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Sulieman A, Taha A, Dawood S, Almujally A, Bradley DA. Radiogenic cancer risk from contrast enhanced computed tomography during pediatric abdomen and pelvis examinations in Saudi Arabia. Appl Radiat Isot 2024; 212:111440. [PMID: 39018816 DOI: 10.1016/j.apradiso.2024.111440] [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: 02/28/2022] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
The sensitivity to ionizing radiation is increasing by age of development for some malignant tumors. Therefore, children have higher risk to radiation induced tumors due the high cellular rate of proliferation and long lifespan probability. The risk is also increase with increase the effective and organ doses. Computed tomography (CT) exposed pediatric patients to higher radiation dose during multiphase image acquisition, repeated exams, for follow-up procedures. This research intended to estimate the radiogenic risks and effective radiation doses resulted from CT enhanced contrast for abdomen and pelvis. 126 (66 (62.3%) males, 60 (47.7%) females) pediatric patients underwent CT enhanced abdominal examination at Medical Imaging Department at King Khalid Hospital and Prince Sultan Center for Health Services, Alkharj, Saudi Arabia. The average and range of pediatric age (years) is 11.6 ± 5.0 (0.1-17). The mean, standard deviation, and range of the volume CT air kerma index (CVOL (mGy) and the air kerma length product (PKL, mGy.cm) were 9.8 ± 9.4 (2.1-45.8) and 1795 (221-3150) per abdominopelvic procedure, respectively. The mean and range of the effective dose (mSv) per procedure are 26.9 (2.4-59.1). The effective dose is higher compared to the most previously published studies. The effective dose per pediatric abdomen and pelvis with contrast procedure suggest that the patient dose is not optimized yet. Because the chest and pelvis region contain sensitive organs that are irradiated repeatedly, dose optimization is crucial.
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Affiliation(s)
- Abdelmoneim Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O.Box 422, Alkharj, 11942, Saudi Arabia.
| | - Afaf Taha
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O.Box 422, Alkharj, 11942, Saudi Arabia
| | - Sali Dawood
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, P.O.Box 422, Alkharj, 11942, Saudi Arabia
| | - Abdullah Almujally
- Biomedical Physics Department, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh, 11211, Saudi Arabia
| | - David A Bradley
- Applied Physics and Radiation Technologies Group, CCDCU, Sunway University, Malaysia; School of Mathematics and Physics, University of Surrey, Guildford, UK
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Smith-Bindman R, Kang T, Chu PW, Wang Y, Stewart C, Das M, Duong PA, Cervantes L, Lamba R, Lee RK, MacLeod F, Kasraie N, Neill R, Pike P, Roehm J, Schindera S, Chung R, Delman BN, Jeukens CRLPN, Starkey LJ, Szczykutowicz TP. Large variation in radiation dose for routine abdomen CT: reasons for excess and easy tips for reduction. Eur Radiol 2024; 34:2394-2404. [PMID: 37735276 PMCID: PMC10957641 DOI: 10.1007/s00330-023-10076-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To characterize the use and impact of radiation dose reduction techniques in actual practice for routine abdomen CT. METHODS We retrospectively analyzed consecutive routine abdomen CT scans in adults from a large dose registry, contributed by 95 hospitals and imaging facilities. Grouping exams into deciles by, first, patient size, and second, size-adjusted dose length product (DLP), we summarized dose and technical parameters and estimated which parameters contributed most to between-protocols dose variation. Lastly, we modeled the total population dose if all protocols with mean size-adjusted DLP above 433 or 645 mGy-cm were reduced to these thresholds. RESULTS A total of 748,846 CTs were performed using 1033 unique protocols. When sorted by patient size, patients with larger abdominal diameters had increased dose and effective mAs (milliampere seconds), even after adjusting for patient size. When sorted by size-adjusted dose, patients in the highest versus the lowest decile in size-adjusted DLP received 6.4 times the average dose (1680 vs 265 mGy-cm) even though diameter was no different (312 vs 309 mm). Effective mAs was 2.1-fold higher, unadjusted CTDIvol 2.9-fold, and phase 2.5-fold for patients in the highest versus lowest size-adjusted DLP decile. There was virtually no change in kV (kilovolt). Automatic exposure control was widely used to modulate mAs, whereas kV modulation was rare. Phase was the strongest driver of between-protocols variation. Broad adoption of optimized protocols could result in total population dose reductions of 18.6-40%. CONCLUSION There are large variations in radiation doses for routine abdomen CT unrelated to patient size. Modification of kV and single-phase scanning could result in substantial dose reduction. CLINICAL RELEVANCE Radiation dose-optimization techniques for routine abdomen CT are routinely under-utilized leading to higher doses than needed. Greater modification of technical parameters and number of phases could result in substantial reduction in radiation exposure to patients. KEY POINTS • Based on an analysis of 748,846 routine abdomen CT scans in adults, radiation doses varied tremendously across patients of the same size and optimization techniques were routinely under-utilized. • The difference in observed dose was due to variation in technical parameters and phase count. Automatic exposure control was commonly used to modify effective mAs, whereas kV was rarely adjusted for patient size. Routine abdomen CT should be performed using a single phase, yet multi-phase was common. • kV modulation by patient size and restriction to a single phase for routine abdomen indications could result in substantial reduction in radiation doses using well-established dose optimization approaches.
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Affiliation(s)
- Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
| | - Taewoon Kang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Philip W Chu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Yifei Wang
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Carly Stewart
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Marco Das
- Department of Diagnostic and Interventional Radiology, Helios Hospital Duisburg, An Der Abtei 7-11, 47166, Duisburg, Germany
| | - Phuong-Anh Duong
- Department of Radiology, New York University Langone, 6 Ohio Drive, Lake Success, NY, 11042, USA
| | - Luisa Cervantes
- Department of Radiology, Nicklaus Children's Hospital, 3100 SW 62Nd Avenue, Miami, FL, 33155, USA
| | - Ramit Lamba
- Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Ryan K Lee
- Department of Radiology, Ground Floor, Einstein Healthcare Network, 5501 Old York Road, Levy Bldg, Philadelphia, PA, 19141, USA
| | - Fiona MacLeod
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
| | - Nima Kasraie
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Rebecca Neill
- Department of Radiology and Imaging Sciences, Emory University, 1365 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Pavlina Pike
- Huntsville Hospital, 101 Sivley Rd SW, Huntsville, AL, 35801, USA
| | | | - Sebastian Schindera
- Institute of Radiology, Kantonsspital Aarau AG, Tellstrasse 25, 5001, Aarau, Switzerland
| | - Robert Chung
- Department of Demography, University of California Berkeley, 310 Social Sciences Building, Berkeley, CA, 94720-2120, USA
| | - Bradley N Delman
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029-6574, USA
| | - Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25 6229 HX, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - L Jay Starkey
- Department of Radiology, St Luke's International Hospital, 9-1 Akashicho, Tokyo, 104-8560, Chuo City, Japan
| | - Timothy P Szczykutowicz
- Departments of Radiology, Medical Physics, and Biomedical Engineering, University of Wisconsin Madison, Madison, WI, USA
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Rizzo S, Bellesi L, D'Ermo A, Bonomo L, D'Ecclesiis O, Magoga F, Presilla S, Spanò A, Minzolini V, Lo Piccolo F, Heinkel J, Rezzonico E, Del Grande M, Merli M, Del Grande F. Body CT examinations in oncologic patients: the impact of subspecialty radiology on radiation exposure in the clinical practice. A quality care study. LA RADIOLOGIA MEDICA 2024; 129:429-438. [PMID: 38341817 PMCID: PMC10943144 DOI: 10.1007/s11547-024-01790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/15/2024] [Indexed: 02/13/2024]
Abstract
PURPOSES The primary objective of this retrospective study was to assess whether the CT dose delivered to oncologic patients was different in a subspecialty radiology department, compared to a general radiology department. The secondary explorative objective was to assess whether the objective image quality of CT examinations was different in the two settings. MATERIALS AND METHODS Chest and abdomen CT scans performed for oncologic indications were selected from a general radiology department and a subspecialty radiology department. By using a radiation dose management platform, we extracted and compared CT dose index (CTDIvol) and dose length product (DLP) both for each phase and for the entire CT exams. For objective image quality evaluation, we calculated the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) at the level of the liver and of the aorta. A P-value < 0.05 was considered significant. RESULTS A total of 7098 CT examinations were included. CTDIvol was evaluated in 12,804 phases; DLP in 10,713 phases and in 6714 examinations. The CTDIvol and DLP overall were significantly lower in the subspecialty radiology department compared to the general radiology department CTDI median (IQR) 5.19 (3.91-7.00) and 5.51 (4.17-7.72), DLP median and IQR of 490.0 (342.4-710.6) and 503.4 (359.9-728.8), p < 0.001 and p = 0.01, respectively. The objective image quality showed no significant difference in the general and subspecialty radiology departments, with median and IQR of 4.03 (2.82-5.51) and 3.84 (3.09-4.94) for SNRLiv (p = 0.58); 4.81 (2.70-7.62) and 4.34 (3.05-6.25) for SNRAo (p = 0.30); 0.83 (0.20-1.89) and 1.00 (0.35-1.57) for CNRLiv (p = 0.99); 2.23 (0.09-3.83) and 1.01 (0.15-2.84) for CNRAo (p = 0.24) with SNRLiv (p = 0.58), SNRAo (p = 0.30), CNRLiv (p = 0.99) and CNRAo (p = 0.24). CONCLUSION In a subspecialty radiology department, CT protocols are optimized compared to a general radiology department leading to lower doses to oncologic patients without significant objective image quality degradation.
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Affiliation(s)
- Stefania Rizzo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland.
| | - Luca Bellesi
- Service of Medical Physics, Maging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Andrea D'Ermo
- Service of Process Organization and Information, EOC, Support Area, Via Lugano 4D, 6500, Bellinzona, Switzerland
| | - Luca Bonomo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Magoga
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Stefano Presilla
- Service of Medical Physics, Maging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Arturo Spanò
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Veronica Minzolini
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesca Lo Piccolo
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Jurgen Heinkel
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Ermidio Rezzonico
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Matteo Merli
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
| | - Filippo Del Grande
- Clinic of Radiology, Imaging Institute of Southern Switzerland (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
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4
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Lucas AN, Tay-Lasso E, Zezoff DC, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Kirby KA, Nahmias J. Significant variation in computed tomography imaging of pregnant trauma patients: a retrospective multicenter study. Emerg Radiol 2024; 31:53-61. [PMID: 38150084 PMCID: PMC10830714 DOI: 10.1007/s10140-023-02195-w] [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: 10/11/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Following motor vehicle collisions (MVCs), patients often undergo extensive computed tomography (CT) imaging. However, pregnant trauma patients (PTPs) represent a unique population where the risk of fetal radiation may supersede the benefits of liberal CT imaging. This study sought to evaluate imaging practices for PTPs, hypothesizing variability in CT imaging among trauma centers. If demonstrated, this might suggest the need to develop specific guidelines to standardize practice. METHODS A multicenter retrospective study (2016-2021) was performed at 12 Level-I/II trauma centers. Adult (≥18 years old) PTPs involved in MVCs were included, with no patients excluded. The primary outcome was the frequency of CT. Chi-square tests were used to compare categorical variables, and ANOVA was used to compare the means of normally distributed continuous variables. RESULTS A total of 729 PTPs sustained MVCs (73% at high speed of ≥ 25 miles per hour). Most patients were mildly injured but a small variation of injury severity score (range 1.1-4.6, p < 0.001) among centers was observed. There was a variation of imaging rates for CT head (range 11.8-62.5%, p < 0.001), cervical spine (11.8-75%, p < 0.001), chest (4.4-50.2%, p < 0.001), and abdomen/pelvis (0-57.3%, p < 0.001). In high-speed MVCs, there was variation for CT head (12.5-64.3%, p < 0.001), cervical spine (16.7-75%, p < 0.001), chest (5.9-83.3%, p < 0.001), and abdomen/pelvis (0-60%, p < 0.001). There was no difference in mortality (0-2.9%, p =0.19). CONCLUSION Significant variability of CT imaging in PTPs after MVCs was demonstrated across 12 trauma centers, supporting the need for standardization of CT imaging for PTPs to reduce unnecessary radiation exposure while ensuring optimal injury identification is achieved.
