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Milos RI, Lechner L, Korajac A, Kifjak D, Watzenböck ML, Tamandl D, Strassl A, Stuempflen M, Beer L, Weber M, Jaksch P, Muraközy G, Hielle-Wittmann E, Kovacs Z, Hoetzenecker K, Prosch H. Accuracy of Ultralow-Dose Photon-counting CT in the Detection of Lung Changes after Lung Transplant. Radiology 2024; 312:e240271. [PMID: 39254452 DOI: 10.1148/radiol.240271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background Data on the diagnostic accuracy of ultralow-dose (ULD) CT protocols for periodic surveillance in recipients of lung transplant are lacking. Purpose To assess the potential for radiation dose reduction using ULD photon-counting CT (PCT) to detect lung abnormalities in recipients of lung transplant during repeat CT follow-up. Materials and Methods Consecutive adult recipients of lung transplant undergoing same-day standard-of-care low-dose (LD) and ULD PCT from March 2023 to May 2023 were prospectively included. The ULD protocols were performed with two target effective doses comprising 20% (hereafter, ULD1) and 10% (hereafter, ULD2) of the standard LD protocol. The 1-mm reconstructions were reviewed by three readers. Subjective image quality, the visibility of certain anatomic structures (using a five-point Likert scale), and the presence of lung abnormalities were independently assessed. The χ2 or t tests were used to evaluate differences between the ULD1 and ULD2 protocols. Results A total of 82 participants (median age, 64 years [IQR, 54-69 years]; 47 male) were included (41 participants for each ULD protocol). The mean effective doses per protocol were 1.41 mSv ± 0.44 (SD) for LD, 0.26 mSv ± 0.08 for ULD1, and 0.17 mSv ± 0.04 for ULD2. According to three readers, the subjective image quality of the ULD images was deemed diagnostic (Likert score ≥3) in 39-40 (ULD1) and 40-41 (ULD2) participants, and anatomic structures could be adequately visualized (Likert score ≥3) in 33-41 (ULD1) and 34-41 (ULD2) participants. The detection accuracy for individual lung anomalies exceeded 70% for both ULD protocols, except for readers 1 and 3 detecting proximal bronchiectasis and reader 3 detecting bronchial wall thickening and air trapping. No evidence of a statistically significant difference in noise (P = .96), signal-to-noise ratio (P = .77), or reader accuracy (all P ≥ .05) was noted between the ULD protocols. Conclusion ULD PCT was feasible for detecting lung abnormalities following lung transplant, with a tenfold radiation dose reduction. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Ciet in this issue.
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Affiliation(s)
- Ruxandra-Iulia Milos
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Lisa Lechner
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Aida Korajac
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Daria Kifjak
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Martin Luther Watzenböck
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Dietmar Tamandl
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Andreas Strassl
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Marlene Stuempflen
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Lucian Beer
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Michael Weber
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Peter Jaksch
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Gabriella Muraközy
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Elisabeth Hielle-Wittmann
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Zsofia Kovacs
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Konrad Hoetzenecker
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Helmut Prosch
- From the Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Wassipaul C, Janata-Schwatczek K, Domanovits H, Tamandl D, Prosch H, Scharitzer M, Polanec S, Schernthaner RE, Mang T, Asenbaum U, Apfaltrer P, Cacioppo F, Schuetz N, Weber M, Homolka P, Birkfellner W, Herold C, Ringl H. Ultra-low-dose CT vs. chest X-ray in non-traumatic emergency department patients - a prospective randomised crossover cohort trial. EClinicalMedicine 2023; 65:102267. [PMID: 37876998 PMCID: PMC10590727 DOI: 10.1016/j.eclinm.2023.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
