1
|
Nihalani S, Bloodworth A, Frith K, Ashley P, Williams KA, Conklin MJ. Utility of Follow-up Radiographs in Type 1 Supracondylar Humerus Fractures. J Pediatr Orthop 2024; 44:e530-e535. [PMID: 38512220 DOI: 10.1097/bpo.0000000000002679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Supracondylar humerus (SCH) fractures are common among pediatric patients, with the severity categorized using the Gartland classification system. Type 1 SCH fractures are nondisplaced and treated with immobilization, while more displaced fractures require surgery. The need for follow-up radiographs, particularly for type 1 fractures, is an area where evidence is lacking. This study investigates the clinical value and financial implications of follow-up radiographs for type 1 SCH fractures, hypothesizing that they do not alter clinical management and, therefore, represent an unnecessary expense. METHODS This retrospective cohort study, approved by the Institutional Review Board, focused on patients under 18 with nondisplaced SCH fractures treated nonoperatively. One hundred one type 1 SCH fractures, in which the fracture was visible on presenting radiographs, were chosen from patients presenting between January 2021 and December 2022. Charts were reviewed for demographic information, time of cast removal, and complications. A pediatric orthopaedic surgeon and orthopaedic resident reviewed the radiographs to confirm the injury to be a type 1 SCH fracture. RESULTS Among the 101 patients, after the initial presentation, 79 attended an interim visit and 101 attended a "3-week follow-up" at an average of 23 days postinjury. All patients underwent radiographs during these visits for a total of 180 radiographs after confirmation of type 1 SCH fracture. No changes in management resulted from follow-up radiographs. One instance of refracture was noted ~3 months after cast removal. There were 180 superfluous follow-up radiographs taken at subsequent clinic visits. The total charge for these radiographs was $76,001.40, averaging $752.49 per patient. CONCLUSION Follow-up radiographs for type 1 SCH fractures did not lead to changes in clinical management, aligning with previous findings in more severe SCH fractures. This approach can reduce costs, radiation exposure, and clinic time without compromising patient care. The study can reassure providers and parents about the lack of necessity for follow-up radiographs to document healing. LEVEL OF EVIDENCE Level-IV.
Collapse
Affiliation(s)
- Shrey Nihalani
- Department of Orthopaedic Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | | |
Collapse
|
2
|
Pham TS, Montini F, Pham HN, Nguyen Tran MT, Huy NT, Cacciaguerra L, Filippi M. Radiological Features of Herpetic Encephalitis in Children. Pediatr Neurol 2024; 156:99-105. [PMID: 38744070 DOI: 10.1016/j.pediatrneurol.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/02/2024] [Accepted: 03/31/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Nonspecific clinical manifestations and unclear radiological features may delay treatment initiation in pediatric patients with Herpes simplex encephalitis (HSE). The aim of this study is to analyze the clinical and radiological features of the disease. METHODS Clinical, laboratory, and magnetic resonance imaging (MRI) data were obtained retrospectively from a group of 37 hospitalized pediatric patients older than two months and with a polymerase chain reaction-confirmed HSE diagnosis. Clinical severity (i.e., mechanical ventilatory support) and outcome at discharge (i.e., pediatric modified Rankin Scale [ped-mRS]) were also assessed. RESULTS Median age was 14 months (interquartile range: 10-36). All patients survived, 15 (41%) had complete recovery (i.e., ped-mRS = 0), and 10 (27%) had significant residual disability at discharge (i.e., ped-mRS ≥3). Brain MRI was obtained in 31 patients. T2-hyperintense lesions were usually bilateral (28, 90%) and multifocal (30, 97%). Hemorrhage and mass effect were observed in 13 (42%) and 15 (48%) patients, respectively. Parenchymal lesions involved the temporal lobes (94%), insula (90%), parietal lobes (84%), and frontal lobes (61%). Occipital lesions were rare. In multivariable binary logistic regression models the presence of altered consciousness was associated with mechanical ventilation (odds ratio [OR] = 8.2, Nagelkerke R2 = 0.22), whereas the involvement of the occipital lobes (OR = 7.8) and the administration of vasopressors (OR = 12.1) were independent predictors of poor outcome (Nagelkerke R2 = 0.41). CONCLUSIONS Brain MRI is useful for diagnosis and outcome assessment in pediatric HSE. Radiological patterns with common frontotemporal involvement overlap adults, but multifocal and parietal lobe abnormalities are observed as well.
Collapse
Affiliation(s)
- Thai Son Pham
- Department of Covid-19, Children's Hospital 2, Ho Chi Minh, Vietnam
| | - Federico Montini
- Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Institute of Research and Development, Duy Tan University, Da Nang, Vietnam; School of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam
| | - Laura Cacciaguerra
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
3
|
Easter JS, Rose E. Advances in pediatric emergency from 2023. Am J Emerg Med 2024; 80:77-86. [PMID: 38518545 DOI: 10.1016/j.ajem.2024.03.010] [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: 01/01/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024] Open
Abstract
Most children receive emergency care by general emergency physicians and not in designated children's hospitals. There are unique considerations in the care of children that differ from the care of adults. Many management principles can be extrapolated from adult studies, but the unique pathophysiology of pediatric disease requires specialized attention and management updates. This article highlights ten impactful articles from the year 2023 whose findings can improve the care of children in the Emergency Department (ED). These studies address pediatric resuscitation, traumatic arrest, septic shock, airway management, nailbed injuries, bronchiolitis, infant fever, cervical spine injuries, and cancer risk from radiation (Table 1). The findings in these articles have the potential to impact the evaluation and management of children (Table 2).
Collapse
Affiliation(s)
- Joshua S Easter
- Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Emily Rose
- Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
4
|
Zhong Y, Chen Z, Li B, Ma H, Yang B. Correlation analysis of airway-facial phenotype in Crouzon syndrome by geometric morphometrics: A promising method for non-radiation airway evaluation. Orthod Craniofac Res 2024; 27:504-513. [PMID: 38300018 DOI: 10.1111/ocr.12759] [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] [Accepted: 01/13/2024] [Indexed: 02/02/2024]
Abstract
AIM This study aimed to verify the correlation of the airway-facial phenotype and visualize the morphological variation in Crouzon syndrome patients. Additionally, to develop a non-radiation methodology for airway assessments. METHOD In this study, 22 patients diagnosed with Crouzon syndrome (Age: 7.80 ± 5.63 years; Gender distribution: 11 females and 11 males) were analysed. The soft tissue surface and airway were three-dimensionally reconstructed, and the entire facial phenotype was topologized and converted into spatial coordinates. Geometric morphometrics was employed to verify the correlation and visualize dynamic phenotypic variation associated with airway volume. A total of 276 linear variables were automatically derived from 24 anatomical landmarks, and principal component analysis (PCA) identified the 20 most significant parameters for airway evaluation. Correlation analyses between parameters and airway volume were performed. Then, patients were classified into three groups based on airway volume, and the differences among the groups were compared for evaluating the differentiating effectiveness of parameters. RESULTS The facial phenotype was strongly correlated with the airway (coefficient: 0.758). Morphological variation was characterized by (i) mandibular protrusion and anticlockwise rotation; (ii) midface retrusion; (iii) supraorbital frontward and (iv) lengthening of the facial height. All the anthropometric parameters were strongly associated with the airway, and the differences among the groups were statistically significant. CONCLUSION This study confirmed the strong correlation between facial phenotype and airway parameters in Crouzon syndrome patients. Despite the development of the airway, pathological midface retrusion was still aggravated, suggesting that surgical intervention was inevitable. Three-dimensional facial anthropometry has potential as a non-radiation examination for airway evaluation.
