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New Evaluation Method for Bone Formation around a Fully Hydroxyapatite-Coated Stem Using Digital Tomosynthesis: A Retrospective Cross-Sectional Study. Diagnostics (Basel) 2021; 11:diagnostics11112094. [PMID: 34829440 PMCID: PMC8623614 DOI: 10.3390/diagnostics11112094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Digital tomosynthesis (DTS) is a new imaging technique derived from radiography, and its usefulness has been gradually reported in the field of orthopedic diagnosis in recent years. A fully hydroxyapatite (HA)-coated stem, which is used for total hip arthroplasty (THA), is a type of cementless stem that has been widely used recently and reported to have good results. However, stem loosening on plain radiographs is difficult to determine in some cases due to cancellous condensation around the stem. In this retrospective cross-sectional study, we compared the results of plain radiography versus DTS to evaluate the imaging findings after THA using a fully HA-coated stem. Twenty joints each in the 3 y and 1 y postoperative groups underwent plain radiography and DTS. On DTS, bone formation around the stem was confirmed in all cases; however, this formation was not reproducible on plain radiography, and there were cases in which the reaction could not be confirmed or cases with cancellous condensation resembling reactive lines. This reaction was not reproducible on plain radiographs, and in some cases, the reaction could not be confirmed, or there were cases with cancellous condensation that resembled reactive lines. Therefore, DTS was useful in the diagnosis of bone formation around the implant.
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2
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Rossi Norrlund R, Meltzer C, Söderman C, Johnsson ÅA, Vikgren J, Molnar D, Gilljam M, Båth M. EVALUATION OF TWO CHEST TOMOSYNTHESIS CYSTIC FIBROSIS SCORING SYSTEMS USING HIGH-RESOLUTION COMPUTED TOMOGRAPHY BRODY SCORING AS REFERENCE. RADIATION PROTECTION DOSIMETRY 2021; 195:443-453. [PMID: 33948650 DOI: 10.1093/rpd/ncab057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To evaluate two chest tomosynthesis (CTS) scoring systems for cystic fibrosis (CF), one system developed by Vult von Steyern et al. (VvS) and one system based on the Brody scoring system for high-resolution computed tomography (HRCT) (modified Brody (mB)). Brody scoring of HRCT was used as reference. METHODS In conjunction with routine control HRCT at clinical follow-up, 10 consecutive adult CF patients underwent CTS for research purposes. Four radiologists scored the CTS examinations using the mB and VvS scoring systems. All scores were compared to the Brody HRCT scores. The agreement between the evaluated CTS scoring systems and the reference HRCT scoring system was determined using Spearman's rank correlation coefficient and the intraclass correlation coefficient (ICC). MAJOR FINDINGS Spearman's rank correlation coefficient showed strong correlations between HRCT score and both the mB and the VvS CTS total scores (median rs = 0.81 and 0.85, respectively). The ICC showed strong correlation between the CTS scoring systems and the reference: 0.88 for mB and 0.85 for VvS scoring. The median time for scoring was 20 and 10 minutes for the mB and VvS scoring systems, respectively. CONCLUSIONS Both evaluated CTS scoring systems correlate well with the reference standard Brody HRCT scoring. The VvS CTS scoring system has a shorter reading time, suggesting its advantage in clinical practice.
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Affiliation(s)
- Rauni Rossi Norrlund
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Carin Meltzer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
- Departments of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo 0372, Norway
| | - Christina Söderman
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Åse Allansdotter Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Jenny Vikgren
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - David Molnar
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Marita Gilljam
- CF-Centre, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
- Department of Respiratory Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 413 45, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 405 30, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
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3
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Meltzer C, Gilljam M, Vikgren J, Norrlund RR, Vult von Steyern K, Båth M, Johnsson ÅA. QUANTIFICATION OF PULMONARY PATHOLOGY IN CYSTIC FIBROSIS-COMPARISON BETWEEN DIGITAL CHEST TOMOSYNTHESIS AND COMPUTED TOMOGRAPHY. RADIATION PROTECTION DOSIMETRY 2021; 195:434-442. [PMID: 33683309 PMCID: PMC8507459 DOI: 10.1093/rpd/ncab017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 09/18/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Digital tomosynthesis (DTS) is currently undergoing validation for potential clinical implications. The aim of this study was to investigate the potential for DTS as a low-dose alternative to computed tomography (CT) in imaging of pulmonary pathology in patients with cystic fibrosis (CF). METHODS DTS and CT were performed as part of the routine triannual follow-up in 31 CF patients. Extent of disease was quantified according to modality-specific scoring systems. Statistical analysis included Spearman's rank correlation coefficient (r) and Krippendorff's alpha (α). MAJOR FINDINGS The median effective dose was 0.14 for DTS and 2.68 for CT. Intermodality correlation was very strong for total score and the subscores regarding bronchiectasis and bronchial wall-thickening (r = 0.82-0.91, P < 0.01). Interobserver reliability was high for total score, bronchiectasis and mucus plugging (α = 0.83-0.93) in DTS. CONCLUSION Chest tomosynthesis could be a low-dose alternative to CT in quantitative estimation of structural lung disease in CF.
