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Hardie RC, Trout AT, Dillman JR, Narayanan BN, Tanimoto AA. Performance of Lung-Nodule Computer-Aided Detection Systems on Standard-Dose and Low-Dose Pediatric CT Scans: An Intraindividual Comparison. AJR Am J Roentgenol 2024. [PMID: 39382534 DOI: 10.2214/ajr.24.31972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
Background: When applying lung-nodule computer-aided detection (CAD) systems for pediatric CT, performance may be degraded on low-dose scans due to increased image noise. Objective: To conduct an intraindividual comparison of the performance for lung nodule detection of two CAD systems trained using adult data between low-dose and standard-dose pediatric chest CT scans. Methods: This retrospective study included 73 patients (32 female, 41 male; mean age, 14.7 years; age range, 4-20 years) who underwent both clinical standard-dose and investigational low-dose chest CT examinations within the same encounter from November 30, 2018 to August 31, 2020 as part of an earlier prospective study. Fellowship-trained pediatric radiologists annotated lung nodules to serve as the reference standard. Both CT scans were processed using two publicly available lung-nodule CAD systems previously trained using adult data: FlyerScan and Medical Open Network for Artificial Intelligence (MONAI). The systems' sensitivities for nodules measuring 3-30 mm (n=247) were calculated when operating at a fixed frequency of two false-positives per scan. Results: FlyerScan exhibited detection sensitivities of 76.9% (190/247; 95% CI: 73.3-80.8%) on standard-dose scans and 66.8% (165/247; 95% CI: 62.6-71.5) on low-dose scans. MONAI exhibited detection sensitivities of 67.6% (167/247, 95% CI: 61.5-72.1) on standard-dose scans and 62.3% (154/247, 95% CI: 56.1-66.5%) on low-dose scans. The number of detected nodules for standard-dose versus low-dose scans for 3-mm nodules was 33 versus 24 (FlyerScan) and 16 versus 13 (MONAI), 4-mm nodules was 46 versus 42 (FlyerScan) and 39 versus 30 (MONAI), 5-mm nodules was 38 versus 33 (FlyerScan) and 32 versus 31 (MONAI), and 6-mm nodules was 27 versus 20 (FlyerScan) and 24 versus 24 (MONAI). For nodules measuring ≥7 mm, detection did not show a consistent pattern between standard-dose and low-dose scans for either system. Conclusions: Two lung-nodule CAD systems demonstrated decreased sensitivity on low-dose versus standard-dose pediatric CT scans performed in the same patients. The reduced detection at low dose was overall more pronounced for nodules measuring less than 5 mm. Clinical Impact: Caution is needed when using low-dose CT protocols in combination with CAD systems to help detect small lung nodules in pediatric patients.
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Affiliation(s)
- Russell C Hardie
- Department of Electrical and Computer Engineering, University of Dayton, Dayton Ohio USA 45469
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio USA 45229-3026
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Ohio USA 45267
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Ohio USA 45267
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio USA 45229-3026
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Ohio USA 45267
| | - Barath N Narayanan
- University of Dayton Research Institute, Sensor and Software Systems, 1700 South Patterson Blvd., Dayton Ohio USA 45469
| | - Aki A Tanimoto
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio USA 45229-3026
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati Ohio USA 45267
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Shcherbakova YM, Lafranca PPG, Foppen W, van der Velden TA, Nievelstein RAJ, Castelein RM, Ito K, Seevinck PR, Schlosser TPC. A multipurpose, adolescent idiopathic scoliosis-specific, short MRI protocol: A feasibility study in volunteers. Eur J Radiol 2024; 177:111542. [PMID: 38861906 DOI: 10.1016/j.ejrad.2024.111542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/31/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Visualization of scoliosis typically requires ionizing radiation (radiography and CT) to visualize bony anatomy. MRI is often additionally performed to screen for neural axis abnormalities. We propose a 14-minutes radiation-free scoliosis-specific MRI protocol, which combines MRI and MRI-based synthetic CT images to visualize soft and osseous structures in one examination. We assess the ability of the protocol to visualize landmarks needed to detect 3D patho-anatomical changes, screen for neural axis abnormalities, and perform surgical planning and navigation. METHODS 18 adult volunteers were scanned on 1.5 T MR-scanner using 3D T2-weighted and synthetic CT sequences. A predefined checklist of relevant landmarks was used for the parameter assessment by three readers. Parameters included Cobb angles, rotation, torsion, segmental height, area and centroids of Nucleus Pulposus and Intervertebral Disc. Precision, reliability and agreement between the readers measurements were evaluated. RESULTS 91 % of Likert-based questions scored ≥ 4, indicating moderate to high confidence. Precision of 3D dot positioning was 1.0 mm. Precision of angle measurement was 0.6° (ICC 0.98). Precision of vertebral and IVD height measurements was 0.4 mm (ICC 0.99). Precision of area measurement for NP was 8 mm2 (ICC 0.55) and for IVD 18 mm2 (ICC 0.62) for IVD. Precision of centroid measurement for NP was 1.3 mm (ICC 0.88-0.92) and for IVD 1.1 mm (ICC 0.88-91). CONCLUSIONS The proposed MRI protocol with synthetic CT reconstructions, has high precision, reliability and agreement between the readers for multiple scoliosis-specific measurements. It can be used to study scoliosis etiopathogenesis and to assess 3D spinal morphology.
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Affiliation(s)
- Yulia M Shcherbakova
- Department of Radiology, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands.
| | | | - Wouter Foppen
- Department of Radiology & Nuclear Medicine, Division Imaging & Oncology, UMC Utrecht, Utrecht, Netherlands
| | - Tijl A van der Velden
- Department of Radiology, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands; MRIguidance B.V., Utrecht, Netherlands
| | - Rutger A J Nievelstein
- Department of Radiology & Nuclear Medicine, Division Imaging & Oncology, UMC Utrecht, Utrecht, Netherlands
| | - Rene M Castelein
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, Netherlands
| | - Keita Ito
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Peter R Seevinck
- Department of Radiology, Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands; MRIguidance B.V., Utrecht, Netherlands
| | - Tom P C Schlosser
- Department of Orthopaedic Surgery, UMC Utrecht, Utrecht, Netherlands
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Duan Y, Yao J, Jiang Y, Sun W, Li F. A retrospective study of non-equidistant interstitial brain CT perfusion scanning and prediction of time to peak. Heliyon 2024; 10:e24758. [PMID: 38312599 PMCID: PMC10835286 DOI: 10.1016/j.heliyon.2024.e24758] [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] [Received: 09/04/2023] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 02/06/2024] Open
Abstract
Background Eexploring the limits of CT cranial perfusion scan acquisition intervals and predicting time to peak. Methods A retrospective analysis was conducted on 45 patients with suspected stroke who underwent brain CTP scans. Different sampling intervals were set based on the TDC. The patients were divided into four groups: Group 1 underwent continuous scanning with a uniform interval of 1.5 s; Group 2 had a uniform interval of 3 s; Group 3 had a 1.5-s interval between arterial and venous peak vertices with 1 point retained before and after the peak for 1.5 s and with a remaining acquisition interval of 4.5 s; and Group 4 had a uniform interval of 4.5 s. Statistical analysis was performed on the perfusion parameters of each group. Additionally, in 286 patients who underwent head and neck CTA examinations, the peak time of contrast medium was recorded, and the peak time was predicted based on factors such as age, height, weight, heart rate, systolic blood pressure, diastolic blood pressure, triglycerides, and total cholesterol. The results compared with Group 1 and Group 2, as well as Group 1 and Group 3, the P values of CBF, CBV, MTT, and Tmax in the left and right cerebral hemispheres of healthy subjects and in the infarct and noninfarct areas of patients were all >0.05. A comparison between Group 1 and Group 4 showed that right cerebral hemisphere CBF and CBV, left cerebral hemisphere CBF, CBV, and Tmax, infarct area CBV and Tmax, and noninfarct area CBF, CBV, and MTT had P values > 0.05, while other groups all had P values < 0.05. Bland‒Altman analysis showed that the perfusion parameters in Group 1 were consistent with those in Group 2, and those in Group 1 were consistent with those in Group 3. The radiation doses in the second and third groups were lower, and the dose in the third group was lower than that in the second group. Conclusion Continuous acquisition between the peak points of the arterial and venous phases, with 1 point reserved before and after the peak and a 4.5-s interval for the rest, represents the maximum time interval for CTP scanning and can effectively reduce the radiation dose. The formula Tmax (s) = 0.290 × height (cm) - 0.226 × heart rate (times/min) + 0.216 × age (years) - 1.901 × triglycerides (mmol/L) - 0.061 × systolic blood pressure (mmHg) - 7.216 (R2 = 0.449, F = 17.905, P < 0.01) was established for predicting time to peak enhancement.
