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König AM, Pöschke A, Mahnken AH. Health risks for medical personnel due to magnetic fields in magnetic resonance imaging. ROFO-FORTSCHR RONTG 2024. [PMID: 39029511 DOI: 10.1055/a-2296-3860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
The current state of medical and scientific knowledge on the effects of exposure to electromagnetic fields on workers in the field of clinical magnetic resonance imaging (MRI) is summarized here.A systematic literature search was conducted to analyze the health risks to medical personnel from magnetic fields in MRI. A total of 7273 sources were identified, with 7139 being excluded after screening of the title and abstract. After full-text screening, 34 sources remained and were included in this paper.There are a number of scientific publications on the occurrence of short-term sensory effects such as vertigo, metallic taste, phosphenes as well as on the occurrence of neurocognitive and neurobehavioral effects. For example, short-term exposure to clinical magnetic fields has been reported to result in a 4% reduction in speed and precision and a 16% reduction in visual contrast sensitivity at close range. Both eye-hand precision and coordination speed are affected. The long-term studies concern, among other things, the influence of magnetic fields on sleep quality, which could be linked to an increased risk of accidents. The data on the exposure of healthcare workers to magnetic fields during pregnancy is consistently outdated. However, it has been concluded that there are no particular deviations with regard to the duration of pregnancy, premature births, miscarriages, and birth weight. Epidemiological studies are lacking. With a focus on healthcare personnel, there is a considerable need for high-quality data, particularly on the consequences of long-term exposure to electromagnetic fields from clinical MRI and the effects on pregnancy. · Short-term sensory effects such as vertigo, metallic taste, phosphenes as well as neurocognitive and neurological behavioral effects may occur upon exposure to magnetic fields.. · Long-term effects mainly concern quality of sleep, which can be associated with an increased risk of accidents.. · When pregnant women were exposed to magnetic fields, no particular deviations were found with regard to the duration of pregnancy, premature births, miscarriages, and birth weight.. · König AM, Pöschke A, Mahnken AH. Health risks for medical personnel due to magnetic fields in magnetic resonance imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2296-3860.
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Affiliation(s)
- Alexander Marc König
- Diagnostic and Interventional Radiology, Philipps University of Marburg, Marburg, Germany
| | - Antje Pöschke
- Diagnostic and Interventional Radiology, Philipps University of Marburg, Marburg, Germany
| | - Andreas H Mahnken
- Diagnostic and Interventional Radiology, Philipps University of Marburg, Marburg, Germany
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Fink A, Tran H, Reisert M, Rau A, Bayer J, Kotter E, Bamberg F, Russe MF. A deep learning approach for projection and body-side classification in musculoskeletal radiographs. Eur Radiol Exp 2024; 8:23. [PMID: 38353812 PMCID: PMC10866807 DOI: 10.1186/s41747-023-00417-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The growing prevalence of musculoskeletal diseases increases radiologic workload, highlighting the need for optimized workflow management and automated metadata classification systems. We developed a large-scale, well-characterized dataset of musculoskeletal radiographs and trained deep learning neural networks to classify radiographic projection and body side. METHODS In this IRB-approved retrospective single-center study, a dataset of musculoskeletal radiographs from 2011 to 2019 was retrieved and manually labeled for one of 45 possible radiographic projections and the depicted body side. Two classification networks were trained for the respective tasks using the Xception architecture with a custom network top and pretrained weights. Performance was evaluated on a hold-out test sample, and gradient-weighted class activation mapping (Grad-CAM) heatmaps were computed to visualize the influential image regions for network predictions. RESULTS A total of 13,098 studies comprising 23,663 radiographs were included with a patient-level dataset split, resulting in 19,183 training, 2,145 validation, and 2,335 test images. Focusing on paired body regions, training for side detection included 16,319 radiographs (13,284 training, 1,443 validation, and 1,592 test images). The models achieved an overall accuracy of 0.975 for projection and 0.976 for body-side classification on the respective hold-out test sample. Errors were primarily observed in projections with seamless anatomical transitions or non-orthograde adjustment techniques. CONCLUSIONS The deep learning neural networks demonstrated excellent performance in classifying radiographic projection and body side across a wide range of musculoskeletal radiographs. These networks have the potential to serve as presorting algorithms, optimizing radiologic workflow and enhancing patient care. RELEVANCE STATEMENT The developed networks excel at classifying musculoskeletal radiographs, providing valuable tools for research data extraction, standardized image sorting, and minimizing misclassifications in artificial intelligence systems, ultimately enhancing radiology workflow efficiency and patient care. KEY POINTS • A large-scale, well-characterized dataset was developed, covering a broad spectrum of musculoskeletal radiographs. • Deep learning neural networks achieved high accuracy in classifying radiographic projection and body side. • Grad-CAM heatmaps provided insight into network decisions, contributing to their interpretability and trustworthiness. • The trained models can help optimize radiologic workflow and manage large amounts of data.
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Affiliation(s)
- Anna Fink
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
| | - Hien Tran
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jörg Bayer
- Department of Trauma and Orthopaedic Surgery, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - Elmar Kotter
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Maximilian F Russe
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
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Klein K, Schafigh DG, Wallis MG, Campbell GM, Malter W, Schömig-Markiefka B, Maintz D, Hellmich M, Krug KB. Assignment of the biological value of solid breast masses based on quantitative evaluations of spectral CT examinations using electron density mapping, Zeffective mapping and iodine mapping. Eur J Radiol 2024; 171:111280. [PMID: 38219351 DOI: 10.1016/j.ejrad.2023.111280] [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: 10/09/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVE We aimed to asses, in a clinical setting, whether the newly available quantitative evaluation of electron density (ED) in spectral CT examinations of the breast provide information on the biological identity of solid breast masses and whether ED maps yield added value to the diagnostic information of iodine maps and Zeff maps calculated from the same CT image datasets. METHODS All patients at the University Breast Cancer Center who underwent a clinically indicated Dual Layer Computed Tomography (DLCT) examination for staging of invasive breast cancer from 2018 to 2020 were prospectively included. Iodine concentration maps, Zeff maps and ED maps were automatically reconstructed from the DLCT datasets. Region of interest (ROI) based evaluations in the breast target lesions and in the aorta were performed semi-automatically in identical anatomical positions using dedicated evaluation software. Case-by-case evaluations were carried independently by 2 of 4 radiologists for each examination, respectively. Statistical analysis derived from the ROIs was done by calculating ROC/AUC curves and Youden indices. RESULTS The evaluations comprised 166 DLCT examinations. In the ED maps the measurements in the breast target lesions yielded Youden cutpoints of 104.0% (reader 1) and 103.8% (reader 2) resulting in AUCs of 0.63 and 0.67 at the empirical cutpoints. The variables "Zeff" and "iodine content" derived from the target lesions showed superior diagnostical results, with a Youden cutpoint of 8.0 mg/ml in the iodine maps and cutpoints of 1.1/1.2 in the Zeff maps the AUCs ranging from 0.84 to 0.85 (p = 0.023 to <0.000). The computational combination of Zeff and ED measurements in the target lesions yielded a slight AUC increase (readers 1: 0.85-0.87; readers 2: 0.84-0.94). The ratios of the measured values in the target lesions normalized to the values measured in the aorta showed comparable results. The AUCs of ED derived from the cutpoints showed inferior results to those derived from the Zeff maps and iodine maps (ED: 0.64 and 0.66 for reader 1 and 2; Zeff: 0.86 for both readers; iodine content: 0.89 and 0.86 for reader 1 and 2, respectively). The computational combination of the ED results and the Zeff measurements did not lead to a clinically relevant diagnostic gain with AUCs ranging from 0.86 to 0.88. CONCLUSIONS Quantitative assessments of Zeff, iodine content and ED all targeting the physical and chemical aspects of iodine uptake in solid breast masses confirmed diagnostically robust cutpoints for the differentiation of benign and malignant findings (Zeff < 7.7, iodine content of <0.8 mg/ml). The evaluations of the ED did not indicate any added diagnostic value beyond the quantitative assessments of Zeff and iodine content. Further research is warranted to develop suitable clinical indications for the use of ED maps.
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Affiliation(s)
- Konstantin Klein
- Dept. of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Darius Gabriel Schafigh
- Dept. of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany; Dept. of ENT Surgery, University Hospital of Cologne, Cologne, Germany
| | - Matthew G Wallis
- Cambridge Breast Unit, NIHR Cambridge Biomedical Research Centre Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Wolfram Malter
- Breast Cancer Center, Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | | | - David Maintz
- Dept. of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Bioinformatics, Medical Faculty, University of Cologne, Germany
| | - Kathrin Barbara Krug
- Dept. of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany.
