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Quarton S, Livesey A, Pittaway H, Adiga A, Grudzinska F, McNally A, Dosanjh D, Sapey E, Parekh D. Clinical challenge of diagnosing non-ventilator hospital-acquired pneumonia and identifying causative pathogens: a narrative review. J Hosp Infect 2024; 149:189-200. [PMID: 38621512 DOI: 10.1016/j.jhin.2024.02.029] [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: 12/21/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 04/17/2024]
Abstract
Non-ventilated hospital-acquired pneumonia (NV-HAP) is associated with a significant healthcare burden, arising from high incidence and associated morbidity and mortality. However, accurate identification of cases remains challenging. At present, there is no gold-standard test for the diagnosis of NV-HAP, requiring instead the blending of non-specific signs and investigations. Causative organisms are only identified in a minority of cases. This has significant implications for surveillance, patient outcomes and antimicrobial stewardship. Much of the existing research in HAP has been conducted among ventilated patients. The paucity of dedicated NV-HAP research means that conclusions regarding diagnostic methods, pathology and interventions must largely be extrapolated from work in other settings. Progress is also limited by the lack of a widely agreed definition for NV-HAP. The diagnosis of NV-HAP has large scope for improvement. Consensus regarding a case definition will allow meaningful research to improve understanding of its aetiology and the heterogeneity of outcomes experienced by patients. There is potential to optimize the role of imaging and to incorporate novel techniques to identify likely causative pathogens. This would facilitate both antimicrobial stewardship and surveillance of an important healthcare-associated infection. This narrative review considers the utility of existing methods to diagnose NV-HAP, with a focus on the significance and challenge of identifying pathogens. It discusses the limitations in current techniques, and explores the potential of emergent molecular techniques to improve microbiological diagnosis and outcomes for patients.
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Affiliation(s)
- S Quarton
- National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
| | - A Livesey
- National Institute for Health Research/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham, Birmingham, UK
| | - H Pittaway
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Birmingham, UK
| | - A Adiga
- Warwick Hospital, South Warwickshire University NHS Foundation Trust, Warwick, UK
| | - F Grudzinska
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - A McNally
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - D Dosanjh
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - E Sapey
- National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; National Institute for Health Research Midlands Patient Safety Research Collaboration, University of Birmingham, Birmingham, UK; National Institute for Health Research Midlands Applied Research Collaborative, University of Birmingham, Birmingham, UK
| | - D Parekh
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Kasuga I, Yokoe Y, Gamo S, Sugiyama T, Tokura M, Noguchi M, Okayama M, Nagakura R, Ohmori N, Tsuchiya T, Sofuni A, Itoi T, Ohtsubo O. Which is a real valuable screening tool for lung cancer and measure thoracic diseases, chest radiography or low-dose computed tomography?: A review on the current status of Japan and other countries. Medicine (Baltimore) 2024; 103:e38161. [PMID: 38728453 PMCID: PMC11081589 DOI: 10.1097/md.0000000000038161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
Chest radiography (CR) has been used as a screening tool for lung cancer and the use of low-dose computed tomography (LDCT) is not recommended in Japan. We need to reconsider whether CR really contributes to the early detection of lung cancer. In addition, we have not well discussed about other major thoracic disease detection by CR and LDCT compared with lung cancer despite of its high frequency. We review the usefulness of CR and LDCT as veridical screening tools for lung cancer and other thoracic diseases. In the case of lung cancer, many studies showed that LDCT has capability of early detection and improving outcomes compared with CR. Recent large randomized trial also supports former results. In the case of chronic obstructive pulmonary disease (COPD), LDCT contributes to early detection and leads to the implementation of smoking cessation treatments. In the case of pulmonary infections, LDCT can reveal tiny inflammatory changes that are not observed on CR, though many of these cases improve spontaneously. Therefore, LDCT screening for pulmonary infections may be less useful. CR screening is more suitable for the detection of pulmonary infections. In the case of cardiovascular disease (CVD), CR may be a better screening tool for detecting cardiomegaly, whereas LDCT may be a more useful tool for detecting vascular changes. Therefore, the current status of thoracic disease screening is that LDCT may be a better screening tool for detecting lung cancer, COPD, and vascular changes. CR may be a suitable screening tool for pulmonary infections and cardiomegaly.