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Affiliation(s)
- Yaxin Duan
- Department of Radiology, Tianjin Medical University General Hospital, 300070, China
| | - Jia Yao
- Department of Radiology, Tianjin Medical University General Hospital, 300070, China
| | - Yingjian Jiang
- Department of Radiology, Tianjin Medical University General Hospital, 300070, China
| | - Wen Sun
- Department of Radiology, Tianjin Medical University General Hospital, 300070, China
| | - Fengtan Li
- Department of Radiology, Tianjin Medical University General Hospital, 300070, China
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Cameron PA, Mitra B, Kelly AM. Zero risk is not possible in emergency medicine. Emerg Med Australas 2023; 35:4-5. [PMID: 36645835 DOI: 10.1111/1742-6723.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Peter A Cameron
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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Sulieman A, Almogren KS, Tamam N. Radiation exposure estimation in pediatric patients during computed tomography imaging procedures. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Almodóvar A, Ronda E, Flores R, Lumbreras B. Appropriateness of radiological diagnostic tests in otolaryngology. Insights Imaging 2022; 13:126. [PMID: 35925527 PMCID: PMC9352825 DOI: 10.1186/s13244-022-01263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the appropriateness of imaging tests associated with radiation in the field of otolaryngology according to the available recommendations, and to estimate the effective radiation dose associated. METHOD Cross-sectional epidemiological study of the totality of the imaging test requests carried out by two Spanish hospitals (n = 1931). We collected the following information: patient demographic data, type of imaging test, imaging tests referred in the previous 12 months, referrer department and diagnostic suspicion. In accordance with the available guidelines, we considered the requests: (a) Appropriate; (b) Inappropriate; (c) Not adequately justified; (d) Not included in the guidelines. We calculated the prevalence of each category and their variation according to the different variables. Collective and per capita effective dose were calculated for each category. RESULTS Of the 538 requests, 42% were considered appropriate, 34.4% inappropriate, 11.9% not adequately justified and 11.7% not included in the guidelines. Imaging tests requested by general partitioners (aOR: 0.18; 95% CI: 0.06-0.50) and clinical departments (aOR: 0.27; 95% CI: 0.11-0.60) were less likely to be considered appropriate than those requested by the Otolaryngology department. Patients with a diagnosis suspicion of tumour pathology were more likely to have a requested imaging test classified as appropriate (aOR: 7.12; 95% CI: 3.25-15.61). The cumulative effective dose was 877.8 mSv, of which 40% corresponded to tests classified as inappropriate. CONCLUSIONS A high percentage of imaging tests are considered as inappropriate in the field of otolaryngology, with a relevant frequency of associated effective radiation dose. Type of department, the diagnostic suspicion and the type of imaging tests were variables associated to the inappropriateness of the test.
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Affiliation(s)
| | - Elena Ronda
- CIBERESP, Madrid, Spain.
- Public Health Research Group, University of Alicante, Carretera San Vicente del Raspeig s/n, San Vicente del Raspeig, 03690, Alicante, Spain.
| | | | - Blanca Lumbreras
- CIBERESP, Madrid, Spain
- Department of Public Health, History of Science and Gynaecology, Miguel Hernandez University, Elche, Spain
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Shi HM, Sun ZC, Ju FH. Understanding the harm of low‑dose computed tomography radiation to the body (Review). Exp Ther Med 2022; 24:534. [PMID: 35911849 DOI: 10.3892/etm.2022.11461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hai-Min Shi
- Department of Gynecology and Obstetrics Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Zhi-Chao Sun
- Department of Medical Imaging, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Fang-He Ju
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310006, P.R. China
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8
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Almujally A, Tamam N, Sulieman A, Doung TT, Omer H, Abuhadi N, Salah H, Mattar E, Khandaker MU, Bradley D. Evaluation of paediatric computed tomography imaging for brain, abdomen procedures. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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9
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Wisnowski JL, Wintermark P, Bonifacio SL, Smyser CD, Barkovich AJ, Edwards AD, de Vries LS, Inder TE, Chau V. Neuroimaging in the term newborn with neonatal encephalopathy. Semin Fetal Neonatal Med 2021; 26:101304. [PMID: 34736808 PMCID: PMC9135955 DOI: 10.1016/j.siny.2021.101304] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neuroimaging is widely used to aid in the diagnosis and clinical management of neonates with neonatal encephalopathy (NE). Yet, despite widespread use clinically, there are few published guidelines on neuroimaging for neonates with NE. This review outlines the primary patterns of brain injury associated with hypoxic-ischemic injury in neonates with NE and their frequency, associated neuropathological features, and risk factors. In addition, it provides an overview of neuroimaging methods, including the most widely used scoring systems used to characterize brain injury in these neonates and their utility as predictive biomarkers. Last, recommendations for neuroimaging in neonates with NE are presented.
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Affiliation(s)
- Jessica L Wisnowski
- Departments of Radiology and Pediatrics (Neonatology), Children's Hospital Los Angeles, 4650 Sunset Blvd. MS #81, Los Angeles CA 90027, USA.
| | - Pia Wintermark
- Department of Pediatrics (Neonatology), McGill University/Montreal Children's Hospital, Division of Newborn Medicine, Research Institute of the McGill University Health Centre, 1001 boul. Décarie, Site Glen Block E, EM0.3244, Montréal, QC H4A 3J1, Canada.
| | - Sonia L Bonifacio
- Division of Neonatal and Developmental Medicine, Department of Pediatrics (Neonatology), Lucile Packard Children's Hospital, Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto, CA 94304, USA.
| | - Christopher D Smyser
- Departments of Neurology, Radiology, and Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO 63110-1093, USA.
| | - A James Barkovich
- Department of Radiology, UCSF Benioff Children's Hospital, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA.
| | - A David Edwards
- Evelina London Children's Hospital, Centre for Developing Brain, King's College London, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht University, Lundlaan 6, 3584 EA, Utrecht, the Netherlands.
| | - Terrie E Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | - Vann Chau
- Department of Pediatrics (Neurology), The Hospital for Sick Children, University of Toronto, 555 University Avenue, Room 6513, Toronto, ON M5G 1X8, Canada.
