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Lortie J, Gage G, Rush B, Heymsfield SB, Szczykutowicz TP, Kuchnia AJ. The effect of computed tomography parameters on sarcopenia and myosteatosis assessment: a scoping review. J Cachexia Sarcopenia Muscle 2022; 13:2807-2819. [PMID: 36065509 PMCID: PMC9745495 DOI: 10.1002/jcsm.13068] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/21/2022] [Accepted: 07/20/2022] [Indexed: 12/15/2022] Open
Abstract
Computed tomography (CT) is a valuable assessment method for muscle pathologies such as sarcopenia, cachexia, and myosteatosis. However, several key underappreciated scan imaging parameters need consideration for both research and clinical use, specifically CT kilovoltage and the use of contrast material. We conducted a scoping review to assess these effects on CT muscle measures. We reviewed articles from PubMed, Scopus, and Web of Science from 1970 to 2020 on the effect of intravenous contrast material and variation in CT kilovoltage on muscle mass and density. We identified 971 articles on contrast and 277 articles on kilovoltage. The number of articles that met inclusion criteria for contrast and kilovoltage was 11 and 7, respectively. Ten studies evaluated the effect of contrast on muscle density of which nine found that contrast significantly increases CT muscle density (arterial phase 6-23% increase, venous phase 19-57% increase, and delayed phase 23-43% increase). Seven out of 10 studies evaluating the effect of contrast on muscle area found significant increases in area due to contrast (≤2.58%). Six studies evaluating kilovoltage on muscle density found that lower kilovoltage resulted in a higher muscle density (14-40% increase). One study reported a significant decrease in muscle area when reducing kilovoltage (2.9%). The use of contrast and kilovoltage variations can have dramatic effects on skeletal muscle analysis and should be considered and reported in CT muscle analysis research. These significant factors in CT skeletal muscle analysis can alter clinical and research outcomes and are therefore a barrier to clinical application unless better appreciated.
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Affiliation(s)
- Jevin Lortie
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Grace Gage
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Benjamin Rush
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | | | - Adam J Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Optimization of the Parameters for the Test Bolus Technique in Computed Tomography Angiography of Head and Neck. J Comput Assist Tomogr 2022; 46:257-263. [PMID: 35297582 DOI: 10.1097/rct.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to optimize low-dose scanning protocols for the test bolus technique in 64-detector computed tomography (CT) angiography (CTA) of the head and neck. METHODS A total of 250 patients were randomly divided into 5 groups of 50 patients each: conventional group (group A: 120 kV, 100 mA) and low-dose groups (group B: 100 kV, 100 mA; group C: 100 kV, 50 mA; group D: 80 kV, 100 mA; and group E: 80 kV, 50 mA). Subjective scores and objective measurements (CT values of the aortic arch, image noise, and signal-to-noise ratio) were used to evaluate the image quality and compare the radiation doses of the 5 groups. RESULTS The image quality of the 5 groups met the diagnostic requirements, with no significant difference in the subjective evaluation findings (P > 0.05). There were significant differences in the CT values between the conventional group and low-dose groups (P < 0.05); however, there was no significant difference between groups B and C and between groups D and E (P > 0.05). Moreover, the volume CT dose index and dose length product of groups B, C, D, and E decreased by 37.62%, 70.45%, 65.28%, and 83.39%, respectively, compared with those of group A. Although the image noise of the low-dose groups increased, an appropriate reduction in the tube voltage enhanced the contrast medium-induced x-ray attenuation and increased the CT value, which resulted in a nonsignificant difference in the signal-to-noise ratio. Therefore, the image quality of the low-dose groups was not affected compared with that of the conventional group. CONCLUSIONS In the test bolus technique in 64-detector CTA, the low-dose protocol of using 80 kV and 50 mA reduces the radiation dose by 83.39% compared with the conventional scan, without affecting the image quality.