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Affiliation(s)
- Alexa N Lucas
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erika Tay-Lasso
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA
| | - Danielle C Zezoff
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA
| | - Sigrid Burruss
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Alden Dahan
- Riverside School of Medicine, University of California, Riverside, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System Medical Center, Riverside, CA, USA
| | - Rahul Tuli
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System Medical Center, Riverside, CA, USA
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA
| | - Katharine A Kirby
- Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA.
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Palm V, Heye T, Molwitz I, von Stackelberg O, Kauczor HU, Schreyer AG. Sustainability and Climate Protection in Radiology - An Overview. ROFO-FORTSCHR RONTG 2023; 195:981-988. [PMID: 37348529 DOI: 10.1055/a-2093-4177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Sustainability is becoming increasingly important in radiology. Besides climate protection - economic, ecological, and social aspects are integral elements of sustainability. An overview of the scientific background of the sustainability and environmental impact of radiology as well as possibilities for future concepts for more sustainable diagnostic and interventional radiology are presented below.The three elements of sustainability:1. EcologyWith an annually increasing number of tomographic images, Germany is in one of the leading positions worldwide in a per capita comparison. The energy consumption of an MRI system is comparable to 26 four-person households annually. CT and MRI together make a significant contribution to the overall energy consumption of a hospital. In particular, the energy consumption in the idle or inactive state is responsible for a relevant proportion.2. EconomyA critical assessment of the indications for radiological imaging is important not only because of radiation protection, but also in terms of sustainability and "value-based radiology". As part of the "Choosing Wisely" initiative, a total of 600 recommendations for avoiding unnecessary examinations were compiled from various medical societies, including specific indications in radiological diagnostics.3. Social SustainabilityThe alignment of radiology to the needs of patients and referring physicians is a core aspect of the social component of sustainability. Likewise, ensuring employee loyalty by supporting and maintaining motivation, well-being, and job satisfaction is an essential aspect of social sustainability. In addition, sustainable concepts are of relevance in teaching and research, such as the educational curriculum for residents in radiology, RADUCATION or the recommendations of the International Committee of Medical Journal Editors. KEY POINTS · Sustainability comprises three pillars: economy, ecology and the social component.. · Radiologies have a high optimization potential due to a significant demand of these resources.. · A dialogue between medicine, politics and industry is necessary for a sustainable radiology.. · The discourse, knowledge transfer and public communication of recommendations are part of the sustainability network of the German Roentgen Society (DRG).. CITATION FORMAT · Palm V, Heye T, Molwitz I et al. Sustainability and Climate Protection in Radiology - An Overview. Fortschr Röntgenstr 2023; 195: 981 - 988.
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Affiliation(s)
- Viktoria Palm
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg University, Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik am Universitätsklinikum Heidelberg, Germany
| | - Tobias Heye
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Switzerland
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oyunbileg von Stackelberg
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg University, Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik am Universitätsklinikum Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Clinic for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg University, Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik am Universitätsklinikum Heidelberg, Germany
| | - Andreas G Schreyer
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
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Westmark S, Hessellund T, Hoffmann A, Madsen BB, Jensen TS, Gielen M, Bøggild H, Leutscher PDC. Increasing use of computed tomography scans in the North Denmark Region raises patient safety concern. Eur J Radiol 2023; 166:110997. [PMID: 37499480 DOI: 10.1016/j.ejrad.2023.110997] [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: 04/18/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Use of computed tomography (CT) scans raises safety concern as lifetime cumulative ionising radiation exposure is associated with risk of developing malignancies. This study aimed to investigate use of abdominal CT scans in the Danish health care sector. METHODS Data on abdominal CT scans performed annually in the North Denmark Region between 2005 and 2018 were extracted from the regional registry with emphasis on patients with a medical history of a repeated abdominal CT scan within 28 days. An audit of the medical files was subsequently conducted in 100 randomly selected patient cases to evaluate clinical information being provided, in addition to justification for a repeated abdominal CT scan, and finally if other radiology modalities could have been applied. RESULTS Number of annually performed abdominal CT scans in this demographically stable regional population increased by a factor 4.3 from 15 in 2005 to 65 in 2018 per 1,000 inhabitants. The audit revealed that 31% of the secondabdominal CT scans within a 28 days period were categorized as either doubtful whether justified or not justified. Moreover, 20% of theCT scans were considered replaceable by ultrasonography. CONCLUSIONS Annual performance of abdominal CT scans increased fourfold during the 14 years period. This tendency is probably attributable to changes in the Danish health care sector by which CT scan examination are used more frequently aiming at more accelerated patient investigation flow in conjunction with shorter length of hospitalization stay. Alertness is strongly warranted towards the associated risk of cancer due to life-time cumulative ionising radiation exposure by this strategy.
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Affiliation(s)
- Signe Westmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Thomas Hessellund
- Department of Radiology, Clinic for Diagnostics, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Andreas Hoffmann
- Department of Radiology, Gødstrup Regional Hospital, Gødstrup, Denmark
| | | | - Trine S Jensen
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Mahican Gielen
- Department of Radiology, Clinic for Diagnostics, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Masuda H, Kotecha K, Maitra R, Maher R, Mittal A, Samra JS. The role of repeated imaging in detecting complications in the post-operative period following pancreaticoduodenectomy: Serial CT imaging post-pancreaticoduodenectomy. ANZ J Surg 2023; 93:1314-1321. [PMID: 36782399 DOI: 10.1111/ans.18327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Post-pancreaticoduodenectomy haemorrhage is a potentially life-threatening complication. Delay in the detection and subsequent management of complications contribute significantly to post-operative mortality and morbidity associated with pancreaticoduodenectomy. METHODS All patients undergoing pancreaticoduodenectomy at an Australian-based tertiary referral center between 2017 and 2022 were reviewed retrospectively. We identified those patients who suffered a post-pancreaticoduodenectomy haemorrhage and further analysed those patients who had their post-pancreaticoduodenectomy haemorrhage identified on repeated CT imaging performed within 24 h of their previous CT scan. RESULTS A total of 232 pancreaticoduodenectomies were identified for analysis during the study period, of which 23 patients (9.9%) suffered a post-pancreaticoduodenectomy haemorrhage. We present four patients who had their post-pancreaticoduodenectomy haemorrhage identified on repeat CT scan in the setting of a recent (within 24 h) CT scan which showed no evidence of active haemorrhage or pseudoaneurysm formation. All patients received prompt and definitive endovascular management through stent insertion or coil embolization resulting in successful cessation of bleeding. Three patients made an uncomplicated recovery thereafter. Unfortunately, one patient died as a complication of the bleed despite early and definitive endovascular intervention. CONCLUSION Our study highlights the importance of having a low threshold for repeated CT imaging in the post-pancreaticoduodenectomy setting, particularly when there remains a high index of suspicion clinically for a post-operative complication, even in the context of previous benign imaging. Given the complexity of pancreaticoduodenectomy, we believe early detection with liberal imaging allows the best chance at successfully managing the morbidity and mortality associated in the post-pancreaticoduodenectomy setting.
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Affiliation(s)
- Hiro Masuda
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Krishna Kotecha
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rudra Maitra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Richard Maher
- Department of Interventional Radiology, Royal North Shore Hospital and North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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8
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Herbst CT, Emerich K, Mayr MA, Rudisch A, Kremser C, Talasz H, Kofler M. Time-Synchronized MRI-Assessment of Respiratory Apparatus Subsystems-A Feasibility Study. J Voice 2023:S0892-1997(22)00358-7. [PMID: 36642590 DOI: 10.1016/j.jvoice.2022.11.006] [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: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 01/15/2023]
Abstract
The thorax (TH), the thoracic diaphragm (TD), and the abdominal wall (AW) are three sub-systems of the respiratory apparatus whose displacement motion has been well studied with the use of magnetic resonance imaging (MRI). Another sub-system, which has however received less research attention with respect to breathing, is the pelvic floor (PF). In particular, there is no study that has investigated the displacement of all four sub-systems simultaneously. Addressing this issue, it was the purpose of this feasibility study to establish a data acquisition paradigm for time-synchronous quantitative analysis of dynamic MRI data from these four major contributors to respiration and phonation (TH, TD, AW, and PF). Three healthy females were asked to breathe in and out forcefully while being recorded in a 1.5-Tesla whole body MR-scanner. Spanning a sequence of 15.12 seconds, 40 MRI data frames were acquired. Each data frame contained two slices, simultaneously documenting the mid-sagittal (TH, TD, PF) and transversal (AW) planes. The displacement motion of the four anatomical structures of interest was documented using kymographic analysis, resulting in time-varying calibrated structure displacement data. After computing the fundamental frequency of the cyclical breathing motion, the phase offsets of the TH, PF, and AW with respect to the TD were computed. Data analysis revealed three fundamentally different displacement patterns. Total structure displacement was in the range of 0.94 cm (TH) to 4.27 cm (TD). Phase delays of up to 90∘ (i.e., a quarter of a breathing cycle) between different structures were found. Motion offsets in the range of -28.30∘ to 14.90∘ were computed for the PF with respect to the TD. The diversity of results in only three investigated participants suggests a variety of possible breathing strategies, warranting further research.
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Affiliation(s)
- Christian T Herbst
- Department of Vocal Studies, Mozarteum University, Salzburg, Austria; Janette Ogg Voice Research Center, Shenandoah Conservatory, Winchester, VA, USA.
| | - Kate Emerich
- University of Denver, Lamont School of Music, Newman Center for the Performing Arts, Denver, CO, USA; Vocal Essentials, LLC., Denver, CO, USA
| | - Michaela A Mayr
- Antonio Salieri Department of Vocal Studies and Vocal Research in Music Education, University of Music and Performing Arts, Vienna, Austria
| | - Ansgar Rudisch
- Department of Radiology, Medical University of Innsbruck, Austria
| | | | - Helena Talasz
- Department of Internal Medicine, Hochzirl Hospital, Zirl, Austria
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
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9
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Rafique U, Elfeky MA, Bhatti K, Siddique K. Does Diagnostic Laparoscopy Still Have a Role in the Evaluation of Right Iliac Fossa Pain Versus Imaging Techniques or Experience? Cureus 2022; 14:e30678. [PMID: 36439602 DOI: 10.7759/cureus.30678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
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10
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Raskolnikov D, Tzou DT, Ahn J, Bechis SK, Chi T, Sorensen MD, Stoller M, Harper JD. Multi-institutional variation in performance of low dose computerized tomography for the evaluation of suspected nephrolithiasis. J Endourol 2022; 36:1377-1381. [PMID: 35652350 DOI: 10.1089/end.2022.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objective Guidelines from the American Urological Association (AUA) and American College of Radiology (ACR) recommend that patients with suspected nephrolithiasis undergo low dose computerized tomography (LD CT KUB) as opposed to higher dose conventional imaging. We hypothesized that even at institutions with established LD protocols, higher dose imaging is common. Methods We identified four academic medical centers where LD CT KUB protocols were implemented to yield an Effective Dose (EDose) consistent with national guidelines. Fifty consecutive adult patients who underwent CT KUB specifically for the evaluation of nephrolithiasis were retrospectively reviewed at each site. Patient age, sex, BMI, imaging location, and EDose (millisieverts, mSv) were recorded. Results 200 patients with a mean age of 54 years were identified. 46 patients (23%) underwent CT KUB with EDose ≤ 4 mSv, accounting for 10-48% of each institution's cohort. 116 patients had a BMI < 30, and would have been expected to receive LD CTs by the AUA criteria for LD CT KUB. Within this subset, only 37 patients (32%) actually underwent LD CT KUB. The highest dose CT KUB at each institution resulted in EDose of 33.8-44.6 mSv, exceeding the recommended exposure of LD CT KUB by tenfold. Conclusions At academic institutions where LD CT KUB was implemented for the evaluation of nephrolithiasis, a minority of patients with BMI < 30 receive guideline-concordant imaging. Differences in patient BMI did not account for the variation in radiation exposure. Further research is necessary to elucidate barriers to low dose CT implementation.