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10
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Roberts S, Goldwasser B, Nixon AF, Borkar D, Brookman M, Fox CE, Rosenfeld C, Meltzer JA. Effect of focused protocol on reducing radiation dose for children who require computed tomography for suspected appendicitis. Am J Emerg Med 2021; 50:76-79. [PMID: 34304094 DOI: 10.1016/j.ajem.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite efforts to incorporate ultrasound into the evaluation of children for appendicitis, computed tomography (CT) is often used to aid in its diagnosis. CT scans, however, expose children to a considerable amount of radiation. In 2017, our institution began using a height-based Focused CT protocol for children with suspected appendicitis in need of CT. OBJECTIVE To compare the radiation dose received by children with suspected appendicitis who underwent a Standard CT of the abdomen and pelvis (CTAP) with that of a Focused CT. METHODS We conducted a retrospective study of children <18 years who underwent a CT scan for suspected appendicitis (2014-2020). We included all patients whose indication for CT was "appendicitis" or "right lower quadrant pain" and excluded those whose CT scan record lacked a radiation dose report. The effective radiation dose delivered was calculated using the dose-length product from the dose report. We compared the effective dose of those who received a Standard CTAP to those who received a Focused CT. To account for differences in radiation dose over time and by CT scanner, analyses were adjusted for CT dose index volume (CTDIvol) and size-specific dose estimate (SSDE) using quantile regression. RESULTS A total of 474 patients who underwent CT were included. Prior to CT, 362(76%) had received an ultrasound. In total, 309(65%) patients underwent a Standard CTAP and 165(35%) underwent a Focused CT. The appendix was identified in 259(84%) Standard CTAPs compared to 151(92%) Focused CTs (p = 0.02). Compared to the Standard CTAP, children who received a Focused CT were exposed to a significantly lower effective dose (relative difference: CTDI-adjusted -13%[95% CI:-21,-5]; SSDE-adjusted -14%[95% CI:-24,-3]). CONCLUSIONS Our height-based Focused CT protocol reduces radiation for children undergoing CT evaluation for suspected appendicitis without sacrificing diagnostic accuracy. Further study is needed to validate these findings at other institutions.
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Affiliation(s)
- Suzanne Roberts
- Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, NY, United States of America.
| | - Bernard Goldwasser
- Department of Radiology, Division of Pediatrics, Jacobi Medical Center, Bronx, NY, United States of America.
| | - Abigail F Nixon
- Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, NY, United States of America.
| | - Deeksha Borkar
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States of America.
| | - Max Brookman
- Department of Pediatrics, Jacobi Medical Center, Bronx, NY, United States of America.
| | - Carolyn E Fox
- Department of Emergency Medicine, Division of Pediatrics, Oregon Health and Science University, Portand, OR, United States of America.
| | - Cyril Rosenfeld
- Department of Radiology, Jacobi Medical Center, Bronx, NY, United States of America.
| | - James A Meltzer
- Department of Pediatrics, Division of Emergency Medicine, Jacobi Medical Center, Bronx, NY, United States of America.
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Thierry-Chef I, Ferro G, Le Cornet L, Dabin J, Istad TS, Jahnen A, Lee C, Maccia C, Malchair F, Olerud HM, Harbron RW, Figuerola J, Hermen J, Moissonnier M, Bernier MO, Bosch de Basea MB, Byrnes G, Cardis E, Hauptmann M, Journy N, Kesminiene A, Meulepas JM, Pokora R, Simon SL. Dose Estimation for the European Epidemiological Study on Pediatric Computed Tomography (EPI-CT). Radiat Res 2021; 196:74-99. [PMID: 33914893 DOI: 10.1667/rade-20-00231.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/26/2021] [Indexed: 11/03/2022]
Abstract
Within the European Epidemiological Study to Quantify Risks for Paediatric Computerized Tomography (EPI-CT study), a cohort was assembled comprising nearly one million children, adolescents and young adults who received over 1.4 million computed tomography (CT) examinations before 22 years of age in nine European countries from the late 1970s to 2014. Here we describe the methods used for, and the results of, organ dose estimations from CT scanning for the EPI-CT cohort members. Data on CT machine settings were obtained from national surveys, questionnaire data, and the Digital Imaging and Communications in Medicine (DICOM) headers of 437,249 individual CT scans. Exposure characteristics were reconstructed for patients within specific age groups who received scans of the same body region, based on categories of machines with common technology used over the time period in each of the 276 participating hospitals. A carefully designed method for assessing uncertainty combined with the National Cancer Institute Dosimetry System for CT (NCICT, a CT organ dose calculator), was employed to estimate absorbed dose to individual organs for each CT scan received. The two-dimensional Monte Carlo sampling method, which maintains a separation of shared and unshared error, allowed us to characterize uncertainty both on individual doses as well as for the entire cohort dose distribution. Provided here are summaries of estimated doses from CT imaging per scan and per examination, as well as the overall distribution of estimated doses in the cohort. Doses are provided for five selected tissues (active bone marrow, brain, eye lens, thyroid and female breasts), by body region (i.e., head, chest, abdomen/pelvis), patient age, and time period (1977-1990, 1991-2000, 2001-2014). Relatively high doses were received by the brain from head CTs in the early 1990s, with individual mean doses (mean of 200 simulated values) of up to 66 mGy per scan. Optimization strategies implemented since the late 1990s have resulted in an overall decrease in doses over time, especially at young ages. In chest CTs, active bone marrow doses dropped from over 15 mGy prior to 1991 to approximately 5 mGy per scan after 2001. Our findings illustrate patterns of age-specific doses and their temporal changes, and provide suitable dose estimates for radiation-induced risk estimation in epidemiological studies.
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Affiliation(s)
- Isabelle Thierry-Chef
- International Agency for Research on Cancer, Lyon, France
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gilles Ferro
- International Agency for Research on Cancer, Lyon, France
| | - Lucian Le Cornet
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Jérémie Dabin
- Belgian Nuclear Research Centre, SCK CEN, Mol, Belgium
| | - Tore S Istad
- Norwegian Radiation and Nuclear Safety Authority, NO-0213 Oslo, Norway
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology, Esch-sur-Alzette, Luxembourg
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | | | | | - Hilde M Olerud
- University of South-Eastern Norway, Faculty of Health and Social Sciences, Kongsberg, Norway
| | - Richard W Harbron
- Institute of Health and Society, Newcastle University (UNEW), Newcastle upon Tyne, United Kingdom
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, United Kingdom
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Johannes Hermen
- Luxembourg Institute of Science and Technology, Esch-sur-Alzette, Luxembourg
| | | | - Marie-Odile Bernier
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire d'épidémiologie des Rayonnements Ionisants, Fontenay-aux-Roses, France
| | - Magda Bosch Bosch de Basea
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Graham Byrnes
- International Agency for Research on Cancer, Lyon, France
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Ciber Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Institute of BiostatisTics and Registry Research, Medical University Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Neige Journy
- Institut de Radioprotection et de Sûreté Nucléaire, Laboratoire d'épidémiologie des Rayonnements Ionisants, Fontenay-aux-Roses, France
- French National Institute of Health and Medical Research (Inserm) Unit 1018, Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiations Group, Gustave Roussy, Villejuif, France
| | | | - Johanna M Meulepas
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Steven L Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Jha N, Kim YJ, Lee Y, Lee JY, Lee WJ, Sung SJ. Projected lifetime cancer risk from cone-beam computed tomography for orthodontic treatment. Korean J Orthod 2021; 51:189-198. [PMID: 33984226 PMCID: PMC8133899 DOI: 10.4041/kjod.2021.51.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/20/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To estimate the projected cancer risk attributable to diagnostic cone-beam computed tomography (CBCT) performed under different exposure settings for orthodontic purposes in children and adults. Methods We collected a list of CBCT machines and their specifications from 38 orthodontists. Organ doses were estimated using median and maximum exposure settings of 105 kVp/156.8 mAs and 130 kVp/200 mAs, respectively. The projected cancer risk attributable to CBCT procedures performed 1-3 times within 2 years was calculated for children (aged 5 and 10 years) and adult (aged 20, 30, and 40 years) male and female patients. Results For maximum exposure settings, the mean lifetime fractional ratio (LFR) was 14.28% for children and 0.91% for adults; this indicated that the risk to children was 16 times the risk to adults. For median exposure settings, the mean LFR was 5.25% and 0.58% for children and adults, respectively. The risk of cancer decreased with increasing age. For both median and maximum exposure settings, females showed a higher risk of cancer than did males in all age groups. Cancer risk increased with an increase in the frequency of CBCT procedures within a given period. Conclusions The projected dental CBCT-associated cancer risk spans over a wide range depending on the machine parameters and image acquisition settings. Children and female patients are at a higher risk of developing cancer associated with diagnostic CBCT. Therefore, the use of diagnostic CBCT should be justified, and protective measures should be taken to minimize the harmful biological effects of radiation.