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Wang Y, Chen Y, Liu P, Lv W, Wu J, Wei M, Shi D, Wu X, Liu W, Tao X, Hu H, Ma X, Yang X, Xue H, Jin Z. Clinical effectiveness of contrast medium injection protocols for 80-kV coronary and craniocervical CT angiography-a prospective multicenter observational study. Eur Radiol 2022; 32:3808-3818. [PMID: 35103828 DOI: 10.1007/s00330-021-08505-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/22/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Decreasing X-ray tube voltage is an effective way to reduce radiation and contrast dose, especially in non-obese patients. The current study focuses on CTA in non-obese patients to evaluate image quality and feasibility of 80-kV acquisition protocols with varying iodine delivery rates (IDR) and contrast concentrations in routine clinical practice. METHODS A prospective observational study in patients ≥ 18 years and ≤ 90 kg referred for coronary or craniocervical CTA at 10 centers in China (ClinicalTrials.gov: NCT02840903). Patients were divided into four groups: a standard 100-kV protocol (370 mgI/ml, IDR 1.48 gI/s), and three 80-kV protocols (370 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 0.96gI/s). The primary outcome was contrast opacification of target vascular segments. Secondary outcomes were image quality (contrast-to-noise ratio, signal-to-noise ratio, visual image quality, and diagnostic confidence assessment), radiation, and iodine dose. RESULTS From July 2016 to July 2017, 1213 patients were enrolled: 614 coronary and 599 craniocervical CTA. The mean contrast opacification was ≥ 300 HU for 80-kV 1.2 gI/s IDR scanned segments; IDR 0.96 gI/s led to lower opacification. Image quality and diagnostic confidence were fair to excellent (≥ 98% of images), despite lower contrast-to-noise ratios and signal-to-noise ratios in 80-kV images. Compared to the standard protocol, 80-kV protocols led to 44-52% radiation dose reductions (p < 0.001) and 19% iodine dose reductions (p < 0.001). CONCLUSION Eighty-kilovolt 1.2 gI/s IDR protocols can be recommended for coronary and craniocervical CTA in non-obese patients, reducing radiation and iodine dose without compromising image quality. KEY POINTS • Using low-voltage scanning CTA protocols, in which tube voltage and iodine delivery rate are reduced proportionally (voltage: 80 kV, IDR: 1.2 gI/s), reduces radiation and contrast dose without compromising image quality in routine clinical practice. • Reducing iodine delivery rate beyond direct proportionality to tube voltage is not beneficial.
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Affiliation(s)
- Yining Wang
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Yu Chen
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Peijun Liu
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Wan Lv
- The First People's Hospital of Yulin, # 495, JiaoYu Central Road, Yulin, 537000, Guangxi, China
| | - Jianlin Wu
- Affiliated Zhongshan Hospital of Dalian University, # 6, Jiefang Road Zhongshan District, Dalian, 116001, Liaoning, China
| | - Mengqi Wei
- The First Affiliated Hospital of Air Force Medical University, # 15 Changle West Road, Xian, 710032, Shanxi, China
| | - Dapeng Shi
- Henan Provincial People's Hospital, # 7, Weiwu Road, Zhengzhou, 450000, Henan, China
| | - Xianheng Wu
- The Second People's Hospital of Shantou, # 28, Waimalu Road, Shantou, 515031, Guangdong, China
| | - Wenya Liu
- The First Affiliated Hospital of Xinjiang Medical University, # 137, Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Xiaofeng Tao
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, # 639, Zaoju Road, Shanghai, 200011, China
| | - Hongjie Hu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun East Road, Hangzhou, 310016, Zhejiang, China
| | - Xiangxing Ma
- Qilu Hospital of Shandong University (Qingdao), North District, # 758, Hefei Road, Qingdao, 266035, Shandong, China
| | - Xiaozheng Yang
- Medical Affairs, Bayer Healthcare Co. Ltd, Dongshanhuan Central Road, Beijing, 100010, China
| | - Huadan Xue
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Zhengyu Jin
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China.
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Image quality comparison of single-energy and dual-energy computed tomography for head and neck patients: a prospective randomized study. Eur Radiol 2022; 32:7700-7709. [PMID: 35441839 PMCID: PMC9668949 DOI: 10.1007/s00330-022-08689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim of this study was to compare the quality of images obtained using single-energy computed tomography (SECT) performed with automated tube voltage adaptation (TVA) with dual-energy CT (DECT) weighted average images. METHODS Eighty patients were prospectively randomized to undergo either SECT with TVA (n = 40, ref. mAs 200) or radiation dose-matched DECT (n = 40, 80/Sn150 kV, ref. mAs tube A 91/tube B 61) on a dual-source CT scanner. Objective image quality was evaluated as dose-normalized contrast-to-noise ratio (CNRD) for the jugular veins relative to fatty tissue and muscle tissue and for muscle tissue relative to fatty issue. For subjective image quality, reproduction of anatomical structures, image artifacts, image noise, spatial resolution, and overall diagnostic acceptability were evaluated at sixteen anatomical substructures using Likert-type scales. RESULTS Effective radiation dose (ED) was comparable between SECT and DECT study groups (2.9 ± 0.6 mSv/3.1 ± 0.7 mSv, p = 0.5). All examinations were rated as excellent or good for clinical diagnosis. Compared to the CNRD in the SECT group, the CNRD in the DECT group was significantly higher for the jugular veins relative to fatty tissue (7.51/6.08, p < 0.001) and for muscle tissue relative to fatty tissue (4.18/2.90, p < 0.001). The CNRD for the jugular veins relative to muscle tissue (3.33/3.18, p = 0.51) was comparable between groups. Image artifacts were less pronounced and overall diagnostic acceptability was higher in the DECT group (all p = 0.01). CONCLUSIONS DECT weighted average images deliver higher objective and subjective image quality than SECT performed with TVA in head and neck imaging. KEY POINTS • Weighted average images derived from dual-energy CT deliver higher objective and subjective image quality than single-energy CT using automated tube voltage adaptation in head and neck imaging. • If available, dual-energy CT acquisition may be preferred over automated low tube voltage adopted single-energy CT for both malignant and non-malignant conditions.
