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Inoue Y. Radiation Dose Management in Computed Tomography: Introduction to the Practice at a Single Facility. Tomography 2023; 9:955-966. [PMID: 37218938 DOI: 10.3390/tomography9030078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
Although the clinical benefits of computed tomography (CT) are undoubtedly high, radiation doses received by patients are also relatively high; therefore, radiation dose management is mandatory to optimize CT radiation doses and prevent excessive radiation events. This article describes CT dose management practice at a single facility. Many imaging protocols are used in CT depending on the clinical indications, scan region, and CT scanner; thus, managing the protocols is the first step for optimization. The appropriateness of the radiation dose for each protocol and scanner is verified, while answering whether the dose is the minimum to obtain diagnostic-quality images. Moreover, examinations with exceptionally high doses are identified, and the cause and clinical validity of the high dose are assessed. Daily imaging practice should follow standardized procedures, avoiding operator-dependent errors, and information required for radiation dose management should be recorded at each examination. The imaging protocols and procedures are reviewed for continuous improvement based on regular dose analysis and multidisciplinary team collaboration. The participation of many staff members in the dose management process is expected to contribute to promoting radiation safety through increased staff awareness.
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Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
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Zhang T, Geng X, Li D, Xu Y, Zhao Y. Comparison of the image quality and radiation dose of different scanning modes in head-neck CT angiography. Dentomaxillofac Radiol 2021; 50:20200428. [PMID: 33353399 DOI: 10.1259/dmfr.20200428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To analyze and compare the radiation dose and image quality of different CT scanning modes on head-neck CT angiography. METHODS A total of 180 patients were divided into Group A and Group B. The groups were further subdivided according to different scanning modes: subgroups A1, A2, A3, B1, B2, and B3. Subgroups A1 and B1 used conventional CT protocol, subgroups A2 and B2 used the kV-Assist scan mode, and subgroups A3 and B3 used the dual-energy gemstone spectral imaging protocol. The CT dose index and dose-length product were recorded. The objective image quality and subjective image evaluation was conducted by two independent radiologists. RESULTS The signal-to-noise ratios, contrast-to-noise ratios, and subjective scores of subgroups A3 and B3 were higher than the other subgroups. In subgroups B1 and B2, the subjective scores of 9 patients and 12 patients were lower than 3, respectively. The subjective scores of subgroups B1 and B2 were lower than the other subgroups. There was no statistically significant difference in signal-to-noise ratios, contrast-to-noise ratios, and subjective scores between subgroups A1 and A2. The effective dose of subgroup A2 was 41.7 and 36.4% lower than that in subgroups A1 and A3, respectively (p < 0.05). In Group B, there were no statistically significant differences in CT dose indexvol, dose-length product, and ED among the subgroups (p > 0.05). CONCLUSION In the head-neck CT angiography, the kV-Assist scan mode is recommended for patients with body mass index between 18.5 and 34.9 kg m-2; gemstone spectral imaging scanning mode is recommended for patients with body mass index ≥34.9 kg m-2.
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Affiliation(s)
- Tianle Zhang
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
| | - Xue Geng
- Department of Radiology, Baoding No.2 hospital, Baoding, China
| | - Dongxue Li
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
| | - Yize Xu
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
| | - Yongxia Zhao
- Department of Radiology, The Affiliated Hospital of Hebei University, Baoding, China
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A Universal Protocol for Abdominal CT Examinations Performed on a Photon-Counting Detector CT System: A Feasibility Study. Invest Radiol 2020; 55:226-232. [PMID: 32049691 DOI: 10.1097/rli.0000000000000634] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were to investigate the feasibility of using a universal abdominal acquisition protocol on a photon-counting detector computed tomography (PCD-CT) system and to compare its performance to that of single-energy (SE) and dual-energy (DE) CT using energy-integrating detectors (EIDs). METHODS Iodine inserts of various concentrations and sizes were embedded into different sizes of adult abdominal phantoms. Phantoms were scanned on a research PCD-CT and a clinical EID-CT with SE and DE modes. Virtual monoenergetic images (VMIs) were generated from PCD-CT and DE mode of EID-CT. For each image type and phantom size, contrast-to-noise ratio (CNR) was measured for each iodine insert and the area under the receiver operating characteristic curve (AUC) for iodine detectability was calculated using a channelized Hotelling observer. The optimal energy (in kiloelectrovolt) of VMIs was determined separately as the one with highest CNR and the one with the highest AUC. The PCD-CT VMIs at the optimal energy were then compared with DE VMIs and SE images in terms of CNR and AUC. RESULTS Virtual monoenergetic image at 50 keV had both the highest CNR and highest AUC for PCD-CT and DECT. For 1.0 mg I/mL iodine and 35 cm phantom, the CNRs of 50 keV VMIs from PCD-CT (2.01 ± 0.67) and DE (1.96 ± 0.52) were significantly higher (P < 0.001, Wilcoxon signed-rank test) than SE images (1.11 ± 0.35). The AUC of PCD-CT (0.98 ± 0.01) was comparable to SE (0.98 ± 0.01), and both were slightly lower than DE (0.99 ± 0.01, P < 0.01, Wilcoxon signed-rank test). A similar trend was observed for other phantom sizes and iodine concentrations. CONCLUSIONS Virtual monoenergetic images at a fixed energy from a universal acquisition protocol on PCD-CT demonstrated higher iodine CNR and comparable iodine detectability than SECT images, and similar performance compared with DE VMIs.