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Affiliation(s)
- Dima Raskolnikov
- University of Washington School of Medicine, 12353, Department of Urology, 1959 NE Pacific St, Box 356510, Seattle, Washington, United States, 98195-6340;
| | - David T Tzou
- University of Arizona, Urology, 1501 N. Campbell Ave, PO Box 245077, Tucson, Arizona, United States, 85724;
| | - Justin Ahn
- University of California San Francisco, Urology, San Francisco, California, United States;
| | - Seth K Bechis
- University of California San Diego Health System, 21814, Urology, San Diego, California, United States;
| | - Thomas Chi
- University of California San Francisco, Urology, 400 Parnassus Ave, 6th floor Urology Clinics A638, San Francisco, California, United States, 94143;
| | - Mathew D Sorensen
- University of Washington, Department of Urology, 1959 NE Pacific Street, Box 356510, Seattle, Washington, United States, 98195;
| | - Marshall Stoller
- University of California San Francisco, Urology, San Francisco, California, United States;
| | - Jonathan D Harper
- University of Washington, Department of Urology, Seattle, Washington, United States;
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11
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Smith-Bindman R, Yu S, Wang Y, Kohli MD, Chu P, Chung R, Luong J, Bos D, Stewart C, Bista B, Alejandrez Cisneros A, Delman B, Einstein AJ, Flynn M, Romano P, Seibert JA, Westphalen AC, Bindman A. An Image Quality-informed Framework for CT Characterization. Radiology 2022; 302:380-389. [PMID: 34751618 PMCID: PMC8805663 DOI: 10.1148/radiol.2021210591] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
Background Lack of standardization in CT protocol choice contributes to radiation dose variation. Purpose To create a framework to assess radiation doses within broad CT categories defined according to body region and clinical imaging indication and to cluster indications according to the dose required for sufficient image quality. Materials and Methods This was a retrospective study using Digital Imaging and Communications in Medicine metadata. CT examinations in adults from January 1, 2016 to December 31, 2019 from the University of California San Francisco International CT Dose Registry were grouped into 19 categories according to body region and required radiation dose levels. Five body regions had a single dose range (ie, extremities, neck, thoracolumbar spine, combined chest and abdomen, and combined thoracolumbar spine). Five additional regions were subdivided according to dose. Head, chest, cardiac, and abdomen each had low, routine, and high dose categories; combined head and neck had routine and high dose categories. For each category, the median and 75th percentile (ie, diagnostic reference level [DRL]) were determined for dose-length product, and the variation in dose within categories versus across categories was calculated and compared using an analysis of variance. Relative median and DRL (95% CI) doses comparing high dose versus low dose categories were calculated. Results Among 4.5 million examinations, the median and DRL doses varied approximately 10 times between categories compared with between indications within categories. For head, chest, abdomen, and cardiac (3 266 546 examinations [72%]), the relative median doses were higher in examinations assigned to the high dose categories than in examinations assigned to the low dose categories, suggesting the assignment of indications to the broad categories is valid (head, 3.4-fold higher [95% CI: 3.4, 3.5]; chest, 9.6 [95% CI: 9.3, 10.0]; abdomen, 2.4 [95% CI: 2.4, 2.5]; and cardiac, 18.1 [95% CI: 17.7, 18.6]). Results were similar for DRL doses (all P < .001). Conclusion Broad categories based on image quality requirements are a suitable framework for simplifying radiation dose assessment, according to expected variation between and within categories. © RSNA, 2021 See also the editorial by Mahesh in this issue.
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Affiliation(s)
- Rebecca Smith-Bindman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Sophronia Yu
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Yifei Wang
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Marc D. Kohli
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Philip Chu
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Robert Chung
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Jason Luong
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Denise Bos
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Carly Stewart
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Biraj Bista
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Alejandro Alejandrez Cisneros
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Bradley Delman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Andrew J. Einstein
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Michael Flynn
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Patrick Romano
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - J. Anthony Seibert
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Antonio C. Westphalen
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Andrew Bindman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
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12
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A survey of the pediatric radiation doses during multiphase abdominal computed tomography examinations. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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13
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Camera L, Dell'Aversano-Orabona G, Gambardella M, Riccitiello F, Galatola R, Liuzzi R, Longobardi M, Danzi R, Ponsiglione A, Stanzione A, Maurea S, Brunetti A. Tailored versus fixed scan delay in contrast-enhanced abdominal multi-detector CT: An intra-patient comparison of image quality. Eur J Radiol 2021; 143:109914. [PMID: 34509881 DOI: 10.1016/j.ejrad.2021.109914] [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: 05/04/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To perform anintra-patient comparison betweena single-pass protocol (SP) and a portal venous phase (PVP) by means ofboth quantitative and qualitative analysis of image quality. METHODS Forty patients (31 M; 9F; aged 20-77 years; BMI 23 ± 4 Kg/m2) underwent both a SP and a PVP using a 64-rows multi-detector CT with a median interval time of 56 days (range5-903). All patients underwent i.v. bolus injection (2.0 cc/sec) of 1.7 cc/Kg of a non ionic iodinated contrast-media (370 mgI/ml) with scan delays of 67 ± 8 and 90 s for the SP and the PVP, respectively. Signal- (SNR) and contrast-to-noise ratios (CNR) were calculated for most visceral organs and for both abdominal aorta (AA) and main portal vein (MPV). For qualitative analysis, reproduction of abdominal viscera and vascular structures was blindly evaluated and inter-observer agreement calculated by the weighted Cohen k-analysis. RESULTS Attenuation values (H.U.) of AA (232 ± 53vs180 ± 36) and MPV (215 ± 39vs187 ± 42) were significantly (p < 0.001) higher in the SP than in PVP, respectively. At qualitative analysis, reproduction of mostabdominal viscerawas also significantly sharper (p < 0.001) with the SP than the PVPwith inter-observer agreement scores (k)ranging from 0.60 to 0.88 for all but one imaging criteria. CONCLUSIONS As the SP resulted in a significantly higher vascular enhancement and in a sharper reproduction of most abdominal viscera, it may be better suited than a PVP for the CT evaluation of non traumatic acute abdomen.
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Affiliation(s)
- Luigi Camera
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1).
| | | | - Michele Gambardella
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | | | - Roberta Galatola
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Raffaele Liuzzi
- Institute of Biostructures and Bioimaging (National Research Council), (https://www.cnr.it/en/institute/017), University "Federico II", Naples, Italy(2)
| | - Margaret Longobardi
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Roberta Danzi
- Ospedale S. Maria delle Grazie, Pozzuoli, NA, Italy(3)
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Simone Maurea
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
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14
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A Metric for Quantification of Iodine Contrast Enhancement (Q-ICE) in Computed Tomography. J Comput Assist Tomogr 2021; 45:870-876. [PMID: 34469906 DOI: 10.1097/rct.0000000000001215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Poor contrast enhancement is related to issues with examination execution, contrast prescription, computed tomography (CT) protocols, and patient conditions. Currently, our community has no metric to monitor true enhancement on routine single-phase examinations because this requires knowledge of both pre- and postcontrast CT number. PURPOSE We propose an automatable solution to quantifying contrast enhancement without requiring a dedicated noncontrast series. METHODS The difference in CT number between a target region in an enhanced and unenhanced image defines the metric "quantification of iodine contrast enhancement" (Q-ICE). Quantification of iodine contrast enhancement uses the noncontrast bolus tracking baseline image from routine abdominal examinations, which mitigates the need for a dedicated noncontrast series. We applied this method retrospectively to 312 patient livers from 2 sites between 2017 and 2020. Each site used a weight-based contrast injection protocol for weights 60 to 113 kg and a constant volume less than 60 kg and greater than 113 kg. Hypothesis testing was performed to compare Q-ICE between sites and detect Q-ICE dependence on weight and kilovoltage (kV). RESULTS Mean Q-ICE differed between sites (P = 0.004) by 4.96 Hounsfield unit with 95% confidence interval (1.63-8.28), albeit this difference was roughly 2 times smaller than the SD in Q-ICE across patients at a single site. For patients between 60 and 113 kg, we did not observe evidence of Q-ICE varying with patient weight (P = 0.920 and 0.064 for 120 and 140 kV, respectively). The Q-ICE did vary with patient weight for patients less than 60 kg (P = 0.003) and greater than 113 kg (P = 0.04). We observed a roughly 10 Hounsfield unit reduction in Q-ICE liver for patients scanned with 140 versus 120 kV. We observed several underenhancing examinations with an arterial phase appearance motivating our CT protocol optimization team to consider increasing the delay for slowly enhancing patients. CONCLUSIONS A quality metric for quantifying CT contrast enhancement was developed and suggested tangible opportunities for quality improvement and potential financial savings.
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15
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Kim HI, Lim J, Shim JH. Role of the alpha-fetoprotein response in immune checkpoint inhibitor-based treatment of patients with hepatocellular carcinoma. J Cancer Res Clin Oncol 2021; 148:2069-2077. [PMID: 34459972 DOI: 10.1007/s00432-021-03727-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/04/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The dynamics of serum alpha-fetoprotein (AFP) level have been found to be a useful predictor of therapeutic responsiveness in patients with hepatocellular carcinoma (HCC). We evaluated whether AFP changes were able to accurately reflect imaging-based responses and predict prognosis in patients receiving therapies including immune-checkpoint inhibitors (ICIs). METHODS A total of 108 HCC patients with baseline serum AFP ≥ 20 ng/mL who received ICI-based treatment were included. We evaluated AFP-based responses, coupled with radiographic responses by RECIST, at 6-10 (time-point 1, TP1) and 14-18 weeks (time-point 2, TP2) of therapy in terms of the change of AFP from baseline, with a > 20% decrease or increase in level corresponding to the AFP response and progression, respectively. We examined the correlations between AFP and imaging-based responses, and the prognostic implications of the AFP-based measure. RESULTS Based on AFP change, there were 24 and 20 responders and 74 and 24 progressors at TP1 and TP2, respectively. The AFP responders yielded radiological objective responses in 90.9% (10/11) and 93.8% (15/16) of the cases at TP1 and TP2, respectively, compared with only 1.4% and none, respectively, of the AFP progressors at the corresponding times. The agreement between progression by RECIST and increased AFP level at the two time-points was 93.8% and 95.0%, respectively. The accuracy of the AFP-based criterion for predicting radiologic response/progression was comparable at TP1 and TP2. Both "AFP responder" and "AFP progressor" at TP1 or TP2 independently predicted the overall survival of patients (adjusted hazard ratios [95% confidence intervals], 0.360 [0.174-0.743] and 0.315 [0.117-0.850]; and 2.525 [1.362-4.679] and 3.908 [1.563-9.769], respectively). CONCLUSION Our study suggests that on-treatment AFP changes can complement imaging findings and provide prognostic information for evaluating patients with AFP-producing HCC treated with ICI-based regimens.