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Affiliation(s)
| | - M Gilljam
- Gothenburg CF-Center, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Respiratory Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden
| | - J Vikgren
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna stråket 11b V 2 SU/Sahlgrenska, 413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Bruna stråket 11b V 2 SU/Sahlgrenska, 413 45 Gothenburg, Sweden
| | - R R Norrlund
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna stråket 11b V 2 SU/Sahlgrenska, 413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Bruna stråket 11b V 2 SU/Sahlgrenska, 413 45 Gothenburg, Sweden
| | - K Vult von Steyern
- Center for Medical Imaging and Physiology, Skåne University Hospital, Getingevägen 4, 22185 Lund, Sweden
| | - M Båth
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gula stråket 2B, Plan 3, 413 45 Gothenburg, Sweden
- Department of Radiation Physics, Sahlgrenska Academy, University of Gothenburg, Gula stråket 2B, Plan 3, 413 45 Gothenburg, Sweden
| | - Å A Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Bruna stråket 11b V 2 SU/Sahlgrenska, 413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Bruna stråket 11b V 2 SU/Sahlgrenska, 413 45 Gothenburg, Sweden
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Johansen A, Conners GP, Lee J, Robinson AL, Chew WL, Chan SS. Pediatric Esophageal Foreign Body: Possible Role for Digital Tomosynthesis. Pediatr Emerg Care 2021; 37:208-212. [PMID: 29768297 DOI: 10.1097/pec.0000000000001517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Foreign body (FB) ingestion is a common reason for emergency department visits, affecting more than 80,000 children in the United States annually. Whereas most ingested FBs are coins or other radiopaque objects, some are radiolucent FBs such as food. Digital tomosynthesis (DTS) is a radiographic technique that produces cross-sectional images with in-plane resolution similar to that of traditional radiographs. Our pilot study evaluated the sensitivity and specificity of DTS to detect FB in comparison to esophagram and clinical impression. METHODS This was a retrospective review on patients aged 0 to 18 years with suspected esophageal FB who received an esophagram with DTS at our institution between January 2014 and June 2016. Digital tomosynthesis images were analyzed by 3 readers for identification of FB impaction and compared with esophagram and discharge diagnosis. This study was approved by our local institutional review board. RESULTS A total of 17 patients underwent an esophagography with DTS for suspected esophageal FB, of which 9 (53%) were suspected of having an FB on esophagram. Compared with esophagram, DTS had a sensitivity of 44%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 62%. Compared with clinical impression, DTS had a sensitivity of 33%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 38%. CONCLUSIONS This pilot study showed that chest DTS has a very high positive predictive value, compared with esophagram and clinical impression, in detecting radiolucent esophageal FBs in children. Chest DTS is a promising modality for ruling in the presence of a radiolucent esophageal FB.
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Affiliation(s)
- Andrew Johansen
- From the School of Medicine, University of Missouri at Kansas City
| | | | - Jacob Lee
- From the School of Medicine, University of Missouri at Kansas City
| | - Amie L Robinson
- Department of Radiology, Children's Mercy Hospital, Kansas City, MO
| | - William L Chew
- Department of Radiology, Children's Mercy Hospital, Kansas City, MO
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Goralski JL, Stewart NJ, Woods JC. Novel imaging techniques for cystic fibrosis lung disease. Pediatr Pulmonol 2021; 56 Suppl 1:S40-S54. [PMID: 32592531 PMCID: PMC7808406 DOI: 10.1002/ppul.24931] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022]
Abstract
With an increasing number of patients with cystic fibrosis (CF) receiving highly effective CFTR (cystic fibrosis transmembrane regulator protein) modulator therapy, particularly at a young age, there is an increasing need to identify imaging tools that can detect and regionally visualize mild CF lung disease and subtle changes in disease state. In this review, we discuss the latest developments in imaging modalities for both structural and functional imaging of the lung available to CF clinicians and researchers, from the widely available, clinically utilized imaging methods for assessing CF lung disease-chest radiography and computed tomography-to newer techniques poised to become the next phase of clinical tools-structural/functional proton and hyperpolarized gas magnetic resonance imaging (MRI). Finally, we provide a brief discussion of several newer lung imaging techniques that are currently available only in selected research settings, including chest tomosynthesis, and fluorinated gas MRI. We provide an update on the clinical and/or research status of each technique, with a focus on sensitivity, early disease detection, and possibilities for monitoring treatment efficacy.
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Affiliation(s)
- Jennifer L Goralski
- UNC Cystic Fibrosis Center, Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Pediatric Pulmonology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neil J Stewart
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Infection, Immunity & Cardiovascular Disease, POLARIS Group, Imaging Sciences, University of Sheffield, Sheffield, UK
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.,Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio
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7
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Accuracy of Digital Tomosynthesis of the Chest in Detection of Interstitial Lung Disease Comparison With Digital Chest Radiography. J Comput Assist Tomogr 2019; 43:109-114. [PMID: 30119061 DOI: 10.1097/rct.0000000000000780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to assess the ability of chest digital tomosynthesis (DTS) for detection of interstitial lung disease (ILD) compared with conventional chest radiography. MATERIALS AND METHODS We retrospectively reviewed 78 patients (60 males, 18 females, mean age = 53.05 years, range, 19-83 years) who underwent chest DTS for a 5-year interval (January 1, 2009-December 31, 2014). Of the 78 patients, 33 (42.3%) carried a diagnosis of ILD and 45 (57.7%) were not ILD. All computed tomography reports and medical records were reviewed. The conventional chest radiography and DTS were separately reviewed by 2 radiologists for the presence of ILD and the confidence in diagnosis. RESULTS The diagnostic accuracy of DTS for the detection of ILD was better than conventional chest radiography (P < 0.05). Digital tomosynthesis had a sensitivity of 83.3% and negative predictive value of 89.0% that were statistically significantly better than conventional chest radiography (43.9% and 70.9%, respectively). Confidence in diagnosing ILD at DTS was higher than conventional chest radiography (P < 0.001) and had higher interobserver agreement than conventional chest radiography (P < 0.01). CONCLUSIONS Digital tomosynthesis improves diagnostic performance and confidence in diagnosing ILD compared with conventional chest radiography. Digital tomosynthesis can be suggested as the initial diagnostic technique for patients with suspected ILD.