Background Ultra-low-dose CT (ULDCT) examinations of the chest at only twice the radiation dose of a chest X-ray (CXR) now offer a valuable imaging alternative to CXR. This trial prospectively compares ULDCT and CXR for the detection rate of diagnoses and their clinical relevance in a low-prevalence cohort of non-traumatic emergency department patients. Methods In this prospective crossover cohort trial, 294 non-traumatic emergency department patients with a clinically indicated CXR were included between May 2nd and November 26th of 2019 (www.clinicaltrials.gov: NCT03922516). All participants received both CXR and ULDCT, and were randomized into two arms with inverse reporting order. The detection rate of CXR was calculated from 'arm CXR' (n = 147; CXR first), and of ULDCT from 'arm ULDCT' (n = 147; ULDCT first). Additional information reported by the second exam in each arm was documented. From all available clinical and imaging data, expert radiologists and emergency physicians built a compound reference standard, including radiologically undetectable diagnoses, and assigned each finding to one of five clinical relevance categories for the respective patient. Findings Detection rates for main diagnoses by CXR and ULDCT (mean effective dose: 0.22 mSv) were 9.1% (CI [5.2, 15.5]; 11/121) and 20.1% (CI [14.2, 27.7]; 27/134; P = 0.016), respectively. As an additional imaging modality, ULDCT added 9.1% (CI [5.2, 15.5]; 11/121) of main diagnoses to prior CXRs, whereas CXRs did not add a single main diagnosis (0/134; P < 0.001). Notably, ULDCT also offered higher detection rates than CXR for all other clinical relevance categories, including findings clinically irrelevant for the respective emergency department visit with 78.5% (CI [74.0, 82.5]; 278/354) vs. 16.2% (CI [12.7, 20.3]; 58/359) as a primary modality and 68.2% (CI [63.3, 72.8]; 245/359) vs. 2.5% (CI [1.3, 4.7]; 9/354) as an additional imaging modality. Interpretation In non-traumatic emergency department patients, ULDCT of the chest offered more than twice the detection rate for main diagnoses compared to CXR. Funding The Department of Biomedical Imaging and Image-guided Therapy of Medical University of Vienna received funding from Siemens Healthineers (Erlangen, Germany) to employ two research assistants for one year.
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Affiliation(s)
- Christian Wassipaul
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | | | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | | | - Ruediger E. Schernthaner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Clinic Landstrasse, Vienna Healthcare Group, Austria
| | - Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Ulrika Asenbaum
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Paul Apfaltrer
- Department of Radiology, Medical University of Graz, Austria
| | - Filippo Cacioppo
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Nikola Schuetz
- Department of Emergency Medicine, Medical University of Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Peter Homolka
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Wolfgang Birkfellner
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Helmut Ringl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Clinic Donaustadt, Vienna Healthcare Group, Austria
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Kristjánsdóttir B, Taekker M, Andersen MB, Bentsen LP, Berntsen MH, Dahlin J, Fransen ML, Gosvig K, Greisen PW, Laursen CB, Mussmann B, Posth S, Rasmussen CH, Sjölander H, Graumann O. Ultra-low dose computed tomography of the chest in an emergency setting: A prospective agreement study. Medicine (Baltimore) 2022; 101:e29553. [PMID: 35945776 PMCID: PMC9351905 DOI: 10.1097/md.0000000000029553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ultra-low dose computed tomography (ULD-CT) assessed by non-radiologists in a medical Emergency Department (ED) has not been examined in previous studies. To (i) investigate intragroup agreement among attending physicians caring for ED patients (i.e., radiologists, senior- and junior clinicians) and medical students for the detection of acute lung conditions on ULD-CT and supine chest X-ray (sCXR), and (ii) evaluate the accuracy of interpretation compared to the reference standard. In this prospective study, non-traumatic patients presenting to the ED, who received an sCXR were included. Between February and July 2019, 91 patients who underwent 93 consecutive examinations were enrolled. Subsequently, a ULD-CT and non-contrast CT were performed. The ULD-CT and sCXR were assessed by 3 radiologists, 3 senior clinicians, 3 junior clinicians, and 3 medical students for pneumonia, pneumothorax, pleural effusion, and pulmonary edema. The non-contrast CT, assessed by a chest radiologist, was used as the reference standard. The results of the assessments were compared within each group (intragroup agreement) and with the reference standard (accuracy) using kappa statistics. Accuracy and intragroup agreement improved for pneumothorax on ULD-CT compared with the sCXR for all groups. Accuracy and intragroup agreement improved for pneumonia on ULD-CT when assessed by radiologists and for pleural effusion when assessed by medical students. In patients with acute lung conditions ULD-CT offers improvement in the detection of pneumonia by radiologists and the detection of pneumothorax by radiologists as well as non-radiologists compared to sCXR. Therefore, ULD-CT may be considered as an alternative first-line imaging modality to sCXR for non-traumatic patients who present to EDs.