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Altmann S, Grauhan NF, Brockstedt L, Kondova M, Schmidtmann I, Paul R, Clifford B, Feiweier T, Hosseini Z, Uphaus T, Groppa S, Brockmann MA, Othman AE. Ultrafast Brain MRI with Deep Learning Reconstruction for Suspected Acute Ischemic Stroke. Radiology 2024; 310:e231938. [PMID: 38376403 DOI: 10.1148/radiol.231938] [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: 02/21/2024]
Abstract
Background Deep learning (DL)-accelerated MRI can substantially reduce examination times. However, studies prospectively evaluating the diagnostic performance of DL-accelerated MRI reconstructions in acute suspected stroke are lacking. Purpose To investigate the interchangeability of DL-accelerated MRI with conventional MRI in patients with suspected acute ischemic stroke at 1.5 T. Materials and Methods In this prospective study, 211 participants with suspected acute stroke underwent clinically indicated MRI at 1.5 T between June 2022 and March 2023. For each participant, conventional MRI (including T1-weighted, T2-weighted, T2*-weighted, T2 fluid-attenuated inversion-recovery, and diffusion-weighted imaging; 14 minutes 18 seconds) and DL-accelerated MRI (same sequences; 3 minutes 4 seconds) were performed. The primary end point was the interchangeability between conventional and DL-accelerated MRI for acute ischemic infarction detection. Secondary end points were interchangeability regarding the affected vascular territory and clinically relevant secondary findings (eg, microbleeds, neoplasm). Three readers evaluated the overall occurrence of acute ischemic stroke, affected vascular territory, clinically relevant secondary findings, overall image quality, and diagnostic confidence. For acute ischemic lesions, size and signal intensities were assessed. The margin for interchangeability was chosen as 5%. For interrater agreement analysis and interrater reliability analysis, multirater Fleiss κ and the intraclass correlation coefficient, respectively, was determined. Results The study sample consisted of 211 participants (mean age, 65 years ± 16 [SD]); 123 male and 88 female). Acute ischemic stroke was confirmed in 79 participants. Interchangeability was demonstrated for all primary and secondary end points. No individual equivalence indexes (IEIs) exceeded the interchangeability margin of 5% (IEI, -0.002 [90% CI: -0.007, 0.004]). Almost perfect interrater agreement was observed (P > .91). DL-accelerated MRI provided higher overall image quality (P < .001) and diagnostic confidence (P < .001). The signal properties of acute ischemic infarctions were similar in both techniques and demonstrated good to excellent interrater reliability (intraclass correlation coefficient, ≥0.8). Conclusion Despite being four times faster, DL-accelerated brain MRI was interchangeable with conventional MRI for acute ischemic lesion detection. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Haller in this issue.
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Affiliation(s)
- Sebastian Altmann
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Nils F Grauhan
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Lavinia Brockstedt
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Mariya Kondova
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Irene Schmidtmann
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Roman Paul
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Bryan Clifford
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Thorsten Feiweier
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Zahra Hosseini
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Timo Uphaus
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Sergiu Groppa
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Marc A Brockmann
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
| | - Ahmed E Othman
- From the Department of Neuroradiology (S.A., N.F.G., L.B., M.K., M.A.B., A.E.O.), Institute of Medical Biostatistics, Epidemiology and Informatics (I.S., R.P.), and Department of Neurology (T.U., S.G.), University Medical Center Mainz, Johannes Gutenberg University, Langenbeckstr 1, 55131 Mainz, Germany; Siemens Medical Solutions USA, Boston, Mass (B.C.); and Siemens Healthcare, Erlangen, Germany (T.F., Z.H.)
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Salhöfer L, Haubold J, Gutt M, Hosch R, Umutlu L, Meetschen M, Schuessler M, Forsting M, Nensa F, Schaarschmidt BM. The importance of educational tools and a new software solution for visualizing and quantifying report correction in radiology training. Sci Rep 2024; 14:1172. [PMID: 38216664 PMCID: PMC10786897 DOI: 10.1038/s41598-024-51462-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
A novel software, DiffTool, was developed in-house to keep track of changes made by board-certified radiologists to preliminary reports created by residents and evaluate its impact on radiological hands-on training. Before (t0) and after (t2-4) the deployment of the software, 18 residents (median age: 29 years; 33% female) completed a standardized questionnaire on professional training. At t2-4 the participants were also requested to respond to three additional questions to evaluate the software. Responses were recorded via a six-point Likert scale ranging from 1 ("strongly agree") to 6 ("strongly disagree"). Prior to the release of the software, 39% (7/18) of the residents strongly agreed with the statement that they manually tracked changes made by board-certified radiologists to each of their radiological reports while 61% were less inclined to agree with that statement. At t2-4, 61% (11/18) stated that they used DiffTool to track differences. Furthermore, we observed an increase from 33% (6/18) to 44% (8/18) of residents who agreed to the statement "I profit from every corrected report". The DiffTool was well accepted among residents with a regular user base of 72% (13/18), while 78% (14/18) considered it a relevant improvement to their training. The results of this study demonstrate the importance of providing a time-efficient way to analyze changes made to preliminary reports as an additive for professional training.
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Affiliation(s)
- Luca Salhöfer
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany.
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Maurice Gutt
- Central IT Services, University Hospital Essen, Essen, Germany
| | - René Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Mathias Meetschen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Maximilian Schuessler
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Felix Nensa
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
| | - Benedikt Michael Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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Altmann S, Abello Mercado MA, Brockstedt L, Kronfeld A, Clifford B, Feiweier T, Uphaus T, Groppa S, Brockmann MA, Othman AE. Ultrafast Brain MRI Protocol at 1.5 T Using Deep Learning and Multi-shot EPI. Acad Radiol 2023; 30:2988-2998. [PMID: 37211480 DOI: 10.1016/j.acra.2023.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/23/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate clinical feasibility and image quality of a comprehensive ultrafast brain MRI protocol with multi-shot echo planar imaging and deep learning-enhanced reconstruction at 1.5T. MATERIALS AND METHODS Thirty consecutive patients who underwent clinically indicated MRI at a 1.5 T scanner were prospectively included. A conventional MRI (c-MRI) protocol, including T1-, T2-, T2*-, T2-FLAIR, and diffusion-weighted images (DWI)-weighted sequences were acquired. In addition, ultrafast brain imaging with deep learning-enhanced reconstruction and multi-shot EPI (DLe-MRI) was performed. Subjective image quality was evaluated by three readers using a 4-point Likert scale. To assess interrater agreement, Fleiss' kappa (ϰ) was determined. For objective image analysis, relative signal intensity levels for grey matter, white matter, and cerebrospinal fluid were calculated. RESULTS Time of acquisition (TA) of c-MRI protocols added up to 13:55 minutes, whereas the TA of DLe-MRI-based protocol added up to 3:04 minutes, resulting in a time reduction of 78%. All DLe-MRI acquisitions yielded diagnostic image quality with good absolute values for subjective image quality. C-MRI demonstrated slight advantages for DWI in overall subjective image quality (c-MRI: 3.93 [+/- 0.25] vs DLe-MRI: 3.87 [+/- 0.37], P = .04) and diagnostic confidence (c-MRI: 3.93 [+/- 0.25] vs DLe-MRI: 3.83 [+/- 3.83], P = .01). For most evaluated quality scores, moderate interobserver agreement was found. Objective image evaluation revealed comparable results for both techniques. CONCLUSION DLe-MRI is feasible and allows for highly accelerated comprehensive brain MRI within 3minutes at 1.5 T with good image quality. This technique may potentially strengthen the role of MRI in neurological emergencies.
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Affiliation(s)
- Sebastian Altmann
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany (S.A., M.A.M., L.B., A.K., M.A.B., A.E.O.).
| | - Mario Alberto Abello Mercado
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany (S.A., M.A.M., L.B., A.K., M.A.B., A.E.O.)
| | - Lavinia Brockstedt
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany (S.A., M.A.M., L.B., A.K., M.A.B., A.E.O.)
| | - Andrea Kronfeld
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany (S.A., M.A.M., L.B., A.K., M.A.B., A.E.O.)
| | - Bryan Clifford
- Siemens Medical Solutions USA, Boston, Massachusetts (B.C.)
| | | | - Timo Uphaus
- Department of Neurology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany (T.U., S.G.)
| | - Sergiu Groppa
- Department of Neurology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany (T.U., S.G.)
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany (S.A., M.A.M., L.B., A.K., M.A.B., A.E.O.)
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center Mainz, Johannes Gutenberg University, Langenbeckst. 1, 55131 Mainz, Germany (S.A., M.A.M., L.B., A.K., M.A.B., A.E.O.)
