilisation is likely to be activity-based funding policy-driven based on the discordance between LOS and readmissions. Meanwhile, the repeat CT reduction aligns with a more selective strategy of use based on clinical severity. Future research should incorporate in-hospital and out-of-hospital CT to better understand overall CT trends and potential shifts between settings over time.
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Affiliation(s)
- Thi Ninh Ha
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Sviatlana Kamarova
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - David Youens
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Cameron Wright
- Health Systems and Health Economics, Curtin University School of Public Health, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Donald McRobbie
- The University of Adelaide School of Physical Sciences, Adelaide, South Australia, Australia
| | - Jenny Doust
- Centre for Longitudinal and Life Course Research, The University of Queensland, Herston, Queensland, Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Max K Bulsara
- Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Rachael Moorin
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Lei M, Zhang M, Li H, Liu J, Chen J, Xu R, Xiao M. The diagnostic performance of ultra-low-dose 320-row detector CT with different reconstruction algorithms on limb joint fractures in the emergency department. Jpn J Radiol 2022; 40:1079-1086. [PMID: 35588348 DOI: 10.1007/s11604-022-01290-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of the study was to evaluate whether ultra-low-dose computed tomography (ULD-CT) could replace conventional-dose CT (CD-CT) for diagnosis of acute wrist, ankle, knee, and shoulder fractures in emergency departments (ED). METHODS We developed CD-CT and ULD-CT scanning schemes for the various joints of the four limbs and scanned emergency patients prospectively. When performing CD-CT, a conventional bone reconstruction algorithm was used, while ULD-CT used both soft tissue and bone algorithms. A five-point scale was used to evaluate whether ULD-CT image quality affected surgical planning. The image quality and diagnostic performance of different types of scanned and reconstructed images for diagnosing fractures were evaluated and compared. Effective radiation dose of each group was calculated. RESULTS Our study included 56 normal cases and 185 fracture cases. The combination of bone and soft tissue algorithms on ULD-CT can improve diagnostic performance, such that on ULD-CT, the sensitivity improved from 96.7% to 98.9%, specificity from 98.2% to 100%, positive predictive value from 99.4% to 100%, negative predictive value from 90.2% to 96.6% and diagnostic accuracy ranged from 97.5% to 99.1%. There were no statistically significant differences between ULD-CT and CD-CT on diagnostic performance (p values, 0.40-1.00). The radiation doses for ULD-CT protocols were only 3.0-7.7% of those for CD-CT protocols (all p < 0.01). CONCLUSIONS In the emergency department, the 320-row detector ULD-CT could replace CD-CT in the diagnosis of limb joint fractures. The combination of bone algorithm with soft tissue algorithm reconstruction can further improve the image quality and diagnostic performance.
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Affiliation(s)
- Ming Lei
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Meng Zhang
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Hongyi Li
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Jingfeng Liu
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Jun Chen
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China
| | - Rulin Xu
- Research Collaboration, Canon Medical Systems Co., Ltd, Rm 2906, R&F Centre, No.10 Huaxia Road, Guangzhou, Guangdong, China
| | - Mengqiang Xiao
- Department of Radiology, Zhuhai Hospital, Guangdong Provincial Hospital of Traditional Chinese Medicine, 53 Jingle Road, Zhuhai, Guangdong, China.
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Broder JS, Oliveira J E Silva L, Bellolio F, Freiermuth CE, Griffey RT, Hooker E, Jang TB, Meltzer AC, Mills AM, Pepper JD, Prakken SD, Repplinger MD, Upadhye S, Carpenter CR. Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE-2): Low-risk, recurrent abdominal pain in the emergency department. Acad Emerg Med 2022; 29:526-560. [PMID: 35543712 DOI: 10.1111/acem.14495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 02/07/2023]
Abstract
This second Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-2) from the Society for Academic Emergency Medicine is on the topic "low-risk, recurrent abdominal pain in the emergency department." The multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding four priority questions for adult emergency department patients with low-risk, recurrent, undifferentiated abdominal pain. The intended population includes adults with multiple similar presentations of abdominal signs and symptoms recurring over a period of months or years. The panel reached the following recommendations: (1) if a prior negative computed tomography of the abdomen and pelvis (CTAP) has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended; (2) if CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology; (3) we suggest that screening for depression and/or anxiety may be performed during the ED evaluation; and (4) we suggest an opioid-minimizing strategy for pain control. EXECUTIVE SUMMARY: The GRACE-2 writing group developed clinically relevant questions to address the care of adult patients with low-risk, recurrent, previously undifferentiated abdominal pain in the emergency department (ED). Four patient-intervention-comparison-outcome-time (PICOT) questions were developed by consensus of the writing group, who performed a systematic review of the literature and then synthesized direct and indirect evidence to formulate recommendations, following GRADE methodology. The writing group found that despite the commonality and relevance of these questions in emergency care, the quantity and quality of evidence were very limited, and even fundamental definitions of the population and outcomes of interest are lacking. Future research opportunities include developing precise and clinically relevant definitions of low-risk, recurrent, undifferentiated abdominal pain and determining the scope of the existing populations in terms of annual national ED visits for this complaint, costs of care, and patient and provider preferences.