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Wirth S, Hebebrand J, Basilico R, Berger FH, Blanco A, Calli C, Dumba M, Linsenmaier U, Mück F, Nieboer KH, Scaglione M, Weber MA, Dick E. European Society of Emergency Radiology: guideline on radiological polytrauma imaging and service (short version). Insights Imaging 2020; 11:135. [PMID: 33301105 PMCID: PMC7726597 DOI: 10.1186/s13244-020-00947-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines. RESULTS Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org ) and a short version also covering all recommendations (this article). CONCLUSIONS Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.
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Affiliation(s)
- Stefan Wirth
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria.
- Department of Radiology, LMU University Hospital, Munich, Germany.
- Department of Radiology and Nuclear Medicine, Schwarzwald-Baar-Hospital, Villingen-Schwenningen, Germany.
| | - Julian Hebebrand
- Department of Radiology, LMU University Hospital, Munich, Germany
| | - Raffaella Basilico
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Neurosciences, Imaging and Clinical Science, University of Chieti, Chieti, Italy
| | - Ferco H Berger
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ana Blanco
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, University Hospital JM Morales Meseguer, Murcia, Spain
| | - Cem Calli
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, Ege University Medical Faculty, Izmir, Turkey
| | - Maureen Dumba
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Imperial College NHS Trust, St Mary's Campus, London, UK
| | - Ulrich Linsenmaier
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Helios Clinic Munich West, Munich, Germany
| | - Fabian Mück
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Helios Clinic Munich West, Munich, Germany
| | - Konraad H Nieboer
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Department of Radiology, University Ziekenhuis, Vrije University (VUB), Brussels, Belgium
| | - Mariano Scaglione
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- James Cook University Hospital, Teesside University, Middlesbrough, UK
- Department of Imaging, Pineta Grande Hospital, Castel Volturno, Italy
| | - Marc-André Weber
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Elizabeth Dick
- European Society of Emergency Radiology, ESER Office, Am Gestade 1, 1010, Vienna, Austria
- Imperial College NHS Trust, St Mary's Campus, London, UK
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Kawashima H, Ichikawa K, Takata T, Mitsui W. Algorithm-based artifact reduction in patients with arms-down positioning in computed tomography. Phys Med 2020; 69:61-69. [DOI: 10.1016/j.ejmp.2019.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 11/06/2019] [Accepted: 11/18/2019] [Indexed: 11/25/2022] Open
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Metal implants influence CT scan parameters leading to increased local radiation exposure: A proposal for correction techniques. PLoS One 2019; 14:e0221692. [PMID: 31442288 PMCID: PMC6707604 DOI: 10.1371/journal.pone.0221692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/13/2019] [Indexed: 12/14/2022] Open
Abstract
Metal implants not only deteriorate image quality, but also increase radiation exposure. The purpose of this study was to evaluate the effect of metal hip prosthesis on absorbed radiation dose and assess the efficacy of organ dose modulation (ODM) and metal artifact reduction (MAR) protocols on dose reduction. An anthropomorphic phantom was scanned with and without bilateral metal hip prostheses, and surface and deep level radiation doses were measured at the abdomen and pelvis. Finally, the absorbed radiation doses at pelvic and abdominal cavities in the reference, ODM, and two MAR scans (Gemstone spectral imaging, GE) were compared. The Mann Whitney-U test and Kruskal-Wallis test were performed to compare the volume CT dose index (CTDIvol) and mean absorbed radiation doses. Unilateral and bilateral metal hip prostheses increased CTDIVOL by 14.4% and 30.5%, respectively. MAR protocols decreased absorbed radiation doses in the pelvis. MAR showed the most significant dose reduction in the deep pelvic cavity followed by ODM. However, MAR protocols increased absorbed radiation doses in the upper abdomen. ODM significantly reduced absorbed radiation in the pelvis and abdomen. In conclusion, metal hip implants increased radiation doses in abdominopelvic CT scans. MAR and ODM techniques reduced absorbed radiation dose in abdominopelvic CT scans with metal hip prostheses.
