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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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Dankerl P, May MS, Canstein C, Uder M, Saake M. Cutting Staff Radiation Exposure and Improving Freedom of Motion during CT Interventions: Comparison of a Novel Workflow Utilizing a Radiation Protection Cabin versus Two Conventional Workflows. Diagnostics (Basel) 2021; 11:diagnostics11061099. [PMID: 34208499 PMCID: PMC8235446 DOI: 10.3390/diagnostics11061099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to evaluate the radiation exposure to the radiologist and the procedure time of prospectively matched CT interventions implementing three different workflows—the radiologist—(I) leaving the CT room during scanning; (II) wearing a lead apron and staying in the CT room; (III) staying in the CT room in a prototype radiation protection cabin without lead apron while utilizing a wireless remote control and a tablet. We prospectively evaluated the radiologist’s radiation exposure utilizing an electronic personal dosimeter, the intervention time, and success in CT interventions matched to the three different workflows. We compared the interventional success, the patient’s dose of the interventional scans in each workflow (total mAs and total DLP), the radiologist’s personal dose (in µSV), and interventional time. To perform workflow III, a prototype of a radiation protection cabin, with 3 mm lead equivalent walls and a foot switch to operate the doors, was built in the CT examination room. Radiation exposure during the maximum tube output at 120 kV was measured by the local admission officials inside the cabin at the same level as in the technician’s control room (below 0.5 μSv/h and 1 mSv/y). Further, to utilize the full potential of this novel workflow, a sterile packed remote control (to move the CT table and to trigger the radiation) and a sterile packed tablet anchored on the CT table (to plan and navigate during the CT intervention) were operated by the radiologist. There were 18 interventions performed in workflow I, 16 in workflow II, and 27 in workflow III. There were no significant differences in the intervention time (workflow I: 23 min ± 12, workflow II: 20 min ± 8, and workflow III: 21 min ± 10, p = 0.71) and the patient’s dose (total DLP, p = 0.14). However, the personal dosimeter registered 0.17 ± 0.22 µSv for workflow II, while I and III both documented 0 µSv, displaying significant difference (p < 0.001). All workflows were performed completely and successfully in all cases. The new workflow has the potential to reduce interventional CT radiologists’ radiation dose to zero while relieving them from working in a lead apron all day.
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Affiliation(s)
- Peter Dankerl
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (M.S.M.); (M.U.); (M.S.)
- Correspondence: ; Tel.: +49-9131-8536065; Fax: +49-9131-8536068
| | - Matthias Stefan May
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (M.S.M.); (M.U.); (M.S.)
| | | | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (M.S.M.); (M.U.); (M.S.)
| | - Marc Saake
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany; (M.S.M.); (M.U.); (M.S.)
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Kopp M, Wetzl M, Geissler F, Roth JP, Wallner R, Hoefler D, Faby S, Allmendinger T, Amarteifio P, Wuest W, Cavallaro A, Uder M, May MS. Structured Digital Self-Assessment of Patient Anamnesis Prior to Computed Tomography: Performance Evaluation and Added Value. J Med Syst 2021; 45:30. [PMID: 33511485 PMCID: PMC7843739 DOI: 10.1007/s10916-020-01690-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/01/2020] [Indexed: 01/02/2023]
Abstract
The aim of this study was to evaluate the performance of a tablet-based, digitized structured self-assessment (DSSA) of patient anamnesis (PA) prior to computed tomography (CT). Of the 317 patients consecutively referred for CT, the majority (n = 294) was able to complete the tablet-based questionnaire, which consisted of 67 items covering social anamnesis, lifestyle factors (e.g., tobacco abuse), medical history (e.g., kidney diseases), current symptoms, and the usability of the system. Patients were able to mark unclear questions for a subsequent discussion with the radiologist. Critical issues for the CT examination were structured and automatically highlighted as “red flags” (RFs) in order to improve patient interaction. RFs and marked questions were highly prevalent (69.5% and 26%). Missing creatinine values (33.3%), kidney diseases (14.4%), thyroid diseases (10.6%), metformin (5.5%), claustrophobia (4.1%), allergic reactions to contrast agents (2.4%), and pathological TSH values (2.0%) were highlighted most frequently as RFs. Patient feedback regarding the comprehensibility of the questionnaire and the tablet usability was mainly positive (90.9%; 86.2%). With advanced age, however, patients provided more negative feedback for both (p = 0.007; p = 0.039). The time effort was less than 20 min for 85.1% of patients, and faster patients were significantly younger (p = 0.046). Overall, the DSSA of PA prior to CT shows a high success rate and is well accepted by most patients. RFs and marked questions were common and helped to focus patients’ interactions and reporting towards decisive aspects.
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Affiliation(s)
- M Kopp
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.
| | - M Wetzl
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - F Geissler
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - J P Roth
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - R Wallner
- e.Bavarian Health GmbH, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - D Hoefler
- e.Bavarian Health GmbH, Erlangen, Germany.,Siemens Healthcare GmbH, Forchheim, Germany
| | - S Faby
- Siemens Healthcare GmbH, Forchheim, Germany
| | | | - P Amarteifio
- Siemens Healthcare GmbH, Forchheim, Germany.,Imaging Science Institute, Erlangen, Germany
| | - W Wuest
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - A Cavallaro
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - M Uder
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - M S May
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
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