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Affiliation(s)
- Nayansi Jha
- Department of Dentistry, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Ji Kim
- Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | | | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang-Jin Sung
- Department of Orthodontics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kadowaki Y, Hamada N, Kai M, Furukawa K. Evaluation of the lifetime brain/central nervous system cancer risk associated with childhood head CT scanning in Japan. Int J Cancer 2021; 148:2429-2439. [PMID: 33320957 DOI: 10.1002/ijc.33436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022]
Abstract
The use of computed tomography (CT) scanning has increased worldwide over the decades, and Japan is one of the leading countries in annual frequency of diagnostic CT. Although benefits of CT scan are undisputable, concerns have been raised about potential health effects of ionizing radiation exposure from CT, particularly among children who are likely more susceptible to radiation than adults. Our study aims to evaluate the cumulated lifetime risk of the brain/central nervous system (CNS) cancer due to head CT examinations performed on Japanese children at age 0 to 10 years in 2012, 2015 and 2018. The frequency and dose distribution of head CT examinations were estimated based on information from recent national statistics and nationwide surveys. The lifetime risk attributable to exposure was calculated by applying risk models based on the study of Japanese atomic-bomb survivors. In contrast to the overall increasing trend, the frequency of childhood CT, especially at age < 5, was decreasing, reflecting a growing awareness for efforts to reduce childhood CT exposure over the past decade. In 2018, 138 532 head CT examinations were performed at age 0 to 10, which would consequently induce a lifetime excess of 22 cases (1 per 6300 scans) of brain/CNS cancers, accounting for 5% of the total cases. More excess cases were estimated among men than among women, and excess cases could emerge at relatively young ages. These results would have useful implications as scientific basis for future large-scale epidemiological studies and also as quantitative evidence to justify the benefits of CT vs risks in Japan.
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Affiliation(s)
- Yuko Kadowaki
- Graduate School of Medicine, Kurume University, Fukuoka, Japan
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan
| | - Michiaki Kai
- Department of Environmental Health Science, Oita University of Nursing and Health Sciences, Oita, Japan
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Mehta JS, Hodgson K, Yiping L, Kho JSB, Thimmaiah R, Topiwala U, Sawlani V, Botchu R. Radiation exposure during the treatment of spinal deformities. Bone Joint J 2021; 103-B:1-7. [PMID: 33595351 DOI: 10.1302/0301-620x.103b.bjj-2020-1416.r3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To benchmark the radiation dose to patients during the course of treatment for a spinal deformity. METHODS Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)). RESULTS There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation. CONCLUSION The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible. Cite this article: Bone Joint J 2021;103-B(4):1-7.
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Affiliation(s)
- Jwalant S Mehta
- Birmingham Spinal Unit, Royal Orthopaedic Hospital, Birmingham, UK
| | - Kirsten Hodgson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lu Yiping
- Department of Radiology, University of Birmingham, Birmingham, UK
| | - James Swee Beng Kho
- Radiology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Upasana Topiwala
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Vijay Sawlani
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rajesh Botchu
- Radiology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Assessment of computed tomography radiation doses for paediatric head and chest examinations using paediatric phantoms of three different ages. Radiography (Lond) 2020; 27:332-339. [PMID: 32972850 DOI: 10.1016/j.radi.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION With the rapid development of computed tomography (CT) scanners, the assessment of the radiation dose received by the patient has become a heavily researched topic and may result in a reduction in radiation exposure risk. In this study, radiation doses were measured using three paediatric phantoms for head and chest CT examinations in Najran, Saudi Arabia. METHODS Thirteen scanners were included in the study to estimate the CT radiation doses using three phantoms representing three age groups (1-, 5-, and 10-year-old patients). RESULTS The volume CT dose index (CTDIvol) estimated for each phantom ranged from 6.56 to 41.12 mGy and 0.292 to 11.10 mGy for the head and chest examinations, respectively. The estimation of lifetime attributable risk (LAR) indicated that the cancer risk could reach approximately 0.02-0.16% per 500 children undergoing head and chest CT examinations. CONCLUSION The comparison with the published data of the European Commission (EC) and countries reported in this study revealed that the mean CTDIvol for the head examinations was within the recommended dose reference levels (DRLs). Meanwhile, chest results exceeded the international DRLs for the one-year-old phantoms, suggesting that optimisation work is required at a number of sites. IMPLICATIONS FOR PRACTICE The variation among CT doses reported in this study showed that substantial standardisation is needed.
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Ainsbury EA. The 2019 Bo Lindell Laureate Lecture: On the use of interdisciplinary, stakeholder-driven, radiation protection research in support of medical uses of ionising radiation. Ann ICRP 2020; 49:32-44. [PMID: 32907341 DOI: 10.1177/0146645320946629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Medical exposures form the largest manmade contributor to total ionising radiation exposure of the UK population. In recent years, new technologies have been developed to improve treatment and prognosis of individuals treated with radiation for diseases such as cancer. However, there is evidence of public, patient, and medical professional concern that radiation protection regulations and practices, as well as understanding of potential long-term adverse health effects of radiation exposure (in the context of other health risks), have not always 'kept pace' with technological developments in this field. This is a truly complex, multi-disciplinary problem for the modern world.The 'Radiation Theme' of the Public Health England and Newcastle University Health Protection Research Unit on 'Chemical and Radiation Threats and Hazards' is addressing this need, with a key focus on a genuinely interdisciplinary approach bringing together world-leading epidemiologists, radiation biologists, clinicians, statisticians, and artists. In addition, the project has a strong grounding in public, patient, and medical professional involvement in research. Similarly, the EU-CONCERT-funded LDLensRad project seeks to understand the mechanisms of action of low-dose ionising radiation in the lens of the eye, and the potential contribution to the development of cataract - in contemporary research, such projects will only be considered successful when they make use of expertise from a variety of fields and when they are able to demonstrate that the outputs are not only of benefit to society, but that society understands and welcomes the benefits. Finally, successful engagement, training, and retention of early career scientists within this field is crucial for sustainability of the research. Herein, the contribution of embedded interdisciplinary working, stakeholder involvement, and training of early career scientists to recent advancements in the field of medical (and wider) radiation protection research is discussed and considered.