Collapse
Affiliation(s)
- Yehong Zhong
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhewei Chen
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Binghang Li
- Digital Technology Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hengyuan Ma
- Digital Technology Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bin Yang
- Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| |
Collapse
|
5
|
Willershausen I, Kopp M, Scholz M, Ströbel A, Seidel CL, Paulsen F, Uder M, Gölz L, May MS. Feasibility of 3 Tesla MRI for the assessment of mid-palatal suture maturation: a retrospective pilot study. Odontology 2024:10.1007/s10266-024-00950-0. [PMID: 38758257 DOI: 10.1007/s10266-024-00950-0] [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: 03/08/2024] [Accepted: 05/04/2024] [Indexed: 05/18/2024]
Abstract
The maxilla occupies a key position in dentofacial orthopaedics, since its transversal development can be directly influenced by orthodontic therapy. The maturation stages of the mid-palatal suture, which are obtained from cone-beam computed tomography images (CBCT), present an addition to clinical decision-making in transversal discrepancies of the upper jaw. In an endeavour to reduce ionizing radiation in adolescents and young adults, who are particularly susceptible to long term stochastic irradiation effects, we investigated the feasibility of 3 Tesla (3T) MRI in detecting the maturation stages of the mid-palatal suture. A collective of 30 patients aged 24-93 years with routine neck MRI at 3T, underwent an additional three-dimensional isotropic T1 weighted study sequence of the midface. Image evaluation was performed on axial, multi-planar formatted reconstructions of the dataset aligned to the midline axis of the palate, and curved reconstructions aligned to the concavity of the palate. Inverted images helped to achieve an image impression similar to the well-known CBCT appearance. All datasets were reviewed by three readers and mid-palatal maturation was scored twice according to Angelieri et al. Intra- and inter-rater agreement were evaluated to measure the robustness of the images for clinical evaluation. 3T MRI deemed reliable for the assessment of mid-palatal suture maturation and hence for the appraisal of the hard palate and its adjacent sutures. The data of this pilot study display the feasibility of non-ionizing cross-sectional MRI for the determination of sutural maturation stages. These findings underline the potential of MRI for orthodontic treatment planning, further contributing to the avoidance of unnecessary radiation doses.
Collapse
Affiliation(s)
- Ines Willershausen
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
| | - Markus Kopp
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Scholz
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Ströbel
- Center for Clinical Studies (CCS), Medical Faculty, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital Erlangen, Erlangen, Germany
| | - Corinna Lesley Seidel
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Lina Gölz
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Stefan May
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
6
|
Zhang J, Zhang X. Size specific dose estimation in pediatric CT: preliminary study and conversion factors. RADIATION PROTECTION DOSIMETRY 2024; 200:677-686. [PMID: 38678314 DOI: 10.1093/rpd/ncae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 03/02/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
The objective of this paper is to compare the differences between volumetric CT dose index (CTDIVOL) and size-specific dose estimate (SSDEWED) based on water equivalent diameter (WED) in radiation dose measurement, and explore a new method for fast calculation of SSDEWED. The imaging data of 1238 cases of head, 1152 cases of chest and 976 cases of abdominopelvic were analyzed retrospectively, and they were divided into five age groups: ≤ 0.5, 0.5 ~ ≤ 1, 1 ~ ≤ 5, 5 ~ ≤ 10 and 10 ~ ≤ 15 years according to age. The area of interest (AR), CT value (CTR), lateral diameter (LAT) and anteroposterior diameter (AP) of the median cross-sectional image of the standard scanning range and the SSDEWED were manually calculated, and a t-test was used to compare the differences between CTDIVOL and SSDEWED in different age groups. Pearson analyzed the correlations between DE and age, DE and WED, f and age, and counted the means of conversion factors in each age group, and analyze the error ratios between SSDE calculated based on the mean age group conversion factors and actual measured SSDE. The CTDIVOL in head was (9.41 ± 1.42) mGy and the SSDEWED was (8.25 ± 0.70) mGy: the difference was statistically significant (t = 55.04, P < 0.001); the CTDIVOL of chest was (2.68 ± 0.91) mGy and the SSDEWED was (5.16 ± 1.16) mGy, with a statistically significant difference (t = -218.78, P < 0.001); the CTDIVOL of abdominopelvic was (3.09 ± 1.58) mGy and the SSDEWED was (5.89 ± 2.19) mGy: the difference was also statistically significant (t = -112.28, P < 0.001). The CTDIVOL was larger than the SSDEWED in the head except for the ≤ 0.5 year subgroup, and CTDIVOL was smaller than SSDEWED within each subgroup in chest and abdominopelvic. There were strong negative correlations between f and age (head: r = -0.81; chest: r = -0.89; abdominopelvic: r = -0.86; P < 0.001). The mean values of f at each examination region were 0.81 ~ 1.01 for head, 1.65 ~ 2.34 for chest and 1.71 ~ 2.35 for abdominopelvic region. The SSDEWED could be accurately estimated using the mean f of each age subgroup. SSDEWED can more accurately measure the radiation dose of children. For children of different ages and examination regions, the SSDEWED conversion factors based on age subgroup can be quickly adjusted and improve the accuracy of radiation dose estimation.
Collapse
Affiliation(s)
- Jian Zhang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Xiaojun Zhang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| |
Collapse
|
7
|
Cronin BJ, Lee JC. Discussion: Comparison of Morphometric Outcomes following Open Posterior Expansion versus Endoscopic Strip Craniectomy for Sagittal Synostosis. Plast Reconstr Surg 2024; 153:1107-1108. [PMID: 38657010 DOI: 10.1097/prs.0000000000010780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Brendan J Cronin
- From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles
| | - Justine C Lee
- From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles
| |
Collapse
|
8
|
Eckstein A, Welkoborsky HJ. [Interdisciplinary Management of Orbital Diseases]. Laryngorhinootologie 2024; 103:S43-S99. [PMID: 38697143 DOI: 10.1055/a-2216-8879] [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: 05/04/2024]
Abstract
Diagnosis and therapy of orbital diseases is an interdisciplinary challenge, in which i.e. otorhinolaryngologists, ophthalmologists, radiologists, radiation therapists, maxillo-facial surgeons, endocrinologists, and pediatricians are involved. This review article describes frequent diseases which both, otolaryngologists and ophthalmologists are concerned with in interdisciplinary settings. In particular the inflammatory diseases of the orbit including orbital complications, autoimmunological diseases of the orbit including Grave´s orbitopathy, and primary and secondary tumors of the orbit are discussed. Beside describing the clinical characteristics and diagnostic steps the article focusses on the interdisciplinary therapy. The review is completed by the presentation of most important surgical approaches to the orbit, their indications and possible complications. The authors tried to highlight the relevant facts despite the shortness of the text.
Collapse
Affiliation(s)
| | - H-J Welkoborsky
- Univ. Klinik für Augenheilkunde Universitätsmedizin Essen, Klinik für HNO-Heilkunde, Kopf- und Halschirurgie, Klinikum Nordstadt der KRH
| |
Collapse
|
9
|
Lutz K, Röhrig A, Al-Hourani J, Kunze S, Forkosh J, Wermelinger J, Messing-Jünger M. Long-term results of minimally invasive strip craniectomy without helmet therapy for scaphocephaly - a single-centre experience. Neurosurg Rev 2024; 47:164. [PMID: 38630329 DOI: 10.1007/s10143-024-02406-z] [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: 02/13/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
Scaphocephaly is the most common type of craniosynostosis and various surgical techniques are used for treatment. Due to late postoperative changes of the head shape, long-term outcome data is important for evaluating any new surgical technique. At our institution, minimally invasive strip craniectomy without regular helmet therapy is the standard treatment in scaphocephalic patients. Between October 2021 and February 2023, we retrospectively examined the skull shape of patients who underwent minimally invasive strip craniectomy for scaphocephaly using a 3D surface scan technique. The cephalic index (CI), the need for helmet therapy and additional cosmetic outcome parameters were investigated. We included 70 patients (72.5% male). The mean follow-up time was 46 (10-125) months and the mean CI was 75.7 (66.7-85.2). In 58 patients, the final cosmetic result was rated as "excellent/good" (mean CI: 76.3; 70.4-85.0), in 11 as "intermediate" (mean CI: 73.3; 66.7-77.6), and in one case as "unsatisfactory" (CI 69.3). The presence of a suboccipital protrusion was associated with a "less than good" outcome. The CI correlated significantly with the overall outcome, the presence of frontal bossing, and the interval between scan and surgery (age at scan). Minimally invasive strip craniectomy is an elegant and safe method to correct scaphocephaly. Our data show good cosmetic results in the long term even without regular postoperative helmet therapy.