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Affiliation(s)
- Joshua S Broder
- Department of Surgery, Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline E Freiermuth
- Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Richard T Griffey
- Department of Emergency Medicine and Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Edmond Hooker
- Department of Health Services Administration, Xavier University, Cincinnati, Ohio, USA
| | - Timothy B Jang
- Department of Emergency Medicine, University of California Los Angeles, UCLA Santa Monica Medical Center, Torrance, California, USA
| | - Andrew C Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Angela M Mills
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.,Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
| | | | | | - Michael D Repplinger
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA.,Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
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Carpenter CR, Griffey RT, Mills A, Doering M, Oliveira J. e Silva L, Bellolio F, Upadhye S, Broder JS. Repeat computed tomography in recurrent abdominal pain: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department. Acad Emerg Med 2022; 29:630-648. [PMID: 34897917 DOI: 10.1111/acem.14427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Computed tomography (CT) imaging is frequently obtained for recurrent abdominal pain after a prior emergency department (ED) evaluation. We evaluate the utility of repeat CT imaging following an indeterminate index CT in low-risk abdominal pain adult ED patients. METHODS An electronic search was designed for the patient-intervention-control-outcome-timing (PICOT) question: (P) adult patients with low-risk, recurrent, and previously undifferentiated atraumatic abdominal pain presenting to the ED after an index-negative CT within 12 months; (I) repeat CT versus (C) no repeat CT; for (O) abdominal surgery or other invasive procedure, mortality, identification of potentially life-threatening diagnosis, and hospital and intensive care unit admission rates; and return ED visit (T), all within 30 days. Four reviewers independently selected evidence for inclusion and then synthesized the results around the most prevalent themes of repeat CT timing, diagnostic yield, ionizing radiation exposure, and predictors of repetitive imaging. RESULTS Although 637 articles and abstracts were identified, no direct evidence was found. Thirteen documents were synthesized as indirect evidence. None of the indirect evidence defined a low-risk subset of abdominal pain nor did investigators describe whether reimaging occurred for complaints similar to the initial ED evaluation. Included studies did not describe the index CT findings and some reported explanatory findings noted on the original CT for which repeat CTs might have been indicated. The time frame for a repeat CT ranged from hours to 1 year. The frequency of repeat CTs (2%-47%) varied across studies as did the yield of imaging to alter downstream clinical decision making (range = 5%-67%). CONCLUSION Due to the absence of direct evidence our scoping review is unable to provide high-quality evidence-based recommendations upon which to confidently base an imaging practice guideline. There is no evidence to support or refute performing a CT for low-risk recurrent abdominal pain.
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Affiliation(s)
- Christopher R. Carpenter
- Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis Missouri USA
| | - Richard T. Griffey
- Department of Emergency Medicine Washington University in St. Louis School of Medicine Emergency Care Research Core St. Louis Missouri USA
| | - Angela Mills
- Department of Emergency Medicine Columbia University College of Physicians and Surgeons New York New York USA
| | - Michelle Doering
- Becker Medical Library Washington University in St. Louis School of Medicine St. Louis Missouri USA
| | | | - Fernanda Bellolio
- Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA
| | - Suneel Upadhye
- Emergency Medicine/Health Research Methods Evidence & Impact McMaster University Hamilton Ontario Canada
| | - Joshua S. Broder
- Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
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Aupongkaroon P, Makarawate P, Chaosuwannakit N. Comparison of radiation dose and its correlates between coronary computed tomography angiography and invasive coronary angiography in Northeastern Thailand. Egypt Heart J 2022; 74:6. [PMID: 35076784 PMCID: PMC8789964 DOI: 10.1186/s43044-022-00241-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background The number of coronary computed tomography angiography (CCTA) exams is steadily growing. A novel computed tomography (CT) system has been developed to increase image quality while lowering patient radiation. The radiation dose attributed to CCTA has received considerable attention, whereas the dose associated with invasive catheter angiography (ICA) has received less. This study aims to investigate the radiation exposure of CCTA in patients and compare it to ICA. Results The mean effective dose of CCTA was 2.88 ± 0.85 mSv which was significantly lower than the mean effective dose of ICA (5.61 ± 0.55 mSv), p < 0.0001. The effective dose of CCTA correlated with the weight, height, and BMI, while the effective dose of ICA was associated with patient weight and BMI. The radiation exposure from CCTA has been considerably reduced over the last ten years by almost 2.5 folds. The mean radiation dose from the newer generation CT used in 2019 was significantly lower than that of the single-source CT in 2010 (2.88 ± 0.85 mSv vs. 7.15 ± 3.4 mSv, p < 0.001). Conclusions CCTA allows evaluation of CAD with a significantly less effective radiation dose to patients than diagnostic ICA. There was a significant decrease in radiation dose from CCTA over time. Regular measurement of patient doses is an essential step to optimize exposure. It makes operators aware of their performance and allows comparisons with generally accepted practices.