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Chung MS, Choi YJ, Hwang JY, Yoon DH, Seo KJ, Lee JH, Baek JH. Feasibility of reduced-dose CT of the head and neck with iterative reconstruction: a phantom and prospective clinical study. Acta Radiol 2019; 60:1457-1464. [PMID: 30776905 DOI: 10.1177/0284185119830276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mi Sun Chung
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeonsangnam-do, Republic of Korea
| | - Dok Hyun Yoon
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyeong Jin Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Bron G, Scemama U, Villes V, Fakhry N, Salas S, Chagnaud C, Bendahan D, Varoquaux A. A new CT dynamic maneuver "Mouth Opened with Tongue Extended" can improve the clinical TNM staging of oral cavity and oropharynx squamous cell carcinomas. Oral Oncol 2019; 94:41-46. [PMID: 31178211 DOI: 10.1016/j.oraloncology.2019.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/12/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Cross sectional imaging is mandatory for oral cavity and oropharynx head and neck squamous cell carcinoma's (ooSCC) local extension and TNM staging. However a complex anatomy and frequent dental metallic artifacts make it difficult. This study assesses the clinical benefit of "Mouth Open with Tongue Extended" dynamic maneuver at CT (CTmote) as compared to the conventional CT (CTconv) and MRI. MATERIAL Retrospectively, 58 patients with histologically proven ooSCC (oral cavity: 34; oropharynx: 24) were included in the study. All had endoscopy with biopsies, MRI, CTconv and an CTmote acquisitions. Data were splitted in 3 datasets and 2 independent radiologists performed readings blindly. Gold standard was pTNM in 31% of cases; otherwise cTNM obtained at multidisciplinary team meeting with endoscopy and mapping biopsies were used. RESULTS CTmote was feasible for all patients including those already treated by surgery or radiotherapy. Exact TNM staging was obtained in 68%, 83%, 83% for CTconv, CTmote and MRI respectively. The best exam ratings at paired wise comparisons were 3%, 47%, 50% for CTconv, CTmote and MRI respectively. CTmote and MRI observer agreements, image quality and confidence ratings, were comparable and higher compared to CTconv (p < 0.001). CONCLUSIONS CTmote improves oral cavity and oropharynx tumour stage assessment compared to CTconv with performances close to those of MRI examination. In clinical practice, combining both CT with MOTE maneuver and MRI seems to be the optimal imaging strategy for local staging.
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Affiliation(s)
- Guillaume Bron
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille University, Marseille, France.
| | - Ugo Scemama
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille University, Marseille, France
| | - Virginie Villes
- Department of Public Healthcare EA 3279, Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
| | - Nicolas Fakhry
- Department of Otorhinolaryngology-Head and Neck Surgery, Conception Hospital, Aix-Marseille University, Marseille, France.
| | - Sebastien Salas
- Department of Oncology, Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
| | - Christophe Chagnaud
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille University, Marseille, France; Biophysics and Nuclear Medicine, European Center for Research in Medical Imaging, UMR 7339, La Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
| | - David Bendahan
- Biophysics and Nuclear Medicine, European Center for Research in Medical Imaging, UMR 7339, La Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
| | - Arthur Varoquaux
- Department of Medical Imaging, Conception University Hospital, Aix-Marseille University, Marseille, France; Biophysics and Nuclear Medicine, European Center for Research in Medical Imaging, UMR 7339, La Timone University Hospital, Aix-Marseille University, 264, Rue Saint-Pierre, 13385 Marseille, France.