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Initial clinical evaluation of stationary digital chest tomosynthesis in adult patients with cystic fibrosis. Eur Radiol 2018; 29:1665-1673. [PMID: 30255248 DOI: 10.1007/s00330-018-5703-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The imaging evaluation of cystic fibrosis currently relies on chest radiography or computed tomography. Recently, digital chest tomosynthesis has been proposed as an alternative. We have developed a stationary digital chest tomosynthesis (s-DCT) system based on a carbon nanotube (CNT) linear x-ray source array. This system enables tomographic imaging without movement of the x-ray tube and allows for physiological gating. The goal of this study was to evaluate the feasibility of clinical CF imaging with the s-DCT system. MATERIALS AND METHODS CF patients undergoing clinically indicated chest radiography were recruited for the study and imaged on the s-DCT system. Three board-certified radiologists reviewed both the CXR and s-DCT images for image quality relevant to CF. CF disease severity was assessed by Brasfield score on CXR and chest tomosynthesis score on s-DCT. Disease severity measures were also evaluated against subject pulmonary function tests. RESULTS Fourteen patients underwent s-DCT imaging within 72 h of their chest radiograph imaging. Readers scored the visualization of proximal bronchi, small airways and vascular pattern higher on s-DCT than CXR. Correlation between the averaged Brasfield score and averaged tomosynthesis disease severity score for CF was -0.73, p = 0.0033. The CF disease severity score system for tomosynthesis had high correlation with FEV1 (r = -0.685) and FEF 25-75% (r = -0.719) as well as good correlation with FVC (r = -0.582). CONCLUSION We demonstrate the potential of CNT x-ray-based s-DCT for use in the evaluation of cystic fibrosis disease status in the first clinical study of s-DCT. KEY POINTS • Carbon nanotube-based linear array x-ray tomosynthesis systems have the potential to provide diagnostically relevant information for patients with cystic fibrosis without the need for a moving gantry. • Despite the short angular span in this prototype system, lung features such as the proximal bronchi, small airways and pulmonary vasculature have improved visualization on s-DCT compared with CXR. Further improvements are anticipated with longer linear x-ray array tubes. • Evaluation of disease severity in CF patients is possible with s-DCT, yielding improved visualization of important lung features and high correlation with pulmonary function tests at a relatively low dose.
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9
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Jadidi M, Båth M, Nyrén S. Dependency of image quality on acquisition protocol and image processing in chest tomosynthesis-a visual grading study based on clinical data. Br J Radiol 2018; 91:20170683. [PMID: 29565673 DOI: 10.1259/bjr.20170683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To compare the quality of images obtained with two different protocols with different acquisition time and the influence from image post processing in a chest digital tomosynthesis (DTS) system. METHODS 20 patients with suspected lung cancer were imaged with a chest X-ray equipment with tomosynthesis option. Two examination protocols with different acquisition times (6.3 and 12 s) were performed on each patient. Both protocols were presented with two different image post-processing (standard DTS processing and more advanced processing optimised for chest radiography). Thus, 4 series from each patient, altogether 80 series, were presented anonymously and in a random order. Five observers rated the quality of the reconstructed section images according to predefined quality criteria in three different classes. Visual grading characteristics (VGC) was used to analyse the data and the area under the VGC curve (AUCVGC) was used as figure-of-merit. The 12 s protocol and the standard DTS processing were used as references in the analyses. RESULTS The protocol with 6.3 s acquisition time had a statistically significant advantage over the vendor-recommended protocol with 12 s acquisition time for the classes of criteria, Demarcation (AUCVGC = 0.56, p = 0.009) and Disturbance (AUCVGC = 0.58, p < 0.001). A similar value of AUCVGC was found also for the class Structure (definition of bone structures in the spine) (0.56) but it could not be statistically separated from 0.5 (p = 0.21). For the image processing, the VGC analysis showed a small but statistically significant advantage for the standard DTS processing over the more advanced processing for the classes of criteria Demarcation (AUCVGC = 0.45, p = 0.017) and Disturbance (AUCVGC = 0.43, p = 0.005). A similar value of AUCVGC was found also for the class Structure (0.46), but it could not be statistically separated from 0.5 (p = 0.31). CONCLUSION The study indicates that the protocol with 6.3 s acquisition time yields slightly better image quality than the vender-recommended protocol with acquisition time 12 s for several anatomical structures. Furthermore, the standard gradation processing (the vendor-recommended post-processing for DTS), yields to some extent advantage over the gradation processing/multiobjective frequency processing/flexible noise control processing in terms of image quality for all classes of criteria. Advances in knowledge: The study proves that the image quality may be strongly affected by the selection of DTS protocol and that the vendor-recommended protocol may not always be the optimal choice.