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Affiliation(s)
| | - Pattarapong Makarawate
- Cardiology Unit, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narumol Chaosuwannakit
- Radiology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40000, Thailand.
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Haince JF, Joubert P, Bach H, Ahmed Bux R, Tappia PS, Ramjiawan B. Metabolomic Fingerprinting for the Detection of Early-Stage Lung Cancer: From the Genome to the Metabolome. Int J Mol Sci 2022; 23:ijms23031215. [PMID: 35163138 PMCID: PMC8835988 DOI: 10.3390/ijms23031215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/19/2022] Open
Abstract
The five-year survival rate of lung cancer patients is very low, mainly because most newly diagnosed patients present with locally advanced or metastatic disease. Therefore, early diagnosis is key to the successful treatment and management of lung cancer. Unfortunately, early detection methods of lung cancer are not ideal. In this brief review, we described early detection methods such as chest X-rays followed by bronchoscopy, sputum analysis followed by cytological analysis, and low-dose computed tomography (LDCT). In addition, we discussed the potential of metabolomic fingerprinting, compared to that of other biomarkers, including molecular targets, as a low-cost, high-throughput blood-based test that is both feasible and affordable for early-stage lung cancer screening of at-risk populations. Accordingly, we proposed a paradigm shift to metabolomics as an alternative to molecular and proteomic-based markers in lung cancer screening, which will enable blood-based routine testing and be accessible to those patients at the highest risk for lung cancer.
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Affiliation(s)
| | - Philippe Joubert
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Pathology, Laval University, Quebec, QC G1V 4G5, Canada;
| | - Horacio Bach
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC V6H 3Z6, Canada;
| | - Rashid Ahmed Bux
- BioMark Diagnostics Inc., Richmond, BC V6X 2W8, Canada; (J.-F.H.); (R.A.B.)
| | - Paramjit S. Tappia
- Asper Clinical Research Institute, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada;
- Correspondence: ; Tel.: +1-204-258-1230
| | - Bram Ramjiawan
- Asper Clinical Research Institute, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada;
- Department of Pharmacology & Therapeutics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T6, Canada
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Determine Cumulative Radiation Dose and Lifetime Cancer Risk in Marfan Syndrome Patients Who Underwent Computed Tomography Angiography of the Aorta in Northeast Thailand: A 5-Year Retrospective Cohort Study. Tomography 2022; 8:120-130. [PMID: 35076626 PMCID: PMC8788545 DOI: 10.3390/tomography8010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate computed tomography angiography (CTA) data focusing on radiation dose parameters in Thais with Marfan syndrome (MFS) and estimate the distribution of cumulative radiation exposure from CTA surveillance and the risk of cancers. Methods: Between 1st January 2015 and 31st December 2020, we retrospectively evaluated the cumulative CTA radiation doses of MFS patients who underwent CTA at Khon Kaen University Hospital, a leading teaching hospital and advanced tertiary care institution in northeastern Thailand. We utilized the Radiation Risk Assessment Tool (RadRAT) established at the National Cancer Institute in Bethesda, Maryland, to evaluate the risk of cancer-related CTA radiation. Results: The study recruited 29 adult MFS patients who had CTA of the aorta during a 5-year study period with 89 CTA studies. The mean cumulative CTDI vol is 21.5 ± 14.68 mGy, mean cumulative DLP is 682.2 ± 466.7 mGy.cm, the mean baseline future risk for all cancer is 26,134 ± 7601 per 100,000, and the excess lifetime risk for all cancer is 2080.3 ± 1330 per 100,000. The excess lifetime risk of radiation-induced cancer associated with the CTA surveillance study is significantly lower than the risk of aortic dissection or rupture and lower than the baseline future cancer risk. Conclusions: We attempted to quantify the radiation-induced cancer risk from CTA surveillance imaging performed for MFS patients in this study, with all patients receiving a low-risk cumulative radiation dose (less than 1 Gy) and all patients having a low excessive lifetime risk of cancer as a result of CTA. The risk–benefit decision must be made at the point of care, and it entails balancing the benefits of surveillance imaging in anticipating rupture and providing practical, safe treatment, therefore avoiding morbidity and mortality.