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Pfänder L, Schneider L, Büttner M, Krois J, Meyer-Lueckel H, Schwendicke F. Multi-modal deep learning for automated assembly of periapical radiographs. J Dent 2023; 135:104588. [PMID: 37348642 DOI: 10.1016/j.jdent.2023.104588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/23/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES Periapical radiographs are oftentimes taken in series to display all teeth present in the oral cavity. Our aim was to automatically assemble such a series of periapical radiographs into an anatomically correct status using a multi-modal deep learning model. METHODS 4,707 periapical images from 387 patients (on average, 12 images per patient) were used. Radiographs were labeled according to their field of view and the dataset split into a training, validation, and test set, stratified by patient. In addition to the radiograph the timestamp of image generation was extracted and abstracted as follows: A matrix, containing the normalized timestamps of all images of a patient was constructed, representing the order in which images were taken, providing temporal context information to the deep learning model. Using the image data together with the time sequence data a multi-modal deep learning model consisting of two residual convolutional neural networks (ResNet-152 for image data, ResNet-50 for time data) was trained. Additionally, two uni-modal models were trained on image data and time data, respectively. A custom scoring technique was used to measure model performance. RESULTS Multi-modal deep learning outperformed both uni-modal image-based learning (p<0.001) and time-based learning (p<0.05). The multi-modal deep learning model predicted tooth labels with an F1-score, sensitivity and precision of 0.79, respectively, and an accuracy of 0.99. 37 out of 77 patient datasets were fully correctly assembled by multi-modal learning; in the remaining ones, usually only one image was incorrectly labeled. CONCLUSIONS Multi-modal modeling allowed automated assembly of periapical radiographs and outperformed both uni-modal models. Dental machine learning models can benefit from additional data modalities. CLINICAL SIGNIFICANCE Like humans, deep learning models may profit from multiple data sources for decision-making. We demonstrate how multi-modal learning can assist assembling periapical radiographs into an anatomically correct status. Multi-modal learning should be considered for more complex tasks, as clinically a wealth of data is usually available and could be leveraged.
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Affiliation(s)
- L Pfänder
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany
| | - L Schneider
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; ITU/WHO Focus Group AI4Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva, Switzerland
| | - M Büttner
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; ITU/WHO Focus Group AI4Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva, Switzerland
| | - J Krois
- ITU/WHO Focus Group AI4Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva, Switzerland
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk Bern, University of Bern, Switzerland
| | - F Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, 14197 Berlin, Germany; ITU/WHO Focus Group AI4Health, Topic Group Dental Diagnostics and Digital Dentistry, Geneva, Switzerland.
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8
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Bushra A, Sulieman A, Edam A, Tamam N, Babikir E, Alrihaima N, Alfaki E, Babikir S, Almujally A, Otayni A, Alkhorayef M, Abdelradi A, Bradley DA. Patient's effective dose and performance assessment of computed radiography systems. Appl Radiat Isot 2023; 193:110627. [PMID: 36584412 DOI: 10.1016/j.apradiso.2022.110627] [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: 03/30/2021] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Computed tomography is widely used for planar imaging. Previous studies showed that CR systems involve higher patient radiation doses compared to digital systems. Therefore, assessing the patient's dose and CR system performance is necessary to ensure that patients received minimal dose with the highest possible image quality. The study was performed at three medical diagnostic centers in Sudan: Medical Corps Hospital (MCH), Advance Diagnostic Center (ADC), and Advance Medical Center (AMC). The following tools were used in this study: Tape measure, Adhesive tape, 1.5 mm copper filtration (>10 × 10 cm), TO 20 threshold contrast test object, Resolution test object (e.g., Huttner 18), MI geometry test object or lead ruler, Contact mish, Piranha (semiconductor detector), Small lead or copper block (∼5 × 5 cm), and Steel ruler, to do a different type of tests (Dark Noise, Erasure cycle efficiency, Sensitivity Index calibration, Sensitivity Index consistency, Uniformity, Scaling errors, Blurring, Limiting spatial Resolution, Threshold, and Laser beam Function. Entrance surface air kerma (ESAK (mGy) was calculated from patient exposure parameters using DosCal software for three imaging modalities. A total of 199 patients were examined (112 chest X rays, 77 lumbar spine). The mean and standard deviation (sd) for patients ESAK (mGy) were 2.56 ± 0.1 mGy and 1.6 mGy for the Anteroposterior (AP) and lateral projections for the lumbar spine, respectively. The mean and sd for the patient's chest doses were 0.1 ± 0.01 for the chest X-ray procedures. The three medical diagnostic centers' CR system performance was evaluated and found that all of the three centers have good CR system functions. All the centers satisfy all the criteria of acceptable visual tests. CR's image quality and sensitivity were evaluated, and the CR image is good because it has good contrast and resolution. All the CR system available in the medical centers and upgraded from old X-ray systems to new systems, has been found to work well. The patient's doses were comparable for the chest X-ray procedures, while patients' doses from the lumbar spine showed variation up to 2 folds due to the variation in patients' weight and X-ray machine setting. Patients dose optimization is recommended to ensure the patients received a minimal dose while obtaining the diagnostic findings.
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Affiliation(s)
- A Bushra
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - A Sulieman
- Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P.O.Box 422, Alkharj 11942, Saudi Arabia.
| | - A Edam
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - N Tamam
- Physics Department, College of Science, Princess Nourah bint Abdulrahman University, P.O Box 84428, Riyadh, 11671, Saudi Arabia
| | - E Babikir
- Radiologic Technology Program, Allied Health Department, College of Health and Sport Sciences, University of Bahrain, Bahrain
| | - N Alrihaima
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - E Alfaki
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - S Babikir
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - A Almujally
- Department of Biomedical Physics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Otayni
- Radiology Department, King Khaled Hospital and Prince Sultan Center for Health Care, Ministry of Health, Alkharj, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O Box 10219, Riyadh, 11433, Saudi Arabia
| | - A Abdelradi
- Radiation Safety Institute, Sudan Atomic Energy Commission, Khartoum, Sudan
| | - D A Bradley
- Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK; Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
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9
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Low-Dose CT Imaging of the Pelvis in Follow-up Examinations-Significant Dose Reduction and Impact of Tin Filtration: Evaluation by Phantom Studies and First Systematic Retrospective Patient Analyses. Invest Radiol 2022; 57:789-801. [PMID: 35776429 DOI: 10.1097/rli.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Low-dose (LD) computed tomography (CT) is still rarely used in musculoskeletal (MSK) radiology. This study evaluates the potentials of LD CT for follow-up pelvic imaging with special focus on tin filtration (Sn) technology for normal and obese patients with and without metal implants. MATERIALS AND METHODS In a phantom study, 5 different LD and normal-dose (ND) CT protocols with and without tin filtration were tested using a normal and an obese phantom. Iterative reconstruction (IR) and filtered back projection (FBP) were used for CT image reconstruction. In a subsequent retrospective patient study, ND CT images of 45 patients were compared with follow-up tin-filtered LD CT images with a 90% dose reduction. Sixty-four percent of patients contained metal implants at the follow-up examination. Computed tomography images were objectively (image noise, contrast-to-noise ratio [CNR], dose-normalized contrast-to-noise ratio [CNRD]) and subjectively, using a 6-point Likert score, evaluated. In addition, the figure of merit was calculated. For group comparisons, paired t tests, Wilcoxon signed rank test, analysis of variance, or Kruskal-Wallis tests were used, where applicable. RESULTS The LD Sn protocol with 67% dose reduction resulted in equal values in qualitative (Likert score) and quantitative image analysis (image noise) compared with the ND protocol in the phantom study. For follow-up examinations, dose could be reduced up to 90% by using Sn LD CT scans without impairment in the clinical study. However, metal implants resulted in a mild impairment of Sn LD as well as ND CT images. Cancellous bone ( P < 0.001) was assessed worse and cortical bone ( P = 0.063) equally in Sn LD CT images compared with ND CT images. Figure of merit values were significant ( P ≤ 0.02) lower and hence better in Sn LD as in ND protocols. Obese patients benefited in particular from tin filtration in LD MSK imaging in terms of image noise and CNR ( P ≤ 0.05). CONCLUSIONS Low-dose CT scans with tin filtration allow maximum dose reduction while maintaining high image quality for certain clinical purposes, for example, follow-up examinations, especially metal implant position, material loosening, and consolidation controls. Overweight patients benefit particularly from tin filter technology. Although metal implants decrease image quality in ND as well as in Sn LD CT images, this is not a relevant limitation for assessability.