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Affiliation(s)
- Masoud Jadidi
- 1 Departments of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm , Sweden
| | - Magnus Båth
- 2 Department of Radiation Physics, Sahlgrenska Academy at University of Gothenburg , Gothenburg , Sweden.,3 Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Sven Nyrén
- 4 Molecular medicine and surgery, Karolinska intitutet , Stockholm , Sweden.,5 Department of Thoracic radiology, Karolinska University Hospital , Stockholm , Sweden
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Cant J, Snoeckx A, Behiels G, Parizel PM, Sijbers J. Can portable tomosynthesis improve the diagnostic value of bedside chest X-ray in the intensive care unit? A proof of concept study. Eur Radiol Exp 2017; 1:20. [PMID: 29708195 PMCID: PMC5909351 DOI: 10.1186/s41747-017-0021-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/21/2017] [Indexed: 12/18/2022] Open
Abstract
Portable bedside chest X-ray (CXR) is an important and frequently used tool in the intensive care unit (ICU). Unfortunately, the diagnostic value of portable CXR is often low due to technical limitations and suboptimal patient positioning. Additionally, abnormalities in the chest may be hidden on the projection image by overlapping anatomy and devices such as endotracheal tubes, lines and catheters. Digital tomosynthesis (DTS) can solve the problem of anatomical overlap. In DTS, several low-dose X-ray images from different angles are acquired and subsequently used by a reconstruction algorithm to compute section images along planes parallel to the detector. However, a portable device to be used for portable bedside chest DTS is not on the market yet. In this work, we discuss modifications to a portable X-ray device to enable portable DTS and illustrate the potential of portable DTS to improve the diagnostic value of bedside CXR in the ICU. A simulation, based on computed tomography scans, is presented. Our experiments comparing portable DTS with conventional bedside CXR showed a substantially improved detection of pneumothorax and other abnormalities.
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11
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Puett C, Inscoe C, Hartman A, Calliste J, Franceschi DK, Lu J, Zhou O, Lee YZ. An update on carbon nanotube-enabled X-ray sources for biomedical imaging. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2017; 10. [PMID: 28398001 DOI: 10.1002/wnan.1475] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/04/2017] [Accepted: 03/11/2017] [Indexed: 11/10/2022]
Abstract
A new imaging technology has emerged that uses carbon nanotubes (CNT) as the electron emitter (cathode) for the X-ray tube. Since the performance of the CNT cathode is controlled by simple voltage manipulation, CNT-enabled X-ray sources are ideal for the repetitive imaging steps needed to capture three-dimensional information. As such, they have allowed the development of a gated micro-computed tomography (CT) scanner for small animal research as well as stationary tomosynthesis, an experimental technology for large field-of-view human imaging. The small animal CT can acquire images at specific points in the respiratory and cardiac cycles. Longitudinal imaging therefore becomes possible and has been applied to many research questions, ranging from tumor response to the noninvasive assessment of cardiac output. Digital tomosynthesis (DT) is a low-dose and low-cost human imaging tool that captures some depth information. Known as three-dimensional mammography, DT is now used clinically for breast imaging. However, the resolution of currently-approved DT is limited by the need to swing the X-ray source through space to collect a series of projection views. An array of fixed and distributed CNT-enabled sources provides the solution and has been used to construct stationary DT devices for breast, lung, and dental imaging. To date, over 100 patients have been imaged on Institutional Review Board-approved study protocols. Early experience is promising, showing an excellent conspicuity of soft-tissue features, while also highlighting technical and post-acquisition processing limitations that are guiding continued research and development. Additionally, CNT-enabled sources are being tested in miniature X-ray tubes that are capable of generating adequate photon energies and tube currents for clinical imaging. Although there are many potential applications for these small field-of-view devices, initial experience has been with an X-ray source that can be inserted into the mouth for dental imaging. Conceived less than 20 years ago, CNT-enabled X-ray sources are now being manufactured on a commercial scale and are powering both research tools and experimental human imaging devices. WIREs Nanomed Nanobiotechnol 2018, 10:e1475. doi: 10.1002/wnan.1475 This article is categorized under: Diagnostic Tools > Diagnostic Nanodevices Diagnostic Tools > In Vivo Nanodiagnostics and Imaging.
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Affiliation(s)
- Connor Puett
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA
| | - Christina Inscoe
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, NC, USA.,Department of Applied Physical Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Allison Hartman
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, NC, USA
| | - Jabari Calliste
- Department of Applied Physical Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Dora K Franceschi
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Jianping Lu
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, NC, USA.,Department of Applied Physical Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Otto Zhou
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, NC, USA.,Department of Applied Physical Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Yueh Z Lee
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA.,Department of Physics and Astronomy, University of North Carolina, Chapel Hill, NC, USA.,Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
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de Brito MCB, Ota MK, Leitão Filho FSS, Meirelles GDSP. Radiologist agreement on the quantification of bronchiectasis by high-resolution computed tomography. Radiol Bras 2017; 50:26-31. [PMID: 28298729 PMCID: PMC5347500 DOI: 10.1590/0100-3984.2015.0146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To evaluate radiologist agreement on the quantification of bronchiectasis by
high-resolution computed tomography (HRCT). Materials and Methods The HRCT scans of 43 patients with bronchiectasis were analyzed by two
radiologists, who used a scoring system to grade the findings. Kappa
(κ) values and overall agreement were calculated. Results For the measurement and appearance of bronchiectasis, the interobserver
agreement was moderate (κ = 0.45 and κ = 0.43, respectively),
as was the intraobserver agreement (κ = 0.54 and κ = 0.47,
respectively). Agreement on the presence of mucous plugging was fair, for
central distribution (overall interobserver agreement of 68.3% and κ
= 0.39 for intraobserver agreement) and for peripheral distribution
(κ = 0.34 and κ = 0.35 for interobserver and intraobserver
agreement, respectively). The agreement was also fair for peribronchial
thickening (κ = 0.21 and κ = 0.30 for interobserver and
intraobserver agreement, respectively). There was fair interobserver and
intraobserver agreement on the detection of opacities (κ = 0.39 and
71.9%, respectively), ground-glass attenuation (64.3% and κ = 0.24,
respectively), and cysts/bullae (κ = 0.47 and κ = 0.44,
respectively). Qualitative analysis of the HRCT findings of bronchiectasis
and the resulting individual patient scores showed that there was an
excellent correlation between the observers (intraclass correlation
coefficient of 0.85 and 0.81 for interobserver and intraobserver agreement,
respectively). Conclusion In the interpretation of HRCT findings of bronchiectasis, radiologist
agreement appears to be fair. In our final analysis of the findings using
the proposed score, we observed excellent interobserver and intraobserver
agreement.