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Kim NT, Kwon SS, Park MS, Lee KM, Sung KH. National Trends in Pediatric CT Scans in South Korea: A Nationwide Cohort Study. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:138-148. [PMID: 36237356 PMCID: PMC9238215 DOI: 10.3348/jksr.2021.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/08/2021] [Accepted: 06/29/2021] [Indexed: 12/01/2022]
Abstract
Purpose This study evaluated the rates and annual trends of pediatric CT scans in South Korea using a nationwide population-based database. Materials and Methods Data regarding pediatric CT scan usage between 2012 and 2017 were retrieved from the health insurance review and assessment service. Data on the age, sex, diagnosis, and the anatomical area of involved patients were also extracted. Results A total of 576376 CT examinations were performed among 58527528 children aged below 18 years (9.8 scans/1000 children), and the number of CT examinations per 1000 children was noted to have increased by 23.2% from 9.0 in 2012 to 11.0 in 2017. Specifically, the number of CT examinations increased by 32.9% for the 6–12 years of age group (7.4/1000 to 9.8/1000) and by 34.0% for the 13–18 years of age group (11.4/1000 to 15.3/1000). Moreover, majority of the CT scans were limited to the head (39.1%), followed by the extremities (32.5%) and the abdomen (13.7%). Notably, the number of extremity CT scans increased by 83.6% (2.3/1000 to 4.2/1000), and its proportion as compared to other scans increased from 25.3% to 37.7%. Conclusion CT scans in the pediatric population increased continuously from 2012 to 2017 at an annual rate of 4.4%. Therefore, physicians should balance the benefits of CT with its potential harms from associated radiation exposure in pediatric patients.
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Affiliation(s)
- Nak Tscheol Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon-Sun Kwon
- Department of Mathematics, College of Natural Sciences, Ajou University, Suwon, Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Deininger-Czermak E, Euler A, Franckenberg S, Finkenstaedt T, Villefort C, Gascho D, Guggenberger R. Evaluation of ultrashort echo-time (UTE) and fast-field-echo (FRACTURE) sequences for skull bone visualization and fracture detection - A postmortem study. J Neuroradiol 2021; 49:237-243. [PMID: 34758365 DOI: 10.1016/j.neurad.2021.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE CT is considered the modality of choice in the assessment of the skull due to the fast and accurate depiction of bone structures. Nevertheless, MRI has evolved into a possible alternative due to optimal soft tissue contrast and recent advances with the ability to visualize tissues with shortest T2 times, such as osseous structures. In this study we compare skull bone visualization and fracture detection across two MRI sequences to CT as reference standard. MATERIAL AND METHODS Twenty subjects underwent CT and MRI with less than 72 h between examination. The MRI protocol included a 2D ultrashort echo time (UTE) and a 3D multi-echo in-phase fast-field-echo (FRACTURE) sequence. Independent raters evaluated qualitative characteristics and fracture detectability in different skull subregions (skull vault, skull base and viscerocranium). Interrater and intermodality agreement was evaluated by calculating intraclass coefficients (ICC). RESULTS FRACTURE ICC indicated a good agreement in all subregions (ICC = 0.83 - 0.88), whereas UTE had excellent results calculated in the skull vault and viscerocranium (ICC = 0.91 - 0.94). At the skull vault, both MRI sequences received an overall good rating (UTE: 2.63 ± 0.42 FRACTURE. 2.81 ± 0.32). Fracture detection using MRI sequences for the skull vault, was highest compared to other subregions. CONCLUSIONS Both MRI sequences may provide an alternative e.g. for surgical planning or follow up exams of the osseous neurocranium; although, at the skull base and viscerocranium bone visualization with MRI bone imaging sequences perform inferior to CT standard imaging.
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Affiliation(s)
- Eva Deininger-Czermak
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andre Euler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Sabine Franckenberg
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Abstract
Medical imaging professionals have an accountability for both quality and safety in the care of patients that have unexpected or anticipated repeated imaging examinations that use ionizing radiation. One measure in the safety realm for repeated imaging is cumulative effective dose (CED). CED has been increasingly scrutinized in patient populations, including adults and children. Recognizing the challenges with effective dose, including the cumulative nature, effective dose is still the most prevalent exposure currency for recurrent imaging examinations. While the responsibility for dose monitoring incorporates an element of tracking an individual patient cumulative radiation record, a more complex aspect is what should be done with this information. This challenge also differs between the pediatric and adult population, including the fact that high cumulative doses (e.g.,>100 mSv) are reported to occur much less frequently in children than in the adult population. It is worthwhile, then, to review the general construct of CED, including the comparison between the relative percentage occurrence in adult and pediatric populations, the relevant pediatric medical settings in which high CED occurs, the advances in medical care that may affect CED determinations in the future, and offer proposals for the application of the CED paradigm, considering the unique aspects of pediatric care.