Collapse
Affiliation(s)
- Katharina Lutz
- Neurosurgery Department, Inselspital, Bern University Hospital and University of Bern, Bern, 3010, Switzerland.
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany.
| | - Andreas Röhrig
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jasmin Al-Hourani
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Sandra Kunze
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jana Forkosh
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jonathan Wermelinger
- Neurosurgery Department, Inselspital, Bern University Hospital and University of Bern, Bern, 3010, Switzerland
| | | |
Collapse
|
10
|
Schindler P, Gerwing M. Using deep learning-based denoising and iterative reconstruction to reduce radiation exposure - How low can we go? Eur J Radiol 2024; 173:111376. [PMID: 38377893 DOI: 10.1016/j.ejrad.2024.111376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Philipp Schindler
- Clinic for Radiology, University and University Hospital of Münster, Münster, Germany
| | - Mirjam Gerwing
- Clinic for Radiology, University and University Hospital of Münster, Münster, Germany.
| |
Collapse
|
11
|
Shihabul Hassan M, Stevenson J, Gandikota G, Veeratterapillay A, Bhamidipaty K, Botchu R. Current updates in MSK infection imaging: A narrative review. J Clin Orthop Trauma 2024; 51:102396. [PMID: 38585385 PMCID: PMC10998214 DOI: 10.1016/j.jcot.2024.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
This article presents a comprehensive overview of the diagnostic utility of existing imaging techniques including radiography, computed tomography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide imaging in the context of the most common orthopaedic or musculoskeletal infections. It also includes illustrative images showcasing significant findings in various musculoskeletal infections including osteomyelitis, cellulitis, septic arthritis, necrotising infections and peri-prosthetic joint infections and their associated complications.
Collapse
Affiliation(s)
- M. Shihabul Hassan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J. Stevenson
- Department of Orthopedics, Royal Orthopedic Hospital, Birmingham, UK
| | - G. Gandikota
- Department of Radiology, University of North Carolina, USA
| | | | | | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
| |
Collapse
|
12
|
Lee C, Moroz B, Thome C, Gaudreau K, Emami P, Little MP. Reconstruction of organ doses for patients undergoing computed tomography examinations in Canada 1992-2019. RADIATION PROTECTION DOSIMETRY 2024; 200:379-386. [PMID: 38186237 PMCID: PMC10954068 DOI: 10.1093/rpd/ncad315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/31/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024]
Abstract
We derived the first comprehensive organ dose library for Canadian pediatric and adult patients who underwent computed tomography (CT) scans between 1992 and 2019 to support epidemiological analysis of radiation risk. We calculated organ absorbed doses for Canadian CT patients in two steps. First, we modeled Computed Tomography Dose Index (CTDI) values by patient age, scan body part, and scan year for the scan period between 1992 and 2019 using national survey data conducted in Canada and partially the United Kingdom survey data as surrogates. Second, we converted CTDI values to organ absorbed doses using a library of organ dose conversion coefficients built in an organ dose calculation program, the National Cancer Institute dosimetry system for CT. In result, we created a library of doses delivered to 33 organs and tissues by different patient ages and genders, scan body parts and scan years. In the scan period before 2000, the organs receiving the greatest dose in the head, chest and abdomen-pelvis scans were the active marrow (3.7-15.2 mGy), lungs (54.7-62.8 mGy) and colon (54.9-68.5 mGy), respectively. We observed organ doses reduced by 24% (pediatric head and torso scans, and adult head scans) and 55% (adult torso scans) after 2000. The organ dose library will be used to analyse the risk of radiation exposure from CT scans in the Canadian CT patient cohort.
Collapse
Affiliation(s)
- Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, United States
| | - Brian Moroz
- Computing and Software Solutions for Science, LLC, Bethany Beach, DE, 19930, United States
| | - Christopher Thome
- Medical Sciences Division, NOSM University, Sudbury, ON, P3E 2C6, Canada
- School of Natural Sciences, Laurentian University, Sudbury, ON, P3E 2C6, Canada
| | - Katherine Gaudreau
- Medical Sciences Division, NOSM University, Sudbury, ON, P3E 2C6, Canada
| | - Pirouz Emami
- Department of Physics & Astronomy, McMaster University, Hamilton, ON, ON L8S 4L8, Canada
| | - Mark P Little
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, United States
| |
Collapse
|
13
|
Kurniawan MS, Tio PA, Abdel Alim T, Roshchupkin G, Dirven CM, Pleumeekers MM, Mathijssen IM, van Veelen MLC. 3D Analysis of the Cranial and Facial Shape in Craniosynostosis Patients: A Systematic Review. J Craniofac Surg 2024; 35:00001665-990000000-01410. [PMID: 38498012 PMCID: PMC11045556 DOI: 10.1097/scs.0000000000010071] [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: 12/18/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024] Open
Abstract
With increasing interest in 3D photogrammetry, diverse methods have been developed for craniofacial shape analysis in craniosynostosis patients. This review provides an overview of these methods and offers recommendations for future studies. A systematic literature search was used to identify publications on 3D photogrammetry analyses in craniosynostosis patients until August 2023. Inclusion criteria were original research reporting on 3D photogrammetry analyses in patients with craniosynostosis and written in English. Sixty-three publications that had reproducible methods for measuring cranial, forehead, or facial shape were included in the systematic review. Cranial shape changes were commonly assessed using heat maps and curvature analyses. Publications assessing the forehead utilized volumetric measurements, angles, ratios, and mirroring techniques. Mirroring techniques were frequently used to determine facial asymmetry. Although 3D photogrammetry shows promise, methods vary widely between standardized and less conventional measurements. A standardized protocol for the selection and documentation of landmarks, planes, and measurements across the cranium, forehead, and face is essential for consistent clinical and research applications.
Collapse
Affiliation(s)
| | | | - Tareq Abdel Alim
- Department of Neurosurgery
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center
| | - Gennady Roshchupkin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center
- Department of Epidemiology, Erasmus MC, University Medical Center
| | | | | | | | - Marie-Lise C. van Veelen
- Department of Neurosurgery
- Child Brain Center, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| |
Collapse
|
14
|
Zhang K, Lin PC, Pan J, Shao R, Xu PX, Cao R, Wu CG, Crookes D, Hua L, Wang L. DeepmdQCT: A multitask network with domain invariant features and comprehensive attention mechanism for quantitative computer tomography diagnosis of osteoporosis. Comput Biol Med 2024; 170:107916. [PMID: 38237237 DOI: 10.1016/j.compbiomed.2023.107916] [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: 08/30/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 02/28/2024]
Abstract
In the medical field, the application of machine learning technology in the automatic diagnosis and monitoring of osteoporosis often faces challenges related to domain adaptation in drug therapy research. The existing neural networks used for the diagnosis of osteoporosis may experience a decrease in model performance when applied to new data domains due to changes in radiation dose and equipment. To address this issue, in this study, we propose a new method for multi domain diagnostic and quantitative computed tomography (QCT) images, called DeepmdQCT. This method adopts a domain invariant feature strategy and integrates a comprehensive attention mechanism to guide the fusion of global and local features, effectively improving the diagnostic performance of multi domain CT images. We conducted experimental evaluations on a self-created OQCT dataset, and the results showed that for dose domain images, the average accuracy reached 91%, while for device domain images, the accuracy reached 90.5%. our method successfully estimated bone density values, with a fit of 0.95 to the gold standard. Our method not only achieved high accuracy in CT images in the dose and equipment fields, but also successfully estimated key bone density values, which is crucial for evaluating the effectiveness of osteoporosis drug treatment. In addition, we validated the effectiveness of our architecture in feature extraction using three publicly available datasets. We also encourage the application of the DeepmdQCT method to a wider range of medical image analysis fields to improve the performance of multi-domain images.