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Affiliation(s)
- E A Ainsbury
- Public Health England Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxford OX11 0RQ, UK; e-mail:
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Follow-Up in Bone Sarcoma Care: A Cross-Sectional European Study. Sarcoma 2020; 2020:2040347. [PMID: 32675939 PMCID: PMC7350160 DOI: 10.1155/2020/2040347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/17/2020] [Accepted: 06/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Follow-up of high-grade bone sarcoma patients with repeated radiological imaging aims at early detection of recurrent disease or distant metastasis. Repeated radiological imaging does expose (mostly young) patients to ionising radiation. At this point, it is not known whether frequent follow-up increases overall survival. Additionally, frequent follow-up subjects patients and families to psychological stress. This study aims to assess follow-up procedures in terms of frequency and type of imaging modalities in bone tumour centres across Europe for comparison and improvement of knowledge as a first step towards a more uniform approach towards bone sarcoma follow-up. Methods Data were obtained through analysis of several follow-up protocols and a digital questionnaire returned by EMSOS members of bone tumour centres all across Europe. Results All participating bone tumour centres attained a minimum follow-up period of ten years. National guidelines revealed variations in follow-up intervals and use of repeated imaging with ionising radiation. A local and a chest X-ray were obtained at 47.6% of the responding clinics at every follow-up patient visit. Conclusions Variations were seen among European bone sarcoma centres with regards to follow-up intervals and use of repeated imaging. The majority of these expert centres follow existing international guidelines and find them sufficient as basis for a follow-up surveillance programme despite lack of evidence. Future research should aim towards evidence-based follow-up with focus on the effects of follow-up strategies on health outcomes, cost-effectiveness, and individualised follow-up algorithms.
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Radiation dose from computed tomography in patients with acute pancreatitis: an audit from a tertiary care referral hospital. Abdom Radiol (NY) 2020; 45:1517-1523. [PMID: 31960118 DOI: 10.1007/s00261-020-02408-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is a limited data on the radiation dose from computed tomography (CT) in patients with acute pancreatitis (AP). The present study evaluated the radiation dose from CT scans in patients with AP. MATERIAL A retrospective review of CT reports of patients with AP was conducted. The type of CT scan (non-contrast vs. single-phase vs. biphasic CT) was recorded. The mean number of CT scans and cumulative radiation dose was calculated. The indications and abnormalities on biphasic CT scans were recorded. The radiation doses between different types of the scan were compared. RESULTS 495 CT studies in 351 patients were evaluated. In patients (n = 78, 22.2%) undergoing multiple CT scans, mean number of CT scans per patient and mean radiation dose were 2.64 ± 1.18 (range 2-9) and 24 ± 15 mSv (range 8.3-79.8 mSv), respectively. The mean radiation dose was significantly greater in patients with modified CT severity index ≥ 8 (n = 63) [25.08 mSv vs. 18.96 mSv, (P = 0.048)]. 61 (12.32%) biphasic scans were performed. A definite indication for a biphasic CT scan was identified in 20 (32.7%) patients. Arterial abnormalities were detected in 6 (9.8%) patients undergoing CT for defined indication. Mean radiation dose in this group was 13.26 ± 7.64 mSv (range 3.42-38.27 mSv) which was significantly greater than the single venous phase scan (7.96 ± 3.48 mSv, P < 0.001). CONCLUSION There is a potential for substantial radiation exposure from CT scans to patients with AP. Patients with severe AP and those undergoing biphasic scans have significantly higher radiation exposure. Hence, routine arterial phase acquisition should be avoided.
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Dong X, Lei Y, Wang T, Higgins K, Liu T, Curran WJ, Mao H, Nye JA, Yang X. Deep learning-based attenuation correction in the absence of structural information for whole-body positron emission tomography imaging. Phys Med Biol 2020; 65:055011. [PMID: 31869826 PMCID: PMC7099429 DOI: 10.1088/1361-6560/ab652c] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Deriving accurate structural maps for attenuation correction (AC) of whole-body positron emission tomography (PET) remains challenging. Common problems include truncation, inter-scan motion, and erroneous transformation of structural voxel-intensities to PET µ-map values (e.g. modality artifacts, implanted devices, or contrast agents). This work presents a deep learning-based attenuation correction (DL-AC) method to generate attenuation corrected PET (AC PET) from non-attenuation corrected PET (NAC PET) images for whole-body PET imaging, without the use of structural information. 3D patch-based cycle-consistent generative adversarial networks (CycleGAN) is introduced to include NAC-PET-to-AC-PET mapping and inverse mapping from AC PET to NAC PET, which constrains NAC-PET-to-AC-PET mapping to be closer to one-to-one mapping. Since NAC PET images share similar anatomical structures to the AC PET image but lack contrast information, residual blocks, which aim to learn the differences between NAC PET and AC PET, are used to construct generators of CycleGAN. After training, patches from NAC PET images were fed into NAC-PET-to-AC-PET mapping to generate DL-AC PET patches. DL-AC PET image was then reconstructed through patch fusion. We conducted a retrospective study on 55 datasets of whole-body PET/CT scans to evaluate the proposed method. In comparing DL-AC PET with original AC PET, average mean error (ME) and normalized mean square error (NMSE) of the whole-body were 0.62% ± 1.26% and 0.72% ± 0.34%. The average intensity changes measured on sequential PET images with AC and DL-AC on both normal tissues and lesions differ less than 3%. There was no significant difference of the intensity changes between AC and DL-AC PET, which demonstrate DL-AC PET images generated by the proposed DL-AC method can reach a same level to that of original AC PET images. The method demonstrates excellent quantification accuracy and reliability and is applicable to PET data collected on a single PET scanner or hybrid platform with computed tomography (PET/CT) or magnetic resonance imaging (PET/MRI).
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Affiliation(s)
- Xue Dong
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Yang Lei
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Tonghe Wang
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Walter J. Curran
- Department of Radiation Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Hui Mao
- Winship Cancer Institute, Emory University, Atlanta, GA
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Jonathon A. Nye
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
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Xiao Y, Liu P, Liang Y, Stolte S, Sanelli P, Gupta A, Ivanidze J, Fang R. STIR-Net: Deep Spatial-Temporal Image Restoration Net for Radiation Reduction in CT Perfusion. Front Neurol 2019; 10:647. [PMID: 31297079 PMCID: PMC6607281 DOI: 10.3389/fneur.2019.00647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/03/2019] [Indexed: 02/04/2023] Open
Abstract
Computed Tomography Perfusion (CTP) imaging is a cost-effective and fast approach to provide diagnostic images for acute stroke treatment. Its cine scanning mode allows the visualization of anatomic brain structures and blood flow; however, it requires contrast agent injection and continuous CT scanning over an extended time. In fact, the accumulative radiation dose to patients will increase health risks such as skin irritation, hair loss, cataract formation, and even cancer. Solutions for reducing radiation exposure include reducing the tube current and/or shortening the X-ray radiation exposure time. However, images scanned at lower tube currents are usually accompanied by higher levels of noise and artifacts. On the other hand, shorter X-ray radiation exposure time with longer scanning intervals will lead to image information that is insufficient to capture the blood flow dynamics between frames. Thus, it is critical for us to seek a solution that can preserve the image quality when the tube current and the temporal frequency are both low. We propose STIR-Net in this paper, an end-to-end spatial-temporal convolutional neural network structure, which exploits multi-directional automatic feature extraction and image reconstruction schema to recover high-quality CT slices effectively. With the inputs of low-dose and low-resolution patches at different cross-sections of the spatio-temporal data, STIR-Net blends the features from both spatial and temporal domains to reconstruct high-quality CT volumes. In this study, we finalize extensive experiments to appraise the image restoration performance at different levels of tube current and spatial and temporal resolution scales.The results demonstrate the capability of our STIR-Net to restore high-quality scans at as low as 11% of absorbed radiation dose of the current imaging protocol, yielding an average of 10% improvement for perfusion maps compared to the patch-based log likelihood method.