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Affiliation(s)
| | - Maurício Kenji Ota
- MD, Radiologist for the Fundação Instituto de Pesquisa e Estudos de Diagnóstico por Imagem (FIDI), São Paulo, SP, Brazil
| | | | - Gustavo de Souza Portes Meirelles
- PhD, Coordinator of the Thoracic Imaging Team of the Grupo Fleury, São Paulo, SP, Professor and Advisor for the Graduate Course in Clinical Radiology at the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Abstract
OBJECTIVE The purpose of this study was to quantitatively and qualitatively determine the impact of radiation dose reduction on the image noise and quality of tomosynthesis studies of the wrist. MATERIALS AND METHODS Imaging of six cadaver wrists was performed with tomosynthesis in anteroposterior position at a tube voltage of 60 kV and tube current of 80 mA and subsequently at 60 or 50 kV with different tube currents of 80, 40, or 32 mA. Dose-area products (DAP) were obtained from the electronically logged protocol. Image noise was measured with an ROI. Two independent and blinded readers evaluated all images. Interreader agreement was measured with a Cohen kappa. Readers assessed overall quality and delineation of soft tissue, cortical bone, and trabecular bone on a 4-point Likert scale. RESULTS The highest DAP (3.892 ± 0.432 Gy · cm2) was recorded for images obtained with 60 kV and 80 mA; the lowest (0.857 ± 0.178 Gy · cm2) was recorded for images obtained with 50 kV and 32 mA. Noise was highest when a combination of 50 kV and 32 mA (389 ± 26.6) was used and lowest when a combination of 60 kV and 80 mA (218 ± 12.3) was used. The amount of noise on images acquired using 60 kV and 80 mA was statistically significantly different from the amount measured on all other images (p < 0.0001). Interreader agreement was excellent (κ = 0.93). Delineation of anatomy and overall quality were scored best on images obtained with 60 kV and 80 mA and worst on images obtained with 50 kV and 32 mA. The difference in delineation and quality on images obtained using 50 kV and 40 mA was not statistically significantly different compared with images obtained using 60 kV and 80 mA. CONCLUSION Significant dose reduction for tomosynthesis of the wrist is possible while image quality and delineation of anatomic structures remain preserved.
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Petersson C, Båth M, Vikgren J, Johnsson ÅA. AN ANALYSIS OF THE POTENTIAL ROLE OF CHEST TOMOSYNTHESIS IN OPTIMISING IMAGING RESOURCES IN THORACIC RADIOLOGY. RADIATION PROTECTION DOSIMETRY 2016; 169:165-170. [PMID: 26979807 PMCID: PMC4911966 DOI: 10.1093/rpd/ncw040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of the study was to investigate the potential role of chest tomosynthesis (CTS) at a tertiary referral centre by exploring to what extent CTS could substitute chest radiography (CXR) and computed tomography (CT). The study comprised 1433 CXR, 523 CT and 216 CTS examinations performed 5 years after the introduction of CTS. For each examination, it was decided if CTS would have been appropriate instead of CXR (CXR cases), if CTS could have replaced the performed CT (CT cases) or if CT would have been performed had CTS not been available (CTS cases). It was judged that (a) CTS had been appropriate in 15 % of the CXR examinations, (b) CTS could have replaced additionally 7 % of the CT examinations and (c) CT would have been carried out in 63 % of the performed CTS examinations, had CTS not been available. In conclusion, the potential role for CTS to substitute other modalities during office hours at a tertiary referral centre may be in the order of 20 and 25 % of performed CXR and chest CT, respectively.
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Affiliation(s)
- Cecilia Petersson
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Jenny Vikgren
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Åse Allansdotter Johnsson
- Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Radiology, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
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Meltzer C, Båth M, Kheddache S, Ásgeirsdóttir H, Gilljam M, Johnsson ÅA. VISIBILITY OF STRUCTURES OF RELEVANCE FOR PATIENTS WITH CYSTIC FIBROSIS IN CHEST TOMOSYNTHESIS: INFLUENCE OF ANATOMICAL LOCATION AND OBSERVER EXPERIENCE. RADIATION PROTECTION DOSIMETRY 2016; 169:177-87. [PMID: 26842827 PMCID: PMC4911964 DOI: 10.1093/rpd/ncv556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The aims of this study were to assess the visibility of pulmonary structures in patients with cystic fibrosis (CF) in digital tomosynthesis (DTS) using computed tomography (CT) as reference and to investigate the dependency on anatomical location and observer experience. Anatomical structures in predefined regions of CT images from 21 patients were identified. Three observers with different levels of experience rated the visibility of the structures in DTS by performing a head-to-head comparison with visibility in CT. Visibility of the structures in DTS was reported as equal to CT in 34 %, inferior in 52 % and superior in 14 % of the ratings. Central and peripheral lateral structures received higher visibility ratings compared with peripheral structures anteriorly, posteriorly and surrounding the diaphragm (p ≤ 0.001). Reported visibility was significantly higher for the most experienced observer (p ≤ 0.01). The results indicate that minor pathology can be difficult to visualise with DTS depending on location and observer experience. Central and peripheral lateral structures are generally well depicted.