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10
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Barbara Krug K, Schömig-Markiefka B, Campbell GM, Püsken M, Maintz D, Schlamann M, Klein K, Gabriel Schafigh D, Malter W, Hellmich M. Correlation of CT-data derived from multiparametric dual-layer CT-maps with immunohistochemical biomarkers in invasive breast carcinomas. Eur J Radiol 2022; 156:110544. [PMID: 36219916 DOI: 10.1016/j.ejrad.2022.110544] [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: 06/23/2022] [Revised: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the correlation of quantitative measurements from material decomposition maps calculated from dual-layer CT (DLCT)-image datasets with immunohistochemical biomarkers of invasive breast carcinomas. MATERIAL AND METHODS All patients at the University Breast Cancer Center who underwent a clinically indicated dual-layer CT-scan for staging of invasive ductal breast carcinoma from 01/2016 to 07/2020 were prospectively included. Iodine concentration maps and maps of the effective atomic numbers (Zeffective) were reconstructed from the image datasets. ROI-based evaluations of the index tumors and predefined references tissues for normalization were performed semi-automatically in identical anatomical positions using dedicated evaluation software. Statistical analysis was essentially descriptive using Spearmańs rank correlation and (multivariable) partial correlation. RESULTS Bivariate showed statistically significant correlations of iodine contents (r = -0.154/-0.202/0.180, p = 0.039/0.006/0.015), and Zeffective-values (r = -0.158/-0.199/0.179, p = 0.034/0.007/0.016) for all 184 carcinomas and the subgroup of 168 invasive ductal carcinomas. The results were confirmed by multivariate analyses with "age", "diameter" and "ACR-grade" as possible confounders. Normalization of the measured target values with those in the aorta confirmed significant correlations of iodine content and Zeffective compared to Estrogen (r = 0.174, p = 0.019), Progesteron (r = 0.168/0.177, p = 0.024/0.017), and HER2 receptor expression (r = -0.222/-0.184, p = 0.003/0.013). All CT-parameters showed significant correlations with immunohistochemical subtyping (r = 0.191/0.192, p = 0.010). CONCLUSIONS Our preliminary results indicate that iodine content and Zeffective-values derived from DLCT-examinations correlate with hormone receptor expression in invasive breast carcinomas. Assignments to benign entities already seam feasible in clinical routine CT-diagnostics. After further investigations iodine content and Zeffective may be translated as diagnostical and prognostical biomarkers into clinical routine in the long term.
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Affiliation(s)
- Kathrin Barbara Krug
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany.
| | | | | | - Michael Püsken
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - David Maintz
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Konstantin Klein
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Darius Gabriel Schafigh
- Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany; Ear, Nose and Throat Clinic, University Hospital of Cologne, Cologne, Germany
| | - Wolfram Malter
- Breast Cancer Center, Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Bioinformatics, Medical Faculty, University of Cologne, Germany
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11
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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: 1.0] [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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12
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Hinsen M, Heiss R, Nagel AM, Lévy S, Uder M, Bickelhaupt S, May MS. [Imaging of the lung using low-field magnetic resonance imaging]. Radiologe 2022; 62:418-428. [PMID: 35416476 PMCID: PMC9006515 DOI: 10.1007/s00117-022-00996-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
Hintergrund Die Untersuchung der Lunge mit der Magnetresonanztomographie (MRT) geht mit hohen Herausforderungen einher und konnte sich im klinischen Alltag bisher nicht durchsetzen. Aktuelle Entwicklungen der Niederfeld-MRT, in Kombination mit neuen computergestützten Aufnahme- und Auswertungsalgorithmen, versprechen neue Perspektiven für die bildgebende Diagnostik pulmonaler Erkrankungen. Ziel dieser Arbeit Diese Übersichtsarbeit soll ein Verständnis der physikalischen Vorteile der Niederfeld-MRT für die Lungenbildgebung vermitteln, einen Überblick über die spärlich vorhandenen Vorkenntnisse aus der Literatur bieten und erste Ergebnisse eines neu entwickelten Niederfeld-MRT präsentieren. Methoden Inhalte dieses Artikels basieren auf physikalischen Grundlagen, Recherchen in Literaturdatenbanken und eigenen Erfahrungen in der Lungenbildgebung mit einem modernen 0,55-T-MRT. Schlussfolgerung Die Niederfeld-MRT (< 1 T) kann technische und ökonomische Vorteile gegenüber höheren Feldstärken für die Lungenbildgebung haben. Die physikalischen Voraussetzungen sind aufgrund geringerer Suszeptibilitätseffekte, längerer transversaler Relaxationszeiten und niedrigerer spezifischer Absorptionsraten besonders für die Anatomie der Lunge vorteilhaft. Die geringeren Anschaffungs- und Betriebskosten haben zudem ein großes Potenzial, die Verfügbarkeit zu erhöhen und gleichzeitig die Nachhaltigkeit zu verbessern. Durch die Kombination moderner Sequenzen und computergestützter Auswertungen kann die morphologische Bildgebung um orts- und zeitaufgelöste funktionelle Untersuchungen der Lunge ohne Strahlenbelastung ergänzt werden. Sowohl für kritische Szenarien, wie Screening und engmaschiges Therapiemonitoring, als auch für besonders gefährdete Patientengruppen könnten Lücken geschlossen werden. Dazu gehören beispielsweise akute und chronische Lungenerkrankungen bei Kindern oder die Abklärung einer Lungenembolie bei Schwangeren.
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Affiliation(s)
- Maximilian Hinsen
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Armin M Nagel
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland
| | - Simon Lévy
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Sebastian Bickelhaupt
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Matthias S May
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland. .,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland.
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13
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Tristram J, Steuwe A, Kröpil F, Thomas C, Rubbert C, Antoch G, Boos J. Typical doses and typical values for fluoroscopic diagnostic and interventional procedures. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021510. [PMID: 35130526 DOI: 10.1088/1361-6498/ac5294] [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: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
To implement typical doses (TD) and typical values (TV) for fluoroscopic diagnostic and interventional procedures. A total of 3811 fluoroscopic procedures performed within 34 months on three devices were included in this retrospective study. Dose-, patient- and procedure-related information were extracted using the institutional dose management system (DMS). TD/TV were defined as median dose and calculated for the five most frequent procedures per device for dose area product (DAP), cumulative air kerma (CAK) and fluoroscopy time (FT). National diagnostic reference levels and other single facility studies were compared to our results. Additionally, the five procedures with the highest doses of each device were analysed. To evaluate the data coverage of the DMS compared to the picture archiving and communication system (PACS), procedure lists were extracted from the PACS and compared to the procedure information extracted from the DMS. TD/TV for 15 procedures were implemented. Among all devices, TD for DAP ranged between 0.6 Gycm2for port catheter control (n= 64) and 145.9 Gycm2for transarterial chemoembolisation (n= 84). TD for CAK ranged between 5 mGy for port catheter control and 1397 mGy for aneurysm treatment (n= 129) and TV for FT ranged between 0.3 min for upper cavography (n= 67) and 51.4 min for aneurysm treatment. TD for DAP and CAK were lower or within the range of other single facility studies. The five procedures with the highest median DAP per device were identified, 6 of 15 procedures were also found to be among the most frequent procedures. Data coverage of the DMS compared to the PACS ranged between 71% (device 2, stroke treatment) and 78% (device 1, lower limb angiography) for the most common procedure per device. Thus, in 22%-29% of cases dose data of the performed procedure was not transferred into the DMS. We implemented TD/TV for fluoroscopic diagnostic and interventional procedures which enable a comprehensive dose analysis and comparison with previously published values.
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Affiliation(s)
- Juliana Tristram
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Andrea Steuwe
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Feride Kröpil
- Medical Faculty, Department of Surgery, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Christoph Thomas
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Christian Rubbert
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
| | - Johannes Boos
- Medical Faculty, Department of Diagnostic and Institutional Radiology, University Dusseldorf, D-40225 Dusseldorf, Germany
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14
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Kolck J, Ziegeler K, Walter-Rittel T, Hermann KGA, Hamm B, Beck A. Clinical utility of postprocessed low-dose radiographs in skeletal imaging. Br J Radiol 2022; 95:20210881. [PMID: 34919419 PMCID: PMC8822553 DOI: 10.1259/bjr.20210881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing have opened up new opportunities to minimize the radiation dosage. These advances are contingent upon quality controls to ensure adequate image detail and maintenance of diagnostic confidence. The purpose of this study was to investigate the clinical applicability of postprocessed low-dose images in skeletal radiography. METHODS In our study setting, the median radiation dose for full dose X-rays was 9.61 dGy*cm2 for pelvis, 1.20 dGy*cm2 for shoulder and 18.64 dGy*cm2 for lumbar spine exams. Based on these values, we obtained 200 radiographs for each anatomic region in four consecutive steps, gradually reducing the dose to 84%, 71%, 60% and 50% of the baseline using an automatic exposure control (AEC). 549 patients were enrolled for a total of 600 images. All X-rays were postprocessed with a spatial noise reduction algorithm. Two radiologists assessed the diagnostic value of the radiographs by rating the visualization of anatomical landmarks and image elements on a five-point Likert scale. A mean-sum score was calculated by averaging the two reader's total scores. Given the non-parametric distribution, we used the Mann-Whitney U test to evaluate the scores. RESULTS Median dosage at full dose accounted for 38.4%, 48 and 53.2% of the German reference dose area product for shoulder, pelvis and lumbar spine, respectively. The applied radiation was incrementally reduced to 21.5%, 18.4% and 18.7% of the respective reference value for shoulder, pelvis and lumbar spine. Throughout the study, we observed an estimable tendency of superior quality at higher dosage in overall image quality. Statistically significant differences in image quality were restricted to the 50% dose groups in shoulder and lumbar spine images. Regardless of the applied dosage, 598 out of 600 images were of sufficient diagnostic value. CONCLUSION In digital radiography image postprocessing allows for extensive reduction of radiation dosage. Despite a trend of superior image detail at higher dose levels, overall quality and, more importantly, diagnostic utility of low-dose images was not significantly affected. Therefore, our results not only confirm the clinical utility of postprocessed low-dose radiographs, but also suggest a widespread deployment of this advanced technology to ensure further dose limitations in clinical practice. ADVANCES IN KNOWLEDGE The diagnostic image quality of postprocessed skeletal radiographs is not significantly impaired even after extensive dose reduction by up to 20% of the reference value.