Collapse
Affiliation(s)
- Kun Zhang
- School of Electrical Engineering, Nantong University, Nantong, Jiangsu, 226001, China; Nantong Key Laboratory of Intelligent Control and Intelligent Computing, Nantong, Jiangsu, 226001, China; Nantong Key Laboratory of Intelligent Medicine Innovation and Transformation, Nantong, Jiangsu, 226001, China
| | - Peng-Cheng Lin
- School of Electrical Engineering, Nantong University, Nantong, Jiangsu, 226001, China
| | - Jing Pan
- Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China
| | - Rui Shao
- School of Electrical Engineering, Nantong University, Nantong, Jiangsu, 226001, China
| | - Pei-Xia Xu
- School of Electrical Engineering, Nantong University, Nantong, Jiangsu, 226001, China
| | - Rui Cao
- Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China
| | - Cheng-Gang Wu
- School of Electrical Engineering, Nantong University, Nantong, Jiangsu, 226001, China
| | - Danny Crookes
- School of Electronics, Electrical Engineering and Computer Science, Queen's University Belfast, Belfast, BT7 1NN, UK
| | - Liang Hua
- School of Electrical Engineering, Nantong University, Nantong, Jiangsu, 226001, China.
| | - Lin Wang
- Department of Radiology, Affiliated Hospital 2 of Nantong University, Nantong, Jiangsu, 226001, China.
| |
Collapse
|
15
|
Caramenti L, Gradowska PL, Moriña D, Byrnes G, Cardis E, Hauptmann M. Finite-Sample Bias of the Linear Excess Relative Risk in Cohort Studies of Computed Tomography-Related Radiation Exposure and Cancer. Radiat Res 2024; 201:206-214. [PMID: 38323646 DOI: 10.1667/rade-23-00187.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
The linear excess relative risk (ERR) is the most commonly reported measure of association in radiation epidemiological studies, when individual dose estimates are available. While the asymptotic properties of the ERR estimator are well understood, there is evidence of small sample bias in case-control studies of treatment-related radiation exposure and second cancer risk. Cohort studies of cancer risk after exposure to low doses of radiation from diagnostic procedures, e.g., computed tomography (CT) examinations, typically have small numbers of cases and risks are small. Therefore, understanding the properties of the estimated ERR is essential for interpretation and analysis of such studies. We present results of a simulation study that evaluates the finite-sample bias of the ERR estimated by time-to-event analyses and its confidence interval using simulated data, resembling a retrospective cohort study of radiation-related leukemia risk after CT examinations in childhood and adolescence. Furthermore, we evaluate how the Firth-corrected estimator reduces the finite-sample bias of the classical estimator. We show that the ERR is overestimated by about 30% for a cohort of about 150,000 individuals, with 42 leukemia cases observed on average. The bias is reduced for higher baseline incidence rates and for higher values of the true ERR. As the number of cases increases, the ERR is approximately unbiased. The Firth correction reduces the bias for all cohort sizes to generally around or under 5%. Epidemiological studies showing an association between radiation exposure from pediatric CT and cancer risk, unless very large, may overestimate the magnitude of the relationship, while there is no evidence of an increased chance for false-positive results. Conducting large studies, perhaps by pooling individual studies to increase the number of cases, should be a priority. If this is not possible, Firth correction should be applied to reduce small-sample bias.
Collapse
Affiliation(s)
- L Caramenti
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane; Neuruppin, Germany
| | - P L Gradowska
- Erasmus MC Cancer Institute; Rotterdam, The Netherlands
| | - D Moriña
- Department of Econometrics, Statistics and Applied Economics, Riskcenter-IREA, Universitat de Barcelona (UB); Barcelona, Spain
| | - G Byrnes
- International Agency for Research in Cancer (IARC); Lyon, France
| | - E Cardis
- Institute for Global Health, ISGlobal; Barcelona, Spain
- Universitat Pompeu Fabra (UPF); Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Madrid, Spain
| | - M Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane; Neuruppin, Germany
| |
Collapse
|
16
|
Priyanka, Kadavigere R, Sukumar S. Low Dose Pediatric CT Head Protocol using Iterative Reconstruction Techniques: A Comparison with Standard Dose Protocol. Clin Neuroradiol 2024; 34:229-239. [PMID: 38015280 DOI: 10.1007/s00062-023-01361-4] [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: 07/11/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Pediatric computed tomography (CT) head examination has also increased in recent years with the advancement in CT technology; however, children exposed to radiation at the youngest age are more vulnerable to the risks of radiation. The aim of the study is to evaluate radiation dose and image quality of low dose pediatric CT head protocol compared to standard dose pediatric CT head protocol. METHODS This was a prospective study. Group 1 included 73 patients aged < 1 year and 70 patients in the 1-5 years age group and had undergone CT head examination using the standard dose protocol. Group 2 included 31 patients aged < 1 year and 40 patients in the 1-5 years age group and had undergone CT head examination using the low dose protocol. The radiation dose was measured and image quality was assessed quantitatively and qualitatively. RESULTS There was a significant difference in radiation dose between the standard and low dose protocols (p > 0.05) with lower radiation dose for low dose group. The qualitative analysis did not show a significant difference between the standard and low dose protocols. The gray-white matter differentiation (GWMD), attenuation, contrast to noise ratio (CNR) and figure of merit (FOM) were higher in the low dose protocol compared to the standard dose with a significant difference (p > 0.05). CONCLUSION The study concludes that a low dose protocol at 80 kV tube voltage/150 mAs tube current exposure time product/iterative reconstruction-iDose4 (level 3) for < 1 year age group and 100 kV/200m As/iDose4 (level 3) for 1-5 years age group provides ultra-low effective dose with diagnostically acceptable image quality for pediatric CT head examination compared with standard dose protocol.
Collapse
Affiliation(s)
- Priyanka
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Rajagopal Kadavigere
- Department of Radio diagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104.
| | - Suresh Sukumar
- Department of Medical Imaging Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| |
Collapse
|
17
|
Lee S, Kim HY, Lee KH, Cho J, Lee C, Kim KP, Hwang J, Park JH. Risk of hematologic malignant neoplasms from head CT radiation in children and adolescents presenting with minor head trauma: a nationwide population-based cohort study. Eur Radiol 2024:10.1007/s00330-024-10646-2. [PMID: 38358528 DOI: 10.1007/s00330-024-10646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/06/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES The carcinogenic risks of CT radiation in children and adolescents remain debated. We aimed to assess the carcinogenic risk of CTs performed in children and adolescents with minor head trauma. METHODS In this nationwide population-based cohort study, we included 2,411,715 patients of age 0-19 with minor head trauma from 2009 to 2017. We excluded patients with elevated cancer risks or substantial past medical radiation exposure. Patients were categorized into CT-exposed or CT-unexposed group according to claim codes for head CT. The primary outcome was development of hematologic malignant neoplasms. Secondary outcomes included development of malignant solid neoplasms and benign neoplasms in the brain. We measured the incidence rate ratio (IRR) and incidence rate difference (IRD) using G-computation with Poisson regression adjusting for age, sex, hospital setting, and the type of head trauma. RESULTS Hematologic malignant neoplasms developed in 100 of 216,826 patients during 1,303,680 person-years in the CT-exposed group and in 808 of 2,194,889 patients during 13,501,227 person-years in the CT-unexposed group. For hematologic malignant neoplasms, the IRR was 1.29 (95% CI, 1.03-1.60) and the IRD was 1.71 (95% CI, 0.04-3.37) per 100,000 person-years at risk. The majority of excess hematologic malignant neoplasms were leukemia (IRR, 1.40 [98.3% CI, 1.05-1.87]; IRD, 1.59 [98.3% CI, 0.02-3.16] per 100,000 person-years at risk). There were no between-group differences for secondary outcomes. CONCLUSIONS Radiation exposure from head CTs in children and adolescents with minor head trauma was associated with an increased incidence of hematologic malignant neoplasms. CLINICAL RELEVANCE STATEMENT Our study provides a quantitative grasp of the risk conferred by CT examinations in children and adolescents, thereby providing the basis for cost-benefit analyses and evidence-driven guidelines for patient triaging in head trauma. KEY POINTS • This nationwide population-based cohort study showed that radiation exposure from head CTs in children and adolescents was associated with a higher incidence of hematologic malignant neoplasms. • The incidence rate of hematologic malignant neoplasms in the CT-exposed group was 29% higher than that in the CT-unexposed group (IRR, 1.29 [95% CI, 1.03-1.60]), and there were approximately 1.7 excess neoplasms per 100,000 person-years at risk in the CT-exposed group (IRD, 1.71 [0.04-3.37]). • Our study provides a quantified grasp of the risk conferred by CT examinations in children and adolescents, while controlling for biases observed in previous studies via specifying CT indication and excluding patients with predisposing conditions for cancer development.