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Affiliation(s)
- Yao Xiao
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Peng Liu
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Yun Liang
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Skylar Stolte
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Pina Sanelli
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
- Imaging Clinical Effectiveness and Outcomes Research, Department of Radiology, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Jana Ivanidze
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Ruogu Fang
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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Lee WJ, Choi Y, Ko S, Cha ES, Kim J, Kim YM, Kong KA, Seo S, Bang YJ, Ha YW. Projected lifetime cancer risks from occupational radiation exposure among diagnostic medical radiation workers in South Korea. BMC Cancer 2018; 18:1206. [PMID: 30514249 PMCID: PMC6278159 DOI: 10.1186/s12885-018-5107-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/19/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Timely assessment of cancer risk from current radiation exposure among medical radiation workers can contribute to the development of strategies to prevent excessive occupational radiation exposure. The purpose of the present study is to estimate the lifetime risk of cancers induced by occupational radiation exposure among medical radiation workers. METHODS Using estimated organ doses and the RadRAT risk assessment tool, the lifetime cancer risk was estimated among medical radiation workers who were enrolled in the Korean National Dose Registry from 1996 to 2011. Median doses were used for estimating the risk because of the skewed distribution of radiation doses. Realistic representative exposure scenarios in the study population based on sex, job start year, and occupational group were created for calculating the lifetime attributable risk (LAR) and lifetime fractional risk (LFR). RESULTS The mean estimated lifetime cancer risk from occupational radiation exposure varied significantly by sex and occupational group. The highest LAR was observed in male and female radiologic technologists who started work in 1991 (264.4/100,000 and 391.2/100,000, respectively). Female workers had a higher risk of radiation-related excess cancer, although they were exposed to lower radiation doses than male workers. The higher LAR among women was attributable primarily to excess breast and thyroid cancer risks. LARs among men were higher than women in most other cancer sites. With respect to organ sites, LAR of colon cancer (44.3/100,000) was the highest in male radiologic technologists, whereas LAR of thyroid cancer (222.0/100,000) was the highest in female radiologic technologists among workers who started radiologic practice in 1991. Thyroid and bladder cancers had the highest LFR among radiologic technologists. CONCLUSIONS Our findings provide an assessment of the potential cancer risk from occupational radiation exposure among medical radiation workers, based on current knowledge about radiation risk. Although the radiation-related risk was small in most cases, it varied widely by sex and occupational group, and the risk would be underestimated due to the use of median, rather than mean, doses. Therefore, careful monitoring is necessary to optimize radiation doses and protect medical radiation workers from potential health risks, particularly female radiologic technologists.
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Affiliation(s)
- Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Yeongchull Choi
- Seoul Workers’ Health Center, Ewha Womans University, Seoul, South Korea
| | - Seulki Ko
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Eun Shil Cha
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Jaeyoung Kim
- Department of Preventive Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Young Min Kim
- Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Kyoung Ae Kong
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Songwon Seo
- Laboratory of Low Dose Risk Assessment, National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Ye Jin Bang
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Yae Won Ha
- Department of Preventive Medicine, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841 South Korea
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Bosch de Basea M, Moriña D, Figuerola J, Barber I, Muchart J, Lee C, Cardis E. Subtle excess in lifetime cancer risk related to CT scanning in Spanish young people. ENVIRONMENT INTERNATIONAL 2018; 120:1-10. [PMID: 30053755 DOI: 10.1016/j.envint.2018.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND CT scan is a life-saving medical diagnostic tool, entailing higher levels of ionising radiation exposure than conventional radiography, which may result in an increase in cancer risk, particularly in children. Information about the use and potential health effects of CT scan imaging among young people in Spain is scarce. OBJECTIVE This paper aims to estimate the number of radiation-related cancer cases which can be expected due to the use of CT scanning in Spanish children and young adults in a single year (2013). METHODS The 2013 distribution of number and types of CT scans performed in young people was obtained for Catalonia and extrapolated to the whole Spain. Organ doses were estimated based on the technical characteristics of 17,406 CT examinations extracted from radiology records. Age and sex-specific data on cancer incidence and life tables were obtained for the Spanish population. Age and sex-specific risk models developed by the Committee on Health Risks of Exposure to Low Levels of Ionizing Radiations (BEIR VII) and Berrington de Gonzalez were used, together, with the dose estimates to derive the lifetime attributable risks of cancer in Spain due to one year of CT scanning and project the number of future cancer cases to be expected. RESULTS In 2013, 105,802 CT scans were estimated to have been performed in people younger than age 21. It was estimated that a total of 168.6 cancer cases (95% CrI: 30.1-421.1) will arise over life due to the ionising radiation exposure received during these CTs. Lifetime attributable risks per 100,000 exposed patients were highest for breast and lung cancer. The largest proportion of CTs was to the head and neck and hence the highest numbers of projected cancer cases were of thyroid and oral cavity/pharynx. CONCLUSIONS Despite the undeniable medical effectiveness of CT scans, this risk assessment suggests a small excess in cancer cases which underlines the need for justification and optimisation in paediatric scanning. Given the intrinsic uncertainties of these risk projection exercises, care should be taken when interpreting the predicted risks.
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Affiliation(s)
- Magda Bosch de Basea
- Institut de Salut Global (ISGlobal), Centre de Recerca en Epidemiologia Ambiental, Parc de Recerca Biomèdica de Barcelona (PRBB), Carrer del Dr. Aiguader 88, E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
| | - David Moriña
- Unit of Infections and Cancer (UNIC-I & I), Catalan Institute of Oncology (ICO)-IDIBELL, Av Gran Via, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Figuerola
- Institut de Salut Global (ISGlobal), Centre de Recerca en Epidemiologia Ambiental, Parc de Recerca Biomèdica de Barcelona (PRBB), Carrer del Dr. Aiguader 88, E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ignasi Barber
- Radiology department, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Jordi Muchart
- Radiology department, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health, Rockville, MD, United States
| | - Elisabeth Cardis
- Institut de Salut Global (ISGlobal), Centre de Recerca en Epidemiologia Ambiental, Parc de Recerca Biomèdica de Barcelona (PRBB), Carrer del Dr. Aiguader 88, E-08003 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Journy N, Dreuil S, Rage E, De Zordo-Banliat F, Bonnet D, Hascoët S, Malekzadeh-Milani S, Petit J, Laurier D, Bernier MO, Baysson H. Projected Future Cancer Risks in Children Treated With Fluoroscopy-Guided Cardiac Catheterization Procedures. Circ Cardiovasc Interv 2018; 11:e006765. [DOI: 10.1161/circinterventions.118.006765] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Neige Journy
- Ionizing Radiation Epidemiology Laboratory (LEPID) (N.J., E.R., F.D.Z.-B., D.L., M.-O.B., H.B.)