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Affiliation(s)
- Ikuma Kasuga
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
- Department of Internal Medicine, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
- Department of Nursing, Faculty of Human Care, Tohto University, Saitama, Japan
| | - Yoshimi Yokoe
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
| | - Sanae Gamo
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
| | - Tomoko Sugiyama
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
| | - Michiyo Tokura
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
| | - Maiko Noguchi
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
| | - Mayumi Okayama
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
| | - Rei Nagakura
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
| | - Nariko Ohmori
- Department of Medicine, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
- Department of Clinical Oncology, Tokyo Medical University, Tokyo Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Osamu Ohtsubo
- Department of Nursing, Faculty of Human Care, Tohto University, Saitama, Japan
- Department of Medicine, Kenkoigaku Association, Tokyo Japan
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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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Wei W, Wang SG, Zhang JY, Togn XY, Li BB, Fang X, Pu RW, Zhou YJ, Liu YJ. Implementation of Individualized Low-Dose Computed Tomography-Guided Hook Wire Localization of Pulmonary Nodules: Feasibility and Safety in the Clinical Setting. Diagnostics (Basel) 2023; 13:3235. [PMID: 37892056 PMCID: PMC10606229 DOI: 10.3390/diagnostics13203235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Background: CT-guided hook-wire localization is an essential step in the management of small pulmonary nodules. Few studies, however, have focused on reducing radiation exposure during the procedure. Purpose: This study aims to explore the feasibility of implementing a low-dose computed tomography (CT)-guided hook wire localization using tailored kVp based on patients' body size. Materials and Methods: A total of 151 patients with small pulmonary nodules were prospectively enrolled for CT-guided hook wire localization using individualized low-dose CT (LDCT) vs. standard-dose CT (SDCT) protocols. Radiation dose, image quality, characteristics of target nodules and procedure-related variables were compared. All variables were analyzed using Chi-Square and Student's t-test. Results: The mean CTDIvol was significantly reduced for LDCT (for BMI ≤ 21 kg/m2, 0.56 ± 0.00 mGy and for BMI > 21 kg/m2, 1.48 ± 0.00 mGy) when compared with SDCT (for BMI ≤ 21 kg/m2, 5.24 ± 0.95 mGy and for BMI > 21 kg/m2, 6.69 ± 1.47 mGy). Accordingly, the DLP of LDCT was significantly reduced as compared with that of SDCT (for BMI ≤ 21 kg/m2, 56.86 ± 4.73 vs. 533.58 ± 122.06 mGy.cm, and for BMI > 21 kg/m2, 167.02 ± 38.76 vs. 746.01 ± 230.91 mGy.cm). In comparison with SDCT, the effective dose (ED) of LDCT decreased by an average of 89.42% (for BMI ≤ 21 kg/m2) and 77.68% (for BMI > 21 kg/m2), respectively. Although the images acquired with the LDCT protocol yielded inferior quality to those acquired with the SDCT protocol, they were clinically acceptable for hook wire localization. Conclusions: LDCT-guided localization can provide safety and nodule detection performance comparable to SDCT-guided localization, benefiting radiation dose reduction dramatically, especially for patients with small body mass indexes.
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Affiliation(s)
| | | | | | | | | | | | | | - Yu-Jing Zhou
- Correspondence: (Y.-J.Z.); (Y.-J.L.); Tel.: +86-180-9887-7000 (Y.J.-L.)
| | - Yi-Jun Liu
- Correspondence: (Y.-J.Z.); (Y.-J.L.); Tel.: +86-180-9887-7000 (Y.J.-L.)
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5
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van den Berk IAH, M N P Kanglie M, van Engelen TSR, Hovinga de Boer MC, de Monyé W, Bipat S, Bossuyt PMM, Prins JM, Stoker J. Pneumonia pattern recognition on ultra-low-dose CT does not allow for a reliable differentiation between viral and bacterial pneumonia: A multicentre observer study. Eur J Radiol 2023; 167:111064. [PMID: 37657382 DOI: 10.1016/j.ejrad.2023.111064] [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: 03/12/2023] [Revised: 08/06/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
PURPOSE While a reliable differentiation between viral and bacterial pneumonia is not possible with chest X-ray, this study investigates whether ultra-low-dose chest-CT (ULDCT) could be used for this purpose. METHODS In the OPTIMACT trial 281 patients had a final diagnosis of pneumonia, and 96/281 (34%) had one or more positive microbiology results: 60 patients viral pathogens, 48 patients bacterial pathogens. These 96 ULDCT's were blindly and independently evaluated by two chest radiologists, who reported CT findings, pneumonia pattern, and most likely type of pathogen. Differences between groups were analysed for each radiologist separately, diagnostic accuracy was evaluated by calculating sensitivity. RESULTS The dominant CT finding significantly differed between the viral and bacterial pathogen groups (p = 0.04; p = 0.04). Consolidation was the most frequent dominant CT finding in both patients with viral and bacterial pathogens, but was observed significantly more often in those with a bacterial pathogen: 32/60 and 22/60 versus 38/48 and 31/48 (p = 0.005; p = 0.004). The lobar pneumonia pattern was more frequently observed in patients with a bacterial pathogen: 23/48 and 18/48, versus 10/60 and 8/60 for viral pathogens (p < 0.001; p = 0.004). For the bronchopneumonia and interstitial pneumonia patterns the proportions of viral and bacterial pathogens were not significantly different. Both radiologists suggested a viral pathogen correctly (sensitivity) in 6/60 (10%), for a bacterial pathogen this was 34/48 (71%). CONCLUSION Reliable differentiation between viral and bacterial pneumonia could not be made by pattern recognition on ULDCT, although a lobar pneumonia pattern was significantly more often observed in bacterial infection.