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Vogl TJ, Eichler K, Marzi I, Wutzler S, Zacharowski K, Frellessen C. [Imaging techniques in modern trauma diagnostics]. Med Klin Intensivmed Notfmed 2019; 112:643-657. [PMID: 28936574 DOI: 10.1007/s00063-017-0359-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.
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Affiliation(s)
- T J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - K Eichler
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - I Marzi
- Zentrum der Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - S Wutzler
- Zentrum der Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - K Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - C Frellessen
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
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Radiation dose reduction using two orthogonal topograms associated with automatic tube voltage selection for lung CT scanning as compared with a single anteroposterior topogram. Jpn J Radiol 2019; 37:292-300. [PMID: 30603833 DOI: 10.1007/s11604-018-00809-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of two orthogonal topograms on radiation dose and image quality (IQ) associated with topogram-based automatic tube voltage selection (ATVS) for lung CT scanning. METHODS Thirty-seven patients were enrolled in this study. At baseline, only an anteroposterior topogram was obtained and at follow-up, both anteroposterior and lateral topograms were performed. ATVS was turned on during all scans. Objective and subjective IQ evaluations were performed and compared; tube voltage and radiation dose of each scan were noted and analyzed. RESULTS A significant difference was observed regarding the objective parameters between baseline and follow-up only in image noise and signal-noise ratio (SNR) in the upper one-third of the image (image noise: 7.49 ± 1.08 vs. 9.10 ± 1.13, p < 0.001; SNR: 4.08 ± 0.87 vs. 3.37 ± 0.63, p < 0.001). No differences were found between baseline and follow-up in the subjective assessment of IQ. The radiation dose was significantly lower at follow-up than that at baseline (2.73 ± 0.83 mSv vs. 3.55 ± 1.24 mSv, respectively; p < 0.001). CONCLUSIONS Using two orthogonal topograms associated with ATVS could significantly reduce the total radiation dose for lung CT scanning, while subjective IQ was maintained.
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Hojreh A, Homolka P, Gamper J, Unterhumer S, Kienzl-Palma D, Balassy C, Wrba T, Prosch H. Automated tube voltage selection in pediatric non-contrast chest CT. PLoS One 2018; 13:e0204794. [PMID: 30281614 PMCID: PMC6169939 DOI: 10.1371/journal.pone.0204794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Modern CT scanners provide automatic dose adjustment systems, which are promising options for reducing radiation dose in pediatric CT scans. Their impact on patient dose, however, has not been investigated sufficiently thus far. OBJECTIVE To evaluate automated tube voltage selection (ATVS) in combination with automated tube current modulation (ATCM) in non-contrast pediatric chest CT, with regard to the diagnostic image quality. MATERIALS AND METHODS There were 160 non-contrast pediatric chest CT scans (8.7±5.4 years) analyzed retrospectively without and with ATVS. Correlations of volume CT Dose Index (CTDIvol) and effective diameter, with and without ATVS, were compared using Fisher's z-transformation. Image quality was assessed by mean signal-difference-to-noise ratios (SDNR) in the aorta and in the left main bronchus using the independent samples t-test. Two pediatric radiologists and a general radiologist rated overall subjective Image quality. Readers' agreement was assessed using weighted kappa coefficients. A p value <0.05 was considered significant. RESULTS CTDIvol correlation with the effective diameter was r = 0.62 without and r = 0.80 with ATVS (CI: -0.04 to -0.60; p = 0.025). Mean SDNR was 10.88 without and 10.03 with ATVS (p = 0.0089). Readers' agreement improved with ATVS (weighted kappa between pediatric radiologists from 0.1 (0.03-0.16) to 0.27 (0.09-0.45) with ATVS; between general and each pediatric radiologist from 0.1 (0.06-0.14) to 0.12 (0.05-0.20), and from 0.22 (0.11-0.34) to 0.36 (0.24-0.49)). CONCLUSION ATVS, combined with ATCM, results in a radiation dose reduction for pediatric non-contrast chest CT without a loss of diagnostic image quality and prevents errors in manual tube voltage setting, and thus protecting larger children against an unnecessarily high radiation exposure.