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Leithner D, Wichmann JL, Mahmoudi S, Martin SS, Albrecht MH, Vogl TJ, Scholtz JE. Diagnostic yield of 90-kVp low-tube-voltage carotid and intracerebral CT-angiography: effects on radiation dose, image quality and diagnostic performance for the detection of carotid stenosis. Br J Radiol 2018; 91:20170927. [PMID: 29493282 DOI: 10.1259/bjr.20170927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To investigate the impact of low-tube-voltage 90-kVp acquisition combined with advanced modeled iterative reconstruction algorithm (Admire) on radiation exposure, image quality, artifacts, and assessment of stenosis in carotid and intracranial CT angiography (CTA). METHODS Dual-energy CTA studies of 43 patients performed on a third-generation 192-slice dual-source CT were retrospectively evaluated. Intraindividual comparison of 90-kVp and linearly blended 120-kVp equivalent image series (M_0.6, 60% 90-kVp, 40% Sn-150-kVp) was performed. Contrast-to-noise and signal-to-noise ratios of common carotid artery, internal carotid artery, middle cerebral artery, and basilar artery were calculated. Qualitative image analysis included evaluation of artifacts and suitability for angiographical assessment at shoulder level, carotid bifurcation, siphon, and intracranial by three independent radiologists. Detection and quantification of carotid stenosis were performed. Radiation dose was expressed as dose-length product (DLP). RESULTS Contrast-to-noise values of all arteries were significantly increased in 90-kVp compared to M_0.6 (p < 0.001). Suitability for angiographical evaluation was rated excellent with low artifacts for all levels in both image series. Both 90-kVp and M_0.6 showed excellent accordance for detection and grading of carotid stenosis with almost perfect interobserver agreement (carotid stenoses in 32 of 129 segments; intraclass correlation coefficient, 0.94). dose-length product was reduced by 40.3% in 90-kVp (110.6 ± 32.1 vs 185.4 ± 47.5 mGy·cm, p < 0.001). CONCLUSION 90-kVp carotid and intracranial CTA with Admire provides increased quantitative and similarly good qualitative image quality, while reducing radiation exposure substantially compared to M_0.6. Diagnostic performance for arterial stenosis detection and quantification remained excellent. Advances in knowledge: 90-kVp carotid and intracranial CTA with an advanced iterative reconstruction algorithm results in excellent image quality and reduction of radiation exposure without limiting diagnostic performance.
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Affiliation(s)
- Doris Leithner
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Julian L Wichmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Scherwin Mahmoudi
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Simon S Martin
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Moritz H Albrecht
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Thomas J Vogl
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany
| | - Jan-Erik Scholtz
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt , Frankfurt , Germany.,2 Division of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Zopfs D, Lennartz S, Laukamp K, Große Hokamp N, Mpotsaris A, Maintz D, Borggrefe J, Neuhaus V. Improved depiction of atherosclerotic carotid artery stenosis in virtual monoenergetic reconstructions of venous phase dual-layer computed tomography in comparison to polyenergetic reconstructions. Eur J Radiol 2018; 100:36-42. [DOI: 10.1016/j.ejrad.2018.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/24/2017] [Accepted: 01/06/2018] [Indexed: 11/27/2022]
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Neuhaus V, Große Hokamp N, Abdullayev N, Maus V, Kabbasch C, Mpotsaris A, Maintz D, Borggrefe J. Comparison of virtual monoenergetic and polyenergetic images reconstructed from dual-layer detector CT angiography of the head and neck. Eur Radiol 2017; 28:1102-1110. [DOI: 10.1007/s00330-017-5081-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/31/2017] [Accepted: 09/13/2017] [Indexed: 02/01/2023]
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Computed Tomography of the Head and Neck Region for Tumor Staging—Comparison of Dual-Source, Dual-Energy and Low-Kilovolt, Single-Energy Acquisitions. Invest Radiol 2017; 52:522-528. [DOI: 10.1097/rli.0000000000000377] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Chen Y, Zhang X, Xue H, Zhu Y, Wang Y, Li Y, Zhang Z, Jin Z. Head and neck angiography at 70 kVp with a third-generation dual-source CT system in patients: comparison with 100 kVp. Neuroradiology 2017; 59:1071-1081. [DOI: 10.1007/s00234-017-1901-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/01/2017] [Indexed: 11/30/2022]
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Abstract
Tumors of the head and neck are predominantly squamous cell carcinomas and those of the salivary glands are predominantly adenocarcinomas, adenoid cystic carcinomas and mucoepidermoid carcinomas. In 2011 the incidence of tumors of the oral cavity and pharynx in Germany was 6839 (5026 male and 1813 female) and of the larynx 1878 (1642 male and 236 female). The incidence of tumors of the nose and paranasal sinuses (467) and salivary glands (470) were much lower (www.krebsdaten.de/abfrage). The primary aim of imaging in head and neck cancer is staging of the disease and a precise assessment of tumor invasion. This information is essential for therapy decision-making (i. e. surgery or radiochemotherapy), planning of the extent of resection and subsequent reconstructive measures and also estimation of functional deficits after therapy. Computed tomography (CT) and magnetic resonance imaging (MRI) are the imaging modalities of choice but both have specific advantages and disadvantages. In certain cases both CT and MRI need to be performed for accurate treatment planning.