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Affiliation(s)
- Johannes Kolck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thula Walter-Rittel
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Beck
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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15
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Ley S, Biederer J, Ley-Zaporozhan J, Wielpütz MO, Vogel-Claussen J, Das M, Hamer O. [Chest X-ray: implementation and indication : Recommendations of the thoracic imaging working group of the German Radiological Society]. Radiologe 2022; 62:149-157. [PMID: 35006315 DOI: 10.1007/s00117-021-00952-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Even after more than 100 years, the chest X‑ray is still an important technique to detect important pathological changes of lungs, heart and vessels in a fast and low-dose manner. For the German-speaking regions, there are only recommendations available published by the "Ständigen Strahlenschutzkommission (SSK)" regarding the indication. These recommendations are not updated on a regular basis and more recent developments are only integrated with delayed. METHODS The chest division of the German Radiological Society has summarized their expertise for the usage and indication of the chest X‑ray. Especially within the field of oncology the usage of chest X‑ray is evaluated differently to the aforementioned recommendations; here chest computed tomography (CT) is much more sensitive for evaluation of metastasis and local invasion of tumors. Also, within the area of infectious diseases in non-immunocompetent patients, CT is the method of choice. Based on the structure of the current recommendations, many current guidelines and indications are summarized and presented within the context of the usage of chest X‑ray.
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Affiliation(s)
- Sebastian Ley
- Diagnostische und Interventionelle Radiologie, Artemed Klinikum München Süd, Am Isarkanal 30, 81379, München, Deutschland. .,Radiologie, Internistisches Klinikum München Süd, Am Isarkanal 36, München, Deutschland.
| | - Jürgen Biederer
- Diagnostische und interventionelle Radiologie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Deutschland.,Translational Lung Research Centre Heidelberg (TLRC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), 69120, Heidelberg, Deutschland.,Faculty of Medicine, University of Latvia, Raina bulvaris 19, 1586, Riga, Lettland.,Medizinische Fakultät, Christian-Albrechts-Universität zu Kiel, 24098, Kiel, Deutschland
| | - Julia Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland.,Comprehensive Pneumology Center Munich (CPC-M), Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
| | - Mark O Wielpütz
- Translational Lung Research Centre Heidelberg (TLRC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), 69120, Heidelberg, Deutschland.,Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.,Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Jens Vogel-Claussen
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland.,2 BREATH (Biomedical Research in End-stage and Obstructive Lung Disease Hannover), Deutsches Zentrum für Lungenforschung (DZL), Hannover, Deutschland
| | - Marco Das
- Klinik für diagnostische und interventionelle Radiologie, Helios Klinikum Duisburg, Duisburg, Deutschland
| | - Okka Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland.,Abteilung für Radiologie, Klinik Donaustauf, Donaustauf, Deutschland
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16
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Becker BV, Kaatsch HL, Nestler K, Jakobi J, Schäfer B, Hantke T, Brockmann MA, Waldeck S, Port M, Ullmann R. Impact of medical imaging on the epigenome - low-dose exposure in the course of computed tomography does not induce detectable changes of DNA-methylation profiles in peripheral blood cells. Int J Radiat Biol 2021; 98:980-985. [PMID: 34779695 DOI: 10.1080/09553002.2021.2004329] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Computed tomography (CT) is a main contributor to artificial low-dose exposure. Understanding the biological effects induced by CT exposure and their dependency on the characteristics of photon spectra is essential for knowledge-driven risk assessment. In a previous gene expression study, we have identified upregulation of AEN, BAX, DDB2, EDA2R and FDXR after ex vivo exposure with single-energy CT and dual-energy CT (DECT). In this study, we focused on CT-induced changes of DNA methylation. This epigenetic modification of DNA is a central regulator of gene expression and instrumental in preserving genome integrity. Previous studies reported focal hypermethylation and global hypomethylation after exposure with doses above 100 mSv, however, the effect of low dose exposure on DNA methylation is hardly explored. MATERIALS AND METHODS DNA was isolated from peripheral blood of three healthy individuals 6 h after ex vivo exposition to single-energy (80 kV and 150 kV) and DECT (80 kV/Sn150 kV) with a calculated effective dose of 7.0 ± 0.08 mSv. The experimental setting was identical to the one used in our previous gene expression study enabling a direct comparison of gene expression results with changes of DNA methylation identified in this study. DNA methylation was analyzed by high-throughput sequencing of bisulfite-treated DNA targeted methylation sequencing. RESULTS Unsupervised hierarchical clustering based on DNA methylation profiles of all samples created three distinct clusters. Formation of these three clusters was solely determined by the origin of samples, indicating the absence of prominent irradiation-associated changes of DNA methylation. In line with this observation, inter-individual comparison of non-irradiated samples revealed 1163, 1224 and 4550 significant differentially methylated regions (DMRs), respectively, whereas the pairwise comparison of irradiated and non-irradiated samples failed to identify irradiation-induced DMRs in any of the three probands. This even applied to the genomic regions harboring AEN, BAX, DDB2, EDA2R and FDXR, the five genes known to be upregulated by CT exposure. CONCLUSIONS CT exposure with various photon spectra did not result in detectable changes of DNA methylation. However, minor effects in a subpopulation of irradiated cells cannot be ruled out. Thus, future studies with extended observation intervals are needed to investigate DNA methylation changes that are induced by indirect effects at later points of time or become detectable by clonal expansion of affected cells. Moreover, our data suggest that DNA methylation analysis is less sensitive in detecting immediate effects of low-dose irradiation when compared to gene expression analysis.
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Affiliation(s)
| | | | - Kai Nestler
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
| | - Julia Jakobi
- Bundeswehr Institute of Radiobiology Affiliated to Ulm University, Munich, Germany
| | - Barbara Schäfer
- Bundeswehr Institute of Radiobiology Affiliated to Ulm University, Munich, Germany
| | - Thomas Hantke
- Bundeswehr Institute of Radiobiology Affiliated to Ulm University, Munich, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany
| | - Stephan Waldeck
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital, Koblenz, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology Affiliated to Ulm University, Munich, Germany
| | - Reinhard Ullmann
- Bundeswehr Institute of Radiobiology Affiliated to Ulm University, Munich, Germany
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17
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Bos D, Zensen S, Opitz M, Haubold J, Forsting M, Nassenstein K, Guberina N, Wetter A. IMAGE QUALITY STUDY OF RADIATION-REDUCED COMBINED CHEST AND ABDOMEN/PELVIS CT COMPARED WITH A STANDARD PROTOCOL. RADIATION PROTECTION DOSIMETRY 2021; 196:190-198. [PMID: 34635920 DOI: 10.1093/rpd/ncab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to examine radiation doses and image quality of a low-dose (LD) protocol for chest and abdomen/pelvis (CAP) CT compared with a standard (STD) protocol. A total of 361 patients were included between October 2019 and April 2020; 104 patients with LD-protocol (100 kV, ref mAs 80 (chest)/145 (abdomen/pelvis)) and 257 patients with STD-protocol (100 kV, ref mAs 100 (chest)/180 (abdomen/pelvis)) at second-generation dual-source CT. Radiation doses for CTDIvol and DLP, and objective and subjective image qualities of 50 examinations from each group were evaluated. The LD-protocol applied significantly lower radiation doses compared with the STD-protocol (p < 0.001), achieving a dose reduction by 37% for the median DLP in chest, 19% in abdomen/pelvis and 22% in total. Median total DLP was 342 mGy·cm (LD) vs. 436 mGy·cm (STD). The LD-CAP CT protocol achieved a significant dose reduction far below national diagnostic reference levels, ensuring acceptable and good image quality.