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Affiliation(s)
- Azadeh Hojreh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Peter Homolka
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Jutta Gamper
- Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Sylvia Unterhumer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Daniela Kienzl-Palma
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Csilla Balassy
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Wrba
- IT-Systems & Communications, IT4Science, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Guchlerner L, Wichmann JL, Tischendorf P, Albrecht M, Vogl TJ, Wutzler S, Ackermann H, Eichler K, Frellesen C. Comparison of thick- and thin-slice images in thoracoabdominal trauma CT: a retrospective analysis. Eur J Trauma Emerg Surg 2018; 46:187-195. [PMID: 30267119 DOI: 10.1007/s00068-018-1021-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare thick (5 mm) and thin slice images (1.5 mm) of lung, soft tissue, and bone window in thoracoabdominal trauma computed tomography. MATERIALS AND METHODS 167 Patients that underwent thoracoabdominal trauma CT between November 2014 and December 2015 were included in the study. CT data were reconstructed in a transverse direction with 5 mm and 1.5 mm slice images of lung, soft tissue, and bone window. Two blinded raters (radiologists) evaluated the collected data by detecting predefined injuries in different organ areas. Reconstruction and evaluation times as well as detected injuries were noted and compared. RESULTS Reconstruction and evaluation times were significantly higher with 1.5 mm thin-slice images, and the effect strength according to Rosenthal displayed a strong effect of 0.61 (< 0.1 small effect, 0.3 middle effect, and > 0.5 strong effect). Average evaluation time differences were 62.7 s (33.9 s-91.5 s) in bone window between 1.5 mm and 3 mm for rater 1 (p < 0.001) and 71.4 s (43.1 s-99.7 s) for rater 2 (p < 0.001). Average time differences between 1.5 mm and 5 mm were 68,7 s (43.9 s-93.5 s) for rater 1 and 75.3 s (44.7 s-105.9 s) for rater 2 in lung window (p < 0.001) and 66.6 s (28.8 s-104.4 s) for rater 1 and 114 s (74.4 s-153.6 s) for rater 2 in soft-tissue window (p < 0.001). There was no significant difference regarding soft-tissue and lung injuries, except non-significant improvement in the detection of bone fractures. CONCLUSION Thin-slice images do not bring any significant benefit in thoracoabdominal trauma CT of soft-tissue and lung injuries, but they can be helpful for the diagnosis of bone fractures and incidental findings.
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Affiliation(s)
- Leon Guchlerner
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Julian Lukas Wichmann
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Patricia Tischendorf
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Moritz Albrecht
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Josef Vogl
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sebastian Wutzler
- Department of Trauma, Hand and Reconstructive Surgery, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Hanns Ackermann
- Department of Biostatistics and Mathematical Modelling, Clinic of the Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Claudia Frellesen
- Department of Diagnostic and Interventional Radiology, Institut fuer Diagnostische und Interventionelle Radiologie, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Vogl TJ, Eichler K, Marzi I, Wutzler S, Zacharowski K, Frellessen C. [Imaging techniques in modern trauma diagnostics]. Unfallchirurg 2018; 120:417-431. [PMID: 28455618 DOI: 10.1007/s00113-017-0352-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Modern trauma room management requires interdisciplinary teamwork and synchronous communication between a team of anaesthesists, surgeons and radiologists. As the length of stay in the trauma room influences morbidity and mortality of a severely injured person, optimizing time is one of the main targets. With the direct involvement of modern imaging techniques the injuries caused by trauma should be detected within a very short period of time in order to enable a priority-orientated treatment. Radiology influences structure and process quality, management and development of trauma room algorithms regarding the use of imaging techniques. For the individual case interventional therapy methods can be added. Based on current data and on the Frankfurt experience the current diagnostic concepts of trauma diagnostics are presented.