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Affiliation(s)
- Ha Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jihye Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ju Hyun Shim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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16
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Rehani MM, Heil J, Baliyan V. Multicentric study of patients receiving 50 or 100 mSv in a single day through CT imaging-frequency determination and imaging protocols involved. Eur Radiol 2021; 31:6612-6620. [PMID: 33683390 DOI: 10.1007/s00330-021-07734-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/17/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess the magnitude and characterization of CT imaging protocols of patients receiving 50 or 100 mSv in a single day. METHODS In this multicentric retrospective study covering up to 279 hospitals from January 2015 to December 2019, the effective dose (E) as estimated by dose management system from dose length product of patients was filtered and grouped into per-day dose bands (≤ 20, > 20-50, > 50-70, > 70-100, > 100-200, > 200 mSv). Information on patient's age and imaging protocol was noted. The data were analyzed to determine the frequency of occurrence in each dose band. Top 20 CT imaging protocols that led to patients with a dose of ≥ 50 mSv in a single acquisition were identified and their relative frequency was estimated. RESULTS A total of approx. 4.3 million (4,283,738) CT exams were performed in approx. 3.9 million (3,880,524) patient-days indicating 9.41% had more than one CT exam in a single day. There were 31,058 (0.8%) patient-days with ≥ 50 mSv and 1191 (0.03%) with ≥ 100 mSv. Nearly 1/3rd patient-days reaching ≥ 50 mSv were of patients aged 50 years or younger. The top 20 CT imaging protocols that led to ≥ 50 mSv in a single day belonged to the body region (chest or abdomen and pelvis) and nearly one-third were angiographic studies. CONCLUSIONS In the first study of its kind, we report that patients with 50 mSv+ in a single day or a single exam are not rare. The information on imaging protocols leading to such doses and their frequency has been provided to help develop dose management strategies. KEY POINTS • Our study of 4,283,738 CT exams performed in 3,880,524 patient-days indicates 0.8% with 50 mSv+ and 0.03% with 100 mSv+ in a single day. • A total of 9.41% underwent more than one CT exam in a single day; nearly 1/3rd of those with 50 mSv+ were ≤ 50 years of age. • Identified top 20 CT imaging protocols that led to 50 mSv+ doses in a single exam. All belong to chest or abdomen and pelvis and nearly 1/3rd were angiographic studies.
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Affiliation(s)
- Madan M Rehani
- Massachusetts General Hospital, 55 Fruit Str, Boston, MA, 02114, USA. .,Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA, 02114, USA.
| | - John Heil
- Imalogix Research Institute, Bryn Mawr, PA, 19010, USA
| | - Vinit Baliyan
- Massachusetts General Hospital, 55 Fruit Str, Boston, MA, 02114, USA
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17
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Sulieman A, Adam H, Elnour A, Tamam N, Alhaili A, Alkhorayef M, Alghamdi S, Khandaker MU, Bradley D. Patient radiation dose reduction using a commercial iterative reconstruction technique package. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.108996] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Chu JS, Wang ZJ. Protocol Optimization for Renal Mass Detection and Characterization. Radiol Clin North Am 2020; 58:851-873. [PMID: 32792119 DOI: 10.1016/j.rcl.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Renal masses increasingly are found incidentally, largely due to the frequent use of medical imaging. Computed tomography (CT) and MR imaging are mainstays for renal mass characterization, presurgical planning of renal tumors, and surveillance after surgery or systemic therapy for advanced renal cell carcinomas. CT protocols should be tailored to different clinical indications, balancing diagnostic accuracy and radiation exposure. MR imaging protocols should take advantage of the improved soft tissue contrast for renal tumor diagnosis and staging. Optimized imaging protocols enable analysis of imaging features that help narrow the differential diagnoses and guide management in patients with renal masses.
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Affiliation(s)
- Jason S Chu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA.
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19
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Use of Multiphase CT Protocols in 18 Countries: Appropriateness and Radiation Doses. Can Assoc Radiol J 2020; 72:381-387. [DOI: 10.1177/0846537119888390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To assess the frequency, appropriateness, and radiation doses associated with multiphase computed tomography (CT) protocols for routine chest and abdomen–pelvis examinations in 18 countries. Materials and Methods: In collaboration with the International Atomic Energy Agency, multi-institutional data on clinical indications, number of scan phases, scan parameters, and radiation dose descriptors (CT dose–index volume; dose–length product [DLP]) were collected for routine chest (n = 1706 patients) and abdomen–pelvis (n = 426 patients) CT from 18 institutions in Asia, Africa, and Europe. Two radiologists scored the need for each phase based on clinical indications (1 = not indicated, 2 = probably indicated, 3 = indicated). We surveyed 11 institutions for their practice regarding single-phase and multiphase CT examinations. Data were analyzed with the Student t test. Results: Most institutions use multiphase protocols for routine chest (10/18 institutions) and routine abdomen–pelvis (10/11 institutions that supplied data for abdomen–pelvis) CT examinations. Most institutions (10/11) do not modify scan parameters between different scan phases. Respective total DLP for 1-, 2-, and 3-phase routine chest CT was 272, 518, and 820 mGy·cm, respectively. Corresponding values for 1- to 5-phase routine abdomen–pelvis CT were 400, 726, 1218, 1214, and 1458 mGy cm, respectively. For multiphase CT protocols, there were no differences in scan parameters and radiation doses between different phases for either chest or abdomen–pelvis CT ( P = 0.40-0.99). Multiphase CT examinations were unnecessary in 100% of routine chest CT and in 63% of routine abdomen–pelvis CT examinations. Conclusions: Multiphase scan protocols for the routine chest and abdomen–pelvis CT examinations are unnecessary, and their use increases radiation dose.
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20
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Eurboonyanun K, Rungwiriyawanich P, Chamadol N, Promsorn J, Eurboonyanun C, Srimunta P. Accuracy of Nonenhanced CT vs Contrast-Enhanced CT for Diagnosis of Acute Appendicitis in Adults. Curr Probl Diagn Radiol 2020; 50:315-320. [PMID: 32037023 DOI: 10.1067/j.cpradiol.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute appendicitis is one of the most common causes of acute abdominal pain requiring emergency intervention. It is often difficult for the clinician to make an accurate diagnosis due to nonspecific and overlapping clinical symptoms. Computed tomography (CT) has become the imaging modality of choice for the evaluation of suspected acute appendicitis. The main purpose of our study was to compare nonenhanced CT (NECT) with contrast-enhanced CT (CECT) for the diagnosis of acute appendicitis. MATERIAL AND METHODS A total of 140 patients were enrolled in the study. Two abdominal radiologists-masked to both the clinical information and the final diagnosis-retrospectively reviewed the computed tomographic findings and made an imaging diagnosis based on (1) NECT only, (2) CECT only, and (3) both NECT and CECT. With the final diagnosis as the reference standard, the accuracy of each CT technique was estimated. RESULTS The respective sensitivity, specificity, and accuracy for NECT, CECT, and NECT + CECT for the diagnosis of acute appendicitis were 80.7%, 86.7%, and 84.3%; 86.0%, 81.9%, and 83.6%; and, 87.7%, 80.7%, and 83.6%. There was no significant difference in the diagnosis of acute appendicitis among the 3 techniques. In order to make a correct diagnosis, the presence of at least 3 imaging findings for NECT or at least 4 for CECT had the best diagnostic accuracy. We also found that 9.25 mm was the optimal cut-off threshold for the detection of patients with acute appendicitis. CONCLUSION Our study allowed direct comparison between NECT, CECT, and NECT + CECT combined. There was no difference in the ability of each CT technique for diagnosing patients with acute appendicitis. For a patient whom iodinated contrast media is contraindicated or a patient who has an increased risk of severe adverse reaction, we would encourage the use of NECT because it provides comparable diagnostic accuracy without further exposing such patient to the contrast media.
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Affiliation(s)
- Kulyada Eurboonyanun
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | | | - Nittaya Chamadol
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Julaluck Promsorn
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chalerm Eurboonyanun
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Piyachat Srimunta
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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21
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Al Naomi H, Aly A, Kharita MH, Hilli SA, Al Obadli A, Singh R, Rehani MM, Kalra MK. Multiphase abdomen-pelvis CT in women of childbearing potential (WOCBP): Justification and radiation dose. Medicine (Baltimore) 2020; 99:e18485. [PMID: 31977845 PMCID: PMC7004794 DOI: 10.1097/md.0000000000018485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess justification and radiation doses of abdomen-pelvis CT in women of childbearing potential (WOCBP) scanned in 2 tertiary hospitals in Qatar.The local ethical committee approved retrospective study of 451 WOCBP (14-55 years) who underwent abdomen-pelvis CT examinations. Patients' age, clinical indications for ordered CT, scanner types and vendors, number and type of scan phases (non-contrast, arterial, portal venous, and/or delayed phases), and radiation dose descriptors (CT dose index volume - CTDIvol and dose length product- DLP) were recorded. Patients undergoing simultaneous chest-abdomen-pelvis CT were excluded. We classified the clinical indications for all 451 CT into indicated and unindicated based on the ACR Appropriateness Criteria. Information regarding the date of last menstrual period, likelihood of pregnancy, and if available, results of the pregnancy test were recorded. Data were analyzed with descriptive statistics (median and inter-quartile range) and analysis of variance (ANOVA).None of the patients were pregnant at the time of their scanning. Amongst the 673 phases acquired for multiphase abdomen-pelvis CT in 451 patients, the 47% unindicated phases (315/673) included non-contrast (122/673, 18%), arterial (33/673, 5%), portal venous (125/673, 19%) and delayed (35/673, 5%) phases. The respective median DLP for indicated and unindicated phases were 266 and 758 mGy.cm (P < .0001).Multiphase abdomen-pelvis CT exams are frequent but seldom justified in WOCBP. They lead to a substantial increase in unindicated radiation dose compared to a single-phase CT.
