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Chang VKO, Liang ES, Schmidt P. The diagnostic utility of computed tomography scans performed for febrile neutropenia in a single centre. Curr Probl Diagn Radiol 2024; 53:341-345. [PMID: 38309990 DOI: 10.1067/j.cpradiol.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/08/2023] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Computed tomography (CT) imaging has become a first line investigation for most cases of febrile neutropenia (FN) which can be the only sign of infection in oncology patients undergoing active chemotherapy and bone marrow transplants. The utility of routine non-targeted imaging remains unclear. OBJECTIVE To assess and compare the diagnostic rate between targeted, non-targeted and pan-scan CT in identifying an acute source of infection in adult oncology patients with FN. MATERIALS AND METHODS A retrospective observational study was conducted between February 2019 and March 2023 on 417 consecutive CT examinations for the clinical indication of source identification in FN. Scans were noted for the anatomical regions that were imaged and reports were classified as positive, negative or equivocal for infection. Pre-existing pathology was also noted. Results were tabulated and statistical analyses for comparison between groups of scans was performed using chi-square test. RESULTS All targeted regional scans had statistically significant difference in positive rate compared to non-targeted scans of the respective region; chest (Χ²(1)=18.11, P<.001); sinus (Χ²(1)=15.36, P<.001); abdomen and pelvis (Χ²(1)=5.95, P=.01). Pneumonia (41.3 %) was much more likely to be the diagnosis compared to sinusitis (16.2 %) in concomitant CT chest to sinus examinations (Χ²(1)=45.3, P<.001). Pan-scans had a higher incidence of positive diagnosis compared to all-targeted scans (Χ²(1)=4.91, P=.03) but when compared to higher yield targeted scans (abdomen and chest), there was no statistical difference (Χ²(1)=2.43, P=.12). 20/54 patients had pan-scans despite having localising symptoms. CONCLUSION Imaging guided by presenting signs and symptoms can help to reduce unnecessary imaging and promote more judicious use of non-targeted and pan-scan CT in current practices.
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Affiliation(s)
- Victor K O Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
| | - Ee Shern Liang
- Radiology and Imaging Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Paul Schmidt
- Radiology and Imaging Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Kyriakides J, Khamar R, Khani A, Khatkar H. A quality improvement project: Reducing the number of unnecessary plain abdominal radiographs performed in the emergency department of a London district general hospital. J Family Med Prim Care 2022; 11:190-193. [PMID: 35309616 PMCID: PMC8930155 DOI: 10.4103/jfmpc.jfmpc_1193_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022] Open
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Nicolan B, Greffier J, Dabli D, de Forges H, Arcis E, Al Zouabi N, Larbi A, Beregi JP, Frandon J. Diagnostic performance of ultra-low dose versus standard dose CT for non-traumatic abdominal emergencies. Diagn Interv Imaging 2021; 102:379-387. [PMID: 33714689 DOI: 10.1016/j.diii.2021.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to compare the diagnostic performance of ultra-low dose (ULD) to that of standard (STD) computed tomography (CT) for the diagnosis of non-traumatic abdominal emergencies using clinical follow-up as reference standard. MATERIALS AND METHODS All consecutive patients requiring emergency abdomen-pelvic CT examination from March 2017 to September 2017 were prospectively included. ULD and STD CTs were acquired after intravenous administration iodinated contrast medium (portal phase). CT acquisitions were performed at 125mAs for STD and 55mAs for ULD. Diagnostic performance was retrospectively evaluated on ULD and STD CTs using clinical follow-up as a reference diagnosis. RESULTS A total of 308 CT examinations from 308 patients (145 men; mean age 59.1±20.7 (SD) years; age range: 18-96 years) were included; among which 241/308 (78.2%) showed abnormal findings. The effective dose was significantly lower with the ULD protocol (1.55±1.03 [SD] mSv) than