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Affiliation(s)
- Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Kai Nassenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Axel Wetter
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
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18
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Viry A, Bize J, Trueb PR, Ott B, Racine D, Verdun FR, LeCoultre R. ANNUAL EXPOSURE OF THE SWISS POPULATION FROM MEDICAL IMAGING IN 2018. RADIATION PROTECTION DOSIMETRY 2021; 195:289-295. [PMID: 33647105 PMCID: PMC8507460 DOI: 10.1093/rpd/ncab012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/18/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
Nationwide surveys on radiation dose to the population from medical imaging are recommended in order to follow trends in population exposure. The goal of the 2018 survey was to investigate the current exposure. The invoice coding information was collected in five university hospitals and large clinics. To improve the estimation of the effective dose delivered in computed tomography (CT), we collected dose data from different Dose Archiving Communication Systems. On average, we found that 1.2 radiological examinations per year and per inhabitant were performed. Dental radiography was the most frequent examination (48% of all the X-ray examinations), followed by conventional radiography (36%) and CT (11%). The average annual effective dose was estimated to be 1.48 mSv per inhabitant, with CT representing 64% of that dose. Our results show that the exposure of the Swiss population from medical imaging has remained stable since 2013, despite a 15% increase in the number of CT examinations.
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Affiliation(s)
| | - Julie Bize
- Institute of Radiation Physics (IRA), Lausanne University Hospital, Lausanne, Switzerland
| | - Philipp R Trueb
- Radiation Protection Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Barbara Ott
- Radiation Protection Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Damien Racine
- Institute of Radiation Physics (IRA), Lausanne University Hospital, Lausanne, Switzerland
| | - Francis R Verdun
- Institute of Radiation Physics (IRA), Lausanne University Hospital, Lausanne, Switzerland
| | - Régis LeCoultre
- University of Health Sciences (HESAV), University of Applied Sciences Western Switzerland (HES-SO), Lausanne, Switzerland
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19
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Schmehl L, Hönning A, Asmus A, Kim S, Mutze S, Eisenschenk A, Goelz L. Incidence and underreporting of osseous wrist and hand injuries on whole-body computed tomographies at a level 1 trauma center. BMC Musculoskelet Disord 2021; 22:866. [PMID: 34635079 PMCID: PMC8507366 DOI: 10.1186/s12891-021-04754-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the incidence of osseous wrist and hand injuries on whole-body computed tomographies (WBCT) at an urban maximum-care trauma center, to report the number of missed cases in primary radiology reports, and to develop an algorithm for improved detection of these injuries. METHODS Retrospective analysis reviewing all WBCT for a period of 8 months for osseous wrist and hand injuries. (1) Reconstruction of hands/wrists in three planes (thickness 1-2 mm) and analysis by a blinded musculoskeletal radiologist. (2) Scanning of primary radiology reports and comparison to the re-evaluation. (3) Calculation of the diagnostic accuracy of WBCT during primary reporting. (4) Search for factors potentially influencing the incidence (trauma mechanism, associated injuries, Glasgow Coma Scale, artifacts). (5) Development of an algorithm to improve the detection rate. RESULTS Five hundred six WBCT were included between 01/2020 and 08/2020. 59 (11.7%) WBCT showed 92 osseous wrist or hand injuries. Distal intra-articular radius fractures occurred most frequently (n = 24, 26.1%); 22 patients (37.3%) showed multiple injuries. The sensitivity of WBCT in the detection of wrist and hand fractures during primary evaluation was low with 4 positive cases identified correctly (6.8%; 95% CI 1.9 to 16.5), while the specificity was 100% (95% CI 99.2 to 100.0). Forty-three cases (72.9%) were detected on additional imaging after clinical reassessment. Twelve injuries remained undetected (20.3%). Motorcycle accidents were more common in positive cases (22.0% vs. 10.1%, p = 0.006). 98% of positive cases showed additional fractures of the upper and/or lower extremities, whereas 37% of the patients without osseous wrist and hand injuries suffered such fractures (p < 0.001). The remaining investigated factors did not seem to influence the occurrence. CONCLUSION Osseous wrist and hand injuries are present in 11.7% on WBCT after polytrauma. 93.2% of injuries were missed primarily, resulting in a very low sensitivity of WBCT during primary reporting. Motorcycle accidents might predispose for these injuries, and they often cause additional fractures of the extremities. Clinical re-evaluation of patients and secondary re-evaluation of WBCT with preparation of dedicated multiplanar reformations are essential in polytrauma cases to detect osseous injuries of wrist and hand reliably. TRIAL REGISTRATION The study was registered prospectively on November 17th, 2020, at the German register for clinical trials (DRKS-ID: DRKS00023589 ).
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Affiliation(s)
- L Schmehl
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - A Hönning
- Center for Clinical Research, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - A Asmus
- Department of Hand-, Replantation- and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - S Kim
- Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
| | - S Mutze
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - A Eisenschenk
- Department of Hand-, Replantation- and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
- Department of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
| | - L Goelz
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
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20
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Galetin T, Merres J, Schieren M, Marks B, Haffke Y, Defosse J, Wappler F, Koryllos A, Stoelben E. Most patient conditions do not a priori debilitate the sensitivity of thoracic ultrasound in thoracic surgery-a prospective comparative study. J Cardiothorac Surg 2021; 16:75. [PMID: 33849605 PMCID: PMC8045207 DOI: 10.1186/s13019-021-01454-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background The few existing studies on the accuracy of lung ultrasound in the detection of a postoperative pneumothorax after thoracic surgery differ in the sonographic technique and the inclusion criteria. Several conditions are considered unfavourable in the sonographic examination of the lung. We aim to test these conditions for their impact on the diagnostic accuracy of lung ultrasound. Methods We compared lung ultrasound and chest roentgenograms for the detection of a pneumothorax after lung-resecting surgery in two prospective trials (register ID DRKS00014557 and DRKS00020216). The ultrasound examiners and radiologists were blinded towards the corresponding findings. We performed posthoc subgroup analyses to determine the influence of various patient or surgery related conditions on the sensitivity and specificity of ultrasound in the detection of pneumothorax. Results We performed 340 examinations in 208 patients. The covariates were age, gender, body mass index, smoking status, severity of chronic obstructive pulmonary disease, previous ipsilateral operation or irradiation, thoracotomy, postoperative skin emphysema, indwelling chest tube and X-ray in supine position. In univariate analysis, an indwelling chest-tube was associated with a higher sensitivity (58%, p = 0.04), and a postoperative subcutaneous emphysema with a lower specificity (73% vs. 88%, p = 0.02). None of the other subgroups differed in sensitivity or specificity from the total population . Conclusions Most of the patient- or surgery related conditions usually considered unfavourable for lung ultrasound did not impair the sensitivity or specificity of lung ultrasound. Further studies should not excluce patients with these conditions, but test the accuracy under routine conditions. Trial registration DRKS, DRKS00014557, registered 06/09/2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014557 and DRKS00020216, registered 03/12/2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020216 Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01454-6.
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Affiliation(s)
- Thomas Galetin
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Julika Merres
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Benjamin Marks
- Department of Radiology, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Yves Haffke
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Jerome Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Aris Koryllos
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Erich Stoelben
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
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21
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Kónya S, Natarajan TRS, Allouch H, Nahleh KA, Dogheim OY, Boehm H. Convolutional neural network-based automated segmentation and labeling of the lumbar spine X-ray. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:136-143. [PMID: 34194159 PMCID: PMC8214241 DOI: 10.4103/jcvjs.jcvjs_186_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE This study investigated the segmentation metrics of different segmentation networks trained on 730 manually annotated lateral lumbar spine X-rays to test the generalization ability and robustness which are the basis of clinical decision support algorithms. METHODS Instance segmentation networks were compared to semantic segmentation networks based on different metrics. The study cohort comprised diseased spines and postoperative images with metallic implants. RESULTS However, the pixel accuracies and intersection over union are similarly high for the best performing instance and semantic segmentation models; the observed vertebral recognition rates of the instance segmentation models statistically significantly outperform the semantic models' recognition rates. CONCLUSION The results of the instance segmentation models on lumbar spine X-ray perform superior to semantic segmentation models in the recognition rates even by images of severe diseased spines by allowing the segmentation of overlapping vertebrae, in contrary to the semantic models where such differentiation cannot be performed due to the fused binary mask of the overlapping instances. These models can be incorporated into further clinical decision support pipelines.