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Affiliation(s)
- M Lell
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Deutschland.
| | - K Mantsopoulos
- Hals-Nasen-Ohren-Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Deutschland
| | - W Wuest
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Deutschland
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Abstract
Tumors of the head and neck are predominantly squamous cell carcinomas and those of the salivary glands are predominantly adenocarcinomas, adenoid cystic carcinomas and mucoepidermoid carcinomas. In 2011 the incidence of tumors of the oral cavity and pharynx in Germany was 6839 (5026 male and 1813 female) and of the larynx 1878 (1642 male and 236 female). The incidence of tumors of the nose and paranasal sinuses (467) and salivary glands (470) were much lower ( www.krebsdaten.de/abfrage ). The primary aim of imaging in head and neck cancer is staging of the disease and a precise assessment of tumor invasion. This information is essential for therapy decision-making (i. e. surgery or radiochemotherapy), planning of the extent of resection and subsequent reconstructive measures and also estimation of functional deficits after therapy. Computed tomography (CT) and magnetic resonance imaging (MRI) are the imaging modalities of choice but both have specific advantages and disadvantages. In certain cases both CT and MRI need to be performed for accurate treatment planning.
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Affiliation(s)
- M Lell
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Deutschland.
| | - K Mantsopoulos
- Hals-Nasen-Ohren-Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Deutschland
| | - W Wuest
- Radiologisches Institut, Universitätsklinikum Erlangen, Maximiliansplatz 1, 91054, Erlangen, Deutschland
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Schmid AI, Uder M, Lell MM. Reaching for better image quality and lower radiation dose in head and neck CT: advanced modeled and sinogram-affirmed iterative reconstruction in combination with tube voltage adaptation. Dentomaxillofac Radiol 2016; 46:20160131. [PMID: 27540625 DOI: 10.1259/dmfr.20160131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate image quality and radiation dose in low-dose head and neck CT comparing two different commercially available iterative reconstruction algorithms: sinogram-affirmed iterative reconstruction (SAFIRE) and advanced modeled iterative reconstruction (ADMIRE) with fixed and automated tube voltage adaptation (TVA). METHODS CT examinations of 103 patients were analysed. 58 patients were examined on a single-source CT at fixed tube voltage of 120 kV and reconstructed with filtered back projection (FBP) and SAFIRE (Strength Level 3). 45 patients were examined in a single-source mode on a dual-source CT with automated TVA and reconstructed with FBP and ADMIRE (Strength Levels 2 and 3). Image noise was calculated in seven anatomical volumes of interest. Subjective evaluation of the CT images was performed using a four-grade scale. RESULTS Mean CT numbers of FBP and the corresponding iterative reconstruction did not differ significantly (p = 0.74-0.99). Image noise was lower with both iterative reconstruction techniques than with FBP (SAFIRE 3: -22.3%; ADMIRE 2: -14.9%; ADMIRE 3: -24.2%; all p < 0.05); hence, the signal-to-noise ratio and the contrast-to-noise values were higher. Subjective image quality revealed a more favourable result for the iterative reconstruction. ADMIRE 3 in combination with automated TVA showed 14.4% (p < 0.05) less image noise with a 7.5% lower radiation dose than SAFIRE 3 with fixed tube voltage. CONCLUSIONS Higher image quality at lower radiation dose can be achieved using ADMIRE in combination with automated TVA.