Collapse
Affiliation(s)
- Seungjae Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Hae Young Kim
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, South Korea
| | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, Seoul, Gyeonggi-Do, South Korea
| | - Jinhee Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, South Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, South Korea.
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
18
|
Proctor A, Lyttle M, Billing J, Shaw P, Simpson J, Voss S, Benger JR. Which elements of hospital-based clinical decision support tools for the assessment and management of children with head injury can be adapted for use by paramedics in prehospital care? A systematic mapping review and narrative synthesis. BMJ Open 2024; 14:e078363. [PMID: 38355171 PMCID: PMC10868315 DOI: 10.1136/bmjopen-2023-078363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Hospital-based clinical decision tools support clinician decision-making when a child presents to the emergency department with a head injury, particularly regarding CT scanning. However, there is no decision tool to support prehospital clinicians in deciding which head-injured children can safely remain at scene. This study aims to identify clinical decision tools, or constituent elements, which may be adapted for use in prehospital care. DESIGN Systematic mapping review and narrative synthesis. DATA SOURCES Searches were conducted using MEDLINE, EMBASE, PsycINFO, CINAHL and AMED. ELIGIBILITY CRITERIA Quantitative, qualitative, mixed-methods or systematic review research that included a clinical decision support tool for assessing and managing children with head injury. DATA EXTRACTION AND SYNTHESIS We systematically identified all in-hospital clinical decision support tools and extracted from these the clinical criteria used in decision-making. We complemented this with a narrative synthesis. RESULTS Following de-duplication, 887 articles were identified. After screening titles and abstracts, 710 articles were excluded, leaving 177 full-text articles. Of these, 95 were excluded, yielding 82 studies. A further 14 studies were identified in the literature after cross-checking, totalling 96 analysed studies. 25 relevant in-hospital clinical decision tools were identified, encompassing 67 different clinical criteria, which were grouped into 18 categories. CONCLUSION Factors that should be considered for use in a clinical decision tool designed to support paramedics in the assessment and management of children with head injury are: signs of skull fracture; a large, boggy or non-frontal scalp haematoma neurological deficit; Glasgow Coma Score less than 15; prolonged or worsening headache; prolonged loss of consciousness; post-traumatic seizure; amnesia in older children; non-accidental injury; drug or alcohol use; and less than 1 year old. Clinical criteria that require further investigation include mechanism of injury, clotting impairment/anticoagulation, vertigo, length of time of unconsciousness and number of vomits.
Collapse
Affiliation(s)
| | - Mark Lyttle
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | | | | | | | - Sarah Voss
- Health and Life Sciences, University of the West of England, Bristol, UK
| | - Jonathan Richard Benger
- Academic Department of Emergency Care, The University Hospitals NHS Foundation Trust, Bristol, UK
- Faculty of Health & Life Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
19
|
Onyije FM, Dolatkhah R, Olsson A, Bouaoun L, Deltour I, Erdmann F, Bonaventure A, Scheurer ME, Clavel J, Schüz J. Risk factors for childhood brain tumours: A systematic review and meta-analysis of observational studies from 1976 to 2022. Cancer Epidemiol 2024; 88:102510. [PMID: 38056243 PMCID: PMC10835339 DOI: 10.1016/j.canep.2023.102510] [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: 10/09/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Childhood brain tumours (CBTs) are the leading cause of cancer death in children under the age of 20 years globally. Though the aetiology of CBT remains poorly understood, it is thought to be multifactorial. We aimed to synthesize potential risk factors for CBT to inform primary prevention. METHODS We conducted a systematic review and meta-analysis of epidemiological studies indexed in the PubMed, Web of Science, and Embase databases from the start of those resources through 27 July 2023. We included data from case-control or cohort studies that reported effect estimates for each risk factor around the time of conception, during pregnancy and/or during post-natal period. Random effects meta-analysis was used to estimate summary effect sizes (ES) and 95% confidence intervals (CIs). We also quantified heterogeneity (I2) across studies. FINDINGS A total of 4040 studies were identified, of which 181 studies (85 case-control and 96 cohort studies) met our criteria for inclusion. Of all eligible studies, 50% (n = 91) were conducted in Europe, 32% (n = 57) in North America, 9% (n = 16) in Australia, 8% (n = 15) in Asia, 1% (n = 2) in South America, and none in Africa. We found associations for some modifiable risk factors including childhood domestic exposures to insecticides (ES 1.44, 95% CI 1.20-1.73) and herbicides (ES 2.38, 95% CI 1.31-4.33). Maternal domestic exposure to insecticides (ES 1.45, 95% CI 1.09-1.94), maternal consumption of cured meat (ES 1.51, 95% CI 1.05-2.17) and coffee ≥ 2 cups/day (ES 1.45, 95% 95% CI 1.07-1.95) during pregnancy, and maternal exposure to benzene (ES 2.22; 95% CI 1.01-4.88) before conception were associated with CBTs in case-control studies. Also, paternal occupational exposure to pesticides (ES 1.48, 95% CI 1.23-1.77) and benzene (ES 1.74, 95% CI 1.10-2.76) before conception and during pregnancy were associated in case-control studies and in combined analysis. On the other hand, assisted reproductive technology (ART) (ES 1.32, 95% CI 1.05-1.67), caesarean section (CS) (ES 1.12, 95% CI 1.01-1.25), paternal occupational exposure to paint before conception (ES 1.56, 95% CI 1.02-2.40) and maternal smoking > 10 cigarettes per day during pregnancy (ES 1.18, 95% CI 1.00-1.40) were associated with CBT in cohort studies. Maternal intake of vitamins and folic acid during pregnancy was inversely associated in cohort studies. Hormonal/infertility treatment, breastfeeding, child day-care attendance, maternal exposure to electric heated waterbed, tea and alcohol consumption during pregnancy were among those not associated with CBT in both case-control and cohort studies. CONCLUSION Our results should be interpreted with caution, especially as most associations between risk factors and CBT were discordant between cohort and case-control studies. At present, it is premature for any CBT to define specific primary prevention guidelines.