with the STD (3.67±2.56 [SD] mSv) (P<0.001). Sensitivity was significantly lower for the ULD protocol (85.5% [95%CI: 80.4-89.4]) than for the STD (93.4% [95%CI: 89.4-95.9], P<0.001) whereas specificities were similar (94.0% [95%CI: 85.1-98.0] vs. 95.5% [95%CI: 87.0-98.9], respectively). ULD sensitivity was equivalent to STD for bowel obstruction and colitis/diverticulitis (96.4% [95%CI: 87.0-99.6] and 86.5% [95%CI: 74.3-93.5] for ULD vs. 96.4% [95%CI: 87.0-99.6] and 88.5% [95%CI: 76.5-94.9] for STD, respectively) but lower for appendicitis, pyelonephritis, abscesses and renal colic (75.0% [95%CI: 57.6-86.9]; 77.3% [95%CI: 56.0-90.1]; 90.5% [95%CI: 69.6-98.4] and 85% [95%CI: 62.9-95.4] for ULD vs. 93.8% [95%CI: 78.6-99.2]; 95.5% [95%CI: 76.2-100.0]; 100.0% [95%CI: 81.4-100.0] and 100.0% [95%CI: 80.6-100.0] for STD, respectively). Sensitivities were significantly different between the two protocols only for appendicitis (P=0.041). CONCLUSION In an emergency context, for patients with non-traumatic abdominal emergencies, ULD-CT showed inferior diagnostic performance compared to STD-CT for most abdominal conditions except for bowel obstruction and colitis/diverticulitis detection.
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Affiliation(s)
- Basien Nicolan
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, EA 2415, 30000 Nîmes, France
| | - Joël Greffier
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, EA 2415, 30000 Nîmes, France
| | - Djamel Dabli
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, EA 2415, 30000 Nîmes, France
| | - Hélène de Forges
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, EA 2415, 30000 Nîmes, France
| | - Elise Arcis
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, EA 2415, 30000 Nîmes, France
| | - Nadir Al Zouabi
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, EA 2415, 30000 Nîmes, France
| | - Ahmed Larbi
- ISERIS imagerie médicale, 34000 Montpellier, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, EA 2415, 30000 Nîmes, France
| | - Julien Frandon
- Department of Medical Imaging, Nîmes University Hospital, University of Montpellier, Medical Imaging Group Nîmes, EA 2415, 30000 Nîmes, France.
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Pyper M, Sidiqi A, Rogalla P, Sabbah S, Kielar A. CT Abdominal Tomography Indications: Are We All Sticking to the Plan? Can Assoc Radiol J 2020; 72:736-741. [PMID: 32903020 DOI: 10.1177/0846537120951078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Ultra-low radiation dose computed tomography (CT) abdominal tomography was introduced in our institution in 2016 to replace standard abdominal radiography in the investigation of emergency department patients. This project aims to ascertain whether investigation of emergency department patients using ultra-low radiation dose CT abdominal tomography complies with original indication guidelines and/or if there has been any "indication creep" 3 years after inception. METHODS Retrospective, quality assurance project with research ethics waiver. A review of 200 consecutive patients investigated with CT abdominal tomography between February and May 2017 was performed. This was compared with 200 consecutive patients investigated between February and May 2019. Data analyzed included patient demographics, indication for scan, as well as scan and patient outcomes. RESULTS In the 2017 group, 29/200 scans were noncompliant with approved indication guidelines. In the 2019 group, 30/200 scans were also noncompliant. There was no statistically significant difference between groups (P < .05) regarding the use of approved indications. Forty of 200 scans performed in 2017 revealed additional findings which are not specifically addressed on the reporting template. Forty-one of 200 scans in 2019 revealed these findings. CONCLUSIONS There has been no "indication creep" for CT abdominal tomography over time.
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Affiliation(s)
- Michael Pyper
- Toronto General Hospital, Toronto, ON, Canada.,Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | | | | | - Sam Sabbah
- Toronto General Hospital, Toronto, ON, Canada
| | - Ania Kielar
- Toronto General Hospital, Toronto, ON, Canada
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