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Affiliation(s)
- Inge A H van den Berk
- Amsterdam UMC location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Maadrika M N P Kanglie
- Amsterdam UMC location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Spaarne Gasthuis, Department of Radiology, Boerhaavelaan 22, Haarlem, the Netherlands
| | - Tjitske S R van Engelen
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - Marieke C Hovinga de Boer
- Amsterdam UMC location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wouter de Monyé
- Spaarne Gasthuis, Department of Radiology, Boerhaavelaan 22, Haarlem, the Netherlands
| | - Shandra Bipat
- Amsterdam UMC location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Patrick M M Bossuyt
- Amsterdam UMC location University of Amsterdam, Department of Epidemiology & Data Science, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Jan M Prins
- Amsterdam UMC location University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jaap Stoker
- Amsterdam UMC location University of Amsterdam, Department of Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands
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van den Berk IAH, Lejeune EH, Kanglie MMNP, van Engelen TSR, de Monyé W, Bipat S, Bossuyt PMM, Stoker J, Prins JM. The yield of chest X-ray or ultra-low-dose chest-CT in emergency department patients suspected of pulmonary infection without respiratory symptoms or signs. Eur Radiol 2023; 33:7294-7302. [PMID: 37115214 PMCID: PMC10511555 DOI: 10.1007/s00330-023-09664-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE The yield of pulmonary imaging in patients with suspected infection but no respiratory symptoms or signs is probably limited, ultra-low-dose CT (ULDCT) is known to have a higher sensitivity than Chest X-ray (CXR). Our objective was to describe the yield of ULDCT and CXR in patients clinically suspected of infection, but without respiratory symptoms or signs, and to compare the diagnostic accuracy of ULDCT and CXR. METHODS In the OPTIMACT trial, patients suspected of non-traumatic pulmonary disease at the emergency department (ED) were randomly allocated to undergo CXR (1210 patients) or ULDCT (1208 patients). We identified 227 patients in the study group with fever, hypothermia, and/or elevated C-reactive protein (CRP) but no respiratory symptoms or signs, and estimated ULDCT and CXR sensitivity and specificity in detecting pneumonia. The final day-28 diagnosis served as the clinical reference standard. RESULTS In the ULDCT group, 14/116 (12%) received a final diagnosis of pneumonia, versus 8/111 (7%) in the CXR group. ULDCT sensitivity was significantly higher than that of CXR: 13/14 (93%) versus 4/8 (50%), a difference of 43% (95% CI: 6 to 80%). ULDCT specificity was 91/102 (89%) versus 97/103 (94%) for CXR, a difference of - 5% (95% CI: - 12 to 3%). PPV was 54% (13/24) for ULDCT versus 40% (4/10) for CXR, NPV 99% (91/92) versus 96% (97/101). CONCLUSION Pneumonia can be present in ED patients without respiratory symptoms or signs who have a fever, hypothermia, and/or elevated CRP. ULDCT's sensitivity is a significant advantage over CXR when pneumonia has to be excluded. CLINICAL RELEVANCE STATEMENT Pulmonary imaging in patients with suspected infection but no respiratory symptoms or signs can result in the detection of clinically significant pneumonia. The increased sensitivity of ultra-low-dose chest CT compared to CXR is of added value in vulnerable and immunocompromised patients. KEY POINTS • Clinical significant pneumonia does occur in patients who have a fever, low core body temperature, or elevated CRP without respiratory symptoms or signs. • Pulmonary imaging should be considered in patients with unexplained symptoms or signs of infections. • To exclude pneumonia in this patient group, ULDCT's improved sensitivity is a significant advantage over CXR.