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Affiliation(s)
- Sándor Kónya
- Center for Diagnostic and Interventional Radiology and Neuroradiology, Bad Berka, Germany
| | | | - Hassan Allouch
- Department of Spinal Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Kais Abu Nahleh
- Department of Spinal Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Omneya Yakout Dogheim
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Alexandria, Egypt
| | - Heinrich Boehm
- Department of Spinal Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
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22
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Hunger T, Nekolla E, Griebel J, Brix G. [Scientific assessment and regulatory approval of radiological screening examinations in Germany]. Radiologe 2021; 61:21-27. [PMID: 33044561 DOI: 10.1007/s00117-020-00758-3] [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: 10/23/2022]
Abstract
BACKGROUND Radiologic imaging technologies like computed tomography (CT) have the potential to screen for various diseases. The potential benefits of screening are always associated with risks, particularly from the application of ionizing radiation. MATERIALS AND METHODS The International Basic Safety Standards as well as the Council Directive 2013/59/Euratom have set guidelines for the application of ionizing radiation in early detection which were transposed into the German Radiation Protection Law. Accordingly, the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU) approves screening examinations on a generic level, based on a scientific report provided by the German Federal Office for Radiation Protection (BfS), and defines in a federal statutory ordinance which type of screening is permissible for detecting a disease for a particular group of persons and under which conditions. RESULTS With exception of the mammography screening programme, no radiological examination for the early detection of disease has been approved in Germany to date. However, such screenings are currently being offered in Germany. The BfS is currently conducting a scientific evaluation for lung cancer screening with low-dose CT. CONCLUSIONS Screening examinations with radiological imaging can only be approved when studies with the highest level of evidence have demonstrated that the benefits outweigh the risks. To translate this favourable benefit-risk balance into general health care, strict requirements for the entire screening process including quality assurance must be defined.
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Affiliation(s)
- T Hunger
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland.
| | - E Nekolla
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
| | - J Griebel
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
| | - G Brix
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
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23
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Nadjiri J, Geith T, Waggershauser T, Heuser L, Morhard D, Bücker A, Paprottka PM. [Comparison of radiation exposure in common hepatic interventions : A retrospective analysis of DeGIR registry data]. Radiologe 2021; 61:80-86. [PMID: 32816049 PMCID: PMC7810650 DOI: 10.1007/s00117-020-00737-8] [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] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Hintergrund Die transarterielle Chemoembolisation (TACE) oder auch Gallenganginterventionen stellen häufige Leberinterventionen dar. Ziel der Arbeit In dieser retrospektiven Studie soll die Strahlenexposition der Patienten mit einem hepatischen Eingriff in Abhängigkeit von Art und Feinziel der Intervention analysiert und verglichen werden. Material und Methoden Dies ist eine Analyse von 7003 DeGIR-Registerdatensätzen aus den Jahren 2016 bis 2018 für TACE und Gallenganginterventionen. Das Dosisflächenprodukt (DFP) und die Durchleuchtungszeit (DL) sowie die Interventionsart und das anatomisch definierte Feinziel der Interventionen wurden erfasst. Ergebnisse Insgesamt lagen Dosiswerte für 4985 durchgeführte TACE und 2018 Gallenganginterventionen vor. Bei Gallenganginterventionen lag der Median des DFP bei 2594 (Interquartilbereich [IQR] = 1174–5858) cGy*cm2. Bei der TACE betrug der Median des DFP 11.632 [IQR = 5530–22.800] cGy*cm2 und lag damit signifikant höher als bei Gallenganginterventionen (p < 0,0001). Gallengangeingriffe mit dem höchsten DFP sind Interventionen am Ductus hepaticus, während Eingriffe mit der längsten DL an der Hepatikusgabel stattfinden. Diskussion Die individuelle Strahlendosis für einen Patienten bei einer Leberintervention hängt weniger von der Komplexität des Eingriffs bzw. Durchleuchtungszeit ab, sondern von der Art des Eingriffs und vom Feinziel der Intervention. Die vorliegenden Dosisdaten können eine Hilfe sein, die Strahlenexposition bei einer Leberintervention bereits vor dem Eingriff grob abzuschätzen.
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Affiliation(s)
- Jonathan Nadjiri
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland.
| | - Tobias Geith
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
| | - Tobias Waggershauser
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
| | | | - Dominik Morhard
- Radiologie und Neuroradiologie, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Deutschland
| | - Arno Bücker
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum der Universität des Saarlandes, Homburg /Saar, Deutschland
| | - Philipp M Paprottka
- Sektion für Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, München, Deutschland
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24
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Gossner J. Early Detection of Breast Cancer is an Important Byproduct of Computed Tomography of the Chest. Eur J Breast Health 2020; 16:298-299. [PMID: 33062973 DOI: 10.5152/ejbh.2020.5743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Johannes Gossner
- Evangelisches Krankenhaus Göttingen-Weende, Diagnostic and Interventional Radiology, Göttingen, Germany
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25
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Highly reduced-dose CT of the lumbar spine in a human cadaver model. PLoS One 2020; 15:e0240199. [PMID: 33031418 PMCID: PMC7544118 DOI: 10.1371/journal.pone.0240199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Feasibility of a highly reduced-dose lumbar spine CT protocol using iterative reconstruction (IR) in a human cadaver model. Materials and methods The lumbar spine of 20 human cadavers was repeatedly examined using three different reduced-dose protocols (RDCT) with decreasing reference tube current-exposure time products (RDCT-1: 50 mAs; RDCT-2: 30 mAs; RDCT-3: 10 mAs) at a constant tube voltage of 140 kV. A clinical standard-dose protocol (SDCT) served as the reference (reference tube current–exposure time product: 70 mAs; tube voltage: 140 kV). Images were reconstructed using filtered back projection (FBP) and two increasing levels of IR: IRL4 and IRL6. A five-point scale was used by two observers to assess the diagnostic quality of anatomical structures (cortical and trabecular bone, intervertebral foramina, pedicles and intervertebral joints, spinous and transverse processes). Objective image noise (OIN) was measured. Results were interpreted using a linear mixed-effects regression model. Results RDCT-2 with IRL6 (1.2 ± 0.5mSv) was the lowest reduced-dose protocol which provided diagnostically acceptable and equivalent image quality compared to the SDCT (2.3 ± 1.1mSV) with FBP (p > 0.05). All RDCT protocols achieved a significant reduction of the mean (±SD) effective radiation doses (RDCT-1: 1.7±0.9mSv; RDCT-2: 1.2±0.5mSv; RDCT-3: 0.4±0.2mSv; p < 0.05) compared to SDCT. OIN was lower in all RDCT protocols with the application of IRL4 and IRL6, compared to the SDCT with FBP (p < 0.05). Conclusion Highly reduced-dose lumbar spine CT providing diagnostically acceptable image quality is feasible using IR in this cadaver model and may be transferred into a clinical setting.
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Kaatsch HL, Majewski M, Schrock G, Obermair R, Seidel J, Nestler K, Abend M, Waldeck S, Port M, Ullmann R, Becker BV. CT Irradiation-induced Changes of Gene Expression within Peripheral Blood Cells. HEALTH PHYSICS 2020; 119:44-51. [PMID: 32167501 DOI: 10.1097/hp.0000000000001231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Computed tomography (CT) is a crucial element of medical imaging diagnostics. The widespread application of this technology has made CT one of the major contributors to medical radiation burden, despite the fact that doses per individual CT scan steadily decrease due to the advancement of technology. Epidemiological risk assessment of CT exposure is hampered by the fact that moderate adverse effects triggered by low doses of CT exposure are likely masked by statistical fluctuations. In light of these limitations, there is need of further insights into the biological processes induced by CT scans to complement the existing knowledge base of risk assessment. This prompted us to investigate the early transcriptomic response of ex vivo irradiated peripheral blood of three healthy individuals. Samples were irradiated employing a modern dual-source-CT-scanner with a tube voltage of 150 kV, resulting in an estimated effective dose of 9.6 mSv. RNA was isolated 1 h and 6 h after exposure, respectively, and subsequently analyzed by RNA deep sequencing. Differential gene expression analysis revealed shared upregulation of AEN, FDXR, and DDB2 6 h after exposure in all three probands. All three genes have previously been discussed as radiation responsive genes and have already been implicated in DNA damage response and cell cycle control after DNA damage. In summary, we substantiated the usefulness of AEN, FDXR, and DDB2 as RNA markers of low dose irradiation. Moreover, the upregulation of genes associated with DNA damage reminds one of the genotoxic nature of CT diagnostics even with the low doses currently applied.