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Affiliation(s)
- Björg Kristjánsdóttir
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
- *Correspondence: Björg Kristjánsdóttir, Research and Innovation Unit of Radiology, University of Southern Denmark, KlØvervænget 10, 112, 2nd floor, 5000 Odense C, Denmark (e-mail: )
| | - Maria Taekker
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Michael B. Andersen
- Department of Radiology, Copenhagen University Hospital Herlev/Gentofte, Hellerup, Denmark
- Roskilde University Hospital, Roskilde, Denmark
| | - Lasse P. Bentsen
- Department of Emergency Medicine, Lillebaelt Hospital, Kolding, Denmark
| | | | - Jan Dahlin
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Maja L. Fransen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Kristina Gosvig
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | | | - Christian B. Laursen
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Bo Mussmann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Stefan Posth
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | | | - Hannes Sjölander
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
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Tækker M, Kristjánsdóttir B, Andersen MB, Fransen ML, Greisen PW, Laursen CB, Mussmann B, Posth S, Graumann O. Diagnostic accuracy of ultra-low-dose chest computed tomography in an emergency department. Acta Radiol 2022; 63:336-344. [PMID: 33663246 DOI: 10.1177/0284185121995804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study examined whether ultra-low-dose chest computed tomography (ULD-CT) could improve detection of acute chest conditions. PURPOSE To determine (i) whether diagnostic accuracy of ULD-CT is superior to supine chest X-ray (sCXR) for acute chest conditions and (ii) the feasibility of ULD-CT in an emergency department. MATERIAL AND METHODS From 1 February to 31 July 2019, 91 non-traumatic patients from the Emergency Department were prospectively enrolled in the study if they received an sCXR. An ULD-CT and a non-contrast chest CT (NCCT) scan were then performed. Three radiologists assessed the sCXR and ULD-CT examinations for cardiogenic pulmonary edema, pneumonia, pneumothorax, and pleural effusion. Resources and effort were compared for sCXR and ULD-CT to evaluate feasibility. Diagnostic accuracy was calculated for sCXR and ULD-CT using NCCT as the reference standard. RESULTS The mean effective dose of ULD-CT was 0.05±0.01 mSv. For pleural effusion and cardiogenic pulmonary edema, no difference in diagnostic accuracy between ULD-CT and sCXR was observed. For pneumonia and pneumothorax, sensitivities were 100% (95% confidence interval [CI] 69-100) and 50% (95% CI 7-93) for ULD-CT and 60% (95% CI 26-88) and 0% (95% CI 0-0) for sCXR, respectively. Median examination time was 10 min for ULD-CT vs. 5 min for sCXR (P<0.001). For ULD-CT 1-2 more staff members were needed compared to sCXR (P<0.001). ULD-CT was rated more challenging to perform than sCXR (P<0.001). CONCLUSION ULD-CT seems equal or better in detecting acute chest conditions compared to sCXR. However, ULD-CT examinations demand more effort and resources.
