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Abstract
The CT manifestation of COVID-19 patients is now well known and essentially reflects pathological changes in the lungs. Actually, there is insufficient knowledge on the long-term outcomes of this new disease, and several chest CTs might be necessary to evaluate the outcomes. The aim of this study is to evaluate the radiation dose for chest CT scans in COVID-19 patients compared to a cohort with pulmonary infectious diseases at the same time of the previous year to value if there is any modification of exposure dose. The analysis of our data shows an increase in the overall mean dose in COVID-19 patients compared with non-COVID-19 patients. In our results, the higher dose increase occurs in the younger age groups (+86% range 21–30 years and +67% range 31–40 years). Our results show that COVID-19 patients are exposed to a significantly higher dose of ionizing radiation than other patients without COVID infectious lung disease, and especially in younger age groups, although some authors have proposed the use of radiotherapy in these patients, which is yet to be validated. Our study has limitations: the use of one CT machine in a single institute and a limited number of patients.
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Finance J, Zieleskewicz L, Habert P, Jacquier A, Parola P, Boussuges A, Bregeon F, Eldin C. Low Dose Chest CT and Lung Ultrasound for the Diagnosis and Management of COVID-19. J Clin Med 2021; 10:jcm10102196. [PMID: 34069557 PMCID: PMC8160936 DOI: 10.3390/jcm10102196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has provided an opportunity to use low- and non-radiating chest imaging techniques on a large scale in the context of an infectious disease, which has never been done before. Previously, low-dose techniques were rarely used for infectious diseases, despite the recognised danger of ionising radiation. METHOD To evaluate the role of low-dose computed tomography (LDCT) and lung ultrasound (LUS) in managing COVID-19 pneumonia, we performed a review of the literature including our cases. RESULTS Chest LDCT is now performed routinely when diagnosing and assessing the severity of COVID-19, allowing patients to be rapidly triaged. The extent of lung involvement assessed by LDCT is accurate in terms of predicting poor clinical outcomes in COVID-19-infected patients. Infectious disease specialists are less familiar with LUS, but this technique is also of great interest for a rapid diagnosis of patients with COVID-19 and is effective at assessing patient prognosis. CONCLUSIONS COVID-19 is currently accelerating the transition to low-dose and "no-dose" imaging techniques to explore infectious pneumonia and their long-term consequences.
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Affiliation(s)
- Julie Finance
- IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix Marseille University, 13005 Marseille, France; (J.F.); (F.B.)
- Service des Explorations Fonctionnelles Respiratoires, APHM, 13005 Marseille, France
| | - Laurent Zieleskewicz
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, APHM, Aix Marseille Université, 13005 Marseille, France;
- INRA, INSERM, Centre for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, 13005 Marseille, France;
| | - Paul Habert
- Service de Radiologie Cardio-Thoracique, Hôpital La Timone, APHM, 13005 Marseille, France; (P.H.); (A.J.)
- LIIE, Aix Marseille University, 13005 Marseille, France
| | - Alexis Jacquier
- Service de Radiologie Cardio-Thoracique, Hôpital La Timone, APHM, 13005 Marseille, France; (P.H.); (A.J.)
- CNRS, CRMBM-CEMEREM (Centre de Résonance Magnétique Biologique et Médicale—Centre d’Exploration Métaboliques par Résonance Magnétique), APHM, Aix-Marseille University, UMR 7339, 13005 Marseille, France
| | - Philippe Parola
- IRD, APHM, SSA, VITROME, Aix Marseille University, 13005 Marseille, France;
- IHU-Méditerranée Infection, Aix Marseille University, 13005 Marseille, France
| | - Alain Boussuges
- INRA, INSERM, Centre for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, 13005 Marseille, France;
| | - Fabienne Bregeon
- IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix Marseille University, 13005 Marseille, France; (J.F.); (F.B.)