Collapse
Affiliation(s)
- Felix M Onyije
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France.
| | - Roya Dolatkhah
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| | - Ann Olsson
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| | - Liacine Bouaoun
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| | - Isabelle Deltour
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| | - Friederike Erdmann
- Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Audrey Bonaventure
- Epidemiology of Childhood and Adolescent Cancers Team, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Villejuif, France
| | - Michael E Scheurer
- Department of Pediatrics, Hematology-Oncology, Baylor College of Medicine and Texas Children's Hospital Cancer Center, Houston, TX, United States
| | - Jacqueline Clavel
- Epidemiology of Childhood and Adolescent Cancers Team, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Villejuif, France; National Registry of Childhood Cancers, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, France; Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| |
Collapse
|
20
|
Fujiwara K, Hiraka K, Shindo K, Abe A, Masatsugu T, Hirano T, Sada M. Variations in the cystic duct: frequency and the relationship among insertion sides and heights on the bile duct. Surg Radiol Anat 2024; 46:223-230. [PMID: 38197959 DOI: 10.1007/s00276-023-03275-9] [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: 08/19/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Evaluation of the cystic duct anatomy prior to bile duct or gallbladder surgery is important, to decrease the risk of bile duct injury. This study aimed to clarify the frequency of cystic duct variations and the relationship between them. METHODS Data of 205 patients who underwent cholecystectomy after imaging at Sada Hospital, Japan, were analyzed. The Chi-square test was used to analyze the relationships among variations. RESULTS The lateral and posterior sides of the bile duct were the two most common insertion points (92 patients, 44.9%), and the middle height was the most common insertion height (135 patients, 65.9%). Clinically important variations (spiral courses, parallel courses, low insertions, and right hepatic duct draining) relating to the risk of bile duct injury were observed in 24 patients (11.7%). Regarding the relationship between the insertion sides and heights, we noticed that the posterior insertion frequently existed in low insertions (75.0%, P < 0.001) and did not exist in high insertions. In contrast, the anterior insertion coexisted with high and never low insertions. Spiral courses have two courses: anterior and posterior, and anterior ones were only found in high insertion cases. CONCLUSIONS The insertion point of the cystic duct and the spiral courses tended to be anterior or lateral superiorly and posterior inferiorly. Clinically significant variations in cystic duct insertions are common and surgeons should be cautious about these variations to avoid complications.
Collapse
Affiliation(s)
- Kenji Fujiwara
- Department of Surgery, Sada Hospital, Fukuoka, Japan.
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Department of Surgery, Kimura Hospital, Fukuoka, Japan.
| | | | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Abe
- Department of Surgery, Sada Hospital, Fukuoka, Japan
- Department of Surgery, Shin-Kokura Hospital, Kitakyushu, Japan
| | | | - Tatsuya Hirano
- Department of Surgery, Sada Hospital, Fukuoka, Japan
- Department of Surgery, Yagi Hospital, Fukuoka, Japan
| | - Masayuki Sada
- Department of Surgery, Sada Hospital, Fukuoka, Japan
| |
Collapse
|
21
|
De Luca F, Kits A, Martin Muñoz D, Aspelin Å, Kvist O, Österman Y, Diaz Ruiz S, Skare S, Falk Delgado A. Elective one-minute full brain multi-contrast MRI versus brain CT in pediatric patients: a prospective feasibility study. BMC Med Imaging 2024; 24:23. [PMID: 38267889 PMCID: PMC10809606 DOI: 10.1186/s12880-024-01196-6] [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: 06/15/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Brain CT can be used to evaluate pediatric patients with suspicion of cerebral pathology when anesthetic and MRI resources are scarce. This study aimed to assess if pediatric patients referred for an elective brain CT could endure a diagnostic fast brain MRI without general anesthesia using a one-minute multi-contrast EPI-based sequence (EPIMix) with comparable diagnostic performance. METHODS Pediatric patients referred for an elective brain CT between March 2019 and March 2020 were prospectively included and underwent EPIMix without general anesthesia in addition to CT. Three readers (R1-3) independently evaluated EPIMix and CT images on two separate occasions. The two main study outcomes were the tolerance to undergo an EPIMix scan without general anesthesia and its performance to classify a scan as normal or abnormal. Secondary outcomes were assessment of disease category, incidental findings, diagnostic image quality, diagnostic confidence, and image artifacts. Further, a side-by-side evaluation of EPIMix and CT was performed. The signal-to-noise ratio (SNR) was calculated for EPIMix on T1-weighted, T2-weighted, and ADC images. Descriptive statistics, Fisher's exact test, and Chi-squared test were used to compare the two imaging modalities. RESULTS EPIMix was well tolerated by all included patients (n = 15) aged 5-16 (mean 11, SD 3) years old. Thirteen cases on EPIMix and twelve cases on CT were classified as normal by all readers (R1-3), while two cases on EPIMix and three cases on CT were classified as abnormal by one reader (R1), (R1-3, p = 1.00). There was no evidence of a difference in diagnostic confidence, image quality, or the presence of motion artifacts between EPIMix and CT (R1-3, p ≥ 0.10). Side-by-side evaluation (R2 + R4 + R5) reviewed all scans as lacking significant pathological findings on EPIMix and CT images. CONCLUSIONS Full brain MRI-based EPIMix sequence was well tolerated without general anesthesia with a diagnostic performance comparable to CT in elective pediatric patients. TRIAL REGISTRATION This study was approved by the Swedish Ethical Review Authority (ethical approval number/ID Ethical approval 2017/2424-31/1). This study was a clinical trial study, with study protocol published at ClinicalTrials.gov with Trial registration number NCT03847051, date of registration 18/02/2019.
Collapse
Affiliation(s)
- Francesca De Luca
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Annika Kits
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Martin Muñoz
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Aspelin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Kvist
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Yords Österman
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Diaz Ruiz
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Lund University, Lund, Sweden
| | - Stefan Skare
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
22
|
De Luca F, Finnbogason T, Kvist O. Specialist learning curves and clinical feasibility of introducing a new MRI grading system for skeletal maturity. BJR Open 2024; 6:tzae008. [PMID: 38680899 PMCID: PMC11052657 DOI: 10.1093/bjro/tzae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/05/2023] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
Objective MRI is an emerging imaging modality to assess skeletal maturity. This study aimed to chart the learning curves of paediatric radiologists when using an unfamiliar MRI grading system of skeletal maturity and to assess the clinical feasibility of implementing said system. Methods 958 healthy paediatric volunteers were prospectively included in a dual-facility study. Each subject underwent a conventional MRI scan at 1.5 T. To perform the image reading, the participants were grouped into five subsets (subsets 1-5) of equal size (n∼192) in chronological order for scan acquisition. Two paediatric radiologists (R1-2) with different levels of MRI experience, both of whom were previously unfamiliar with the study's MRI grading system, independently evaluated the subsets to assess skeletal maturity in five different growth plate locations. Congruent cases at blinded reading established the consensus reading. For discrepant cases, the consensus reading was obtained through an unblinded reading by a third paediatric radiologist (R3), also unfamiliar with the MRI grading system. Further, R1 performed a second blinded image reading for all included subjects with a memory wash-out of 180 days. Weighted Cohen kappa was used to assess interreader reliability (R1 vs consensus; R2 vs consensus) at non-cumulative and cumulative time points, as well as interreader (R1 vs R2) and intrareader (R1 vs R1) reliability at non-cumulative time points. Results Mean weighted Cohen kappa values for each pair of blinded readers compared to consensus reading (interreader reliability, R1-2 vs consensus) were ≥0.85, showing a strong to almost perfect interreader agreement at both non-cumulative and cumulative time points and in all growth plate locations. Weighted Cohen kappa values for interreader (R1 vs R2) and intrareader reliability (R1 vs R1) were ≥0.72 at non-cumulative time points, with values ≥0.82 at subset 5. Conclusions Paediatric radiologists' clinical confidence when introduced to a new MRI grading system for skeletal maturity was high from the outset of their learning curve, despite the radiologists' varying levels of work experience with MRI assessment. The MRI grading system for skeletal maturity investigated in this study is a robust clinical method when used by paediatric radiologists and can be used in clinical practice. Advances in knowledge Radiologists with fellowship training in paediatric radiology experienced no learning curve progress when introduced to a new MRI grading system for skeletal maturity and achieved desirable agreement from the first time point of the learning curve. The robustness of the investigated MRI grading system was not affected by the earlier different levels of MRI experience among the readers.