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Affiliation(s)
- T J Vogl
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - K Eichler
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - I Marzi
- Zentrum der Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - S Wutzler
- Zentrum der Chirurgie, Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - K Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland
| | - C Frellessen
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Frankfurt, Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
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Bildgebende Verfahren der modernen Schockraumdiagnostik. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Peng W, Li Z, Xia C, Guo Y, Zhang J, Zhang K, Li L, Zhao F. A CONSORT-compliant prospective randomized controlled trial: radiation dose reducing in computed tomography using an additional lateral scout view combined with automatic tube current modulation: Phantom and patient study. Medicine (Baltimore) 2017; 96:e7324. [PMID: 28746180 PMCID: PMC5627806 DOI: 10.1097/md.0000000000007324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Radiation exposure has been a hot point in research field of computed tomography (CT). Recently, automated tube current modulation (ATCM) has emerged as an important technique to reduce radiation exposure. Many studies have shown that the difference in scout view would affect modulation. This prospective randomized controlled study is aimed to investigate the impact of an additional lateral scout view on radiation dose and image quality in CT using ACTM. METHODS Combined with ATCM (Care Dose 4D) on multidetector CT, 2 thoracic phantom CT image series were acquired in which planning was conducted with either an anteroposterior (AP) or an AP-lateral scout view. Also, 410 patients underwent thoracic CT examinations using Care Dose 4D modulation and were randomized to either a scan planned with an AP-lateral scout or a single AP scout. Effects of the different scout views on applied effective milliampere seconds (mAs), volume CT dose index (CTDIvol) and dose-length-product (DLP) were analyzed. The quality of patient CT images was also assessed. Data were analyzed using independent t tests and linear correlation analysis. RESULTS Compared with AP groups, the mean CTDIvol (phantom, 0.89 ± 0.08 vs 1.36 ± 0.26 mGy, P < .001; in patients, 1.12 [0.96, 1.34] vs 2.16 [1.66, 2.64] mGy, P < .001) and DLP (in phantom, 26 [23.25, 28] vs 40 [34.25, 48] mGy×cm, P < .001; in patients, 41 [33, 41] vs 77 [60.5, 99.5] mGy×cm, P < .001) were significantly reduced by approximately 50% in AP-lateral scout view group. With the AP-lateral topogram, the radiation dose on different off-center positions was essentially equal (CTDIvol: 0.76-0.99 mGy; DLP: 22-28 mGy×cm effective dose: 0.31-0. 39 mSv). For image quality, contrast-to-noise ratio and signal-to-noise ratio values in the AP group were similar to those of AP-lateral scout view group. CONCLUSION AP combined with an additional lateral scout view using ACTM can significantly reduce the radiation dose without compromising image quality in chest screening CT.
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Affiliation(s)
- Wanlin Peng
- Department of Radiology, West China Hospital of Sichuan University, Chengdu
| | - Zhenlin Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Chengdu, China
| | - Jinge Zhang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu
| | - Kai Zhang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu
| | - Lei Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu
| | - Fei Zhao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu
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Park C, Gruber-Rouh T, Leithner D, Zierden A, Albrecht MH, Wichmann JL, Bodelle B, Elsabaie M, Scholtz JE, Kaup M, Vogl TJ, Beeres M. Single-source chest-abdomen-pelvis cancer staging on a third generation dual-source CT system: comparison of automated tube potential selection to second generation dual-source CT. Cancer Imaging 2016; 16:33. [PMID: 27724954 PMCID: PMC5057380 DOI: 10.1186/s40644-016-0093-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/03/2016] [Indexed: 11/25/2022] Open
Abstract
Background Evaluation of latest generation automated attenuation-based tube potential selection (ATPS) impact on image quality and radiation dose in contrast-enhanced chest-abdomen-pelvis computed tomography examinations for gynaecologic cancer staging. Methods This IRB approved single-centre, observer-blinded retrospective study with a waiver for informed consent included a total of 100 patients with contrast-enhanced chest-abdomen-pelvis CT for gynaecologic cancer staging. All patients were examined with activated ATPS for adaption of tube voltage to body habitus. 50 patients were scanned on a third-generation dual-source CT (DSCT), and another 50 patients on a second-generation DSCT. Predefined image quality setting remained stable between both groups at 120 kV and a current of 210 Reference mAs. Subjective image quality assessment was performed by two blinded readers independently. Attenuation and image noise were measured in several anatomic structures. Signal-to-noise ratio (SNR) was calculated. For the evaluation of radiation exposure, CT dose index (CTDIvol) values were compared. Results Diagnostic image quality was obtained in all patients. The median CTDIvol (6.1 mGy, range 3.9–22 mGy) was 40 % lower when using the algorithm compared with the previous ATCM protocol (median 10.2 mGy · cm, range 5.8–22.8 mGy). A reduction in potential to 90 kV occurred in 19 cases, a reduction to 100 kV in 23 patients and a reduction to 110 kV in 3 patients of our experimental cohort. These patients received significantly lower radiation exposure compared to the former used protocol. Conclusion Latest generation automated ATPS on third-generation DSCT provides good diagnostic image quality in chest-abdomen-pelvis CT while average radiation dose is reduced by 40 % compared to former ATPS protocol on second-generation DSCT.