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Affiliation(s)
- Inge A H van den Berk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Emile H Lejeune
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maadrika M N P Kanglie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, the Netherlands
| | - Tjitske S R van Engelen
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wouter de Monyé
- Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, the Netherlands
| | - Shandra Bipat
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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7
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Milanese G, Ledda RE, Sabia F, Ruggirello M, Sestini S, Silva M, Sverzellati N, Marchianò AV, Pastorino U. Ultra-low dose computed tomography protocols using spectral shaping for lung cancer screening: Comparison with low-dose for volumetric LungRADS classification. Eur J Radiol 2023; 161:110760. [PMID: 36878153 DOI: 10.1016/j.ejrad.2023.110760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE To compare Low-Dose Computed Tomography (LDCT) with four different Ultra-Low-Dose Computed Tomography (ULDCT) protocols for PN classification according to the Lung Reporting and Data System (LungRADS). METHODS Three hundred sixty-one participants of an ongoing lung cancer screening (LCS) underwent single-breath-hold double chest Computed Tomography (CT), including LDCT (120kVp, 25mAs; CTDIvol 1,62 mGy) and one ULDCT among: fully automated exposure control ("ULDCT1"); fixed tube-voltage and current according to patient size ("ULDCT2"); hybrid approach with fixed tube-voltage ("ULDCT3") and tube current automated exposure control ("ULDCT4"). Two radiologists (R1, R2) assessed LungRADS 2022 categories on LDCT, and then after 2 weeks on ULDCT using two different kernels (R1: Qr49ADMIRE 4; R2: Br49ADMIRE 3). Intra-subject agreement for LungRADS categories between LDCT and ULDCT was measured by the k-Cohen Index with Fleiss-Cohen weights. RESULTS LDCT-dominant PNs were detected in ULDCT in 87 % of cases on Qr49ADMIRE 4 and 88 % on Br49ADMIRE 3. The intra-subject agreement was: κULDCT1 = 0.89 [95 %CI 0.82-0.96]; κULDCT2 = 0.90 [0.81-0.98]; κULDCT3 = 0.91 [0.84-0.99]; κULDCT4 = 0.88 [0.78-0.97] on Qr49ADMIRE 4, and κULDCT1 = 0.88 [0.80-0.95]; κULDCT2 = 0.91 [0.86-0.96]; κULDCT3 = 0.87 [0.78-0.95]; and κULDCT4 = 0.88 [0.82-0.94] on Br49ADMIRE 3. LDCT classified as LungRADS 4B were correctly identified as LungRADS 4B at ULDCT3, with the lowest radiation exposure among the tested protocols (median effective doses were 0.31, 0.36, 0.27 and 0.37 mSv for ULDCT1, ULDCT2, ULDCT3, and ULDCT4, respectively). CONCLUSIONS ULDCT by spectral shaping allows the detection and characterization of PNs with an excellent agreement with LDCT and can be proposed as a feasible approach in LCS.
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Affiliation(s)
- Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Roberta Eufrasia Ledda
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Federica Sabia
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Margherita Ruggirello
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Diagnostic Imaging and Radiotherapy, Milan, Italy.
| | - Stefano Sestini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Alfonso Vittorio Marchianò
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Diagnostic Imaging and Radiotherapy, Milan, Italy.
| | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
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8
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Tanguay J, Basharat F. Xenon-enhanced dual-energy tomosynthesis for functional imaging of respiratory disease-Concept and phantom study. Med Phys 2023; 50:719-736. [PMID: 36419344 DOI: 10.1002/mp.16101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Xenon-enhanced dual-energy (DE) computed tomography (CT) and hyperpolarized noble-gas magnetic resonance imaging (MRI) provide maps of lung ventilation that can be used to detect chronic obstructive pulmonary disease (COPD) early in its development and predict respiratory exacerbations. However, xenon-enhanced DE-CT requires high radiation doses and hyper-polarized noble-gas MRI is expensive and only available at a handful of institutions globally. PURPOSE To present xenon-enhanced dual-energy tomosynthesis (XeDET) for low-dose, low-cost functional imaging of respiratory disease in an experimental phantom study. METHODS We propose using digital tomosynthesis to produce Xe-enhanced low-energy (LE) and high-energy (HE) coronal images. DE subtraction of the LE and HE images is used to suppress soft tissues. We used an imaging phantom to investigate image quality in terms of the area under the reciever operating characteristic curve (AUC) for the Non-PreWhitening model observer with an Eye filter and internal noise (NPWEi). The phantom simulated anatomic clutter due to lung parenchyma and attenuation due to soft tissue and lung tissue. Aluminum slats were used to simulate rib structures. A stepwedge consisting of an acrylic casing with sealed cylindrical air-filled cavities was used to simulate ventilation defects with step thicknesses of 0.5, 1, and 2 cm and cylindrical radii of 0.5, 0.75, and 1 cm. The phantom was ventilated with Xe and projection data were acquired using a flat-panel detector, a tube-voltage combination of 60/140 kV with 1.2 mm of copper filtration on the HE spectrum and an angular range of ± 15 ∘ $\pm 15^{\circ}$ in 1° increments. The AUC of a NPWEi observer that has access only to a single coronal slice was calculated from measurements of the three-dimensional noise power spectrum and signal template. The AUC was calculated as a function of ventilation defect thickness and radius for total patient entrance air kermas ranging from 1.42 to 2.84 mGy with and without rib-simulating Al slats. For the AUC analysis, the observer internal noise level was obtained from an ad hoc calibration to a high-dose data set. RESULTS XeDET was able to suppress parenchyma-simulating clutter in coronal images enabling visualization of the simulated ventilation defects, but the limited angle acquisition resulted in residual clutter due to out-of-plane bone-mimmicking structures. The signal power of the defects increased linearly with defect radius and showed a ten-fold to fifteen-fold increase in signal power when the defect thickness increased from 0.5 to 2 cm. These trends agreed with theoretical predictions. Along the depth dimension, the power of the defects decreased exponentially with distance from the center of the defects with full-width half maxima that varied from 1.85 to 2.85 cm depending on the defect thickness and radius. The AUCs of the 1-cm-radius defect that was 2 cm in thickness ranged from good (0.8-0.9) to excellent (0.9-1.0) over the range of air kermas considered. CONCLUSIONS Xenon-enhanced DE tomosynthesis has the potential to enable functional imaging of respiratory disease and should be further investigated as a low-cost alternative to MRI-based approaches and a low-dose alternative to CT-based approaches.