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Affiliation(s)
- Donald Frush
- Duke University Medical Center, Durham, North Carolina 27710, United States
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Schneider A, Donnachie E, Zipfel S, Enck P. Patients With Somatoform Disorders Are Prone To Expensive and Potentially Harmful Medical Procedures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:425-431. [PMID: 34374332 DOI: 10.3238/arztebl.m2021.0135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/10/2020] [Accepted: 01/26/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with functional somatic syndromes (FSS) might be prone to potentially harmful medical investigations in ambulatory care. The primary aim was to investigate whether patients with FSS are more likely to undergo diagnostic examinations such as radiography, computed tomography (CT), magnetic reso - nance imaging (MRI), and outpatient surgical procedures. The secondary aim was to evaluate the extent to which coordination of care by primary care physicians reduces healthcare utilization. METHODS Retrospective cohort study using longitudinal regression analysis of routine data. FSS patients were weighted in the regression model to allow a representative comparison with the Bavarian population. The observation period was from 5 years before until 10 years after the diagnosis of FSS. RESULTS The cohort comprised 43 676 patients with FSS and a control group of 50 003 patients without a diagnosis of FSS. The FSS patients exhibited continuously increased healthcare utilization over the 15-year period. The relative risk (RR) for FSS patients was up to 1.48 (95% confidence interval [1.46; 1.50]) for radiography, 2.01 [1.94; 2.08] for CT, 1.91 [1.87; 1.96] for MRI, and 1.30 [1.27; 1.34] for outpatient surgery. Compared with patients whose treatment was coordinated by their primary care physician, patients with no such coordination showed higher service utilization. The ambulatory care costs were up to 1.37 [1.36; 1.38] times greater. CONCLUSION Patients with FSS more frequently undergo potentially harmful and costly diagnostic testing and outpatient surgery. Coordination of care by the primary care physician is associated with lower healthcare utilization.
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Affiliation(s)
- Antonius Schneider
- Institute of General Practice and Health Services Research, TUM School of Medicine, Klinikumrechts der Isar, Technical University MunichDepartment of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen
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Sodickson AD. Radiation concerns in frequent flyer patients: Should imaging history influence decisions about recurrent imaging? Br J Radiol 2021; 94:20210543. [PMID: 34289325 DOI: 10.1259/bjr.20210543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Radiation risks from diagnostic imaging have captured the attention of patients and medical practitioners alike, yet it remains unclear how these considerations can best be incorporated into clinical decision making. This manuscript presents a framework to consider these issues in a potentially at-risk population, the so called "frequent flyer" patients undergoing a large amount of recurrent imaging over time. Radiation risks from the low-dose exposures of diagnostic imaging are briefly reviewed, as applied to recurrent exposures. Some scenarios are then explored in which it may be helpful to incorporate knowledge of a patient's imaging history. There is no simple or uniformly applicable approach to these challenging and often nuanced clinical decisions. The complexity and variability of the underlying disease states and trajectories argues against alerting mechanisms based on a simple cumulative dose threshold. Awareness of imaging history may instead be beneficial in encouraging physicians and patients to take the long view, and to identify those populations of frequent flyers that might benefit from alternative imaging strategies.
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Vassileva J, Holmberg O. Radiation protection perspective to recurrent medical imaging: what is known and what more is needed? Br J Radiol 2021; 94:20210477. [PMID: 34161167 DOI: 10.1259/bjr.20210477] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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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Impact of a statewide computed tomography scan educational campaign on radiation dose and repeat CT scan rates for transferred injured children. J Clin Transl Sci 2021; 5:e129. [PMID: 34367674 PMCID: PMC8327550 DOI: 10.1017/cts.2021.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose Research demonstrates that children receive twice as much medical radiation from Computed Tomography (CT) scans performed at non-pediatric facilities as equivalent CTs performed at pediatric trauma centers (PTCs). In 2014, AFMC outreach staff educated Emergency Department (ED) staff on appropriate CT imaging utilization to reduce unnecessary medical radiation exposure. We set out to determine the educational campaign's impact on injured children received radiation dose. Methods All injured children who underwent CT imaging and were transferred to a Level I PTC during 2010 to 2013 (pre-campaign) and 2015 (post-campaign) were reviewed. Patient demographics, mode of transportation, ED length of stay, scanned body region, injury severity score, and trauma center level were analyzed. Median effective radiation dose (ERD) controlled for each variable, pre-campaign and post-campaign, was compared using Wilcoxon rank sum test. Results Three hundred eighty-five children under 17 years were transferred from 45 and 48 hospitals, pre- and post-campaign. Most (43%) transferring hospitals were urban or critical access hospitals (30%). Pre- and post-campaign patient demographics were similar. We analyzed 482 and 398 CT scans pre- and post-campaign. Overall, median ERD significantly decreased from 3.80 to 2.80. Abdominal CT scan ERD declined significantly from 7.2 to 4.13 (P-value 0.03). Head CT scan ERD declined from 3.27 to 2.45 (P-value < 0.0001). Conclusion A statewide, CT scan educational campaign contributed to ERD decline (lower dose scans and fewer repeat scans) among transferred injured children seen at PTCs. State-level interventions are feasible and can be effective in changing radiology provider practices.