Collapse
Affiliation(s)
- Francesca De Luca
- Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18 a, 171 77 Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden
| | - Thröstur Finnbogason
- Department of Pediatric Radiology, Karolinska University Hospital, Eugeniavägen 23, 171 64, Stockholm, Sweden
| | - Ola Kvist
- Department of Pediatric Radiology, Karolinska University Hospital, Eugeniavägen 23, 171 64, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institute, Tomtebodavägen 18a, 171 77, Stockholm, Sweden
| |
Collapse
|
23
|
Inoue Y, Mori M, Itoh H, Mitsui K, Miyatake H, Yamane T, Hata H. Age-Dependent Changes in Effective Dose in Pediatric Brain CT: Comparisons of Estimation Methods. Tomography 2023; 10:14-24. [PMID: 38250948 PMCID: PMC10821001 DOI: 10.3390/tomography10010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
The effective dose (ED) in computed tomography (CT) may be calculated by multiplying the dose-length product (DLP) by a conversion factor. As children grow, automatic exposure control increases the DLP, while the conversion factor decreases; these two changes affect the ED in opposite ways. The aim of this study was to investigate the methods of ED estimation according to age in pediatric brain CT. We retrospectively analyzed 980 brain CT scans performed for various clinical indications in children. The conversion factor at each age, in integer years, was determined based on the values at 0, 1, 5, and 10 years provided by the International Commission on Radiological Protection (ICRP), using a curve (curve method) or lines (linear method). In the simple method, the ED was estimated using the ICRP conversion factor for the closest age. We also analyzed the ED estimated by a radiation dose management system. Although the median DLP at each age increased with age, the median ED estimated by the curve method was highest at 0 years, decreased with age, and then plateaued at 9 years. The linear method yielded mildly different results, especially at 2 and 3 years. The ED estimated by the simple method or the radiation dose management system showed inconsistent, up-and-down changes with age. In conclusion, the ED in pediatric brain CT decreases with age despite increased DLP. Determination of the conversion factor at each age using a curve is expected to contribute to estimating the ED in pediatric CT according to age.
Collapse
Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (M.M.); (K.M.); (T.Y.)
| | - Masahiro Mori
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (M.M.); (K.M.); (T.Y.)
| | - Hiroyasu Itoh
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan; (H.I.); (H.M.); (H.H.)
| | - Kohei Mitsui
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (M.M.); (K.M.); (T.Y.)
| | - Hiroki Miyatake
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan; (H.I.); (H.M.); (H.H.)
| | - Takuro Yamane
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan; (M.M.); (K.M.); (T.Y.)
| | - Hirofumi Hata
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan; (H.I.); (H.M.); (H.H.)
| |
Collapse
|
24
|
Bosch de Basea Gomez M, Thierry-Chef I, Harbron R, Hauptmann M, Byrnes G, Bernier MO, Le Cornet L, Dabin J, Ferro G, Istad TS, Jahnen A, Lee C, Maccia C, Malchair F, Olerud H, Simon SL, Figuerola J, Peiro A, Engels H, Johansen C, Blettner M, Kaijser M, Kjaerheim K, Berrington de Gonzalez A, Journy N, Meulepas JM, Moissonnier M, Nordenskjold A, Pokora R, Ronckers C, Schüz J, Kesminiene A, Cardis E. Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults. Nat Med 2023; 29:3111-3119. [PMID: 37946058 PMCID: PMC10719096 DOI: 10.1038/s41591-023-02620-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
Over one million European children undergo computed tomography (CT) scans annually. Although moderate- to high-dose ionizing radiation exposure is an established risk factor for hematological malignancies, risks at CT examination dose levels remain uncertain. Here we followed up a multinational cohort (EPI-CT) of 948,174 individuals who underwent CT examinations before age 22 years in nine European countries. Radiation doses to the active bone marrow were estimated on the basis of body part scanned, patient characteristics, time period and inferred CT technical parameters. We found an association between cumulative dose and risk of all hematological malignancies, with an excess relative risk of 1.96 (95% confidence interval 1.10 to 3.12) per 100 mGy (790 cases). Similar estimates were obtained for lymphoid and myeloid malignancies. Results suggest that for every 10,000 children examined today (mean dose 8 mGy), 1-2 persons are expected to develop a hematological malignancy attributable to radiation exposure in the subsequent 12 years. Our results strengthen the body of evidence of increased cancer risk at low radiation doses and highlight the need for continued justification of pediatric CT examinations and optimization of doses.
Collapse
Affiliation(s)
- Magda Bosch de Basea Gomez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabelle Thierry-Chef
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Richard Harbron
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Graham Byrnes
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Maria-Odile Bernier
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Lucian Le Cornet
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
- German Cancer Research Center, Heidelberg, Germany
| | - Jérémie Dabin
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Gilles Ferro
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Tore S Istad
- Norwegian Radiation and Nuclear Safety Authority, 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, MD, USA
| | - Carlo Maccia
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), Sèvres, France
| | - Françoise Malchair
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé (CAATS), Sèvres, France
| | - Hilde Olerud
- Norwegian Radiation and Nuclear Safety Authority, Oslo, Norway
- Norwegian Radiation Protection Authority, Østerås, Norway
- University of South-Eastern Norway, Kongsberg, Norway
| | - Steven L Simon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jordi Figuerola
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Peiro
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Hilde Engels
- Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - Christoffer Johansen
- Cancer Late Effect Research Oncology Clinic (CASTLE), Center for Surgery and Cancer, Rigshospitalet, Copenhagen, Denmark
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Magnus Kaijser
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- Institute of Cancer Research, London, UK
| | - Neige Journy
- Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
- French National Institute of Health and Medical Research (INSERM) Unit 1018, Centre for Research in Epidemiology and Population Health, Paris Saclay University, Gustave Roussy, Villejuif, France
| | | | - Monika Moissonnier
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Arvid Nordenskjold
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Roman Pokora
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Cecile Ronckers
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Elisabeth Cardis
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
- Pompeu Fabra University, Barcelona, Spain.
- Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
25
|
Moradi H, Chehre H, Ghaderi B, Saghatchi F, Najafi M, Karami P, Rezaeejam H. Evaluating the Necessity and Radiation Risk of Brain CT Scans Requested by the Trauma Emergency Department. J Biomed Phys Eng 2023; 13:515-522. [PMID: 38148965 PMCID: PMC10749414 DOI: 10.31661/jbpe.v0i0.2012-1251] [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: 12/20/2020] [Accepted: 01/22/2021] [Indexed: 12/28/2023]
Abstract
Background Numerous Computed Tomography (CT) scan requests for trauma patients have raised serious concern about the impacts of radiation such as radiation-induced cancers. Objective This study aimed to evaluate the necessity rate of requested head CT scans for traumatic patients and to ultimately estimate the risk of radiation-induced brain cancer. Material and Methods In this retrospective analytical study, traumatic patients, who had undergone a head CT scan in a two-month period from August 23 to October 22, 2018, were considered as the study population. Two radiologists reviewed each patient individually to evaluate the rate of normal and abnormal cases. Dose length product in milligrays (mGy) was utilized to calculate the effective dose (ED) in millisieverts (mSv), resulting in an assessment of the risk of radiation-induced brain cancer using ICRP 103. Results Among 523 scans, 460 patients (88%) received normal reviews, while only 47 patients (9%) had findings related to their current trauma. The mean effective dose value was 1.05±0.36 mSv. Risk of the radiation induced brain cancer was calculated to be 0.037 and 0.030 new cancer cases in 10000 males and females per Gy, respectively. Conclusion Final results demonstrated that a significant number of traumatic patients undergoing a CT scan are in fact, healthy. Such reckless usage of CT and consequently the excess exposure could result in a dramatic rise in cancer rates. The need to limit unnecessary CT scan usage and keeping the radiation given to patients as low as reasonably achievable (ALARA) when collecting essential diagnostic data is more critical than ever.