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Affiliation(s)
- Carin Meltzer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Susanne Kheddache
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Helga Ásgeirsdóttir
- Gothenburg CF-Center, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Respiratory Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Marita Gilljam
- Gothenburg CF-Center, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden Department of Respiratory Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden
| | - Åse Allansdotter Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, SE-413 45 Gothenburg, Sweden Department of Radiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
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Maidment ADA. Commentary on “Whole-Body Clinical Applications of Digital Tomosynthesis,” with Response from Dr Machida and Colleagues. Radiographics 2016; 36:750-2. [DOI: 10.1148/rg.2016160028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Machida H, Yuhara T, Tamura M, Ishikawa T, Tate E, Ueno E, Nye K, Sabol JM. Whole-Body Clinical Applications of Digital Tomosynthesis. Radiographics 2016; 36:735-50. [DOI: 10.1148/rg.2016150184] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Hayashi D, Xu L, Gusenburg J, Roemer FW, Hunter DJ, Li L, Guermazi A. Reliability of semiquantitative assessment of osteophytes and subchondral cysts on tomosynthesis images by radiologists with different levels of expertise. Diagn Interv Radiol 2015; 20:353-9. [PMID: 24834489 DOI: 10.5152/dir.2014.13283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess reliability of the evaluation of osteophytes and subchondral cysts on tomosynthesis images when read by radiologists with different levels of expertise. MATERIALS AND METHODS Forty subjects aged >40 years had both knees evaluated using tomosynthesis. Images were read by an "experienced" reader (musculoskeletal radiologist with prior experience) and an "inexperienced" reader (radiology resident with no prior experience). Readers graded osteophytes from 0 to 3 and noted the presence/absence of subchondral cysts in four locations of the tibiofemoral joint. Twenty knees were randomly selected and re-read. Inter- and intrareader reliabilities were calculated using overall exact percent agreement and weighted κ statistics. Diagnostic performance of the two readers was compared against magnetic resonance imaging readings by an expert reader (professor of musculoskeletal radiology). RESULTS The experienced reader showed substantial intrareader reliability for graded reading of osteophytes (90%, κ=0.93), osteophyte detection (95%, κ=0.86) and cyst detection (95%, κ=0.83). The inexperienced reader showed perfect intrareader reliability for cyst detection (100%, κ=1.00) but intrareader reliability for graded reading (75%, κ=0.79) and detection (80%, κ=0.61) of osteophytes was lower than the experienced reader. Inter-reader reliability was 61% (κ=0.72) for graded osteophyte reading, 91% (κ=0.82) for osteophyte detection, and 88% (κ=0.66) for cyst detection. Diagnostic performance of the experienced reader was higher than the inexperienced reader regarding osteophyte detection (sensitivity range 0.74-0.95 vs. 0.54-0.75 for all locations) but diagnostic performance was similar for subchondral cysts. CONCLUSION Tomosynthesis offers excellent intrareader reliability regardless of the reader experience, but experience is important for detection of osteophytes.
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Affiliation(s)
- Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, Bridgeport, Connecticut, USA.
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Söderman C, Asplund S, Allansdotter Johnsson Å, Vikgren J, Rossi Norrlund R, Molnar D, Svalkvist A, Gunnar Månsson L, Båth M. Image quality dependency on system configuration and tube voltage in chest tomosynthesis-A visual grading study using an anthropomorphic chest phantom. Med Phys 2015; 42:1200-12. [DOI: 10.1118/1.4907963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Chou SHS, Kicska GA, Pipavath SN, Reddy GP. Digital tomosynthesis of the chest: current and emerging applications. Radiographics 2015; 34:359-72. [PMID: 24617684 DOI: 10.1148/rg.342135057] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Digital tomosynthesis (DTS) of the chest is a technique whose basic components are similar to those of digital radiography, but that also provides some of the benefits of computed tomography (CT). The major advantages of DTS over conventional chest radiography are improved visibility of the pulmonary parenchyma and depiction of abnormalities such as pulmonary nodules. Calcifications, vessels, airways, and chest wall abnormalities are also much more readily visualized at DTS than at chest radiography. DTS could potentially be combined with chest radiography to follow up known nodules, confirm or rule out suspected nodules seen at radiography, or evaluate individuals who are at high risk for lung cancer or pulmonary metastases. DTS generates coronal "slices" through the chest whose resolution is superior to that of coronal reconstructed CT images, but it is limited by its suboptimal depth resolution and susceptibility to motion; consequently, potential pitfalls in recognizing lesions adjacent to the pleura, diaphragm, central vessels, and mediastinum can occur. However, the radiation dose and projected cost of chest DTS are lower than those of standard chest CT. Besides pulmonary nodule detection, specific applications of DTS that are under investigation include evaluation of pulmonary tuberculous and nontuberculous mycobacterial disease, cystic fibrosis, interstitial lung disease, and asbestos-related thoracic diseases. A basic understanding of chest DTS and of the emerging applications of this technique can prove useful to the radiologist. Online supplemental material is available for this article.