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Affiliation(s)
- Hanns Leonhard Kaatsch
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstrasse 11, 80937, Munich, Germany
| | - Matthäus Majewski
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstrasse 11, 80937, Munich, Germany
| | - Gerrit Schrock
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstrasse 11, 80937, Munich, Germany
| | - Richard Obermair
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstrasse 11, 80937, Munich, Germany
| | - Jillyen Seidel
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstrasse 11, 80937, Munich, Germany
| | - Kai Nestler
- Bundeswehr Central Hospital Koblenz, Department of Radiology, Rübenacher Straße 170, 56072 Koblenz, Germany
| | - Michael Abend
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstrasse 11, 80937, Munich, Germany
| | - Stephan Waldeck
- Bundeswehr Central Hospital Koblenz, Department of Radiology, Rübenacher Straße 170, 56072 Koblenz, Germany
| | - Matthias Port
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstrasse 11, 80937, Munich, Germany
| | - Reinhard Ullmann
- Bundeswehr Institute of Radiobiology affiliated to the University of Ulm, Neuherbergstrasse 11, 80937, Munich, Germany
| | - Benjamin Valentin Becker
- Bundeswehr Central Hospital Koblenz, Department of Radiology, Rübenacher Straße 170, 56072 Koblenz, Germany
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Nestler K, Becker BV, Majewski M, Veit DA, Krull BF, Waldeck S. Additional CTA-Subtraction Technique in Detection of Pulmonary Embolism-a Benefit for Patients or Only an Increase in Dose? HEALTH PHYSICS 2020; 119:148-152. [PMID: 32371851 DOI: 10.1097/hp.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Latest advantages in computed tomography (CT) come with enhanced diagnostic imaging and also sophisticated dose reduction techniques. However, overall exposure to ionizing radiation of patients in Germany rises slightly, which is mainly based on the growing number of performed CT scans. Furthermore, new possibilities in modern imaging, including 4D scans or perfusion protocols, offer new medical insights but require additional scans.In this study, we reevaluated data sets from patients undergoing CT examinations because of suspected pulmonary embolism and compared doses and diagnostic results of the standard protocol to the additional modern CT subtraction technique. Two groups of single-blinded radiologists were provided with CT data sets from 50 patients. One group (G1) had access to full datasets including CT subtraction with perfusion map. The other group (G2) only evaluated conventional CT angiography. Results were compared to final clinical diagnosis. Dose length product (DLP) of CT angiography was compared to CT subtraction technique, which consists of an additional non-contrast-enhanced scan and perfusion map. Effective dose was calculated using a Monte Carlo simulation-based software tool (ImpactDose). Inter-rater agreement of both groups was strong in G1 with κ = .896 and minimal in G2 (κ = .307). Agreement to final diagnosis was strong in both groups (G1, κ = .848; G2, κ = .767). Doses applied using the CT subtraction technique were 34.8% higher than for CT angiography alone (G1 DLP 337.6 ± 171.3 mGy x cm; G2 DLP 220.2 ± 192.8 mGy x cm; p < .001). Calculated effective dose was therefore significantly higher for G1 (G1 4.82 ± 2.20 mSv; G2 3.04 ± 1.33 mSv; p < .001). Our results indicate a benefit of the CT subtraction technique for the detection of pulmonary embolisms in clinical routine, accompanied by an increase in the dose administered. Although CT protocols should always be applied carefully to specific clinical indications in order to maximize the potential for dose reduction and keep the administered dose as low as reasonably achievable, one should never lose sight of the diagnostic benefit, especially in vital clinical indications.
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Affiliation(s)
| | - Benjamin Valentin Becker
- German Federal Armed Forces Central Hospital Koblenz, Department for Radiology and Neuroradiology, Koblenz, Germany
| | - Matthäus Majewski
- Bundeswehr Institute for Radiobiology affiliated to Ulm University, Munich, Germany
| | - Daniel Anton Veit
- German Federal Armed Forces Central Hospital Koblenz, Department for Radiology and Neuroradiology, Koblenz, Germany
| | - Bastian Felix Krull
- German Federal Armed Forces Central Hospital Koblenz, Department for Radiology and Neuroradiology, Koblenz, Germany
| | - Stephan Waldeck
- German Federal Armed Forces Central Hospital Koblenz, Department for Radiology and Neuroradiology, Koblenz, Germany
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Poehler GH, Alikhani B, Klimes F, Hauck EF, Ringe KI, Sonnow L, Wacker F, Raatschen HJ. Impact of active dose management on radiation exposure and image quality in computed tomography: An observational study in 1315 patients. Eur J Radiol 2020; 125:108900. [DOI: 10.1016/j.ejrad.2020.108900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/17/2022]
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Hingst V, Weber MA. [Dental X-ray diagnostics with the orthopantomography - Technique and typical imaging results]. Radiologe 2020; 60:77-92. [PMID: 31919535 DOI: 10.1007/s00117-019-00620-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite the increasing use of modern digital cross-sectional imaging techniques (especially digital volume tomography) in dental X‑ray examinations, orthopantomography remains the widely available, commonly used basic imaging modality for evaluating dental status prior to extensive treatment. It is also used for inflammatory and tumorous odontogenic osseous pathologies which are demonstrated with typical imaging findings. The classical X‑ray tomography principle has been further developed for the presentation of the differently wide, shape variants of dental arches. The examination unit, consisting of a rigidly connected X‑ray tube and detector, runs on an elliptical path around the facial skull. Thereby different rotation centers are controlled. Due to the different distances of the jaw sections to the X‑ray tube and the image receiver, differencing velocities result and thus blurring effects as the basis of the layer or slice representation. Slit collimators lead to a narrow and continuous line-like representation of the different widths of the dental arch.
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Affiliation(s)
- V Hingst
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Zentrum für Radiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 5, 18055, Rostock, Deutschland.
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Zentrum für Radiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 5, 18055, Rostock, Deutschland
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Oestreicher U, Endesfelder D, Gomolka M, Kesminiene A, Lang P, Lindholm C, Rößler U, Samaga D, Kulka U. Automated scoring of dicentric chromosomes differentiates increased radiation sensitivity of young children after low dose CT exposure in vitro. Int J Radiat Biol 2018; 94:1017-1026. [PMID: 30028637 DOI: 10.1080/09553002.2018.1503429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/28/2018] [Accepted: 06/29/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Automated detection of dicentric chromosomes from a large number of cells was applied to study age-dependent radiosensitivity after in vitro CT exposure of blood from healthy donors. MATERIALS AND METHODS Blood samples from newborns, children (2-5 years) and adults (20-50 years) were exposed in vitro to 0 mGy, 41 mGy and 978 mGy using a CT equipment. In this study, automated scoring based on 13,000-31,000 cells/dose point/age group was performed. Results for control and low dose points were validated by manually counting about 26,000 cells/dose point/age group. RESULTS For all age groups, the high number of analyzed cells enabled the detection of a significant increase in the frequency of radiation induced dicentric chromosomes in cells exposed to 41 mGy as compared to control cells. Moreover, differences between the age groups could be resolved for the low dose: young donors showed significantly increased risk for induced dicentrics at 41 mGy compared to adults. CONCLUSIONS The results very clearly demonstrate that the automated dicentric scoring method is capable of discerning radiation induced biomarkers in the low dose range (<100 mGy) and thus may open possibilities for large-scale molecular epidemiology studies in radiation protection.
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Affiliation(s)
- Ursula Oestreicher
- a Federal Office for Radiation Protection (BfS) , Oberschleissheim , Germany
| | - David Endesfelder
- a Federal Office for Radiation Protection (BfS) , Oberschleissheim , Germany
| | - Maria Gomolka
- a Federal Office for Radiation Protection (BfS) , Oberschleissheim , Germany
| | | | - Peter Lang
- c Department of Radiation Oncology , University Hospital, LMU , Munich , Germany
| | - Carita Lindholm
- d Radiation and Nuclear Safety Authority, STUK , Helsinki , Finland
| | - Ute Rößler
- a Federal Office for Radiation Protection (BfS) , Oberschleissheim , Germany
| | - Daniel Samaga
- a Federal Office for Radiation Protection (BfS) , Oberschleissheim , Germany
- e Research Unit Radiation Cytogenetics , Helmholtz Zentrum Muenchen , Oberschleissheim , Germany
| | - Ulrike Kulka
- a Federal Office for Radiation Protection (BfS) , Oberschleissheim , Germany
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[Magnetic resonance imaging : Recent studies on biological effects of static magnetic and high‑frequency electromagnetic fields]. Radiologe 2017; 57:563-568. [PMID: 28555348 DOI: 10.1007/s00117-017-0260-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PROBLEM During the last few years, new studies on biological effects of strong static magnetic fields and on thermal effects of high-frequency electromagnetic fields used in magnetic resonance imaging (MRI) were published. Many of these studies have not yet been included in the current safety recommendations. METHOD Scientific publications since 2010 on biological effects of static and electromagnetic fields in MRI were researched and evaluated. RESULTS New studies confirm older publications that have already described effects of static magnetic fields on sensory organs and the central nervous system, accompanied by sensory perceptions. A new result is the direct effect of Lorentz forces on ionic currents in the semicircular canals of the vestibular system. Recent studies of thermal effects of high-frequency electromagnetic fields were focused on the development of anatomically realistic body models and a more precise simulation of exposure scenarios. RECOMMENDATION FOR PRACTICE Strong static magnetic fields can cause unpleasant sensations, in particular, vertigo. In addition, they can influence the performance of the medical staff and thus potentially endanger the patient's safety. As a precaution, medical personnel should move slowly within the field gradient. High-frequency electromagnetic fields lead to an increase in the temperature of patients' tissues and organs. This should be considered especially in patients with restricted thermoregulation and in pregnant women and neonates; in these cases exposure should be kept as low as possible.
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