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Affiliation(s)
- Clara Park
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Doris Leithner
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Amelie Zierden
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Mortiz H Albrecht
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Mohamed Elsabaie
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Moritz Kaup
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Martin Beeres
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Haus 23C UG, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Gawlitza J, Haubenreisser H, Meyer M, Hagelstein C, Sudarski S, Schoenberg SO, Henzler T. Comparison of organ-specific-radiation dose levels between 70 kVp perfusion CT and standard tri-phasic liver CT in patients with hepatocellular carcinoma using a Monte-Carlo-Simulation-based analysis platform. Eur J Radiol Open 2016; 3:95-9. [PMID: 27200404 PMCID: PMC4864374 DOI: 10.1016/j.ejro.2016.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023] Open
Abstract
Purpose The aim of this study was to systematically compare organ-specific-radiation dose levels between a radiation dose optimized perfusion CT (dVPCT) protocol of the liver and a tri-phasic standard CT protocol of the liver using a Monte-Carlo-Simulation-based analysis platform. Methods and materials The complete CT data of 52 patients (41 males; mean age 65 ± 12) with suspected HCC that underwent dVPCT examinations on a 3rd generation dual-source CT (Somatom Force, Siemens) with a dose optimized tube voltage of 70 kVp or 80 kVp were exported to an analysis platform (Radimetrics, Bayer). The dVPCT studies were matched with a reference group of 50 patients (35 males; mean age 65 ± 14) that underwent standard tri-phasic CT (sCT) examinations of the liver with 130 kVp using the calculated water-equivalent-diameter of the patients. The analysis platform was used for the calculation of the organ-specific effective dose (ED) as well as global radiation-dose parameters (ICRP103). Results The organ-specific ED of the dVPCT protocol was statistically significantly lower when compared to the sCT in 14 of 21, and noninferior in a total of 18 of 21 examined items (all p < 0.05). The EDs of the dVPCT examinations were especially in the dose sensitive organs such as the red marrow (17.3 mSv vs 24.6 mSv, p = < 0.0001) and the liver (33.3 mSv vs 46.9 mSv, p = 0.0003) lower when compared to the sCT. Conclusion Our results suggest that dVPCT performed at 70 or 80 kVp compares favorably to sCT performed with 130 kVp with regard to effective organ dose levels, especially in dose sensitive organs, while providing additional functional information which is of paramount importance in patients undergoing novel targeted therapies.
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Affiliation(s)
- J Gawlitza
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - H Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - M Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - C Hagelstein
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - S Sudarski
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - S O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - T Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
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How Much Is the Dose Varying between Follow-Up CT-Examinations Performed on the Same Scanner with the Same Imaging Protocol? PLoS One 2016; 11:e0152961. [PMID: 27050659 PMCID: PMC4822887 DOI: 10.1371/journal.pone.0152961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 03/22/2016] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate the dose variation between follow-up CT examinations, when a patient is examined several times on the same scanner with the identical scan protocol which comprised automated exposure control. Material and Methods This retrospective study was approved by the local ethics committee. The volume computed tomography dose index (CTDIvol) and the dose-length-product (DLP) were recorded for 60 cancer patients (29 male, 31 female, mean age 60.1 years), who received 3 follow-up CT examinations each composed of a non-enhanced scan of the liver (LI-CT) and a contrast-enhanced scan of chest (CH-CT) and abdomen (AB-CT). Each examination was performed on the same scanner (Siemens Definition FLASH) equipped with automated exposure control (CARE Dose 4D and CARE KV) using the identical scan protocol. Results The median percentage difference in DLP between follow-up examinations was 9.6% for CH-CT, 10.3% for LI-CT, and 10.1% for AB-CT; the median percentage difference in CTDIvol 8.3% for CH-CT, 7.4% for LI-CT and 7.7% for AB-CT (p<0.0001 for all values). The maximum difference in DLP between follow-up examinations was 67.5% for CH-CT, 50.8% for LI-CT and 74.3% for AB-CT; the maximum difference in CTDIvol 62.9% for CH-CT, 47.2% for LI-CT, and 49% for AB-CT. Conclusion A significant variance in the radiation dose occurs between follow-up CT examinations when the same CT scanner and the identical imaging protocol are used in combination with automated exposure control.