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Affiliation(s)
- Jesse Tanguay
- Department of Physics, Toronto Metropoliton University (formerly Ryerson University), Toronto, ON, Canada
| | - Fateen Basharat
- Department of Physics, Toronto Metropoliton University (formerly Ryerson University), Toronto, ON, Canada
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9
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Pozzessere C, von Garnier C, Beigelman-Aubry C. Radiation Exposure to Low-Dose Computed Tomography for Lung Cancer Screening: Should We Be Concerned? Tomography 2023; 9:166-177. [PMID: 36828367 PMCID: PMC9964027 DOI: 10.3390/tomography9010015] [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: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Lung cancer screening (LCS) programs through low-dose Computed Tomography (LDCT) are being implemented in several countries worldwide. Radiation exposure of healthy individuals due to prolonged CT screening rounds and, eventually, the additional examinations required in case of suspicious findings may represent a concern, thus eventually reducing the participation in an LCS program. Therefore, the present review aims to assess the potential radiation risk from LDCT in this setting, providing estimates of cumulative dose and radiation-related risk in LCS in order to improve awareness for an informed and complete attendance to the program. After summarizing the results of the international trials on LCS to introduce the benefits coming from the implementation of a dedicated program, the screening-related and participant-related factors determining the radiation risk will be introduced and their burden assessed. Finally, future directions for a personalized screening program as well as technical improvements to reduce the delivered dose will be presented.
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Affiliation(s)
- Chiara Pozzessere
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Correspondence:
| | - Christophe von Garnier
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
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10
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Bonnemaison B, Castagna O, de Maistre S, Blatteau JÉ. Chest CT scan for the screening of air anomalies at risk of pulmonary barotrauma for the initial medical assessment of fitness to dive in a military population. Front Physiol 2022; 13:1005698. [PMID: 36277200 PMCID: PMC9585318 DOI: 10.3389/fphys.2022.1005698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: The presence of intra-pulmonary air lesions such as cysts, blebs and emphysema bullae, predisposes to pulmonary barotrauma during pressure variations, especially during underwater diving activities. These rare accidents can have dramatic consequences. Chest radiography has long been the baseline examination for the detection of respiratory pathologies in occupational medicine. It has been replaced since 2018 by the thoracic CT scan for military diving fitness in France. The objective of this work was to evaluate the prevalence of the pulmonary abnormalities of the thoracic CT scan, and to relate them to the characteristics of this population and the results of the spirometry. Methods: 330 records of military diving candidates who underwent an initial assessment between October 2018 and March 2021 were analyzed, in a single-center retrospective analysis. The following data were collected: sex, age, BMI, history of respiratory pathologies and smoking, treatments, allergies, diving practice, results of spirometry, reports of thoracic CT scans, as well as fitness decision. Results: The study included 307 candidates, mostly male, with a median age of 25 years. 19% of the subjects had abnormal spirometry. We identified 25% of divers with CT scan abnormalities. 76% of the abnormal scans were benign nodules, 26% of which measured 6 mm or more. Abnormalities with an aerial component accounted for 13% of the abnormal scans with six emphysema bullae, three bronchial dilatations and one cystic lesion. No association was found between the presence of nodules and the general characteristics of the population, whereas in six subjects emphysema bullae were found statistically associated with active smoking or abnormal spirometry results. Conclusion: The systematic performance of thoracic CT scan in a young population free of pulmonary pathology revealed a majority of benign nodules. Abnormalities with an aerial component are much less frequent, but their presence generally leads to a decision of unfitness. These results argue in favor of a systematic screening of aeric pleuro-pulmonary lesions during the initial assessment for professional divers.