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Affiliation(s)
| | - Antar Aly
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Ramandeep Singh
- Massachusetts General Hospital and Harvard Medical School, Boston MA
| | - Madan M. Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston MA
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22
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Georgieva MV, Wheeler SB, Erim D, Smith-Bindman R, Loo R, Ng C, Garg T, Raynor M, Nielsen ME. Comparison of the Harms, Advantages, and Costs Associated With Alternative Guidelines for the Evaluation of Hematuria. JAMA Intern Med 2019; 179:1352-1362. [PMID: 31355874 PMCID: PMC6664383 DOI: 10.1001/jamainternmed.2019.2280] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Existing recommendations for the diagnostic testing of hematuria range from uniform evaluation of varying intensity to patient-level risk stratification. Concerns have been raised about not only the costs and advantages of computed tomography (CT) scans but also the potential harms of CT radiation exposure. OBJECTIVE To compare the advantages, harms, and costs associated with 5 guidelines for hematuria evaluation. DESIGN, SETTING, AND PARTICIPANTS A microsimulation model was developed to assess each of the following guidelines (listed in order of increasing intensity) for initial evaluation of hematuria: Dutch, Canadian Urological Association (CUA), Kaiser Permanente (KP), Hematuria Risk Index (HRI), and American Urological Association (AUA). Participants comprised a hypothetical cohort of patients (n = 100 000) with hematuria aged 35 years or older. This study was conducted from August 2017 through November 2018. EXPOSURES Under the Dutch and CUA guidelines, patients received cystoscopy and ultrasonography if they were 50 years or older (Dutch) or 40 years or older (CUA). Under the KP and HRI guidelines, patients received different combinations of cystoscopy, ultrasonography, and CT urography or no evaluation on the basis of risk factors. Under the AUA guidelines, all patients 35 years or older received cystoscopy and CT urography. MAIN OUTCOMES AND MEASURES Urinary tract cancer detection rates, radiation-induced secondary cancers (from CT radiation exposure), procedural complications, false-positive rates per 100 000 patients, and incremental cost per additional urinary tract cancer detected. RESULTS The simulated cohort included 100 000 patients with hematuria, aged 35 years or older. A total of 3514 patients had urinary tract cancers (estimated prevalence, 3.5%; 95% CI, 3.0%-4.0%). The AUA guidelines missed detection for the fewest number of cancers (82 [2.3%]) compared with the detection rate of the HRI (116 [3.3%]) and KP (130 [3.7%]) guidelines. However, the simulation model projected 108 (95% CI, 34-201) radiation-induced cancers under the KP guidelines, 136 (95% CI, 62-229) under the HRI guidelines, and 575 (95% CI, 184-1069) under the AUA guidelines per 100 000 patients. The CUA and Dutch guidelines missed detection for a larger number of cancers (172 [4.9%] and 251 [7.1%]) but had 0 radiation-induced secondary cancers. The AUA guidelines cost approximately double the other 4 guidelines ($939/person vs $443/person for Dutch guidelines), with an incremental cost of $1 034 374 per urinary tract cancer detected compared with that of the HRI guidelines. CONCLUSIONS AND RELEVANCE In this simulation study, uniform CT imaging for patients with hematuria was associated with increased costs and harms of secondary cancers, procedural complications, and false positives, with only a marginal increase in cancer detection. Risk stratification may optimize the balance of advantages, harms, and costs of CT.
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Affiliation(s)
- Mihaela V Georgieva
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill
| | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | - Daniel Erim
- Division of eHealth, Quality and Analytics, Social Policy, Health and Economics Research Unit, RTI International, Research Triangle Park, North Carolina
| | - Rebecca Smith-Bindman
- Departments of Radiology, Epidemiology and Biostatistics, University of California at San Francisco, San, Francisco
| | - Ronald Loo
- Department of Urology, Kaiser Permanente Southern California, Los Angeles, California
| | - Casey Ng
- Department of Urology, Kaiser Permanente Southern California, Los Angeles, California
| | - Tullika Garg
- Department of Urology, Geisinger Health, Danville, Pennsylvania
| | - Mathew Raynor
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill
| | - Matthew E Nielsen
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill.,University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill.,Department of Urology, University of North Carolina School of Medicine, Chapel Hill.,Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill.,Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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23
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Doshi AM, Moore WH, Kim DC, Rosenkrantz AB, Fefferman NR, Ostrow DL, Recht MP. Informatics Solutions for Driving an Effective and Efficient Radiology Practice. Radiographics 2019; 38:1810-1822. [PMID: 30303784 DOI: 10.1148/rg.2018180037] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Radiologists are facing increasing workplace pressures that can lead to decreased job satisfaction and burnout. The increasing complexity and volumes of cases and increasing numbers of noninterpretive tasks, compounded by decreasing reimbursements and visibility in this digital age, have created a critical need to develop innovations that optimize workflow, increase radiologist engagement, and enhance patient care. During their workday, radiologists often must navigate through multiple software programs, including picture archiving and communication systems, electronic health records, and dictation software. Furthermore, additional noninterpretive duties can interrupt image review. Fragmented data and frequent task switching can create frustration and potentially affect patient care. Despite the current successful technological advancements across industries, radiology software systems often remain nonintegrated and not leveraged to their full potential. Each step of the imaging process can be enhanced with use of information technology (IT). Successful implementation of IT innovations requires a collaborative team of radiologists, IT professionals, and software programmers to develop customized solutions. This article includes a discussion of how IT tools are used to improve many steps of the imaging process, including examination protocoling, image interpretation, reporting, communication, and radiologist feedback. ©RSNA, 2018.
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Affiliation(s)
- Ankur M Doshi
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016
| | - William H Moore
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016
| | - Danny C Kim
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016
| | - Andrew B Rosenkrantz
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016
| | - Nancy R Fefferman
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016
| | - Dana L Ostrow
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016
| | - Michael P Recht
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, 3rd Floor, New York, NY 10016
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24
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Lee KH, Shim YS, Park SH, Park SH, Choi SJ, Pak SY, Cheong H. Comparison of standard-dose and half-dose dual-source abdominopelvic CT scans for evaluation of acute abdominal pain. Acta Radiol 2019; 60:946-954. [PMID: 30376718 DOI: 10.1177/0284185118809544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background With the increasing number of computed tomography (CT) scans used for evaluation of acute abdominal pain, patient radiation exposure has increased rapidly. Purpose To determine whether the diagnostic performance of half-dose abdominopelvic CT is non-inferior to that of standard-dose CT for patients with acute abdominal pain. Material and Methods Ninety-eight patients with acute abdominal pain underwent dual-source abdominopelvic CT. Three sets of CT images were reconstructed: standard-dose filtered back projection (FBP); half-dose FBP; and half-dose sinogram-affirmed iterative reconstruction (SAFIRE3). Diagnostic performance of the standard-dose scan was compared with that of the half-dose scans by using a non-inferiority test with a 10% margin. The overall image quality was subjectively measured. Results Diagnostic performance for overall disease diagnosis with half-dose scans (area under the receiver operating characteristic curve [AUC] = 0.835 for FBP, 0.881 for SAFIRE3) was non-inferior to that of standard-dose FBP (AUC = 0.891) (95% confidence interval lower limit difference = −5.6% [half-dose FBP], −1.2% [half-dose SAFIRE3]). The diagnostic sensitivity for detection of neoplastic disease was lower with half-dose (75.0%) than with standard-dose FBP (91.7%). Effective dose and dose-length product with standard-dose imaging were 7.99 ± 2.55 mSv and 533.1 ± 170.3 mGy·cm, respectively; those of half-dose imaging were 3.99 ± 1.28 mSv and 266.6 ± 85.2 mGy·cm, respectively. The image quality was lower with half-dose than with standard-dose FBP scans ( P < 0.01). Conclusion Diagnostic performance of half-dose CT is non-inferior to that of standard-dose scan for evaluation of acute abdominal pain, despite inferior image quality.
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Affiliation(s)
- Ki Hyun Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Sup Shim
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seong Ho Park
- Division of Abdominal Radiology, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Joon Choi
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seong Yong Pak
- Imaging and Computer Vision Division, Siemens Healthcare, Seoul, Republic of Korea
| | - Hyunhee Cheong
- University of Ulsan College of Medicine, Seoul, Republic of Korea
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25
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Tzou DT, Zetumer S, Usawachintachit M, Taguchi K, Bechis SK, Duty BD, Harper JD, Hsi RS, Sorensen M, Sur RL, Reliford-Titus S, Chang HC, Isaacson D, Bayne DB, Wang ZJ, Stoller ML, Chi T. Computed Tomography Radiation Exposure Among Referred Kidney Stone Patients: Results from the Registry for Stones of the Kidney and Ureter. J Endourol 2019; 33:619-624. [PMID: 31030576 DOI: 10.1089/end.2019.0091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Kidney stone patients routinely have CT scans during diagnostic work-up before being referred to a tertiary center. How often these patients exceed the recommended dose limits for occupational radiation exposure of >100 mSv for 5 years and >50 mSv in a single year from CT alone remains unknown. This study aimed to quantify radiation doses from CTs received by stone patients before their evaluation at a tertiary care stone clinic. Methods: From November 2015 to March 2017, consecutive new patients enrolled into the Registry for Stones of the Kidney and Ureter (ReSKU™) had the dose-length product of every available CT abdomen/pelvis within 5 years of their initial visit recorded, allowing for an effective dose (EDose) calculation. Multivariate logistic regression analysis identified factors associated with exceeding recommended dose limits. Models were created to test radiation reducing effects of low-dose and phase-reduction CT protocols. Results: Of 343 noncontrast CTs performed, only 29 (8%) were low-dose CTs (calculated EDose <4 mSv). Among 389 total patients, 101 (26%) and 25 (6%) had an EDose >20 mSv and >50 mSv/year, respectively. Increased body mass index, number of scans, and multiphase scans were associated with exceeding exposure thresholds (p < 0.01). The implementation of a low-dose CT protocol decreased the estimated number of scans contributing to overexposure by >50%. Conclusions: Stone patients referred to a tertiary stone center may receive excessive radiation from CT scans alone. Unnecessary phases and underutilization of low-dose CT protocols continue to take place. Enacting new approaches to CT protocols may spare stone patients from exceeding recommended dose limits.
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Affiliation(s)
- David T Tzou
- 1 Department of Urology, University of California, San Francisco, San Francisco, California.,2 Division of Urology, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Samuel Zetumer
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
| | - Manint Usawachintachit
- 1 Department of Urology, University of California, San Francisco, San Francisco, California.,3 Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
| | - Kazumi Taguchi
- 1 Department of Urology, University of California, San Francisco, San Francisco, California.,4 Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Seth K Bechis
- 5 Department of Urology, University of California, San Diego, San Diego, California
| | - Brian D Duty
- 6 Department of Urology, Oregon Health & Science University, Portland, Oregon
| | - Jonathan D Harper
- 7 Department of Urology, University of Washington, Seattle, Washington
| | - Ryan S Hsi
- 8 Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mathew Sorensen
- 7 Department of Urology, University of Washington, Seattle, Washington
| | - Roger L Sur
- 5 Department of Urology, University of California, San Diego, San Diego, California
| | | | - Helena C Chang
- 7 Department of Urology, University of Washington, Seattle, Washington
| | - Dylan Isaacson
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
| | - David B Bayne
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
| | - Zhen J Wang
- 9 Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Marshall L Stoller
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
| | - Thomas Chi
- 1 Department of Urology, University of California, San Francisco, San Francisco, California
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26
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Frush DP. The ABZs of Pediatric CT. J Am Coll Radiol 2019; 16:264-265. [DOI: 10.1016/j.jacr.2018.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022]
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27
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Alvin MD, Shahriari M, Honig E, Liu L, Yousem DM. Clinical Access and Utilization of Reports and Images in Neuroradiology. J Am Coll Radiol 2018; 15:1723-1731. [DOI: 10.1016/j.jacr.2018.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
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28
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Frush DP. 'Here's looking at you, kid' … again? Revisiting multiphase CT in children. Pediatr Radiol 2018; 48:1711-1713. [PMID: 30178080 DOI: 10.1007/s00247-018-4248-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/24/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Donald P Frush
- Department of Radiology, Duke University Medical Center, 1905 McGovern-Davison Children's Health Center, Durham, NC, 27710, USA.