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EREN MB. Volume-based dysplasia severity index with the spheric cup method in the evaluation of adult and adolescent acetabular dysplasia. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.910775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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McEvoy-May JH, Bihari S, Hooker AM, Dixon DL. A retrospective audit of cumulative ionising radiation levels in hospitalised pregnant patients. Aust N Z J Obstet Gynaecol 2021; 61:700-707. [PMID: 33772762 DOI: 10.1111/ajo.13336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/05/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Among hospitalised patients, diagnostic radiation is possibly used least on pregnant patients due to the fear of ionising radiation on the fetus; however, what levels are currently being prescribed? AIMS To assess the cumulative levels of ionising radiation received by pregnant patients during a single admission to a tertiary hospital. MATERIALS AND METHODS A retrospective audit of pregnant patients admitted to Flinders Medical Centre, South Australia, Australia, between 2013 and 2017 inclusive was performed. All procedures utilising ionising radiation were collected including conventional radiology, computed tomography, fluoroscopy and nuclear medicine. Individual and cumulative effective doses for mother and fetus were calculated using patient dose reports and published conversion factors. RESULTS From 547 patients, the median cumulative effective dose was 0.02 mSv and only five patients received more than 10 mSv, with 19.07 mSv the highest dose received. The median fetal cumulative effective dose was 0.01 mSv but only three fetuses received more than 10 mSv, likely due to fetal exclusion in some procedural fields of view. Stays longer than ten days were associated with significantly higher cumulative effective dose, as did those with maternal cardiovascular related admission, for both maternal and fetal exposures. CONCLUSION These results suggest that pregnant patients are exposed to low doses of ionising radiation, in both individual procedures and cumulative doses. The detrimental risks associated with these levels of ionising radiation are not overt and so clinicians should question which risk is higher, the ionising radiation from the radiological procedures received or the lack of diagnostic information if avoided?
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Affiliation(s)
- James H McEvoy-May
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Department of Biology, McMaster University, Hamilton, Ontario, Canada.,Centre for Radiation Research, Education and Innovation, University of Adelaide, Adelaide, South Australia, Australia
| | - Shailesh Bihari
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Antony M Hooker
- Centre for Radiation Research, Education and Innovation, University of Adelaide, Adelaide, South Australia, Australia
| | - Dani-Louise Dixon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,Faculty of Medical Sciences, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Rose S, Viggiano B, Bour R, Bartels C, Kanne JP, Szczykutowicz TP. Applying a New CT Quality Metric in Radiology: How CT Pulmonary Angiography Repeat Rates Compare Across Institutions. J Am Coll Radiol 2021; 18:962-968. [PMID: 33741373 DOI: 10.1016/j.jacr.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To quantify overall CT repeat and reject rates at five institutions and investigate repeat and reject rates for CT pulmonary angiography (CTPA). METHODS In this retrospective study, we apply an automated repeat rate analysis algorithm to 103,752 patient examinations performed at five institutions from July 2017 to August 2019. The algorithm identifies repeated scans for specific scanner and protocol combinations. For each institution, we compared repeat rates for CTPA to all other CT protocols. We used logistic regression and analysis of deviance to compare CTPA repeat rates across institutions and size-based protocols. RESULTS Of 103,752 examinations, 1,447 contained repeated helical scans (1.4%). Overall repeat rates differed across institutions (P < .001) ranging from 0.8% to 1.8%. Large-patient CTPA repeat rates ranged from 3.0% to 11.2% with the odds (95% confidence intervals) of a repeat being 4.8 (3.5-6.6) times higher for large- relative to medium-patient CTPA protocols. CTPA repeat rates were elevated relative to all other CT protocols at four of five institutions, with strong evidence of an effect at two institutions (P < .001 for each; odds ratios: 2.0 [1.6-2.6] and 6.2 [4.4-8.9]) and somewhat weaker evidence at the others (P = .005 and P = 0.011; odds ratios: 2.2 [1.3-3.8] and 3.7 [1.5-9.1], respectively). Accounting for size-based protocols, CTPA repeat rates differed across institutions (P < .001). DISCUSSION The results indicate low overall repeat rates (<2%) with CTPA rates elevated relative to other protocols. Large-patient CTPA rates were highest (eg, 11.2% at one institution). Differences in repeat rates across institutions suggest the potential for quality improvement.