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Impact of the scout view orientation on the radiation exposure and image quality in thoracic and abdominal CT. Eur Radiol 2016; 26:4072-4079. [PMID: 26943131 DOI: 10.1007/s00330-016-4285-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/24/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the impact of the scout view orientation on radiation exposure and image quality in thoracoabdominal CT, when automated tube voltage selection (ATVS) and automated tube current modulation (ATCM) are used in combination with scan planning on a single scout view. METHODS Fifty patients underwent two thoracoabdominal CT examinations, one planned on an anteroposterior scout view, one planned on a lateral scout view. Both examinations included contrast-enhanced imaging of chest (CH) and abdomen (AB) and non-contrast-enhanced imaging of the liver (LI). For all examinations the same imaging protocol was used on the same dual-source CT scanner. The radiation exposure was recorded and objective as well as visual image quality was assessed for all examinations. RESULTS The median dose-length product was significantly lower in scans planned on a lateral scout view (CH: 179 vs. 218 mGy*cm, LI: 148 vs. 178 mGy*cm, AB: 324 vs. 370 mGy*cm, p < 0.0001). Objective image quality was marginal lower in scans planned on a lateral scout view, whereas the visual image quality was rated as equal. CONCLUSION At the tested radiation doses, the orientation of the scout view has a significant impact on the radiation exposure but no clinically relevant impact on the image quality. KEY POINTS • The scout view orientation has a significant impact on the radiation exposure. • The scout view orientation has no clinically relevant impact on image quality. • A lateral scout view should be preferred with regard to radiation exposure.
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Filev PD, Mittal PK, Tang X, Duong PA, Wang X, Small WC, Applegate K, Moreno CC. Increased Computed Tomography Dose Due to Miscentering With Use of Automated Tube Voltage Selection: Phantom and Patient Study. Curr Probl Diagn Radiol 2015; 45:265-70. [PMID: 26810714 DOI: 10.1067/j.cpradiol.2015.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/08/2015] [Indexed: 11/22/2022]
Abstract
The purpose of the article is to determine if miscentering affected dose with use of automated tube voltage selection software. An anthropomorphic phantom was imaged at different table heights (centered in the computed tomography [CT] gantry, and -6, -3, +3, and +5.7cm relative to the centered position). Topogram magnification, tube voltage selection, and dose were assessed. Effect of table height on dose also was assessed retrospectively in human subjects (n = 50). When the CT table was positioned closer to the x-ray source, subjects appeared up to 33% magnified in topogram images. When subjects appeared magnified in topogram images, automated software selected higher tube potentials and tube currents that were based on the magnified size of the subject rather than the subject׳s true size. Table height strongly correlated with CT dose index (r = 0.98, P < 0.05) and dose length product (r = 0.98, P < 0.05) in the phantom study. Transverse dimension in the topogram highly correlated with dose in human subjects (r = 0.75-0.87, P <0.05). Miscentering results in increased dose due to topogram magnification with automated voltage selection software.
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Affiliation(s)
- Peter D Filev
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Xiangyang Tang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Phuong-Anh Duong
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Xiaojing Wang
- Biostatistics Shared Core Resource at Winship Cancer Institute, Atlanta, GA
| | - William C Small
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Kimberly Applegate
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
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Spearman JV, Schoepf UJ, Rottenkolber M, Driesser I, Canstein C, Thierfelder KM, Krazinski AW, De Cecco CN, Meinel FG. Effect of Automated Attenuation-based Tube Voltage Selection on Radiation Dose at CT: An Observational Study on a Global Scale. Radiology 2015; 279:167-74. [PMID: 26473641 DOI: 10.1148/radiol.2015141507] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effect of automated tube voltage selection (ATVS) on radiation dose at computed tomography (CT) worldwide encompassing all body regions and types of CT examinations. MATERIALS AND METHODS No patient information was accessed; therefore, institutional review board approval was not sought. Data from 86 centers across the world were analyzed. All CT interactions were automatically collected and transmitted to the CT vendor during two 6-week periods immediately before and 2 weeks after implementation of ATVS. A total of 164 323 unique CT studies were analyzed. Studies were categorized by body region and type of examination. Tube voltage and volume CT dose index (CTDIvol) were compared between examinations performed with ATVS and those performed before ATVS implementation. Descriptive statistical methods and multilevel linear regression models were used for analysis. RESULTS Across all types of CT examinations and body regions, CTDIvol was 14.7% lower in examinations performed with ATVS (n = 30 313) than in those performed before ATVS implementation (n = 79 275). Relative reductions in mean CTDIvol were most notable for temporal bone CT (-56.1%), peripheral runoff CT angiography (-48.6%), CT of the paranasal sinus (-39.6%), cerebral or carotid CT angiography (-36.4%), coronary CT angiography (-25.1%), and head CT (-23.9%). An increase in mean CTDIvol was observed for renal stone protocols (26.2%) and thoracic or lumbar spine examinations (6.6%). In the multilevel model with fixed effects ATVS and examination type, and the interaction of these variables and the random effect country, a significant influence on CTDIvol for all fixed efects was revealed (ATVS, P = .0031; examination type, P < .0001; interaction term, P < .0001). CONCLUSION ATVS significantly reduces radiation dose across most, but not all, body regions and types of CT examinations.