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29
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Rostad BS, Applegate KE, Kim T, Mansour RM, Milla SS. Multiphase acquisitions in pediatric abdominal-pelvic CT are a common practice and contribute to unnecessary radiation dose. Pediatr Radiol 2018; 48:1714-1723. [PMID: 29980861 DOI: 10.1007/s00247-018-4192-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/23/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Many patients at our pediatric hospital have had a contrast-enhanced CT of the abdomen and pelvis performed by an outside imaging facility before admission. We have noticed that many of these exams are multiphase, which may contribute to unnecessary radiation dose. OBJECTIVE To determine the frequency of multiphase acquisitions and radiation dose indices in contrast-enhanced CTs of the abdomen and pelvis performed by outside imaging facilities in patients who were subsequently transferred to our pediatric hospital for care, and compare these metrics to contrast-enhanced CTs of the abdomen and pelvis performed internally. MATERIALS AND METHODS A retrospective analysis was performed of contrast-enhanced CTs of the abdomen and pelvis from outside imaging facilities uploaded to our picture archiving and communication system (PACS) between January 1, 2012, and December 31, 2015. CT images and dose pages were reviewed to determine the number of phases and dose indices (CT dose index-volume [CTDIvol], dose-length product, size-specific dose estimate). Exams for abdominal or pelvic mass, trauma or urinary leak indications were excluded. Data were compared to internally acquired contrast-enhanced CTs of the abdomen and pelvis by querying the American College of Radiology (ACR) Dose Index Registry. This review was institutional review board and HIPAA compliant. RESULTS There were 754 contrast-enhanced CTs of the abdomen and pelvis from 104 outside imaging facilities. Fifty-three percent (399/754) had 2 phases, and 2% (14/754) had 3 or more phases. Of the 939 contrast-enhanced CTs of the abdomen and pelvis performed internally, 12% (115) were multiphase exams. Of 88% (664) contrast-enhanced CTs of the abdomen and pelvis from outside imaging facilities with dose data, CTDIvol was 2.7 times higher than our institution contrast-enhanced CTs of the abdomen and pelvis (939) for all age categories as defined by the ACR Dose Index Registry (mean: 9.4 vs. 3.5 mGy, P<0.0001). The majority (74%) of multiphase exams were performed by 9 of 104 outside imaging facilities. CONCLUSION Multiphase acquisitions in routine contrast-enhanced CT of the abdomen and pelvis exams at outside imaging facilities are more frequent than those at a dedicated pediatric institution and contribute to unnecessary radiation dose. A contrast-enhanced CT of the abdomen and pelvis exam from an outside imaging facility with two passes may have as much as four times to six times the dose as the same exam performed with a single pass at a pediatric imaging center. We advocate for imaging facilities with high multiphase rates to eliminate multiple phases from routine contrast-enhanced CT of the abdomen and pelvis exams in children.
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Affiliation(s)
- Bradley S Rostad
- Department of Radiology, Children's Healthcare of Atlanta at Egleston, 1405 Clifton Rd., NE, Atlanta, GA, 30322-1101, USA. .,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Kimberly E Applegate
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Tammy Kim
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Renee M Mansour
- Department of Radiology, Children's Healthcare of Atlanta at Egleston, 1405 Clifton Rd., NE, Atlanta, GA, 30322-1101, USA
| | - Sarah S Milla
- Department of Radiology, Children's Healthcare of Atlanta at Egleston, 1405 Clifton Rd., NE, Atlanta, GA, 30322-1101, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
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30
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Johnson PT, Bello JA, Chatfield MB, Flug JA, Pandharipande PV, Rohatgi S, Fishman EK, Megibow AJ. New ACR Choosing Wisely Recommendations: Judicious Use of Multiphase Abdominal CT Protocols. J Am Coll Radiol 2018; 16:56-60. [PMID: 30219345 DOI: 10.1016/j.jacr.2018.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
| | - Jacqueline A Bello
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | - Saurabh Rohatgi
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
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31
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CT and MRI Protocol Variation and Optimization at an Academic Medical Center. J Am Coll Radiol 2018; 15:1254-1258. [PMID: 30082232 DOI: 10.1016/j.jacr.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 04/26/2018] [Accepted: 06/05/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE To reduce CT and MRI protocol variation across a multisite radiology practice at an academic medical center so that patients with similar clinical presentations are examined the same way. MATERIALS AND METHODS This study was performed at a large academic radiology practice performing ∼800,000 radiology examinations annually. To diminish variability across the enterprise (2 general radiology divisions; 10 subspecialty imaging divisions), a Harmonization Oversight Committee was created and tasked with ensuring patients with similar clinical presentations undergo the same CT or MRI protocol, regardless of where they are imaged. A process for decision making and conflict resolution was established, supported by the department chair. Primary outcome measure was standardization of CT and MRI protocols across all sites. Secondary outcome was percent reduction of CT and MRI protocols postharmonization. RESULTS Over the 5-month harmonization process, most conflicts arose for abdominal imaging protocols because they are performed in four distinct subspecialty divisions, but all were addressed effectively through the conflict resolution process. Overall, there was a 31% reduction in the total number of CT and MRI protocols (before harmonization 481, after harmonization 331). There was significant variation in reduction of protocols per workgroup (multiple P values; range <.0001 to .9) with largest reduction in workgroups that overlapped multiple divisions. CONCLUSION A structured, organ system- and consensus-based quality improvement process with unambiguous decision-making and conflict resolution processes can be used to harmonize imaging protocols across complex, matrixed, multisite radiology practices so that patients with similar clinical presentations are imaged with the same imaging protocol.
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32
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Patel M, Jilani D, Oto A, Patel P. Evaluating the Sensitivity of Arterial Phase CT Images for Detection of Hepatic GIST Metastases. Tomography 2018; 3:101-104. [PMID: 30042975 PMCID: PMC6024457 DOI: 10.18383/j.tom.2017.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Gastrointestinal stromal tumor (GIST) frequently metastasizes to the liver, and conventional staging computed tomography (CT) protocols use multiphasic contrast enhancement for detection of hepatic lesions. We evaluated the sensitivity of arterial phase CT imaging for hepatic GIST metastases compared with that of standard (portal venous [PV]) phase imaging. We conducted a retrospective review of patients who presented with hepatic GIST metastases identified on staging CT examinations between 2005 and 2015. Arterial and PV phase CT images were randomized and reviewed by 2 radiologists blinded to clinical history, correlative imaging, and number of controls. In total, 32 patients had hepatic metastases identified on multiphasic (arterial and PV) staging CT examinations. There was no significant difference in identification of metastases between arterial and PV phase imaging (31 vs 32, P = .32). Lesion size measurements did not significantly differ (P = .58). Arterial phase CT imaging did not significantly increase the sensitivity for hepatic GIST metastases compared with PV phase imaging alone.
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Affiliation(s)
- Mikin Patel
- Department of Radiology, The University of Chicago Medicine, Chicago, Illinois
| | - Danial Jilani
- Department of Radiology, The University of Chicago Medicine, Chicago, Illinois
| | - Aytekin Oto
- Department of Radiology, The University of Chicago Medicine, Chicago, Illinois
| | - Pritesh Patel
- Department of Radiology, The University of Chicago Medicine, Chicago, Illinois
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Triple-phase abdomen and pelvis computed tomography: standard unenhanced phase can be replaced with reduced-dose scan. Pol J Radiol 2018; 83:e166-e170. [PMID: 30627230 PMCID: PMC6323542 DOI: 10.5114/pjr.2018.75682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of the study was to test the hypothesis that unenhanced phase does not require as high image quality as subsequent phases acquired after contrast administration in triple-phase abdomen and pelvis computed tomography (CT), and to assess if attenuation value (AV) measurements may be obtained from unenhanced images acquired with three-fold reduced radiation dose. Material and methods In the standard triple-phase abdomen and pelvis CT protocol (unenhanced, late arterial, and portal venous phase) we decreased the tube current time product only in the unenhanced phase. Arterial and venous phases were performed with the standard scanner settings used in our Institution for routine abdomen and pelvis CT. We compared the AV in manually drawn circular-shaped regions of interest (ROIs) obtained from reduced-dose and standard-dose unenhanced images in 52 patients. All ROIs were set in homogeneous parts of psoas muscle, fat tissue, liver, spleen, aorta, and bladder. Results There was no statistically significant difference in AV measurements for all considered areas. More noise does not alter the mean AV inside the ROIs. Radiation dose of unenhanced scans was reduced three times and the total dose length product (DLP) in the triple-phase study was decreased by 22%. Conclusions Unenhanced images performed with three-fold reduced radiation dose allows reliable AV measurements. The unenhanced phase does not require as high image quality as subsequent phases acquired after contrast administration.
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Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults. Eur Radiol 2018; 28:2308-2318. [PMID: 29318431 DOI: 10.1007/s00330-017-5225-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To analyse CT use in recent years in a high-density Italian area (±10 million inhabitants, including 1 million children), focusing on developing age. METHODS Retrospective analysis of records from HealthCare IT System, covering >400 hospitals and clinics. Description of CT use between 2004-2014 in emergency and outpatient care and assessment of radiation exposure trend. RESULTS Over 9 million scans were performed. Emergency procedures showed a global increase of 230 %, mainly head examinations. In the global outpatient setting, the annual number of CT scans/person increased ±19 %. A moderate increase in CT examinations was observed in the developing age population, while a remarkable increase in dental, chest and abdominal procedures occurred for the 10- to 30-year age range. The increase in mean annual dose/capita in the global patient pool was approximately 42 %, increasing from 0.72-1.03 mSv. The population rate receiving an annual CT radiation dose/capita higher than 1 mSv tripled in the 11-year interval, increasing from 16-48 %. CONCLUSIONS The remarkable increase in radiation exposure raises a special concern for teenagers and young adults, whose risk tends to be underestimated. The fivefold increase in dental CTs in the younger age groups requires further investigations. KEY POINTS • Literature highlights a remarkable increase in CT use over the last decades. • The paediatric age had higher exposure to X-ray risk. • A detailed retrospective analysis of more than 9 million scans was performed. • Dental, chest, abdominal procedures increased remarkably in 10- to 30-year age range. • This study raises concern about exposure for teenagers and young adults.
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Abstract
OBJECTIVE Interpretive errors in diagnostic imaging result in significant patient morbidity and mortality, but the importance of errors and process failures in the imaging cycle other than during image interpretation is underappreciated. In this article, we describe these errors and potential solutions, providing a framework to improve patient safety and understand the changing roles of radiologists beyond image interpretation. CONCLUSION For comprehensive improvements to health care delivery, other failures in the cycle besides diagnostic interpretive error-such as ordering inappropriate studies, PACS failures, and a lack of accurate clinician contact information (with resultant communication failure)-should be recognized as contributors to patient harm because they lead to wasted resources and delayed care. By taking ownership of the entire imaging cycle, radiologists can increase their net worth to patient care and cement their roles as experts in the effective, evidence-based use of imaging technologies.