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Affiliation(s)
- Maria Tækker
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- Department of Radiology and OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Björg Kristjánsdóttir
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- Department of Radiology and OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Michael B Andersen
- Department of Radiology, Copenhagen University Hospital Herlev/Gentofte and Roskilde University Hospital, Copenhagen, Denmark
| | - Maja L Fransen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | | | - Christian B Laursen
- Department of Radiology and OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Bo Mussmann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Stefan Posth
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Department of Emergency Medicine and OPEN - Open Patient data Explorative Network, Odense University Hospital, Denmark
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
- Department of Radiology and OPEN – Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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Tækker M, Kristjánsdóttir B, Graumann O, Laursen CB, Pietersen PI. Diagnostic accuracy of low-dose and ultra-low-dose CT in detection of chest pathology: a systematic review. Clin Imaging 2021; 74:139-148. [PMID: 33517021 DOI: 10.1016/j.clinimag.2020.12.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/12/2020] [Accepted: 12/31/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Studies have evaluated imaging modalities with a lower radiation dose than standard-dose CT (SD-CT) for chest examination. This systematic review aimed to summarize evidence on diagnostic accuracy of these modalities - low-dose and ultra-low-dose CT (LD- and ULD-CT) - for chest pathology. METHOD Ovid-MEDLINE, Ovid-EMBASE and the Cochrane Library were systematically searched April 29th-30th, 2019 and screened by two reviewers. Studies on diagnostic accuracy were included if they defined their index tests as 'LD-CT', 'Reduced-dose CT' or 'ULD-CT' and had SD-CT as reference standard. Risk of bias was evaluated on study level using the Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted to compare the diagnostic accuracy measurements. RESULTS Of the 4257 studies identified, 18 were eligible for inclusion. SD-CT (3.17 ± 1.47 mSv) was used as reference standard in all studies to evaluate diagnostic accuracy of LD- (1.22 ± 0.34 mSv) and ULD-CT (0.22 ± 0.05 mSv), respectively. LD-CT had high sensitivities for detection of bronchiectasis (82-96%), honeycomb (75-100%), and varying sensitivities for nodules (63-99%) and ground glass opacities (GGO) (77-91%). ULD-CT had high sensitivities for GGO (93-100%), pneumothorax (100%), consolidations (90-100%), and varying sensitivities for nodules (60-100%) and emphysema (65-90%). CONCLUSION The included studies found LD-CT to have high diagnostic accuracy in detection of honeycombing and bronchiectasis and ULD-CT to have high diagnostic accuracy for pneumothorax, consolidations and GGO. Summarizing evidence on diagnostic accuracy of LD- and ULD-CT for other chest pathology was not possible due to varying outcome measures, lack of precision estimates and heterogeneous study design and methodology.
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Affiliation(s)
- Maria Tækker
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Björg Kristjánsdóttir
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Kloevervaenget 10, entrance 112, 2nd floor, 5000 Odense C, Denmark; Department of Radiology, Odense University Hospital, Kloevervaenget 47, 5000 Odense C, Denmark.
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Kloevervaenget 2, entrance 87-88, 5000 Odense C, Denmark; Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark.
| | - Pia I Pietersen
- Department of Respiratory Medicine, Odense University Hospital, Kloevervaenget 2, entrance 87-88, 5000 Odense C, Denmark; Regional Center for Technical Simulation, Odense University Hospital, Region of Southern Denmark, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
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The influence of model iterative reconstruction on the image quality in standard and low-dose computer tomography of the chest. Experimental study. КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract34900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. One of the ways to reduce the radiation dose in CT is to the image reconstruction algorithms. The latest offer from CT scanner manufacturers is Model Iterative Reconstruction (MIR). Aims: to compare the quality of visualization of the structures of the chest organs and to prove the effectiveness of the low-dose protocol with iterative model reconstruction. Methods. A calibration phantom with a spatial resolution module and an anthropomorphic phantom of the upper body of an adult with nodules in the lungs were scanned using two CT scanners of different manufacturers. Two protocols were applied: the standard dose protocol (SDCT) with the algorithms of hybrid iterative reconstruction (HIR) of images and MIR and a low-dose protocol (LDCT) with the MIRalgorithm. The quality of the obtained images was evaluated by the following parameters: noise (SD), the contrast-to-noise ratio (CNR), spatial resolution and visualization of pulmonary nodules. The radiation dose was calculated according to the scanner data, the data of individual dosimeters placed on the anthropomorphic phantom, and using a dosimetric phantom. Results. The average SD was 11.5; 24.4 and 21.6; CNR 85.47; 40.6 and 45.6; spatial resolution 2 mm; 2 mm and 3 mm for SDCT with MIR, SDCT with HIR and LDCT with MIR respectively. Visualization of the pulmonary lesions remained excellent in all cases. The radiation dose in case of SDCT was 2.7, and in case of LDCT 0.67 mSv. The dose reduction was confirmed by the dosimeter data. Similar results were obtained by repeating the experiment with a second scanner. Conclusions. The model iterative reconstruction application will allow reducing the irradiatin dose during CT scanning of the chest organs without deterioration of the visualization quality.