- INSERM Unit 1018, Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiations group, Gustave Roussy, Villejuif, France (N.J.)
| | - Serge Dreuil
- Medical Radiation Protection Assessment Unit (UEM) (S.D.) and Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenayaux-Roses, France
| | - Estelle Rage
- Ionizing Radiation Epidemiology Laboratory (LEPID) (N.J., E.R., F.D.Z.-B., D.L., M.-O.B., H.B.)
| | | | - Damien Bonnet
- Department of Congenital and Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes (M3C), Necker Hospital, APHP, Paris, France (D.B., S.M.-M.)
- Paris-Descartes University, Sorbonne Paris Cité, France (D.B.)
| | - Sebastien Hascoët
- Department of Congenital Heart Disease, Centre de Référence des Malformations Cardiaques Congénitales Complexes (M3C), Marie Lannelongue Hospital, Le Plessis-Robinson, France (S.H., J.P.)
- INSERM, UMR-S 999, Paris-Sud School of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, France (S.H., J.P.)
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes (M3C), Necker Hospital, APHP, Paris, France (D.B., S.M.-M.)
| | - Jérôme Petit
- Department of Congenital Heart Disease, Centre de Référence des Malformations Cardiaques Congénitales Complexes (M3C), Marie Lannelongue Hospital, Le Plessis-Robinson, France (S.H., J.P.)
- INSERM, UMR-S 999, Paris-Sud School of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, France (S.H., J.P.)
| | - Dominique Laurier
- Ionizing Radiation Epidemiology Laboratory (LEPID) (N.J., E.R., F.D.Z.-B., D.L., M.-O.B., H.B.)
| | - Marie-Odile Bernier
- Ionizing Radiation Epidemiology Laboratory (LEPID) (N.J., E.R., F.D.Z.-B., D.L., M.-O.B., H.B.)
| | - Hélène Baysson
- Ionizing Radiation Epidemiology Laboratory (LEPID) (N.J., E.R., F.D.Z.-B., D.L., M.-O.B., H.B.)
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24
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Nagayama Y, Oda S, Nakaura T, Tsuji A, Urata J, Furusawa M, Utsunomiya D, Funama Y, Kidoh M, Yamashita Y. Radiation Dose Reduction at Pediatric CT: Use of Low Tube Voltage and Iterative Reconstruction. Radiographics 2018; 38:1421-1440. [DOI: 10.1148/rg.2018180041] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Yasunori Nagayama
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Seitaro Oda
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Takeshi Nakaura
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Akinori Tsuji
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Joji Urata
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Mitsuhiro Furusawa
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Daisuke Utsunomiya
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Yoshinori Funama
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Masafumi Kidoh
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
| | - Yasuyuki Yamashita
- From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (Y.N., S.O., T.N., D.U., M.K., Y.Y.), and Department of Medical Physics, Faculty of Life Sciences (Y.F.), Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; and Department of Radiology, Kumamoto City Hospital, Kumamoto, Japan (Y.N., A.T., J.U., M.F.)
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25
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Tsuchiya N, Beek EJRV, Ohno Y, Hatabu H, Kauczor HU, Swift A, Vogel-Claussen J, Biederer J, Wild J, Wielpütz MO, Schiebler ML. Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging. World J Radiol 2018; 10:52-64. [PMID: 29988845 PMCID: PMC6033703 DOI: 10.4329/wjr.v10.i6.52] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/25/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.
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Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0215, Japan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Edwin JR van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Andrew Swift
- Department of Radiology, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2JF, United Kingdom
| | - Jens Vogel-Claussen
- Department of Radiology, Carl-Neuberg Strasse 1, Hannover-Gr-Buchholz 30625, Germany
| | - Jürgen Biederer
- Radiology Darmstadt, Gross-Gerau County Hospital, Gross-Gerau 64521, Germany
| | - James Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2JF, United Kingdom
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, United States
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26
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Schäfer J, Griese M, Chandrasekaran R, Chotirmall SH, Hartl D. Pathogenesis, imaging and clinical characteristics of CF and non-CF bronchiectasis. BMC Pulm Med 2018; 18:79. [PMID: 29788954 PMCID: PMC5964733 DOI: 10.1186/s12890-018-0630-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/25/2018] [Indexed: 12/26/2022] Open
Abstract
Bronchiectasis is a common feature of severe inherited and acquired pulmonary disease conditions. Among inherited diseases, cystic fibrosis (CF) is the major disorder associated with bronchiectasis, while acquired conditions frequently featuring bronchiectasis include post-infective bronchiectasis and chronic obstructive pulmonary disease (COPD). Mechanistically, bronchiectasis is driven by a complex interplay of inflammation and infection with neutrophilic inflammation playing a predominant role. The clinical characterization and management of bronchiectasis should involve a precise diagnostic workup, tailored therapeutic strategies and pulmonary imaging that has become an essential tool for the diagnosis and follow-up of bronchiectasis. Prospective future studies are required to optimize the diagnostic and therapeutic management of bronchiectasis, particularly in heterogeneous non-CF bronchiectasis populations.
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Affiliation(s)
- Jürgen Schäfer
- Department of Radiology, Division of Pediatric Radiology, University of Tübingen, Tübingen, Germany.
| | | | | | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Dominik Hartl
- Department of Pediatrics I, University of Tübingen, Tübingen, Germany.,Roche Pharma Research & Early Development (pRED), Immunology, Inflammation and Infectious Diseases (I3) Discovery and Translational Area, Roche Innovation Center, Basel, Switzerland
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27
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Journy NMY, Dreuil S, Boddaert N, Chateil JF, Defez D, Ducou-le-Pointe H, Garcier JM, Guersen J, Habib Geryes B, Jahnen A, Lee C, Payen-de-la-Garanderie J, Pracros JP, Sirinelli D, Thierry-Chef I, Bernier MO. Individual radiation exposure from computed tomography: a survey of paediatric practice in French university hospitals, 2010-2013. Eur Radiol 2018; 28:630-641. [PMID: 28836026 DOI: 10.1007/s00330-017-5001-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe computed tomography (CT) scanning parameters, volume CT dose index (CTDIvol) and dose-length product (DLP) in paediatric practice and compare them to current diagnostic reference levels (DRLs). METHODS The survey was conducted in radiology departments of six major university hospitals in France in 2010-2013. Data collection was automatised to extract and standardise information on scanning parameters from DICOM-header files. CTDIvol and DLP were estimated based on Monte Carlo transport simulation and computational reference phantoms. RESULTS CTDIvol and DLP were derived for 4,300 studies, four age groups and 18 protocols. CTDIvol was lower in younger patients for non-head scans, but did not vary with age for routine head scans. Ratios of 95th to 5th percentile CTDIvol values were 2-4 for most body parts, but 5-7 for abdominal examinations and 4-14 for mediastinum CT with contrast, depending on age. The 75th percentile CTDIvol values were below the national DRLs for chest (all ages) and head and abdominal scans (≥10 years). CONCLUSION The results suggest the need for a better optimisation of scanning parameters for routine head scans and infrequent protocols with patient age, enhanced standardisation of practices across departments and revision of current DRLs for children. KEY POINTS • CTDIvol varied little with age for routine head scans. • CTDIvol was lowest in youngest children for chest or abdominal scans. • Individual and inter-department variability warrant enhanced standardisation of practices. • Recent surveys support the need for revised diagnostic reference levels. • More attention should be given to specific protocols (sinuses, neck, spine, mediastinum).