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Affiliation(s)
- Sean Rose
- Department of Medical Physics, University of Wisconsin Madison, Madison, Wisconsin
| | - Ben Viggiano
- Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin
| | - Robert Bour
- Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin
| | - Carrie Bartels
- Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin
| | - Jeffery P Kanne
- Vice Chair of Quality and Safety, Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Timothy P Szczykutowicz
- Department of Medical Physics, University of Wisconsin Madison, Madison, Wisconsin; Department of Radiology, University of Wisconsin Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin Madison, Madison, Wisconsin.
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De Mauri A, Matheoud R, Guzzardi G, Vaccarone V, David P, Brambilla M, Chiarinotti D. Ionizing radiation exposure from dialysis tunneled catheters procedures: European directive and legal implications. J Vasc Access 2021; 23:500-507. [PMID: 33719706 DOI: 10.1177/11297298211001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Advances in medical imaging and interventional procedures have been associated with increased exposure to ionizing radiation. Thus, the International Commission on Radiological Protection (ICRP) established uniform safety standards to protect the general public against the dangers arising from ionizing radiations. In Europe, the ICRP standards are listed in the European Directive 2013/59/EURATOM, which should be transposed into national legislation by member states. They require that the administered dose must be part of the radiological report and identify the practitioners' responsibilities in justifying and optimizing the dose and correctly informing the patient.Despite these indications, the literature lacks information about the dose from fluoroscopically inserted dialysis tunneled central venous catheters (td-CVC). This study aimed to quantify the effective dose and organ dose to relevant organs in td-CVC to comply with the EU statements. METHODS We revised fluoroscopically-guided procedures of td-CVC insertion, considering dose per area product, fluoroscopic time, effective dose, organ dose, and anatomical district. We also compared these parameters with those of fluoroscopically inserted oncological central venous devices (Port-a-cath). RESULTS The dose-area product, fluoroscopic time, and organ dose for td-CVC were 13 ± 22.2 Gy*cm2, 81 ± 129 s, and 1.9 ± 3.3 mSv. The radiological parameters for the left internal jugular, subclavian and femoral veins were similar but higher than for the right internal jugular vein. The radiological parameters were significantly higher for td-CVC than for Port-a-cath. CONCLUSIONS Fluoroscopically inserted td-CVC are associated with a relatively low dose of ionizing radiation, with considerable variability due to the anatomical puncture site and previous accesses' history. In light of the European Directive, it is a concern for nephrologists to be aware of the administered ionizing dose to comply with their legal responsibilities.
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Affiliation(s)
- Andreana De Mauri
- Nephrology and Dialysis Department, "Maggiore della Carità" University Hospital, Novara, Italy.,Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Roberta Matheoud
- Medical Physics Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Giuseppe Guzzardi
- Radiology Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Valentina Vaccarone
- Radiology Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Paola David
- Nephrology and Dialysis Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Marco Brambilla
- Medical Physics Department, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Doriana Chiarinotti
- Nephrology and Dialysis Department, "Maggiore della Carità" University Hospital, Novara, Italy
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Maxwell S, Ha NT, Bulsara MK, Doust J, Mcrobbie D, O'Leary P, Slavotinek J, Moorin R. Increasing use of CT requested by emergency department physicians in tertiary hospitals in Western Australia 2003-2015: an analysis of linked administrative data. BMJ Open 2021; 11:e043315. [PMID: 33664075 PMCID: PMC7934721 DOI: 10.1136/bmjopen-2020-043315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aimed to examine trends in number of CT scans requested by tertiary emergency department (ED) physicians in Western Australia (WA) from 2003 to 2015 across broad demographic and presentation characteristics, anatomical areas and presented symptoms. DESIGN An observational cross-sectional study over study period from 2003 to 2015. SETTING Linked administrative health service data at individual level from WA. PARTICIPANTS A total of 1 666 884 tertiary hospital ED presentations of people aged 18 years or older were included in this study MAIN OUTCOME MEASURE: Number of CT scans requested by tertiary ED physicians in an ED presentation. METHODS Poisson regression models were used to assess variation and trends in number of CT scans requested by ED physicians across demographic characteristics, clinical presentation characteristics and anatomical areas. RESULTS Over the entire study duration, 71 per 1000 ED episodes had a CT requested by tertiary ED physicians. Between 2003 and 2015, the rate of CT scanning almost doubled from 58 to 105 per 1000 ED presentations. After adjusted for all observed characteristics, the rate of CT scans showed a downward trend from 2009 to 2011 and subsequent increase. Males, older individuals, those attending ED as a result of pain, those with neurological symptoms or injury or with higher priority triage code were the most likely to have CT requested by tertiary ED physicians. CONCLUSIONS Noticeable changes in the number of CTs requested by tertiary ED physicians corresponded to the time frame of major health reforms happening within WA and nationally.