- Service des Explorations Fonctionnelles Respiratoires, APHM, 13005 Marseille, France
| | - Carole Eldin
- IRD, APHM, SSA, VITROME, Aix Marseille University, 13005 Marseille, France;
- IHU-Méditerranée Infection, Aix Marseille University, 13005 Marseille, France
- Correspondence:
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Thoracic lymph node delineation at dose-reduced (1 mSv) dose-modulated contrast enhanced MDCT: a retrospective pilot study. Radiol Med 2016; 121:644-51. [DOI: 10.1007/s11547-016-0645-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/18/2016] [Indexed: 11/27/2022]
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Kim HJ, Park SY, Lee HY, Lee KS, Shin KE, Moon JW. Ultra-Low-Dose Chest CT in Patients with Neutropenic Fever and Hematologic Malignancy: Image Quality and Its Diagnostic Performance. Cancer Res Treat 2014; 46:393-402. [PMID: 25308150 PMCID: PMC4206072 DOI: 10.4143/crt.2013.132] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/24/2013] [Indexed: 12/11/2022] Open
Abstract
Purpose The aim of this study was to evaluate the image quality of ultra-low-dose computed tomography (ULDCT) and its diagnostic performance in making a specific diagnosis of pneumonia in febrile neutropenic patients with hematological malignancy. Materials and Methods ULDCT was performed prospectively in 207 febrile neutropenic patients with hematological malignancy. Three observers independently recorded the presence of lung parenchymal abnormality, and also indicated the cause of the lung parenchymal abnormality between infectious and noninfectious causes. If infectious pneumonia was considered the cause of lung abnormalities, they noted the two most appropriate diagnoses among four infectious conditions, including fungal, bacterial, viral, and Pneumocystis pneumonia. Sensitivity for correct diagnoses and receiver operating characteristic (ROC) curve analysis for evaluation of diagnostic accuracy were calculated. Interobserver agreements were determined using intraclass correlation coefficient. Results Of 207 patients, 139 (67%) had pneumonia, 12 had noninfectious lung disease, and 56 had no remarkable chest computed tomography (CT) (20 with extrathoracic fever focus and 36 with no specific disease). Mean radiation expose dose of ULDCT was 0.60±0.15 mSv. Each observer regarded low-dose CT scans as unacceptable in only four (1.9%), one (0.5%), and three (1.5%) cases of ULDCTs. Sensitivity and area under the ROC curve in making a specific pneumonia diagnosis were 63.0%, 0.65 for reader 1; 63.0%, 0.61 for reader 2; and 65.0%, 0.62 for reader 3; respectively conclusion ULDCT, with a sub-mSv radiation dose and acceptable image quality, provides ready and reasonably acceptable diagnostic information for pulmonary infection in febrile neutropenic patients with hematologic malignancy
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Affiliation(s)
- Hae Jin Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Park
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Eun Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Won Moon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Christe A, Szucs-Farkas Z, Huber A, Steiger P, Leidolt L, Roos JE, Heverhagen J, Ebner L. Optimal dose levels in screening chest CT for unimpaired detection and volumetry of lung nodules, with and without computer assisted detection at minimal patient radiation. PLoS One 2013; 8:e82919. [PMID: 24386126 PMCID: PMC3873253 DOI: 10.1371/journal.pone.0082919] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/29/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this phantom study was to minimize the radiation dose by finding the best combination of low tube current and low voltage that would result in accurate volume measurements when compared to standard CT imaging without significantly decreasing the sensitivity of detecting lung nodules both with and without the assistance of CAD. METHODS An anthropomorphic chest phantom containing artificial solid and ground glass nodules (GGNs, 5-12 mm) was examined with a 64-row multi-detector CT scanner with three tube currents of 100, 50 and 25 mAs in combination with three tube voltages of 120, 100 and 80 kVp. This resulted in eight different protocols that were then compared to standard CT sensitivity (100 mAs/120 kVp). For each protocol, at least 127 different nodules were scanned in 21-25 phantoms. The nodules were analyzed in two separate sessions by three independent, blinded radiologists and computer-aided detection (CAD) software. RESULTS The mean sensitivity of the radiologists for identifying solid lung nodules on a standard CT was 89.7% ± 4.9%. The sensitivity was not significantly impaired when the tube and current voltage were lowered at the same time, except at the lowest exposure level of 25 mAs/80 kVp [80.6% ± 4.3% (p = 0.031)]. Compared to the standard CT, the sensitivity for detecting GGNs was significantly lower at all dose levels when the voltage was 80 kVp; this result was independent of the tube current. The CAD significantly increased the radiologists' sensitivity for detecting solid nodules at all dose levels (5-11%). No significant volume measurement errors (VMEs) were documented for the radiologists or the CAD software at any dose level. CONCLUSIONS Our results suggest a CT protocol with 25 mAs and 100 kVp is optimal for detecting solid and ground glass nodules in lung cancer screening. The use of CAD software is highly recommended at all dose levels.