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Affiliation(s)
- Neige M Y Journy
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France.
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA.
| | - Serge Dreuil
- Unité d'expertise en radioprotection médicale, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | - Nathalie Boddaert
- Service de radiologie pédiatrique, INSERM U1000, UMR 1163, Institut Imagine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
- PRES Sorbonne Paris, Cité Université René Descartes, 190 avenue de France, 75013, Paris, France
| | - Jean-François Chateil
- Service de radiologie et d'imagerie anténatale, de l'enfant et de la femme, Groupe Hospitalier Pellegrin, Centre Hospitalier Universitaire de Bordeaux, place Amélie Raba-Léon, 33000, Bordeaux, France
| | - Didier Defez
- Service de Physique Médicale, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Benite, France
| | - Hubert Ducou-le-Pointe
- Service de Radiologie, Hôpital d'Enfants Armand-Trousseau, 26 avenue du Dr A. Netter, 75012, Paris, France
| | - Jean-Marc Garcier
- Service de radiologie, Centre Hospitalier Universitaire Estaing, 1 place Lucie-Aubrac, 63003, Clermont-Ferrand Cedex 1, France
| | - Joël Guersen
- Pôle Imagerie et Radiologie Interventionnelle, Centre Hospitalier Universitaire Gabriel Montpied, 58 rue Montalembert, 63003, Clermont Ferrand cedex 1, France
| | - Bouchra Habib Geryes
- Direction des affaires médicales, de la qualité et la relation avec les usagers, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75743, Paris Cedex 15, France
| | - Andreas Jahnen
- Luxembourg Institute of Science and Technology (LIST), 5 avenue des Hauts-Fourneaux, L-4362, Esch/Alzette, Luxembourg, Luxembourg
| | - Choonsik Lee
- Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9760, USA
| | | | - Jean-Pierre Pracros
- Service d'imagerie pédiatrique, Hôpital Femme Mère Enfants, Groupe Hospitalier Est, 59 Boulevard Pinel, 69500, Bron, France
| | - Dominique Sirinelli
- Service de radiologie pediatrique, Hôpital Clocheville, Centre Hospitalier Régional Universitaire de Tours, 49 boulevard Béranger, 37000, Tours, France
| | - Isabelle Thierry-Chef
- Section of Environment and Cancer, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon cedex 08, France
| | - Marie-Odile Bernier
- Laboratoire d'épidémiologie des rayonnements ionisants, Unité Radioprotection de l'Homme, Institut de Radioprotection et de Sûreté Nucléaire, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
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28
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Morris PP, Geer CP, Singh J, Brinjikji W, Carter RE. Radiation dose reduction during neuroendovascular procedures. J Neurointerv Surg 2017; 10:481-486. [PMID: 28942424 DOI: 10.1136/neurintsurg-2017-013189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
AIM To describe the impact of steps towards reduction of procedural doses of radiation during neuroendovascular procedures. METHODS Phantom exposures under controlled circumstances were performed using a Rando-Alderson adult-sized head phantom. Customized imaging protocols were devised for pediatric and adult imaging and implemented in clinical use. Outcome data for estimated skin doses (ESD) and dose-area product (DAP) following pediatric and adult diagnostic and interventional procedures over 4.5 years were analyzed retrospectively. RESULTS Dose estimates were reduced by 50% or more after introduction of customized imaging protocols in association with modification of personnel behavior compared with doses recorded with previously used vendor-recommended protocols. DISCUSSION Substantial reductions in radiation use during neuroendovascular procedures can be achieved through a combination of equipment modification and operator behavior.
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Affiliation(s)
- Pearse P Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carol P Geer
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jasmeet Singh
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Rickey E Carter
- Department of Biomedical Statistics, Mayo Clinic, Rochester, Minnesota, USA
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29
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Pershad J, Taylor A, Hall MK, Klimo P. Imaging Strategies for Suspected Acute Cranial Shunt Failure: A Cost-Effectiveness Analysis. Pediatrics 2017; 140:peds.2016-4263. [PMID: 28771407 DOI: 10.1542/peds.2016-4263] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared cost-effectiveness of cranial computed tomography (CT), fast sequence magnetic resonance imaging (fsMRI), and ultrasonography measurement of optic nerve sheath diameter (ONSD) for suspected acute shunt failure from the perspective of a health care organization. METHODS We modeled 4 diagnostic imaging strategies: (1) CT scan, (2) fsMRI, (3) screening ONSD by using point of care ultrasound (POCUS) first, combined with CT, and (4) screening ONSD by using POCUS first, combined with fsMRI. All patients received an initial plain radiographic shunt series (SS). Short- and long-term costs of radiation-induced cancer were assessed with a Markov model. Effectiveness was measured as quality-adjusted life-years. Utilities and inputs for clinical variables were obtained from published literature. Sensitivity analyses were performed to evaluate the effects of parameter uncertainty. RESULTS At a previous probability of shunt failure of 30%, a screening POCUS in patients with a normal SS was the most cost-effective. For children with abnormal SS or ONSD measurement, fsMRI was the preferred option over CT. Performing fsMRI on all patients would cost $269 770 to gain 1 additional quality-adjusted life-year compared with POCUS. An imaging pathway that involves CT alone was dominated by ONSD and fsMRI because it was more expensive and less effective. CONCLUSIONS In children with low pretest probability of cranial shunt failure, an ultrasonographic measurement of ONSD is the preferred initial screening test. fsMRI is the more cost-effective, definitive imaging test when compared with cranial CT.
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Affiliation(s)
- Jay Pershad
- Departments of Pediatrics and .,Emergency Medicine, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Andrew Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - M Kennedy Hall
- Division of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington; and
| | - Paul Klimo
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee
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30
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Fahey FH, Goodkind A, MacDougall RD, Oberg L, Ziniel SI, Cappock R, Callahan MJ, Kwatra N, Treves ST, Voss SD. Operational and Dosimetric Aspects of Pediatric PET/CT. J Nucl Med 2017; 58:1360-1366. [PMID: 28687601 DOI: 10.2967/jnumed.116.182899] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 01/04/2023] Open
Abstract
No consistent guidelines exist for the acquisition of a CT scan as part of pediatric PET/CT. Given that children may be more vulnerable to the effects of ionizing radiation, it is necessary to develop methods that provide diagnostic-quality imaging when needed, in the shortest time and with the lowest patient radiation exposure. This article describes the basics of CT dosimetry and PET/CT acquisition in children. We describe the variability in pediatric PET/CT techniques, based on a survey of 19 PET/CT pediatric institutions in North America. The results of the survey demonstrated that, although most institutions used automatic tube current modulation, there remained a large variation of practice, on the order of a factor of 2-3, across sites, pointing to the need for guidelines. We introduce the approach developed at our institution for using a multiseries PET/CT acquisition technique that combines diagnostic-quality CT in the essential portion of the field of view and a low-dose technique to image the remainder of the body. This approach leads to a reduction in radiation dose to the patient while combining the PET and the diagnostic CT into a single acquisition. The standardization of pediatric PET/CT provides an opportunity for a reduction in the radiation dose to these patients while maintaining an appropriate level of diagnostic image quality.
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Affiliation(s)
- Frederic H Fahey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts .,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Alison Goodkind
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert D MacDougall
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Leah Oberg
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Sonja I Ziniel
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; and
| | - Richard Cappock
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Michael J Callahan
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - S Ted Treves
- Department of Radiology, Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephan D Voss
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
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