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Affiliation(s)
- Andrea I Schmid
- 1 Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Michael Uder
- 1 Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany.,2 Imaging Science Institute (ISI) Erlangen, Department of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany
| | - Michael M Lell
- 1 Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany.,3 Department of Radiology and Nuclear Medicine, Klinikum Nürnberg, Germany, Paracelsus Medical University
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Scholtz JE, Kaup M, Hüsers K, Albrecht MH, Bodelle B, Metzger SC, Kerl JM, Bauer RW, Lehnert T, Vogl TJ, Wichmann JL. Advanced Modeled Iterative Reconstruction in Low-Tube-Voltage Contrast-Enhanced Neck CT: Evaluation of Objective and Subjective Image Quality. AJNR Am J Neuroradiol 2016; 37:143-50. [PMID: 26427836 DOI: 10.3174/ajnr.a4502] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/10/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Dose-saving techniques in neck CT cause increased image noise that can be counteracted by iterative reconstruction. Our aim was to evaluate the image quality of advanced modeled iterative reconstruction (ADMIRE) in contrast-enhanced low-tube-voltage neck CT. MATERIALS AND METHODS Sixty-one patients underwent 90-kV(peak) neck CT by using third-generation 192-section dual-source CT. Image series were reconstructed with standard filtered back-projection and ADMIRE strength levels 1, 3, and 5. Attenuation and noise of the sternocleidomastoid muscle, internal jugular vein, submandibular gland, tongue, subscapularis muscle, and cervical fat were measured. Signal-to-noise and contrast-to-noise ratios were calculated. Two radiologists assessed image noise, image contrast, delineation of smaller structures, and overall diagnostic acceptability. Interobserver agreement was calculated. RESULTS Image noise was significantly reduced by using ADMIRE compared with filtered back-projection with the lowest noise observed in ADMIRE 5 (filtered back-projection, 9.4 ± 2.4 Hounsfield units [HU]; ADMIRE 1, 8.3 ± 2.8 HU; ADMIRE 3, 6.7 ± 2.0 HU; ADMIRE 5, 5.4 ± 1.7 HU; all, P < .001). Sternocleidomastoid SNR and internal jugular vein-sternocleidomastoid contrast-to-noise ratios were significantly higher for ADMIRE with the best results in ADMIRE 5 (all, P < .001). Subjective image quality and image contrast of ADMIRE 3 and 5 were consistently rated better than those for filtered back-projection and ADMIRE 1 (all, P < .001). Image noise was rated highest for ADMIRE 5 (all, P < .005). Delineation of smaller structures was voted higher in all ADMIRE strength levels compared with filtered back-projection (P < .001). Global interobserver agreement was good (0.75). CONCLUSIONS Contrast-enhanced 90-kVp neck CT is feasible, and ADMIRE 5 shows superior objective image quality compared with filtered back-projection. ADMIRE 3 and 5 show the best subjective image quality.
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Affiliation(s)
- J-E Scholtz
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - M Kaup
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - K Hüsers
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - M H Albrecht
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - B Bodelle
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - S C Metzger
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - J M Kerl
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - R W Bauer
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - T Lehnert
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - T J Vogl
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany
| | - J L Wichmann
- From the Department of Diagnostic and Interventional Radiology (J.-E.S., M.K., K.H., M.H.A., B.B., S.C.M., J.M.K., R.W.B., T.L., T.J.V., J.L.W.), University Hospital Frankfurt, Frankfurt, Germany Department of Radiology and Radiological Science (J.L.W.), Medical University of South Carolina, Charleston, South Carolina
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Automated tube voltage selection in thoracoabdominal computed tomography at high pitch using a third-generation dual-source scanner: image quality and radiation dose performance. Invest Radiol 2015; 50:352-60. [PMID: 25591129 DOI: 10.1097/rli.0000000000000133] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the radiation dose and image quality performance of thoracoabdominal examinations with an automated tube voltage selection (tube voltage adaptation), tube current modulation, and high pitch using a third-generation dual-source computed tomography (CT) compared intraindividually with 120-kV examinations with tube current modulation with special attention on clinically relevant lesions in the liver, the lungs, and extrahepatic soft tissues. MATERIALS AND METHODS This study was approved by the institutional review board. Computed tomography of the body was performed using a third-generation dual-source system in 95 patients (mean body mass index, 25 kg/m²; range, 18-35 kg/m²). For 49 of these patients, all calculated tube settings and resulting dose values were recorded for each of the 12 gradual contrast weightings of the tube voltage adaptation algorithm. Spiral CT was performed for all patients with an intermediate weighting (grade 7) in a portal venous phase at 120 reference kV, 180 reference mAs, and pitch of 1.55. Objective image quality was assessed on the basis of contrast-to-noise ratio. Subjective image quality was assessed on the basis of clarity and sharpness of anatomical and pathological structures as well as interfering beam hardening and spiral and motion artifacts (heart, lungs, diaphragm). Previous examinations on a 64-slice scanner served as reference. RESULTS All examinations were rated good or excellent for clinical diagnosis. Automated tube voltage selection resulted in significantly lower effective radiation dose (9.5 mSv) compared with the reference (12.0 mSv; P < 0.01). Contrast-to-noise ratio and image quality of soft tissue lesions were significantly increased (P < 0.01). Motion artifacts were significantly reduced (P < 0.01). CONCLUSIONS Automated tube voltage adaptation combined with high-pitch protocols allows for a substantial radiation dose reduction while substantially increasing the image quality, even at large-volume exposure.