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Lee SH, Yun SJ, Ryu S, Choi SW, Kim HJ, Kang TK, Oh SC, Cho SJ. Brain Computed Tomography Compared with Facial 3-Dimensional Computed Tomography for Diagnosis of Facial Fractures. J Pediatr 2017; 184:32-37.e2. [PMID: 28190518 DOI: 10.1016/j.jpeds.2017.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/30/2016] [Accepted: 01/12/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To compare the detection of facial fractures and radiation dose between brain computed tomography (CT) and facial 3-dimensional (3D) CT in pediatric patients who have experienced a trauma. STUDY DESIGN Four hundred pediatric patients who experienced a trauma and underwent immediate brain CT and facial 3D CT between January 2016 and June 2016 were included in this retrospective study. Two reviewers independently analyzed and determined the presence of the facial fractures of 8 anatomic regions based on brain CT and facial 3D CT over a 1-week interval. Suggested treatment decisions for facial fractures seen on brain CT and facial 3D CT were evaluated by one physician. The facial 3D CT scans, interpreted by a senior radiologist, were considered as the reference standard. Diagnostic performance, radiation dose, and interobserver agreement of the CT scans were evaluated. RESULTS Brain CT showed a high sensitivity (94.1%-96.5%), high specificity (99.7%-100%), and high accuracy (98.8%-99.0%) in both reviewers, and performed as well as did facial 3D CT (P ≥ .25). The suggested treatment decision was not different between the brain CT and facial 3D CT findings. The agreements between the reference standard and the reviewers, and between reviewers 1 and 2 were excellent (k = 0.946-0.993). The mean effective radiation doses used in brain CT (3.6 mSv) were significantly lower than those in brain CT with facial 3D CT (5.5 mSv) (P < .001). CONCLUSIONS Brain CT showed acceptable diagnostic performance and can be used as the first-line imaging tool in the workup of pediatric patients with suspected facial fractures.
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Affiliation(s)
- Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, Aerospace Medical Center, Republic of Korea Air Force, Cheongwon-gun, Chungcheongbuk-do, Republic of Korea.
| | - Seokyong Ryu
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Seoung Won Choi
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Hye Jin Kim
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Tae Kyug Kang
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Sung Chan Oh
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
| | - Suk Jin Cho
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Nowon-gu, Republic of Korea
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Camera L, Liccardo I, Romano F, Liuzzi R, Rispo A, Imbriaco M, Testa A, Luglio G, De Fronzo S, Castiglione F, Bucci L, Brunetti A. Diagnostic efficacy of single-pass abdominal multidetector-row CT: prospective evaluation of a low dose protocol. Br J Radiol 2016; 90:20160612. [PMID: 27826994 DOI: 10.1259/bjr.20160612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic efficacy of single-pass contrast-enhanced multidetector CT (CE-MDCT) performed with a low-radiation high-contrast (LR-HC) dose protocol in selected patients with non-traumatic acute bowel disease. METHODS 65 (32 males, 33 females; aged 20-67 years) consecutive patients with non-traumatic acute bowel disease underwent single-pass CE-MDCT performed 70-100 s after i.v. bolus injection of a non-ionic iodinated contrast medium (CM) (370 mgI ml-1). In 46 (70%) patients with a clinical and/or ultrasonographic suspicion of inflammatory bowel disease, up to 1.2-1.4 l of a 7% polyethylene-glycol solution was orally administered 45-60 mins prior to the CT examination. Patients were then divided into two groups according to age: Group A (20-44 years; n = 34) and Group B (45-70 years; n = 31). Noise index (NI) and CM dose were selected as follows: Group A (NI = 15; 2.5 ml kg-1) and Group B (NI = 12.5; 2 ml kg-1). All patients of Group A underwent thyroid functional tests at 4-6 weeks. Final diagnoses were obtained by open (n = 12) or laparoscopic surgery (n = 4), endoscopy w/without biopsy (n = 24) and clinical (n = 19) and/or instrumental (ultrasonography) (n = 6) follow-up at 11 ± 4 months (range 6-18 mo.). Statistical analysis was performed by χ2 and Student's t-test for categorical and continuous variables, respectively. RESULTS Sensitivity and specificity were 91.3 vs 95.4% (p = 0.905) and 90.9 vs 88.8% (p = 0.998) with an overall diagnostic accuracy of 91.1 vs 93.5% (p = 0.756), whereas the radiation (in millisievert) and CM dose (in millilitre) were 7.5 ± 2.8 mSv and 155 ± 30 ml for Group A and 14.1 ± 5.3 mSv and 130 ± 24 ml for Group B (p < 0.001), respectively. No patients of Group A showed laboratory signs of thyrotoxicosis at follow-up. CONCLUSION The LR-HC has proved to be a safe and a dose-effective protocol in the evaluation of selected young patients with non-traumatic acute bowel disease. Advances in knowledge: (1) As reaching the highest diagnostic benefit to risk ratio (AHARA) appears to be the current principle of MDCT imaging, an increased amount of iodinated CM (0.7-0.9 gI ml-1) can be safely administered to young patients (<40 years) with normal thyroid and renal function to compensate for the lower image quality resulting from low-dose CT protocols performed with the standard filter back-projection algorithm. Such an approach will result in a significant reduction of the radiation dose, which could be otherwise achieved only using iterative reconstruction algorithms combined with either low tube voltage and/or low tube current protocols. (2) An optimal scan delay (Tdelay) for a venous phase caudocranial acquisition can be calculated by the following formula: Tdelay = CI + 25 - TSD, where CI is the duration of the contrast injection, 25 is the average of the sum of abdominal aortic and peak hepatic arrival times and TSD is the scan duration. With such an approach, the radiation exposure resulting from bolus tracking, albeit performed with low-dose scans, can be spared in patients with normal transit times.
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Affiliation(s)
- Luigi Camera
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.,2 National Research Council (CNR), Institute of Biostructures and Bioimaging, Naples, Italy
| | - Immacolata Liccardo
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Federica Romano
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Raffaele Liuzzi
- 2 National Research Council (CNR), Institute of Biostructures and Bioimaging, Naples, Italy
| | - Antonio Rispo
- 3 Section of Gastroenterology, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Massimo Imbriaco
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Anna Testa
- 3 Section of Gastroenterology, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Gaetano Luglio
- 4 Section of Colo-rectal Surgery, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Simona De Fronzo
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Fabiana Castiglione
- 3 Section of Gastroenterology, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Luigi Bucci
- 4 Section of Colo-rectal Surgery, Department of Clinical Medicine and Surgery, University "Federico ll", Naples, Italy
| | - Arturo Brunetti
- 1 Section of Diagnostic Imaging, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
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Yun SJ, Jin W, Yoon SH, Chun YS, Cha JG, Koo HS, Park SY, Park JS, Ryu KN, Lee SH, Shin JS. Diagnostic performance of abdominal CT for diagnosis of pelvic fractures: comparison with pelvic CT. Acta Radiol 2016; 57:1244-50. [PMID: 26787672 DOI: 10.1177/0284185115626473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/23/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the emergency department, patients with abdominopelvic trauma inadvertently undergo both abdominal computed tomography (CT) (for intra-abdominal and intra-pelvic organs) and pelvic CT (CT with multiplanar reformation in three orthogonal planes of the bony pelvis). However, the systemic use of CT is concerning given the cumulative radiation dose. PURPOSE To evaluate the diagnostic value of abdominal CT in comparison to pelvic CT in patients with suspected pelvic fractures. MATERIAL AND METHODS Seventy-two patients who underwent abdominal CT and pelvic CT within a 2-week period to evaluate pelvic fractures were included. Two reviewers retrospectively analyzed eight anatomical regions of the pelvic bones on both abdominal CT and pelvic CT over a 1-week interval. The interpretation of pelvic CT scans by two senior musculoskeletal radiologists was considered as the reference standard. Diagnostic performance and inter-observer agreement of both CT scans were evaluated. RESULTS For reviewers 1 and 2, abdominal CT showed high accuracy (98% and 98%, respectively) as did pelvic CT. For both abdominal CT and pelvic CT, fracture detection in all anatomical regions of the pelvic bones was not significantly different for the two reviewers (P ≥ 0.25). Inter-observer agreement for all anatomical regions of the pelvic bones was excellent or good (k = 0.785-1.0). CONCLUSION Not only pelvic CT but also abdominal CT is acceptable for detection of pelvic fractures, in spite of its thicker sections and different reconstruction algorithm. Therefore, if abdominal CT has already been performed, additional pelvic CT might no longer be necessary in order to exclude a pelvic fracture.
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Affiliation(s)
- Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - So Hee Yoon
- Department of Radiology, National Police Hospital, Seoul, Republic of Korea
| | - Young Soo Chun
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hye-Soo Koo
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Jong Soo Shin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Alvarado A. How to improve the clinical diagnosis of acute appendicitis in resource limited settings. World J Emerg Surg 2016; 11:16. [PMID: 27118990 PMCID: PMC4845369 DOI: 10.1186/s13017-016-0071-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/18/2016] [Indexed: 12/29/2022] Open
Abstract
This article is a general review of the diagnostic tools that the clinician can use for the early diagnosis of acute appendicitis with emphasis on the Alvarado Score, and it is aimed principally to the medical practitioners in different parts of the world where the diagnostic facilities and technological resources are limited.
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Affiliation(s)
- Alfredo Alvarado
- />Society of Laparoscopic Surgeons, Miami, FL U.S.A
- />International College of Surgeons, Chicago, IL USA
- />American Medical Association, Chicago, IL USA
- />American College of Emergency Physicians, Irving, TX USA
- />Pennsylvania Medical Society, Harrisburg, PA USA
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Chiorean L, Tana C, Braden B, Caraiani C, Sparchez Z, Cui XW, Baum U, Dietrich CF. Advantages and Limitations of Focal Liver Lesion Assessment with Ultrasound Contrast Agents: Comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines. Med Princ Pract 2016; 25:399-407. [PMID: 27318740 PMCID: PMC5588445 DOI: 10.1159/000447670] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 06/16/2016] [Indexed: 12/17/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography. Due to US contrast agents (UCAs) and contrast-specific techniques, sonography offers the potential to show enhancement of liver lesions in a similar way as contrast-enhanced cross-sectional imaging techniques. The real-time assessment of liver perfusion throughout the vascular phases, without any risk of nephrotoxicity, represents one of the major advantages that this technique offers. CEUS has led to a dramatic improvement in the diagnostic accuracy of US and subsequently has been included in current guidelines as an important step in the diagnostic workup of focal liver lesions (FLLs), resulting in a better patient management and cost-effective therapy. The purpose of this review was to provide a detailed description of contrast agents used in different cross-sectional imaging procedures for the study of FLLs, focusing on characteristics, indications and advantages of UCAs in clinical practice.
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Affiliation(s)
- Liliana Chiorean
- Department of Internal Medicine, Wuhan, China
- Department of Medical Imaging, des Cévennes Clinic, Annonay, France
| | - Claudio Tana
- Department of Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Guastalla, Italy
| | - Barbara Braden
- Department of Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, Wuhan, China
| | - Zeno Sparchez
- Department of Gastroenterology, ‘Octavian Fodor’ Institute of Gastroenterology and Hepatology and ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Xin-Wu Cui
- Department of Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ulrich Baum
- Department of Radiology, Caritas Hospital, Bad Mergentheim, Germany
| | - Christoph F. Dietrich
- Department of Internal Medicine, Wuhan, China
- *Prof. Dr. med. Christoph F. Dietrich, Innere Medizin 2, Caritas Krankenhaus, Uhlandstrasse 7, DE—97980 Bad Mergentheim (Germany), E-Mail
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Balancing Radiation and Contrast Media Dose in Single-Pass Abdominal Multidetector CT: Prospective Evaluation of Image Quality. Acad Radiol 2015; 22:1419-26. [PMID: 26264765 DOI: 10.1016/j.acra.2015.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES As both contrast and radiation dose affect the quality of CT images, a constant image quality in abdominal contrast-enhanced multidetector computed tomography (CE-MDCT) could be obtained balancing radiation and contrast media dose according to the age of the patients. MATERIALS AND METHODS Seventy-two (38 Men; 34 women; aged 20-83 years) patients underwent a single-pass abdominal CE-MDCT. Patients were divided into three different age groups: A (20-44 years); B (45-65 years); and C (>65 years). For each group, a different noise index (NI) and contrast media dose (370 mgI/mL) was selected as follows: A (NI, 15; 2.5 mL/kg), B (NI, 12.5; 2 mL/kg), and C (NI, 10; 1.5 mL/kg). Radiation exposure was reported as dose-length product (DLP) in mGy × cm. For quantitative analysis, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated for both the liver (L) and the abdominal aorta (A). Statistical analysis was performed with a one-way analysis of variance. Standard imaging criteria were used for qualitative analysis. RESULTS Although peak hepatic enhancement was 152 ± 16, 128 ± 12, and 101 ± 14 Hounsfield units (P < .001) for groups A, B, and C, respectively, no significant differences were observed in the corresponding SNRL with 9.2 ± 1.4, 9.1 ± 1.2, and 9.2 ± 3. Radiation (mGy × cm) and contrast media dose (mL) administered were 476 ± 147 and 155 ± 27 for group A, 926 ± 291 and 130 ± 16 for group B, and 1981 ± 451 and 106 ± 15 for group C, respectively (P < .001). None of the studies was graded as poor or inadequate by both readers, and the prevalence-adjusted bias-adjusted kappa ranged between 0.48 and 0.93 for all but one criteria. CONCLUSIONS A constant image quality in CE-MDCT can be obtained balancing radiation and contrast media dose administered to patients of different age.