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Affiliation(s)
- James V Spearman
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
| | - U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
| | - Marietta Rottenkolber
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
| | - Ivo Driesser
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
| | - Christian Canstein
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
| | - Kolja M Thierfelder
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
| | - Aleksander W Krazinski
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
| | - Carlo N De Cecco
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
| | - Felix G Meinel
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science (J.V.S., U.J.S., A.W.K., C.N.D.C., F.G.M.) and Division of Cardiology, Department of Medicine (U.J.S.), Medical University of South Carolina, 25 Courtenay Dr, MSC 226, Charleston, SC 29425; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich, Germany (M.R.); Healthcare Division, Computed Tomography, Siemens, Forchheim, Germany (I.D.); Siemens Medical Solutions USA, Malvern, Pa (C.C.); Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany (K.M.T., F.G.M.); and Department of Radiological Sciences, Oncology and Pathology, University of Rome "Sapienza"-Polo Pontino, Latina, Italy (C.N.D.C.)
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First Clinical Evaluation of High-Pitch Dual-Source Computed Tomographic Angiography Comparing Automated Tube Potential Selection With Automated Tube Current Modulation. J Comput Assist Tomogr 2015; 39:624-8. [PMID: 25955395 DOI: 10.1097/rct.0000000000000247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate and compare the use of automated tube potential selection (ATPS) with automated tube current modulation (ATCM) in high-pitch dual-source computed tomographic angiography (CTA) for imaging the whole aorta without electrocardiogram synchronization. METHODS Two groups of 60 patients underwent CTA on a dual-source computed tomographic device in high-pitch mode: ATCM (with 100-kV fixed tube potential) was used in group 1 and ATPS (with the same image quality options) in group 2. For the evaluation of radiation exposure, CT dose index and dose-length product were analyzed. Contrast and image quality were assessed by 2 independent observers. RESULTS The ATPS group received a higher radiation dose than the ATCM group (P < 0.001) because in 80% of patients, the software switched to use of a 120-kV tube potential. In all cases, images of the aorta were of sufficient quality. CONCLUSIONS High-pitch dual-source CTA of the aorta using ATPS is feasible in clinical routine, but is associated with higher radiation exposure than the ATCM protocol. This finding contradicts previously evaluations of ATPS based on single-source techniques.
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Faget C, Taourel P, Charbit J, Ruyer A, Alili C, Molinari N, Millet I. Value of CT to predict surgically important bowel and/or mesenteric injury in blunt trauma: performance of a preliminary scoring system. Eur Radiol 2015; 25:3620-8. [DOI: 10.1007/s00330-015-3771-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 03/24/2015] [Accepted: 04/03/2015] [Indexed: 11/28/2022]
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Medical imaging in personalised medicine: a white paper of the research committee of the European Society of Radiology (ESR). Insights Imaging 2015; 6:141-55. [PMID: 25763994 PMCID: PMC4376812 DOI: 10.1007/s13244-015-0394-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
The future of medicine lies in early diagnosis and individually tailored treatments, a concept that has been designated 'personalised medicine' (PM), which aims to deliver the right treatment to the right patient at the right time. Medical imaging has always been personalised and is fundamental to almost all aspects of PM. It is instrumental in solving clinical differential diagnoses. Imaging procedures are tailored to the clinical problem and patient characteristics. Screening for preclinical disease is done with imaging. Stratification based on imaging biomarkers can help identify individuals suited for preventive intervention. Treatment decisions are based on the in vivo visualisation of the location and extent of an abnormality, as well as the loco-regional physiological, biochemical and biological processes using structural and molecular imaging. Image-guided biopsy provides relevant tissue specimens for genetic/molecular characterisation. In addition, radiogenomics relate imaging biomarkers to these genetic and molecular features. Furthermore, imaging is essential to patient-tailored therapy planning, therapy monitoring and follow-up of disease, as well as targeting non-invasive or minimally invasive treatments, especially with the rise of theranostics. Radiologists need to be prepared for this new paradigm as it will mean changes in training, clinical practice and in research. Key Points • Medical imaging is a key component in personalised medicine • Personalised prevention will rely on image-based screening programmes • Anatomical, functional and molecular imaging biomarkers affect decisions on the type and intensity of treatment • Treatment response assessment with imaging will improve personalised treatment • Image-based invasive intervention integrates personalised diagnosis and personalised treatment.
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