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Affiliation(s)
- Shinn-Huey S Chou
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, UW Mailbox 357115, Seattle, WA 98195-7115
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Lacout A, Marcy PY. Insights into Digital Tomosynthesis of Interstitial Lung Disease. Radiographics 2014; 34:1871. [DOI: 10.1148/rg.347140199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hammon M, Dankerl P, Voit-Höhne HL, Sandmair M, Kammerer FJ, Uder M, Janka R. Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach. BMC Anesthesiol 2014; 14:94. [PMID: 25364301 PMCID: PMC4216356 DOI: 10.1186/1471-2253-14-94] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/29/2014] [Indexed: 11/28/2022] Open
Abstract
Background To assess the value of a score-based system which allows standardized evaluation of pulmonary edema on bedside chest radiographs (CXRs) under routine clinical conditions. Methods Seven experienced readers assessed bedside CXRs of ten patients with an extravascular lung water (EVLW)-value of ≤ 8 mL/kg (range: 4–8 mL/kg; indicates no pulmonary edema) and a series of ten patients with an EVLW-value of ≥ 15 mL/kg (range: 15–21 mL/kg; = indicates a pulmonary edema) with and without customized software which would permit a standardized assessment of the various indications of pulmonary edema. The software provides a score that identifies patients with and without pulmonary edema. EVLW-values were measured instantly after bedside CXR imaging using a pulse contour cardiac output (PiCCO) system and served as a reference standard. The patients were non-traumatic and not treated with diuretics or dobutamine during bedside CXR imaging and the PiCCO measurements. Mean sensitivity, specificity, positive and negative predictive value, the percentage of overall agreement and the free-marginal multirater kappa value was calculated for both the standard and the standardized score-based approach. The net reclassification index was calculated for each reader as well as for all readers. Results Evaluation of bedside CXRs by means of the score-based approach took longer (23 ± 12 seconds versus 7 ± 3 seconds without the use of the software) but improved radiologists’ sensitivity (from 57 to 77%), specificity (from 90 to 100%) and the free-marginal multirater kappa value (from 0.34 to 0.68). The positive predictive value was raised from 85 to 100% and the negative predictive value from 68 to 81%. A net reclassification index of 0.3 (all readers) demonstrates an improvement in prediction performance gained by the score-based approach. The percentage of overall agreement was 67% with the standard approach and 84% with the software-based approach. Conclusions The diagnostic accuracy of bedside CXRs to discriminate patients with elevated EVLW-values from those with a normal value can be improved with the use of a standardized score-based approach. The investigated system is freely available as a web-based application (accessible via: http://www.radiologie.uk-erlangen.de/aerzte-und-zuweiser/edema).
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Affiliation(s)
- Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Peter Dankerl
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | | | - Martin Sandmair
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Ferdinand Josef Kammerer
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
| | - Rolf Janka
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany
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Effect of radiation dose level on the detectability of pulmonary nodules in chest tomosynthesis. Eur Radiol 2014; 24:1529-36. [DOI: 10.1007/s00330-014-3182-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 12/21/2022]
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Diagnostic imaging costs before and after digital tomosynthesis implementation in patient management after detection of suspected thoracic lesions on chest radiography. Insights Imaging 2014; 5:147-55. [PMID: 24420070 PMCID: PMC3948899 DOI: 10.1007/s13244-013-0305-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/28/2013] [Accepted: 12/09/2013] [Indexed: 12/19/2022] Open
Abstract
Objectives To evaluate diagnostic imaging costs before and after DTS implementation in patients with suspected thoracic lesions on CXR. Methods Four hundred sixty-five patients (263 male, 202 female; age, 72.47 ± 11.33 years) with suspected thoracic lesion(s) after CXR underwent DTS. Each patient underwent CT when a pulmonary non-calcified lesion was identified by DTS while CT was not performed when a benign pulmonary or extrapulmonary lesion or pseudolesion was identified. The average per-patient imaging cost was calculated by normalising the costs before and after DTS implementation. Results In 229/465 patients who underwent DTS after suspicious CXR, DTS showed 193 pulmonary lesions and 36 pleural lesions, while in the remaining 236/465 patients, lesions were ruled out as pseudolesions of CXR. Chest CT examination was performed in 127/465 (27 %) patients while in the remaining 338/465 patients (73 %) CXR doubtful findings were resolved by DTS. The average per-patient costs of CXR, DTS and CT were €15.15, 41.55 and 113.66. DTS allowed an annual cost saving of €8,090.2 considering unenhanced CT and €19,298.12 considering contrast-enhanced CT. Considering a DTS reimbursement rate of € 62.7 the break even point corresponds to 479 DTS examinations. Conclusion Per-patient diagnostic imaging costs decreased after DTS implementation in patients with suspected thoracic lesions. Main Messages • Digital tomosynthesis improves the diagnostic accuracy and confidence in chest radiography • Digital tomosynthesis reduces the need for CT for a suspected pulmonary lesion • Digital tomosynthesis requires a dose level equivalent to that of around two chest radiographies • Digital tomosynthesis produces a significant per-patient saving in diagnostic imaging costs
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Vult von Steyern K, Björkman-Burtscher IM, Geijer M, Weber L. Conversion factors for estimation of effective dose in paediatric chest tomosynthesis. RADIATION PROTECTION DOSIMETRY 2013; 157:206-213. [PMID: 23754834 DOI: 10.1093/rpd/nct142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
For chest tomosynthesis in adults, a conversion factor of 0.26 mSv/Gy cm² has been reported for calculating the effective dose from the registered dose-area-product. The aim of this study was to determine conversion factors for chest tomosynthesis in children. Using the Monte Carlo-based computer software PCXMC 2.0, simulations were performed on modified phantoms for males and females aged 8-19 y, in the posteroanterior and anteroposterior projection, with energies 80-140 kV and copper filtration 0.1-0.3 mm. Resulting conversion factors ranged between 0.23 and 1.09 mSv/Gy cm², decreased with patient age, were significantly higher in the anteroposterior projection and increased with increased energy or copper filtration. To avoid an underestimation of effective dose in children, it is recommended to use age-dependent conversion factors. As a simplified approach, three conversion factors might be used for posteroanterior chest tomosynthesis and radiography in children, namely 0.6 (8-10 y), 0.4 (11-14 y) and 0.3 mSv/Gy cm² (15-19 y).