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Affiliation(s)
- Brieuc Bonnemaison
- Service de Médecine Hyperbare et d’Expertise Plongée (SMHEP), Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
| | - Olivier Castagna
- Equipe de Recherche Subaquatique et Hyperbare, Institut de Recherche biomédicale des armées, Toulon, France
- Laboratoire Motricité Humaine Expertise Sport Santé, UPR 6312, Nice, France
| | - Sébastien de Maistre
- Cellule plongée humaine et Intervention sous la Mer (CEPHISMER), Force d’action navale, Toulon, France
| | - Jean-Éric Blatteau
- Service de Médecine Hyperbare et d’Expertise Plongée (SMHEP), Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
- *Correspondence: Jean-Éric Blatteau,
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11
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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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12
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van den Berk IAH, Kanglie MMNP, van Engelen TSR, Altenburg J, Annema JT, Beenen LFM, Boerrigter B, Bomers MK, Bresser P, Eryigit E, Groenink M, Hochheimer SMR, Holleman F, Kooter JAJ, van Loon RB, Keijzers M, van der Lee I, Luijendijk P, Meijboom LJ, Middeldorp S, Schijf LJ, Soetekouw R, Sprengers RW, Montauban van Swijndregt AD, de Monyé W, Ridderikhof ML, Winter MM, Bipat S, Dijkgraaf MGW, Bossuyt PMM, Prins JM, Stoker J. Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial. Thorax 2022; 78:515-522. [PMID: 35688623 PMCID: PMC10176343 DOI: 10.1136/thoraxjnl-2021-218337] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. METHODS Pragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings. RESULTS 2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1-8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1-8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%). CONCLUSIONS Short-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. TRIAL REGISTRATION NUMBER NTR6163.
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Affiliation(s)
- Inge A H van den Berk
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Maadrika M N P Kanglie
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Tjitske S R van Engelen
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Josje Altenburg
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke T Annema
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Ludo F M Beenen
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Boerrigter
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marije K Bomers
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Bresser
- Department of Pulmonary Medicine, OLVG, Amsterdam, The Netherlands
| | - Elvin Eryigit
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten Groenink
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Frits Holleman
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jos A J Kooter
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mitran Keijzers
- Department of Cardiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Ivo van der Lee
- Department of Pulmonary Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Paul Luijendijk
- Department of Cardiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine, division of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Laura J Schijf
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Soetekouw
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Ralf W Sprengers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Wouter de Monyé
- Department of Radiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel M Winter
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Shandra Bipat
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology & Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jan M Prins
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
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Hagen F, Walder L, Fritz J, Gutjahr R, Schmidt B, Faby S, Bamberg F, Schoenberg S, Nikolaou K, Horger M. Image Quality and Radiation Dose of Contrast-Enhanced Chest-CT Acquired on a Clinical Photon-Counting Detector CT vs. Second-Generation Dual-Source CT in an Oncologic Cohort: Preliminary Results. Tomography 2022; 8:1466-1476. [PMID: 35736867 PMCID: PMC9227736 DOI: 10.3390/tomography8030119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Our aim was to compare the image quality and patient dose of contrast-enhanced oncologic chest-CT of a first-generation photon-counting detector (PCD-CT) and a second-generation dual-source dual-energy CT (DSCT). For this reason, one hundred consecutive oncologic patients (63 male, 65 ± 11 years, BMI: 16−42 kg/m2) were prospectively enrolled and evaluated. Clinically indicated contrast-enhanced chest-CT were obtained with PCD-CT and compared to previously obtained chest-DSCT in the same individuals. The median time interval between the scans was three months. The same contrast media protocol was used for both scans. PCD-CT was performed in QuantumPlus mode (obtaining full spectral information) at 120 kVp. DSCT was performed using 100 kV for Tube A and 140 kV for Tube B. “T3D” PCD-CT images were evaluated, which emulate conventional 120 keV polychromatic images. For DSCT, the convolution algorithm was set at I31f with class 1 iterative reconstruction, whereas comparable Br40 kernel and iterative reconstruction strengths (Q1 and Q3) were applied for PCD-CT. Two radiologists assessed image quality using a five-point Likert scale and performed measurements of vessels and lung parenchyma for signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and in the case of pulmonary metastases tumor-to-lung parenchyma contrast ratio. PCD-CT CNRvessel was significantly higher than DSCT CNRvessel (all, p < 0.05). Readers rated image contrast of mediastinum, vessels, and lung parenchyma significantly higher in PCD-CT than DSCT images (p < 0.001). Q3 PCD-CT CNRlung_parenchyma was significantly higher than DSCT CNRlung_parenchyma and Q1 PCD-CT CNRlung_parenchyma (p < 0.01). The tumor-to-lung parenchyma contrast ratio was significantly higher on PCD-CT than DSCT images (0.08 ± 0.04 vs. 0.03 ± 0.02, p < 0.001). CTDI, DLP, SSDE mean values for PCD-CT and DSCT were 4.17 ± 1.29 mGy vs. 7.21 ± 0.49 mGy, 151.01 ± 48.56 mGy * cm vs. 288.64 ± 31.17 mGy * cm and 4.23 ± 0.97 vs. 7.48 ± 1.09, respectively. PCD-CT enables oncologic chest-CT with a significantly reduced dose while maintaining image quality similar to a second-generation DSCT for comparable protocol settings.