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Parker MW, Shah SS, Hall M, Fieldston ES, Coley BD, Morse RB. Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children. Pediatrics 2015; 136:e573-81. [PMID: 26304828 DOI: 10.1542/peds.2015-0995] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many studies have demonstrated a rise in computed tomography (CT) utilization in abstract children's hospitals. However, CT utilization may be declining, perhaps due to awareness of potential hazards of pediatric ionizing radiation, such as increased risk of malignancy. Th e objective is to assess the trend in CT utilization in hospitalized children at freestanding children's hospitals from 2004 to 2012 and we hypothesize decreases are associated with shifts to alternate imaging modalities. METHODS Multicenter cross-sectional study of children admitted to 33 pediatric tertiary-care hospitals participating in the Pediatric Health Information System between January 1, 2004, and December 31, 2012. The rates of CT, ultrasound, and MRI for the top 10 All-Patient Refined Diagnosis Related Groups (APR-DRGs) for which CT was performed in 2004 were determined by billing data. Rates of each imaging modality for those top 10 APR-DRGs were followed through the study period. Odds ratios of imaging were adjusted for demographics and illness severity. RESULTS For all included APR-DRGs except ventricular shunt procedures and nonbacterial gastroenteritis, the number of children imaged with any modality increased. CT utilization decreased for all APR-DRGs (P values , .001). For each of the APR-DRGs except seizure and infections of upper respiratory tract, the decrease in CT was associated with a significant rise in an alternative imaging modality (P values # .005). CONCLUSIONS For the 10 most common APR-DRGs for which children received CT in 2004,a decrease in CT utilization was found in 2012. Alternative imaging modalities for 8 of the diagnoses were used.
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Affiliation(s)
| | | | - Matthew Hall
- Children’s Hospital Association, Overland Park, Kansas
| | - Evan S. Fieldston
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Brian D. Coley
- Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rustin B. Morse
- Department of Pediatrics, Children’s Medical Center, Dallas, Texas
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Pediatric Emergency CT Scans at a Children's Hospital and at Community Hospitals: Radiation Technical Factors Are an Important Source of Radiation Exposure. AJR Am J Roentgenol 2015; 205:409-13. [DOI: 10.2214/ajr.14.13715] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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44
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Performance of CT examinations in children with suspected acute appendicitis in the community setting: a need for more education. AJR Am J Roentgenol 2015; 204:857-60. [PMID: 25794077 DOI: 10.2214/ajr.14.12750] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Despite a recent focus on the preferential use of ultrasound over CT for pediatric appendicitis, most children transferred from community hospitals still undergo diagnostic CT scans. The purpose of this study was to evaluate CT techniques performed for children with acute appendicitis at nonpediatric treatment centers. MATERIALS AND METHODS All patients treated for acute appendicitis at our tertiary-care pediatric hospital from July 1, 2011, through June 30, 2012, were identified. Patient demographics, imaging modality used to diagnoses appendicitis (CT or ultrasound), location (home or referral institution), and CT technique parameters were collected. The estimated mean organ radiation dose, number of imaging phases, and use of contrast media were evaluated at home and referral institutions. RESULTS During the study period, 1215 patients underwent appendectomies after imaging, with 442 (36.4%) imaged at referral facilities. Most referral patients received a diagnosis by CT (n=384, 87%), compared with 73 of 773 (9.4%) who received a diagnosis by CT at the home institution. The estimated mean (±SD) organ radiation dose was not statistically significantly different between home and referral institutions (13.5±7.3 vs 12.9±6.4 mGy; p=0.58) for single-phase examinations. Of 384 referral patients, 344 had images available for review. In total, 40% (138/344) of patients from referral centers were imaged with suboptimal CT techniques: 50 delayed phase only, 52 dual phase (eight of which were imaged twice in delayed phase), eight triple phase, and 36 without IV contrast agent. CONCLUSION CT parameters and radiation doses from single-phase examinations in children with appendicitis were similar at nonpediatric treatment centers and a tertiary care children's hospital. Future educational outreach should focus on optimizing other technical parameters.
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Johnson PT, Mahesh M, Fishman EK. Image Wisely and Choosing Wisely: Importance of Adult Body CT Protocol Design for Patient Safety, Exam Quality, and Diagnostic Efficacy. J Am Coll Radiol 2015; 12:1185-90. [PMID: 25892227 DOI: 10.1016/j.jacr.2015.02.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Pamela T Johnson
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Mahadevappa Mahesh
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins School of Medicine, Baltimore, Maryland
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Boland GW, Duszak R, Kalra M. Protocol design and optimization. J Am Coll Radiol 2015; 11:440-1. [PMID: 24793037 DOI: 10.1016/j.jacr.2014.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/29/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Giles W Boland
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Richard Duszak
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mannudeep Kalra
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Comparison of diagnostic performance between single- and multiphasic contrast-enhanced abdominopelvic computed tomography in patients admitted to the emergency department with abdominal pain: potential radiation dose reduction. Eur Radiol 2014; 25:1048-58. [PMID: 25424561 DOI: 10.1007/s00330-014-3481-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate feasibility of radiation dose reduction by optimal phase selection of computed tomography (CT) in patients who visited the emergency department (ED) for abdominal pain. METHODS We included 253 patients who visited the ED for abdominal pain. They underwent multiphasic CT including precontrast, late arterial phase (LAP), and hepatic venous phase (HVP). Three image sets (HVP, precontrast + HVP, and precontrast + LAP + HVP) were reviewed. Two reviewers determined the most appropriate diagnosis with five-point confidence scale. Diagnostic performances were compared among image sets by weighted-least-squares method or DeLong's method. Linear mixed model was used to assess changes of diagnostic confidence and radiation dose. RESULTS There was no difference in diagnostic performance among three image sets, although diagnostic confidence level was significantly improved after review of triphasic images compared with both HVP images only or HVP with precontrast images (confidence scale, 4.64 ± 0.05, 4.66 ± 0.05, and 4.76 ± 0.04 in the order of the sets; overall P = 0.0008). Similar trends were observed in the subgroup analysis for diagnosis of pelvic inflammatory disease and cholecystitis. CONCLUSIONS There is no difference between HVP-CT alone and multiphasic CT for the diagnosis of causes of abdominal pain in patients admitted to the ED without prior chronic disease or neoplasia. KEY POINTS • There was no difference in diagnostic performance of HVP CT and multiphasic CT. • The diagnostic confidence level was improved after review of the LAP images. • HVP CT can achieve diagnostic performance similar to that of multiphasic CT, while minimizing radiation.
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Opportunities for Radiation-Dose Optimization Through Standardized Analytics and Decision Support. J Am Coll Radiol 2014; 11:1048-52. [DOI: 10.1016/j.jacr.2014.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022]
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Park JH. Diagnostic imaging utilization in cases of acute appendicitis: multi-center experience. J Korean Med Sci 2014; 29:1308-16. [PMID: 25246752 PMCID: PMC4168187 DOI: 10.3346/jkms.2014.29.9.1308] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/26/2014] [Indexed: 11/20/2022] Open
Abstract
The purpose of this cross-sectional study was to measure imaging utilization rates and the negative appendectomy rate (NAR) in metropolitan Seoul, Korea. The study included 2321 adolescents and adults (≥ 15 yr; median [interquartile range] age, 37 [27-50] yr; 46.7% female) undergoing appendectomy in 2011 at eight tertiary and three secondary hospitals. Imaging utilization rate was 99.7% (95% confidence interval, 99.4%-99.9%). CT and ultrasonography utilization rates as an initial imaging modality were 93.1% (92.0%-94.1%), and 6.5% (5.6%-7.6%), respectively. The NAR in patients undergoing CT only, complementary ultrasonography following CT, ultrasonography only, and complementary CT following ultrasonography were 3.3% (2.6%-4.1%), 27% (14%-44%), 9% (4%-16%), and 8% (2%-20%), respectively. The use of ultrasonography instead of CT as the initial imaging modality was significantly associated with higher NAR (adjusted odds ratio [AOR], 2.28 [1.22-4.27]; risk difference, 4.4 [0-8.8] percentage points), however, the population attributable risk was 0.3 [0-0.6] percentage points. We observed a very high CT utilization rate and a low NAR in metropolitan Seoul. Although the use of CT was significantly associated with the lower NAR, CT utilization rate already has reached the level that increase in CT utilization from the status quo would hardly decrease the NAR further.
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Affiliation(s)
- Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Owlia M, Yu L, Deible C, Hughes MA, Jovin F, Bump GM. Head CT scan overuse in frequently admitted medical patients. Am J Med 2014; 127:406-10. [PMID: 24508413 DOI: 10.1016/j.amjmed.2014.01.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/30/2014] [Accepted: 01/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients frequently admitted to medical services undergo extensive computed tomography (CT) imaging. Some of this imaging may be unnecessary, and in particular, head CT scans may be over-used in this patient population. We describe the frequency of abnormal head CT scans in patients with multiple medical hospitalizations. METHODS We retrospectively reviewed all CT scans done in 130 patients with 7 or more admissions to medical services between January 1 and December 31, 2011 within an integrated health care system. We calculated the number of CT scans, anatomic site of imaging, and source of ordering (emergency department, inpatient floor). We scored all head CT scans on a 0-4 scale based on the severity of radiographic findings. Higher scores signified more clinically important findings. RESULTS There were 795 CT scans performed in total, with a mean of 6.7 (± SD 5.8) CT scans per patient. Abdominal/pelvis (39%), chest (30%), and head (22%) CT scans were the most frequently obtained. The mean number of head CT scans performed was 2.9 (SD ± 4.2). Inpatient floors were the major site of CT scan ordering (53.7%). Of 172 head CT scans, only 4% had clinically significant findings (scores of 3 or 4). CONCLUSIONS Patients with frequent medical admissions are medically complex and undergo multiple CT scans in a year. The vast majority of head CT scans lack clinically significant findings and should be ordered less frequently. Interdisciplinary measures should be advocated by hospitalists, emergency departments, and radiologists to decrease unnecessary imaging in this population.
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Affiliation(s)
- Mina Owlia
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
| | - Lan Yu
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pa
| | - Christopher Deible
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Marion A Hughes
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Franziska Jovin
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Gregory M Bump
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
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