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Saade C, El-Merhi F, Mayat A, Brennan PC, Yousem D. Comparison of Standard and Quadruple-Phase Contrast Material Injection for Artifacts, Image Quality, and Radiation Dose in the Evaluation of Head and Neck Cancer Metastases. Radiology 2015; 279:571-7. [PMID: 26624972 DOI: 10.1148/radiol.2015150511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate opacification of head and neck vasculature during computed tomography (CT) of supraclavicular lymph nodes with a quadruple-phase contrast media and saline dual-injection protocol. MATERIALS AND METHODS This retrospective study was institutional review board approved. In 180 consecutive patients, routine head and neck CT was performed with one of two protocols: protocol A, craniocaudal scan direction with 100 mL of contrast material injected intravenously as a single bolus; or protocol B, 100 mL of contrast material injected in four phases (phases 1-2, 60 mL of contrast material and saline injected at 2.5 mL/sec; phases 3-4, 40 mL of contrast material and saline injected at 2.5 mL/sec); both protocols had a fixed scan delay of 70 seconds. Attenuation of supraclavicular arteries and veins was measured with arteriovenous contrast ratio (AVCR) and contrast-to-noise ratio (CNR). Effective dose was calculated. Data were compared with the two-sample t test. Receiver operating characteristic (ROC) and visual grading characteristic analyses were performed. RESULTS Arterial attenuation was up to 20% higher (P < .05) after protocol B (mean ± standard deviation, 234.5 HU ± 33.2) than protocol A (160.0 HU ± 29.5). Venous system attenuation was significantly lower in protocol B (164.0 HU ± 17.0) than in protocol A (664.0 HU ± 12.0), with up to a 75% reduction (P < .0001). Protocol B generated significant (P < .0001) improvements in AVCR at multiple anatomic sites. At all anatomic levels, mean CNR with protocol B (34.4 HU ± 9.0) was significantly higher than that with protocol A (14.5 HU ± 14.0) (P < .0313). Effective dose was significantly reduced with protocol B (2.6 mSv ± 0.4 vs 3.2 mSv ± 0.8 with protocol A; P < .0041). ROC analysis demonstrated significantly higher area under the ROC curve for protocol B (P < .0022), with interreader agreement increasing from poor to excellent in lymph node visualization. CONCLUSION Significant improvement in lymph node visualization at the cervicothoracic junction is achieved with a quadruple-phase contrast media injection protocol.
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Affiliation(s)
- Charbel Saade
- From the Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon (C.S., F.E.); Department of Radiology, Campbelltown Public Hospital, Campbelltown, NSW, Australia (A.M.); Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, NSW, Australia (P.C.B.); and Department of Diagnostic Radiology, Johns Hopkins Hospital, Baltimore, Md (D.Y.)
| | - Fadi El-Merhi
- From the Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon (C.S., F.E.); Department of Radiology, Campbelltown Public Hospital, Campbelltown, NSW, Australia (A.M.); Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, NSW, Australia (P.C.B.); and Department of Diagnostic Radiology, Johns Hopkins Hospital, Baltimore, Md (D.Y.)
| | - Ahmad Mayat
- From the Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon (C.S., F.E.); Department of Radiology, Campbelltown Public Hospital, Campbelltown, NSW, Australia (A.M.); Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, NSW, Australia (P.C.B.); and Department of Diagnostic Radiology, Johns Hopkins Hospital, Baltimore, Md (D.Y.)
| | - Patrick C Brennan
- From the Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon (C.S., F.E.); Department of Radiology, Campbelltown Public Hospital, Campbelltown, NSW, Australia (A.M.); Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, NSW, Australia (P.C.B.); and Department of Diagnostic Radiology, Johns Hopkins Hospital, Baltimore, Md (D.Y.)
| | - David Yousem
- From the Department of Diagnostic Radiology, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon (C.S., F.E.); Department of Radiology, Campbelltown Public Hospital, Campbelltown, NSW, Australia (A.M.); Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, NSW, Australia (P.C.B.); and Department of Diagnostic Radiology, Johns Hopkins Hospital, Baltimore, Md (D.Y.)