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Affiliation(s)
- Florian Hagen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72070 Tübingen, Germany; (F.H.); (K.N.); (M.H.)
| | - Lukas Walder
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72070 Tübingen, Germany; (F.H.); (K.N.); (M.H.)
- Correspondence: ; Tel.: +49-07071-29-68622
| | - Jan Fritz
- NYU Grossman School of Medicine, Department of Radiology, New York, NY 10016, USA;
| | - Ralf Gutjahr
- Siemens Healthcare GmbH, 91052 Erlangen, Germany; (R.G.); (B.S.); (S.F.)
| | - Bernhard Schmidt
- Siemens Healthcare GmbH, 91052 Erlangen, Germany; (R.G.); (B.S.); (S.F.)
| | - Sebastian Faby
- Siemens Healthcare GmbH, 91052 Erlangen, Germany; (R.G.); (B.S.); (S.F.)
| | - Fabian Bamberg
- Department of Radiology, Albert-Ludwigs-University Freiburg, 79106 Freiburg, Germany;
| | - Stefan Schoenberg
- Department of Radiology, University of Mannheim, 68167 Mannheim, Germany;
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72070 Tübingen, Germany; (F.H.); (K.N.); (M.H.)
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72070 Tübingen, Germany; (F.H.); (K.N.); (M.H.)
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Afshar P, Rafiee MJ, Naderkhani F, Heidarian S, Enshaei N, Oikonomou A, Babaki Fard F, Anconina R, Farahani K, Plataniotis KN, Mohammadi A. Human-level COVID-19 diagnosis from low-dose CT scans using a two-stage time-distributed capsule network. Sci Rep 2022; 12:4827. [PMID: 35318368 PMCID: PMC8940967 DOI: 10.1038/s41598-022-08796-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/01/2022] [Indexed: 01/01/2023] Open
Abstract
Reverse transcription-polymerase chain reaction is currently the gold standard in COVID-19 diagnosis. It can, however, take days to provide the diagnosis, and false negative rate is relatively high. Imaging, in particular chest computed tomography (CT), can assist with diagnosis and assessment of this disease. Nevertheless, it is shown that standard dose CT scan gives significant radiation burden to patients, especially those in need of multiple scans. In this study, we consider low-dose and ultra-low-dose (LDCT and ULDCT) scan protocols that reduce the radiation exposure close to that of a single X-ray, while maintaining an acceptable resolution for diagnosis purposes. Since thoracic radiology expertise may not be widely available during the pandemic, we develop an Artificial Intelligence (AI)-based framework using a collected dataset of LDCT/ULDCT scans, to study the hypothesis that the AI model can provide human-level performance. The AI model uses a two stage capsule network architecture and can rapidly classify COVID-19, community acquired pneumonia (CAP), and normal cases, using LDCT/ULDCT scans. Based on a cross validation, the AI model achieves COVID-19 sensitivity of \documentclass[12pt]{minimal}
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\begin{document}$$90\%\pm 0.06$$\end{document}90%±0.06. By incorporating clinical data (demographic and symptoms), the performance further improves to COVID-19 sensitivity of \documentclass[12pt]{minimal}
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\begin{document}$$96.7\%\pm 0.07$$\end{document}96.7%±0.07, normal cases sensitivity (specificity) of \documentclass[12pt]{minimal}
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\begin{document}$$94.1\%\pm 0.03$$\end{document}94.1%±0.03. The proposed AI model achieves human-level diagnosis based on the LDCT/ULDCT scans with reduced radiation exposure. We believe that the proposed AI model has the potential to assist the radiologists to accurately and promptly diagnose COVID-19 infection and help control the transmission chain during the pandemic.