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Affiliation(s)
- Andreas Christe
- Department of Radiology, Hospital and University of Bern, Inselspital, Bern, Switzerland
- * E-mail:
| | | | - Adrian Huber
- Department of Radiology, Hospital and University of Bern, Inselspital, Bern, Switzerland
| | - Philipp Steiger
- Department of Radiology, Hospital and University of Bern, Inselspital, Bern, Switzerland
| | - Lars Leidolt
- Department of Radiology, Hospital and University of Bern, Inselspital, Bern, Switzerland
| | - Justus E. Roos
- Department of Radiology, Duke University, Durham, North Carolina, United States of America
| | - Johannes Heverhagen
- Department of Radiology, Hospital and University of Bern, Inselspital, Bern, Switzerland
| | - Lukas Ebner
- Department of Radiology, Hospital and University of Bern, Inselspital, Bern, Switzerland
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Singh S, Kalra MK, Ali Khawaja RD, Padole A, Pourjabbar S, Lira D, Shepard JAO, Digumarthy SR. Radiation dose optimization and thoracic computed tomography. Radiol Clin North Am 2013; 52:1-15. [PMID: 24267707 DOI: 10.1016/j.rcl.2013.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In the past 3 decades, radiation dose from computed tomography (CT) has contributed to an increase in overall radiation exposure to the population. This increase has caused concerns over harmful effects of radiation dose associated with CT in scientific publications as well as in the lay press. To address these concerns, and reduce radiation dose, several strategies to optimize radiation dose have been developed and assessed, including manual or automatic adjustment of scan parameters. This article describes conventional and contemporary techniques to reduce radiation dose associated with chest CT.
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Affiliation(s)
- Sarabjeet Singh
- Division of Thoracic Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Rizzi EB, Schinina' V, Cristofaro M, Goletti D, Palmieri F, Bevilacqua N, Lauria FN, Girardi E, Bibbolino C. Detection of Pulmonary tuberculosis: comparing MR imaging with HRCT. BMC Infect Dis 2011; 11:243. [PMID: 21923910 PMCID: PMC3184086 DOI: 10.1186/1471-2334-11-243] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 09/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computer Tomography (CT) is considered the gold standard for assessing the morphological changes of lung parenchyma. Although novel CT techniques have substantially decreased the radiation dose, radiation exposure is still high. Magnetic Resonance Imaging (MRI) has been established as a radiation- free alternative to CT for several lung diseases, but its role in infectious diseases still needs to be explored further. Therefore, the purpose of our study was to compare MRI with high resolution CT (HRCT) for assessing pulmonary tuberculosis. METHODS 50 patients with culture-proven pulmonary tuberculosis underwent chest HRCT as the standard of reference and were evaluated by MRI within 24 h after HRCT. Altogether we performed 60 CT and MRI examinations, because 10 patients were also examined by CT and MRI at follow- up. Pulmonary abnormalities, their characteristics, location and distribution were analyzed by two readers who were blinded to the HRCT results. RESULTS Artifacts did not interfere with the diagnostic value of MRI. Both HRCT and MRI correctly diagnosed pulmonary tuberculosis and identified pulmonary abnormalities in all patients. There were no significant differences between the two techniques in terms of identifying the location and distribution of the lung lesions, though the higher resolution of MRI did allow for better identification of parenchymal dishomogeneity, caseosis, and pleural or nodal involvement. CONCLUSION Technical developments and the refinement of pulse sequences have improved the quality and speed of MRI. Our data indicate that in terms of identifying lung lesions in non-AIDS patients with non- miliary pulmonary tuberculosis, MRI achieves diagnostic performances comparable to those obtained by HRCT but with better and more rapid identification of pulmonary tissue abnormalities due to the excellent contrast resolution.
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Affiliation(s)
- Elisa Busi Rizzi
- Diagnostic Department, Radiology, "L, Spallanzani" National Institute for Infectious Diseases, Rome, Italy.