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Leger T, Jacquier A, Barral PA, Castelli M, Finance J, Lagier JC, Million M, Parola P, Brouqui P, Raoult D, Bartoli A, Gaubert JY, Habert P. Low-dose chest CT for diagnosing and assessing the extent of lung involvement of SARS-CoV-2 pneumonia using a semi quantitative score. PLoS One 2020; 15:e0241407. [PMID: 33141845 PMCID: PMC7608883 DOI: 10.1371/journal.pone.0241407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The purpose is to assess the ability of low-dose CT (LDCT) to determine lung involvement in SARS-CoV-2 pneumonia and to describe a COVID19-LDCT severity score. MATERIALS AND METHODS Patients with SARS-CoV-2 infection confirmed by RT-PCR were retrospectively analysed. Clinical data, the National Early Warning Score (NEWS) and imaging features were recorded. Lung features included ground-glass opacities (GGO), areas of consolidation and crazy paving patterns. The COVID19-LDCT score was calculated by summing the score of each segment from 0 (no involvement) to 10 (severe impairment). Univariate analysis was performed to explore predictive factor of high COVID19-LDCT score. The nonparametric Mann-Whitney test was used to compare groups and a Spearman correlation used with p<0.05 for significance. RESULTS Eighty patients with positive RT-PCR were analysed. The mean age was 55 years ± 16, with 42 males (53%). The most frequent symptoms were fever (60/80, 75%) and cough (59/80, 74%), the mean NEWS was 1.7±2.3. All LDCT could be analysed and 23/80 (28%) were normal. The major imaging finding was GGOs in 56 cases (67%). The COVID19-LDCT score (mean value = 19±29) was correlated with NEWS (r = 0.48, p<0.0001). No symptoms were risk factor to have pulmonary involvement. Univariate analysis shown that dyspnea, high respiratory rate, hypertension and diabetes are associated to a COVID19-LDCT score superior to 50. CONCLUSIONS COVID19-LDCT score did correlate with NEWS. It was significantly different in the clinical low-risk and high-risk groups. Further work is needed to validate the COVID19-LDCT score against patient prognosis.
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Affiliation(s)
- Thomas Leger
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Alexis Jacquier
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, UMR 7339, CNRS, Centre de Résonance Magnétique Biologique et Médicale–Centre d’Exploration Métaboliques par Résonance Magnétique, Assistance Publique—Hôpitaux de Marseille, Marseille, France
| | - Pierre-Antoine Barral
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Maxime Castelli
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | | | - Jean-Christophe Lagier
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Matthieu Million
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Philippe Parola
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, SSA, VITROME, Marseille, France
| | - Philippe Brouqui
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France
- Aix Marseille Univ, IRD, APHM, MEPHI, Marseille, France
| | - Axel Bartoli
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, UMR 7339, CNRS, Centre de Résonance Magnétique Biologique et Médicale–Centre d’Exploration Métaboliques par Résonance Magnétique, Assistance Publique—Hôpitaux de Marseille, Marseille, France
| | - Jean-Yves Gaubert
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Aix Marseille Univ, LIIE, Marseille, France
- Aix Marseille Univ, CERIMED, Marseille, France
| | - Paul Habert
- Department of Radiology, La Timone Hospital, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- Aix Marseille Univ, LIIE, Marseille, France
- Aix Marseille Univ, CERIMED, Marseille, France
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8
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Sanguinetti M, Posteraro B, Beigelman-Aubry C, Lamoth F, Dunet V, Slavin M, Richardson MD. Diagnosis and treatment of invasive fungal infections: looking ahead. J Antimicrob Chemother 2020; 74:ii27-ii37. [PMID: 31222314 DOI: 10.1093/jac/dkz041] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Improved standards of care depend on the development of new laboratory diagnostic and imaging procedures and the development of new antifungal compounds. Immunochromatography technologies have led to the development of lateral flow devices for the diagnosis of cryptococcal meningitis and invasive aspergillosis (IA). Similar devices are being developed for the detection of histoplasmosis that meet the requirements for speed (∼15 min assay time) and ease of use for point-of-care diagnostics. The evolution of molecular tools for the detection of fungal pathogens has been slow but the introduction of new nucleic acid amplification techniques appears to be helpful, for example T2Candida. An Aspergillus proximity ligation assay has been developed for a rapid near-patient bedside diagnosis of IA. CT remains the cornerstone for radiological diagnosis of invasive pulmonary fungal infections. MRI of the lungs may be performed to avoid radiation exposure. MRI with T2-weighted turbo-spin-echo sequences exhibits sensitivity and specificity approaching that of CT for the diagnosis of invasive pulmonary aspergillosis. The final part of this review looks at new approaches to drug discovery that have yielded new classes with novel mechanisms of action. There are currently two new classes of antifungal drugs in Phase 2 study for systemic invasive fungal disease and one in Phase 1. These new antifungal drugs show promise in meeting unmet needs with oral and intravenous formulations available and some with decreased potential for drug-drug interactions. Novel mechanisms of action mean these agents are not susceptible to the common resistance mechanisms seen in Candida or Aspergillus. Modification of existing antifungal susceptibility testing techniques may be required to incorporate these new compounds.