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Affiliation(s)
- Parnian Afshar
- Concordia Institute for Information Systems Engineering (CIISE), Concordia University, Montreal, Canada.,Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
| | - Moezedin Javad Rafiee
- Department of Medicine and Diagnostic Radiology, McGill University Health Center-Research Institute, Montreal, QC, Canada
| | - Farnoosh Naderkhani
- Concordia Institute for Information Systems Engineering (CIISE), Concordia University, Montreal, Canada
| | - Shahin Heidarian
- Department of Electrical and Computer Engineering, Concordia University, Montreal, QC, Canada
| | - Nastaran Enshaei
- Concordia Institute for Information Systems Engineering (CIISE), Concordia University, Montreal, Canada
| | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | - Reut Anconina
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Keyvan Farahani
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), Rockville, MD, USA
| | | | - Arash Mohammadi
- Concordia Institute for Information Systems Engineering (CIISE), Concordia University, Montreal, Canada.
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Titanium(IV) immobilized affinity chromatography facilitated phosphoproteomics analysis of salivary extracellular vesicles for lung cancer. Anal Bioanal Chem 2022; 414:3697-3708. [DOI: 10.1007/s00216-022-04013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023]
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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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Urikura A. [A Reconsideration of Fundamental Chest CT Imaging]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2021; 77:1337-1344. [PMID: 34803114 DOI: 10.6009/jjrt.2021_jsrt_77.11.1337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Updated International Tuberous Sclerosis Complex Diagnostic Criteria and Surveillance and Management Recommendations. Pediatr Neurol 2021; 123:50-66. [PMID: 34399110 DOI: 10.1016/j.pediatrneurol.2021.07.011] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease affecting multiple body systems with wide variability in presentation. In 2013, Pediatric Neurology published articles outlining updated diagnostic criteria and recommendations for surveillance and management of disease manifestations. Advances in knowledge and approvals of new therapies necessitated a revision of those criteria and recommendations. METHODS Chairs and working group cochairs from the 2012 International TSC Consensus Group were invited to meet face-to-face over two days at the 2018 World TSC Conference on July 25 and 26 in Dallas, TX, USA. Before the meeting, working group cochairs worked with group members via e-mail and telephone to (1) review TSC literature since the 2013 publication, (2) confirm or amend prior recommendations, and (3) provide new recommendations as required. RESULTS Only two changes were made to clinical diagnostic criteria reported in 2013: "multiple cortical tubers and/or radial migration lines" replaced the more general term "cortical dysplasias," and sclerotic bone lesions were reinstated as a minor criterion. Genetic diagnostic criteria were reaffirmed, including highlighting recent findings that some individuals with TSC are genetically mosaic for variants in TSC1 or TSC2. Changes to surveillance and management criteria largely reflected increased emphasis on early screening for electroencephalographic abnormalities, enhanced surveillance and management of TSC-associated neuropsychiatric disorders, and new medication approvals. CONCLUSIONS Updated TSC diagnostic criteria and surveillance and management recommendations presented here should provide an improved framework for optimal care of those living with TSC and their families.
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Impact of Morphotype on Image Quality and Diagnostic Performance of Ultra-Low-Dose Chest CT. J Clin Med 2021; 10:jcm10153284. [PMID: 34362068 PMCID: PMC8348164 DOI: 10.3390/jcm10153284] [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: 06/16/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: The image quality of an Ultra-Low-Dose (ULD) chest CT depends on the patient’s morphotype. We hypothesize that there is a threshold beyond which the diagnostic performance of a ULD chest CT is too degraded. This work assesses the influence of morphotype (Body Mass Index BMI, Maximum Transverse Chest Diameter MTCD and gender) on image quality and the diagnostic performance of a ULD chest CT. Methods: A total of 170 patients from three prior prospective monocentric studies were retrospectively included. Renewal of consent was waived by our IRB. All the patients underwent two consecutive unenhanced chest CT acquisitions with a full dose (120 kV, automated tube current modulation) and a ULD (135 kV, fixed tube current at 10 mA). Image noise, subjective image quality and diagnostic performance for nine predefined lung parenchyma lesions were assessed by two independent readers, and correlations with the patient’s morphotype were sought. Results: The mean BMI was 26.6 ± 5.3; 20.6% of patients had a BMI > 30. There was a statistically significant negative correlation of the BMI with the image quality (ρ = −0.32; IC95% = (−0.468; −0.18)). The per-patient diagnostic performance of ULD was sensitivity, 77%; specificity, 99%; PPV, 94% and NPV, 65%. There was no statistically significant influence of the BMI, the MTCD nor the gender on the per-patient and per-lesion diagnostic performance of a ULD chest CT, apart from a significant negative correlation for the detection of emphysema. Conclusions: Despite a negative correlation between the BMI and the image quality of a ULD chest CT, we did not find a correlation between the BMI and the diagnostic performance of the examination, suggesting a possible use of the ULD protocol in obese patients.
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