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Affiliation(s)
- Kristina Vult von Steyern
- Center for Medical Imaging and Physiology, Lund University and Skåne University Hospital, Lund S-221 85, Sweden
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Vult von Steyern K, Björkman-Burtscher IM, Geijer M. Radiography, tomosynthesis, CT and MRI in the evaluation of pulmonary cystic fibrosis: an untangling review of the multitude of scoring systems. Insights Imaging 2013; 4:787-98. [PMID: 24065629 PMCID: PMC3846934 DOI: 10.1007/s13244-013-0288-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/04/2013] [Accepted: 09/02/2013] [Indexed: 02/03/2023] Open
Abstract
Objective The first radiographic scoring system for pulmonary cystic fibrosis was presented in 1958. Since then a multitude of scoring systems for radiography and computed tomography (CT) have been presented, recently also for tomosynthesis and magnetic resonance imaging (MRI). The aim of the current review was to analyse and compare the plethora of scoring systems for cystic fibrosis, especially regarding which scoring components are considered most important. Methods Four scoring systems for chest radiography, one for tomosynthesis, eight for CT and one for MRI were compared regarding components evaluated and their terminology; the areas scored; scoring levels; the weighting of each component in percentage of the total score; and the calculations for the final score. Results In most radiological scoring systems the lungs are evaluated for increased volume, bronchial wall thickening, bronchiectasis, mucus plugging, atelectasis and consolidation. In addition, for instance abscesses, bullae, septal thickening, mosaic perfusion, ground glass opacities and air trapping are evaluated in some CT scoring systems. Pleural affection and perfusion defects are scored on MRI. Conclusions Bronchiectasis alone, or in combination with mucus plugging, is given the highest weighting in most scoring systems and is thus commonly considered to be the most significant finding when evaluating cystic fibrosis lung disease. Teaching points Scoring of examinations is used for comparison of outcome in studies. Scoring of examinations can also be used for monitoring disease progression. Cystic fibrosis can be scored on radiography, tomosynthesis, CT or MRI. The typical imaging findings of cystic fibrosis depend on the imaging modality used. Bronchiectasis is commonly considered the most significant finding when scoring cystic fibrosis.
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Affiliation(s)
- Kristina Vult von Steyern
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Lund University, 221 85, Lund, Sweden,
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Vult von Steyern K, Björkman-Burtscher IM, Weber L, Höglund P, Geijer M. Effective dose from chest tomosynthesis in children. RADIATION PROTECTION DOSIMETRY 2013; 158:290-298. [PMID: 24026899 DOI: 10.1093/rpd/nct224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Tomosynthesis (digital tomography) is a recently introduced low-dose alternative to CT in the evaluation of the lungs in patients with cystic fibrosis and pulmonary nodules. Previous studies have reported an adult effective dose of 0.12-0.13 mSv for chest tomosynthesis. The aim of this study was to determine the paediatric effective dose from the dose-area-product. During a 3-y period, 38 children with cystic fibrosis and 36 paediatric oncology patients were examined with chest tomosynthesis, totally 169 posteroanterior and 17 anteroposterior examinations (40 boys and 34 girls, mean age 13.7 y, range 7-20 y). Using recently reported paediatric chest tomosynthesis conversion factors (0.23-1.09 mSv Gy cm(-2)) corrected for sex, age and energy, the mean posteroanterior effective dose calculated was 0.17 mSv; using the proposed simplified conversion factors of 0.6 (8-10 y), 0.4 (11-14 y) and 0.3 mSv Gy cm(-2) (15-19 y), the mean posteroanterior effective dose calculated was 0.15 mSv. As the difference in the calculated effective dose was minor, it is recommendable to use the simplified conversion factors. Using the conversion factor for adult chest tomosynthesis (0.26 mSv Gy cm(-2)), the mean effective dose was 0.11 mSv. Anteroposterior exposures had considerably higher effective dose. By using conversion factors adapted for children, the calculated risks from radiologic procedures will be more accurate.
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The utility of digital linear tomosynthesis imaging of total hip joint arthroplasty with suspicion of loosening: a prospective study in 40 patients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:594631. [PMID: 24078921 PMCID: PMC3776365 DOI: 10.1155/2013/594631] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 11/24/2022]
Abstract
Aim. The clinical utility of digital linear tomosynthesis in musculoskeletal applications has been validated in only a few reports. Technical performance and utility in hip prosthesis imaging have been discussed in technical reports, but no clinical evaluation has been reported. The purpose of the current study was to assess the added clinical utility of digital linear tomosynthesis compared to radiography in loosening of total hip joint arthroplasty. Materials and Methods. In a prospective study, radiography and digital tomosynthesis were performed in 40 consecutive patients with total hip arthroplasty referred for suspect prosthesis loosening. Tomosynthesis images were compared to anterior-posterior (AP) and cross-table lateral radiographs regarding demarcation and extent of demineralization and osteolysis. Further noted were skeletal fractures, cement fractures, fragmentation, and artifacts interfering with the diagnosis. Results. Tomosynthesis was superior to radiography with sharper delineation of demineralization and osteolysis in the AP projection. A limitation was the inability to generate lateral tomosynthesis images, with inferior assessment of the area anterior and posterior to the acetabular cup compared to cross-table radiographs. Artifacts interfering with diagnosis were found in one hip. Conclusion. Tomosynthesis improved evaluation of total hip arthroplasty in the AP projection but was limited by the lack of lateral projections.
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