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Affiliation(s)
- Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brunella Posteraro
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Patologia Medica e Semeiotica Medica, Università Cattolica del Sacro Cuore Rome, Italy
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratory Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Monica Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Malcolm D Richardson
- Mycology Reference Centre Manchester, ECMM Excellence Centre of Medical Mycology, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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9
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Wressnegger A, Prosch H, Moser B, Klepetko W, Jaksch P, Lambers C, Hoetzenecker K, Schestak C, De Bettignies A, Beer L, Apfaltrer G, Ringl H, Apfaltrer P. Chest CT in patients after lung transplantation: A retrospective analysis to evaluate impact on image quality and radiation dose using spectral filtration tin-filtered imaging. PLoS One 2020; 15:e0228376. [PMID: 32023294 PMCID: PMC7001933 DOI: 10.1371/journal.pone.0228376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/14/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the impact of a 150kV spectral filtration chest imaging protocol (Sn150kVp) combined with advanced modeled iterative reconstruction (ADMIRE) on radiation dose and image quality in patients after lung-transplantation. METHODS This study included 102 patients who had unenhanced chest-CT examinations available on both, a second-generation dual-source CT (DSCT) using standard protocol (100kVp, filtered-back-projection) and, on a third-generation DSCT using Sn150kVp protocol with ADMIRE. Signal-to-noise-ratio (SNR) was measured in 6 standardized regions. A 5-point Likert scale was used to evaluate subjective image quality. Radiation metrics were compared. RESULTS The mean time interval between the two acquisitions was 1.1±0.7 years. Mean-volume-CT-dose-index, dose-length-product and effective dose were significantly lower for Sn150kVp protocol (2.1±0.5mGy;72.6±16.9mGy*cm;1.3±0.3mSv) compared to 100kVp protocol (6.2±1.8mGy;203.6±55.6mGy*cm;3.7±1.0mSv) (p<0.001), equaling a 65% dose reduction. All studies were considered of diagnostic quality. SNR measured in lung tissue, air inside trachea, vertebral body and air outside the body was significantly higher in 100kVp protocol compared to Sn150kVp protocol (12.5±2.7vs.9.6±1.5;17.4±3.6vs.11.8±1.8;0.7±0.3vs.0.4±0.2;25.2±6.9vs.14.9±3.3;p<0.001). SNR measured in muscle tissue was significantly higher in Sn150kVp protocol (3.2±0.9vs.2.6±1.0;p<0.001). For SNR measured in descending aorta there was a trend towards higher values for Sn150kVp protocol (2.8±0.6 vs. 2.7±0.9;p = 0.3). Overall SNR was significantly higher in 100kVp protocol (5.0±4.0vs.4.0±4.0;p<0.001). On subjective analysis both protocols achieved a median Likert rating of 1 (25th-75th-percentile:1-1;p = 0.122). Interobserver agreement was good (intraclass correlation coefficient = 0.73). CONCLUSIONS Combined use of 150kVp tin-filtered chest CT protocol with ADMIRE allows for significant dose reduction while maintaining highly diagnostic image quality in the follow up after lung transplantation when compared to a standard chest CT protocol using filtered back projection.