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Affiliation(s)
- Susannah Maxwell
- Health Economics and Data Analytics, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Ninh Thi Ha
- Health Economics and Data Analytics, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Jenny Doust
- Centre for Longitudinal and Life Course Research, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Donald Mcrobbie
- School of Physical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter O'Leary
- Health Economics and Data Analytics, Curtin University Bentley Campus, Perth, Western Australia, Australia
- Obstetrics and Gynaecology Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- PathWest Laboratory Medicine, QE2 Medical Centre, Nedlands, Western Australia, Australia
| | - John Slavotinek
- Flinders Medical Centre, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Rachael Moorin
- Health Economics and Data Analytics, Curtin University Bentley Campus, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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Impact of Dual-Energy CT in the Emergency Department: Increased Radiologist Confidence, Reduced Need for Follow-Up Imaging, and Projected Cost Benefit. AJR Am J Roentgenol 2020; 215:1528-1538. [DOI: 10.2214/ajr.19.22357] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
OBJECTIVE. Repeated imaging is an unnecessary source of patient radiation exposure, a detriment to patient satisfaction, and a waste of time and money. Although analysis of rates of repeated and rejected images is mandated in mammography and recommended in radiography, the available data on these rates for CT are limited. MATERIALS AND METHODS. In this retrospective study, an automated repeat-reject rate analysis algorithm was used to quantify repeat rates from 61,102 patient examinations obtained between 2015 and 2018. The algorithm used DICOM metadata to identify repeat acquisitions. We quantified rates for one academic site and one rural site. The method allows scanner-, technologist-, protocol-, and indication-specific rates to be determined. Positive predictive values and sensitivity were estimated for correctly identifying and classifying repeat acquisitions. Repeat rates were compared between sites to identify areas for targeted technologist training. RESULTS. Of 61,102 examinations, 4676 instances of repeat scanning contributed excess radiation dose to patients. Estimated helical overlap repeat rates were 1.4% (95% CI, 1.2-1.6%) for the rural site and 1.1% (95% CI, 1.0-1.2%) for the academic site. Significant differences in rates of repeat imaging required because of bolus tracking (11.6% vs 4.3%; p < 0.001) and helical extension (3.3% vs 1.8%; p < 0.001) were observed between sites. Positive predictive values ranged from 91% to 99% depending on the reason for repeat imaging and site location. Sensitivity of the algorithm was 92% (95% CI, 87-96%). Rates tended to be highest for emergent imaging procedures and exceeded 9% for certain protocols. CONCLUSION. Our multiinstitutional automated quantification of repeat rates for CT provided a useful metric for unnecessary radiation exposure and identification of technologists in need of training.
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Photoacoustic Imaging for Assessing Tissue Oxygenation Changes in Rat Hepatic Fibrosis. Diagnostics (Basel) 2020; 10:diagnostics10090705. [PMID: 32957666 PMCID: PMC7555416 DOI: 10.3390/diagnostics10090705] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 12/29/2022] Open
Abstract
Chronic liver inflammation progressively evokes fibrosis and cirrhosis resulting in compromised liver function, and often leading to cancer. Early diagnosis and staging of fibrosis is crucial because the five-year survival rate of early-stage liver cancer is high. This study investigates the progression of hepatic fibrosis induced in rats following ingestion of diethylnitrosamine (DEN). Changes in oxygen saturation and hemoglobin concentration resulting from chronic inflammation were assayed longitudinally during DEN ingestion by photoacoustic imaging (PAI). Accompanying liver tissue changes were monitored simultaneously by B-mode sonographic imaging. Oxygen saturation and hemoglobin levels in the liver increased over 5 weeks and peaked at 10 weeks before decreasing at 13 weeks of DEN ingestion. The oxygenation changes were accompanied by an increase in hepatic echogenicity and coarseness in the ultrasound image. Histology at 13 weeks confirmed the development of severe fibrosis and cirrhosis. The observed increase in PA signal representing enhanced blood oxygenation is likely an inflammatory physiological response to the dietary DEN insult that increases blood flow by the development of neovasculature to supply oxygen to a fibrotic liver during the progression of hepatic fibrosis. Assessment of oxygenation by PAI may play an important role in the future assessment of hepatic fibrosis.
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