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Third-generation dual-source CT of the neck using automated tube voltage adaptation in combination with advanced modeled iterative reconstruction: evaluation of image quality and radiation dose. Eur Radiol 2015; 26:2623-31. [PMID: 26560726 DOI: 10.1007/s00330-015-4099-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 02/03/2023]
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Automated tube voltage adaptation in combination with advanced modeled iterative reconstruction in thoracoabdominal third-generation 192-slice dual-source computed tomography: effects on image quality and radiation dose. Acad Radiol 2015; 22:1081-7. [PMID: 26163706 DOI: 10.1016/j.acra.2015.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate image quality and radiation exposure of portal venous-phase thoracoabdominal third-generation 192-slice dual-source computed tomography (DSCT) with automated tube voltage adaptation (TVA) in combination with advanced modeled iterative reconstruction (ADMIRE). MATERIALS AND METHODS Fifty-one patients underwent oncologic portal venous-phase thoracoabdominal follow-up CT twice within 7 months. The initial examination was performed on second-generation 128-slice DSCT with fixed tube voltage of 120 kV in combination with filtered back projection reconstruction. The second examination was performed on a third-generation 192-slice DSCT using automated TVA in combination with ADMIRE. Attenuation and image noise of liver, spleen, renal cortex, aorta, vena cava inferior, portal vein, psoas muscle, and perinephric fat were measured. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Radiation dose was assessed as size-specific dose estimates (SSDE). Subjective image quality was assessed by two observers using five-point Likert scales. Interobserver agreement was calculated using intraclass correlation coefficients (ICC). RESULTS Automated TVA set tube voltage to 90 kV (n = 8), 100 kV (n = 31), 110 kV (n = 11), or 120 kV (n = 1). Average SSDE was decreased by 34.9% using 192-slice DSCT compared to 128-slice 120-kV DSCT (7.8 ± 2.4 vs. 12.1 ± 3.2 mGy; P < .001). Image noise was substantially lower; SNR and CNR were significantly increased in 192-slice DSCT compared to 128-slice DSCT (all P < .005). Image quality was voted excellent for both acquisition techniques (5.00 vs. 4.93; P = .083). CONCLUSIONS Automated TVA in combination with ADMIRE on third-generation 192-slice DSCT in portal venous-phase thoracoabdominal CT provides excellent image quality with reduced image noise and increased SNR and CNR, whereas average radiation dose is reduced by 34.9% compared to 128-slice DSCT.
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Evaluation of image quality and dose reduction of 80 kVp neck computed tomography in patients with suspected peritonsillar abscess. Clin Radiol 2015; 70:e67-73. [DOI: 10.1016/j.crad.2015.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/09/2015] [Accepted: 04/20/2015] [Indexed: 12/12/2022]
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Objective and subjective image quality of primary and recurrent squamous cell carcinoma on head and neck low-tube-voltage 80-kVp computed tomography. Neuroradiology 2015; 57:645-51. [DOI: 10.1007/s00234-015-1512-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022]
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Wallace AN, Vyhmeister R, Bagade S, Chatterjee A, Hicks B, Ramirez-Giraldo JC, McKinstry RC. Evaluation of the use of automatic exposure control and automatic tube potential selection in low-dose cerebrospinal fluid shunt head CT. Neuroradiology 2015; 57:639-44. [PMID: 25779098 DOI: 10.1007/s00234-015-1508-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cerebrospinal fluid shunts are primarily used for the treatment of hydrocephalus. Shunt complications may necessitate multiple non-contrast head CT scans resulting in potentially high levels of radiation dose starting at an early age. A new head CT protocol using automatic exposure control and automated tube potential selection has been implemented at our institution to reduce radiation exposure. The purpose of this study was to evaluate the reduction in radiation dose achieved by this protocol compared with a protocol with fixed parameters. METHODS A retrospective sample of 60 non-contrast head CT scans assessing for cerebrospinal fluid shunt malfunction was identified, 30 of which were performed with each protocol. The radiation doses of the two protocols were compared using the volume CT dose index and dose length product. The diagnostic acceptability and quality of each scan were evaluated by three independent readers. RESULTS The new protocol lowered the average volume CT dose index from 15.2 to 9.2 mGy representing a 39 % reduction (P < 0.01; 95 % CI 35-44 %) and lowered the dose length product from 259.5 to 151.2 mGy/cm representing a 42 % reduction (P < 0.01; 95 % CI 34-50 %). The new protocol produced diagnostically acceptable scans with comparable image quality to the fixed parameter protocol. CONCLUSION A pediatric shunt non-contrast head CT protocol using automatic exposure control and automated tube potential selection reduced patient radiation dose compared with a fixed parameter protocol while producing diagnostic images of comparable quality.
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Affiliation(s)
- Adam N Wallace
- Mallinckrodt Institute of Radiology, Barnes Jewish Hospital, St. Louis, MO, USA
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Optimizing Contrast Media Injection Protocols in State-of-the Art Computed Tomographic Angiography. Invest Radiol 2015; 50:161-7. [DOI: 10.1097/rli.0000000000000119] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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