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Affiliation(s)
- Alexander Wressnegger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Bernhard Moser
- Division of Surgery, Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Surgery, Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Surgery, Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Christopher Lambers
- Division of Surgery, Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Surgery, Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Christian Schestak
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Albert De Bettignies
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lucian Beer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Georg Apfaltrer
- Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Helmut Ringl
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Paul Apfaltrer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- * E-mail:
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10
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Lin S, Lin M, Lau KK. Image quality comparison between model-based iterative reconstruction and adaptive statistical iterative reconstruction chest computed tomography in cystic fibrosis patients. J Med Imaging Radiat Oncol 2019; 63:602-609. [PMID: 31090256 DOI: 10.1111/1754-9485.12895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF) predominantly affects young adults. Accurate radiological assessment of pulmonary disease is vital for predicting exacerbations, one of the leading causes of morbidity and mortality. We evaluated the image quality of model-based iterative reconstruction (MBIR) ultra-low-dose CT chest (ULD-CT) in CF evaluation. METHODS We compared ULD-CT with standard adaptive statistical iterative reconstruction (ASIR) low-dose CT (LD-CT). Subjective assessment of contrast and noise were performed for each study. Background noise, signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated and compared between the CT studies. Conspicuity of major structures was assessed. These aspects of image quality were compared to determine whether ULD-CT was superior to LD-CT in assessment of CF. RESULTS The ULD-CT achieved median effective dose of 0.073 mSv, comparable to one standard chest radiograph and significantly lower than the median LD-CT dose of 1.22 mSv. ULD-CT had lower subjective contrast and higher subjective noise when compared to LD-CT. Objectively measured background noise was lower in ULD-CT (16.33 HU vs 38.53 HU, P < 0.0001) compared to LD-CT. ULD-CT had higher median CNR (52.65 vs 22.09, P < 0.0001) and SNR in lung (9.08 vs 7.29, P = 0.002) compared to LD-CT. ULD-CT was equal to LD-CT in identification of trachea, bronchi, pleural and pericardium. Interobserver reliability showed agreement of 80-92%. CONCLUSIONS The image quality of ULD-CT is similar to LD-CT, at 1/16th the dose. MBIR constructed ULD-CT is an effective imaging modality for CF surveillance, with potential applications in other disease settings.
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Affiliation(s)
- Sandra Lin
- Austin Health, Melbourne, Victoria, Australia
| | - Monica Lin
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Kenneth K Lau
- Department of Diagnostic Imaging, Monash Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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11
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Fitton I, Revel MP, Burgel PR, Hernigou A, Boussaud V, Guillemain R, Le Pimpec-Barthes F, Bennani S, Freche G, Frija G, Chassagnon G. Cumulative radiation dose after lung transplantation in patients with cystic fibrosis. Diagn Interv Imaging 2019; 100:287-294. [DOI: 10.1016/j.diii.2018.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
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12
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Yan C, Xu J, Liang C, Wei Q, Wu Y, Xiong W, Zheng H, Xu Y. Radiation Dose Reduction by Using CT with Iterative Model Reconstruction in Patients with Pulmonary Invasive Fungal Infection. Radiology 2018; 288:285-292. [DOI: 10.1148/radiol.2018172107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chenggong Yan
- From the Department of Medical Imaging Center (C.Y., C.L., Y.W., W.X., H.Z., Y.X.) and Department of Hematology (J.X., Q.W.), Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong, People’s Republic of China
| | - Jun Xu
- From the Department of Medical Imaging Center (C.Y., C.L., Y.W., W.X., H.Z., Y.X.) and Department of Hematology (J.X., Q.W.), Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong, People’s Republic of China
| | - Chunyi Liang
- From the Department of Medical Imaging Center (C.Y., C.L., Y.W., W.X., H.Z., Y.X.) and Department of Hematology (J.X., Q.W.), Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong, People’s Republic of China