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Christe A, Lin MC, Yen AC, Hallett RL, Roychoudhury K, Schmitzberger F, Fleischmann D, Leung AN, Rubin GD, Rubin GD, Vock P, Roos JE. CT patterns of fungal pulmonary infections of the lung: comparison of standard-dose and simulated low-dose CT. Eur J Radiol 2011; 81:2860-6. [PMID: 21835569 DOI: 10.1016/j.ejrad.2011.06.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 06/23/2011] [Accepted: 06/25/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the effect of radiation dose reduction on the appearance and visual quantification of specific CT patterns of fungal infection in immuno-compromised patients. MATERIALS AND METHODS Raw data of thoracic CT scans (64 × 0.75 mm, 120 kVp, 300 reference mAs) from 41 consecutive patients with clinical suspicion of pulmonary fungal infection were collected. In 32 patients fungal infection could be proven (median age of 55.5 years, range 35-83). A total of 267 cuboids showing CT patterns of fungal infection and 27 cubes having no disease were reconstructed at the original and 6 simulated tube currents of 100, 40, 30, 20, 10, and 5 reference mAs. Eight specific fungal CT patterns were analyzed by three radiologists: 76 ground glass opacities, 42 ground glass nodules, 51 mixed, part solid, part ground glass nodules, 36 solid nodules, 5 lobulated nodules, 6 spiculated nodules, 14 cavitary nodules, and 37 foci of air-space disease. The standard of reference was a consensus subjective interpretation by experts whom were not readers in the study. RESULTS The mean sensitivity and standard deviation for detecting pathological cuboids/disease using standard dose CT was 0.91 ± 0.07. Decreasing dose did not affect sensitivity significantly until the lowest dose level of 5 mAs (0.87 ± 0.10, p=0.012). Nodular pattern discrimination was impaired below the dose level of 30 reference mAs: specificity for fungal 'mixed nodules' decreased significantly at 20, 10 and 5 reference mAs (p<0.05). At lower dose levels, classification drifted from 'solid' to 'mixed nodule', although no lesion was missed. CONCLUSION Our simulation data suggest that tube current levels can be reduced from 300 to 30 reference mAs without impairing the diagnostic information of specific CT patterns of pulmonary fungal infections.
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Affiliation(s)
- Andreas Christe
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Zhu L, Wang J, Xie Y, Starman J, Fahrig R, Xing L. A patient set-up protocol based on partially blocked cone-beam CT. Technol Cancer Res Treat 2010; 9:191-8. [PMID: 20218741 DOI: 10.1177/153303461000900208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Three-dimensional x-ray cone-beam CT (CBCT) is being increasingly used in radiation therapy. Since the whole treatment course typically lasts several weeks, the repetitive x-ray imaging results in large radiation dose delivered on the patient. In the current radiation therapy treatment, CBCT is mainly used for patient set-up, and a rigid transformation of the CBCT data from the planning CT data is also assumed. For an accurate rigid registration, it is not necessary to acquire a full 3D image. In this paper, we propose a patient set-up protocol based on partially blocked CBCT. A sheet of lead strips is inserted between the x-ray source and the scanned patient. From the incomplete projection data, only several axial slices are reconstructed and used in the image registration for patient set-up. Since the radiation is partially blocked, the dose delivered onto the patient is significantly reduced, with an additional benefit of reduced scatter signals. The proposed approach is validated using experiments on two anthropomorphic phantoms. As x-ray beam blocking ratio increases, more dose reduction is achieved, while the patient set-up error also increases. To investigate this tradeoff, two lead sheets with different strip widths are implemented, which correspond to radiation dose reduction of approximately 6 and approximately 11, respectively. We compare the registration results using the partially blocked CBCT with those using the regular CBCT. Both lead sheets achieve high patient set-up accuracies. It is seen that, using the lead sheet with radiation dose reduction by a factor of approximately 11, the patient set-up error is still less than 1mm in translation and less than 0.2 degrees in rotation. The comparison of the reconstructed images also shows that the image quality of the illuminated slices in the partially blocked CBCT is much improved over that in the regular CBCT.
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Affiliation(s)
- Lei Zhu
- Nuclear and Radiological Engineering and Medical Physics Programs, George W. Woodruff School of Mechanical Engineering, Atlanta, Georgia 30332, USA.
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Multidetector Computed Tomography Chest Examinations With Low-Kilovoltage Protocols in Adults. J Comput Assist Tomogr 2009; 33:416-21. [PMID: 19478637 DOI: 10.1097/rct.0b013e318181fab5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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