| | - Qi Wei
- From the Department of Medical Imaging Center (C.Y., C.L., Y.W., W.X., H.Z., Y.X.) and Department of Hematology (J.X., Q.W.), Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong, People’s Republic of China
| | - Yuankui Wu
- From the Department of Medical Imaging Center (C.Y., C.L., Y.W., W.X., H.Z., Y.X.) and Department of Hematology (J.X., Q.W.), Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong, People’s Republic of China
| | - Wei Xiong
- From the Department of Medical Imaging Center (C.Y., C.L., Y.W., W.X., H.Z., Y.X.) and Department of Hematology (J.X., Q.W.), Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong, People’s Republic of China
| | - Huan Zheng
- From the Department of Medical Imaging Center (C.Y., C.L., Y.W., W.X., H.Z., Y.X.) and Department of Hematology (J.X., Q.W.), Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong, People’s Republic of China
| | - Yikai Xu
- From the Department of Medical Imaging Center (C.Y., C.L., Y.W., W.X., H.Z., Y.X.) and Department of Hematology (J.X., Q.W.), Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou 510515, Guangdong, People’s Republic of China
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13
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Padole A, Digumarthy S, Flores E, Madan R, Mishra S, Sharma A, Kalra MK. Assessment of chest CT at CTDI vol less than 1 mGy with iterative reconstruction techniques. Br J Radiol 2017; 90:20160625. [PMID: 28055250 DOI: 10.1259/bjr.20160625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the image quality of chest CT reconstructed with image-based iterative reconstruction (SafeCT; MedicVision®, Tirat Carmel, Israel), adaptive statistical iterative reconstruction (ASIR; GE Healthcare, Waukesha, WI) and model-based iterative reconstruction (MBIR; GE Healthcare, Waukesha, WI) techniques at CT dose index volume (CTDIvol) <1 mGy. METHODS In an institutional review board-approved study, 25 patients gave written informed consent for acquisition of three reduced dose (0.25-, 0.4- and 0.8-mGy) chest CT after standard of care CT (8 mGy) on a 64-channel multidetector CT (MDCT) and reconstructed with SafeCT, ASIR and MBIR. Two board-certified thoracic radiologists evaluated images from the lowest to the highest dose of the reduced dose CT series and subsequently for standard of care CT. RESULTS Out of the 182 detected lesions, the missed lesions were 35 at 0.25, 24 at 0.4 and 9 at 0.8 mGy with SafeCT, ASIR and MBIR, respectively. The most missed lesions were non-calcified lung nodules (NCLNs) 25/112 (<5 mm) at 0.25, 18/112 (<5 mm) at 0.4 and 3/112 (<4 mm) at 0.8 mGy. There were 78%, 84% and 97% lung nodules detected at 0.25, 0.4 and 0.8 mGy, respectively regardless of iterative reconstruction techniques (IRTs), Most mediastinum structures were not sufficiently seen at 0.25-0.8 mGy. CONCLUSION NCLNs can be missed in chest CT at CTDIvol of <1 mGy (0.25, 0.4 and 0.8 mGy) regardless of IRTs. The most lung nodules (97%) were detected at CTDIvol of 0.8 mGy. The most mediastinum structures were not sufficiently seen at 0.25-0.8 mGy. Advances in knowledge: NCLNs can be missed regardless of IRTs in chest CT at CTDIvol of <1 mGy. The performance of ASIR, SafeCT and MBIR was similar for lung nodule detection at 0.25, 0.4 and 0.8 mGy.
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Affiliation(s)
- Atul Padole
- 1 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Subba Digumarthy
- 1 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Efren Flores
- 1 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rachna Madan
- 2 Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shelly Mishra
- 1 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Amita Sharma
- 1 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mannudeep K Kalra
- 1 Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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14
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Kubo T, Ohno Y, Seo JB, Yamashiro T, Kalender WA, Lee CH, Lynch DA, Kauczor HU, Hatabu H. Securing safe and informative thoracic CT examinations—Progress of radiation dose reduction techniques. Eur J Radiol 2017; 86:313-319. [DOI: 10.1016/j.ejrad.2016.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 12/16/2022]
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15
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Breast dose reduction for chest CT by modifying the scanning parameters based on the pre-scan size-specific dose estimate (SSDE). Eur Radiol 2016; 27:2267-2274. [DOI: 10.1007/s00330-016-4618-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 01/20/2023]
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