Collapse
Affiliation(s)
- Hadi Moradi
- Student Research Committee, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Chehre
- Department of Biomedical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Ghaderi
- Department of Radiology, Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Faranak Saghatchi
- Department of Radiology, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Masoud Najafi
- Department of Radiology, Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Parisa Karami
- Department of Radiology, Mousavi Hospital, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hamed Rezaeejam
- Department of Radiology, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
26
|
Krishnan S, Soltesz E, Hanks J, Adi A, Elgharably H, McCurry K, Bribriesco A. Radiation Exposure in Extracorporeal Life Support. ASAIO J 2023; 69:1049-1054. [PMID: 37875016 DOI: 10.1097/mat.0000000000002037] [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: 10/26/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) exposes patients to multiple radiologic studies. We hypothesized ECMO patients endure radiation exposure in excess of the International Commission of Radiological Protection (ICRP) recommendations of cumulative effective dose (CED, >20 mSv and 5-year cumulative limit of CED >100 mSv). We conducted a retrospective observational study in an academic medical center between January 2016 and December 2018 involving adult admissions (N = 306) on ECMO. Ionizing radiation was calculated from reference values to determine CED. Approximately 9.4% (N = 29) patients accrued CED >50 mSv and 4.5% (N = 14) accrued CED >100 mSv during ECMO. Over the entire hospitalization, 28% (N = 85) accrued >50 mSv and 14.7% (N = 45) accrued CED >100 mSv. Median CED during ECMO was 2.3 mSv (IQR, -0.82 to 8.1 mSv), and the entire hospitalization was 17.4 mSv (IQR, -4.5 to 56.6 mSv). Thirteen percent of the median CED accrued during hospitalization could be attributed to ECMO. Longer hospitalization was associated with a higher CED (50 days [IQR, -25 to 76 days] in CED >50 vs. 19 days [IQR, -10 to 32 days] in CED <50). Computer tomography (CT) scans and interventional radiology (IR) procedures contributed to 43.8% and 44.86%, respectively, of CED accrued on ECMO and 52.2% and 37.1% of CED accumulated during the whole hospitalization. Guidelines aimed at mitigating radiation exposure are urgently needed.
Collapse
Affiliation(s)
- Sudhir Krishnan
- From the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward Soltesz
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin Hanks
- From the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ahmad Adi
- Anesthesia Institute, Cleveland Clinic, Cleveland, Ohio
| | - Haytham Elgharably
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth McCurry
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | |
Collapse
|
27
|
Smith DE, Hamby T, Heym K, Mohamed A, Vallance KL, Ray A. Intracranial Relapse in Pediatric Sarcoma. J Pediatr Hematol Oncol 2023; 45:e810-e816. [PMID: 37526369 DOI: 10.1097/mph.0000000000002713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/08/2023] [Indexed: 08/02/2023]
Abstract
Advances in local control techniques, chemotherapy regimens, and imaging modalities have led to improvements in both morbidity and mortality in pediatric sarcoma patients. However, approximately one-third of patients develop disease relapse and intracranial metastasis was considered rare. The incidence of sarcoma brain metastasis is thought to have increased and is associated with grim outcomes. This was a retrospective study of 3 deidentified patient charts illustrating the possibility of the central nervous system as a potential site for pediatric sarcoma relapse and investigate the patterns of such relapses. We note this is the first report of infantile fibrosarcoma brain metastasis and a rare report of sarcoma lymph node metastasis. In addition, each patient was treated with targeted therapies, including entrectinib, Ruxolitnib, and pazopanib. Caregivers in cases 2 and 3 reported new-onset neurological manifestations before identification of new brain metastasis, indicating a lag in detection of new intracranial relapse in asymptomatic sarcoma patients. We suggest implementing a brief review of systems screening tool focused on concerning neurological manifestations to screen for new brain metastasis.
Collapse
Affiliation(s)
- Danielle E Smith
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine
| | - Tyler Hamby
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine
- Departments of Research Operations
| | - Kenneth Heym
- Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Ashraf Mohamed
- Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Kelly L Vallance
- Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Anish Ray
- Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| |
Collapse
|
28
|
Little MP, Wakeford R, Zablotska LB, Borrego D, Griffin KT, Allodji RS, de Vathaire F, Lee C, Brenner AV, Miller JS, Campbell D, Pearce MS, Sadetzki S, Doody MM, Holmberg E, Lundell M, French B, Adams MJ, Berrington de González A, Linet MS. Radiation exposure and leukaemia risk among cohorts of persons exposed to low and moderate doses of external ionising radiation in childhood. Br J Cancer 2023; 129:1152-1165. [PMID: 37596407 PMCID: PMC10539334 DOI: 10.1038/s41416-023-02387-8] [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: 12/21/2022] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Many high-dose groups demonstrate increased leukaemia risks, with risk greatest following childhood exposure; risks at low/moderate doses are less clear. METHODS We conducted a pooled analysis of the major radiation-associated leukaemias (acute myeloid leukaemia (AML) with/without the inclusion of myelodysplastic syndrome (MDS), chronic myeloid leukaemia (CML), acute lymphoblastic leukaemia (ALL)) in ten childhood-exposed groups, including Japanese atomic bomb survivors, four therapeutically irradiated and five diagnostically exposed cohorts, a mixture of incidence and mortality data. Relative/absolute risk Poisson regression models were fitted. RESULTS Of 365 cases/deaths of leukaemias excluding chronic lymphocytic leukaemia, there were 272 AML/CML/ALL among 310,905 persons (7,641,362 person-years), with mean active bone marrow (ABM) dose of 0.11 Gy (range 0-5.95). We estimated significant (P < 0.005) linear excess relative risks/Gy (ERR/Gy) for: AML (n = 140) = 1.48 (95% CI 0.59-2.85), CML (n = 61) = 1.77 (95% CI 0.38-4.50), and ALL (n = 71) = 6.65 (95% CI 2.79-14.83). There is upward curvature in the dose response for ALL and AML over the full dose range, although at lower doses (<0.5 Gy) curvature for ALL is downwards. DISCUSSION We found increased ERR/Gy for all major types of radiation-associated leukaemia after childhood exposure to ABM doses that were predominantly (for 99%) <1 Gy, and consistent with our prior analysis focusing on <100 mGy.
Collapse
Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA.
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B Zablotska
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, 550 16th Street, 2nd floor, San Francisco, CA, 94143, USA
| | - David Borrego
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Keith T Griffin
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Rodrigue S Allodji
- Equipe d'Epidémiologie des radiations, Unité 1018 INSERM, Bâtiment B2M, Institut Gustave Roussy, Villejuif, Cedex, 94805, France
| | - Florent de Vathaire
- Equipe d'Epidémiologie des radiations, Unité 1018 INSERM, Bâtiment B2M, Institut Gustave Roussy, Villejuif, Cedex, 94805, France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Alina V Brenner
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Jeremy S Miller
- Information Management Services, Silver Spring, MD, 20904, USA
| | - David Campbell
- Information Management Services, Silver Spring, MD, 20904, USA
| | - Mark S Pearce
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
- NIHR Health Protection Research Unit in chemical and radiation threats and hazards, Newcastle University, Newcastle upon Tyne, UK
| | - Siegal Sadetzki
- Israel Ministry of Health, Jerusalem, Israel
- Cancer & Radiation Epidemiology Unit, Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel-Hashomer, Israel & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Michele M Doody
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Erik Holmberg
- Department of Oncology, Sahlgrenska University Hospital, S-413-45, Göteborg, Sweden
| | - Marie Lundell
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, S-17176, Stockholm, Sweden
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Jacob Adams
- University of Rochester School of Medicine and Dentistry, 265 Crittenden Boulevard, CU 420644, Rochester, NY, 14642-0644, USA
| | - Amy Berrington de González
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Martha S Linet
- Radiation Epidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| |
Collapse
|
29
|
Tan Z, Zhang L, Sun X, Yang M, Makamure J, Wu H, Wang J. Dual-Layer Detector Head CT to Maintain Image Quality While Reducing the Radiation Dose in Pediatric Patients. AJNR Am J Neuroradiol 2023; 44:1212-1218. [PMID: 37735089 PMCID: PMC10549953 DOI: 10.3174/ajnr.a7999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/02/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND AND PURPOSE Radiation exposure in the CT diagnostic imaging process is a conspicuous concern in pediatric patients. This study aimed to evaluate whether 60-keV virtual monoenergetic images of the pediatric cranium in dual-layer CT can reduce the radiation dose while maintaining image quality compared with conventional images. MATERIALS AND METHODS One hundred six unenhanced pediatric head scans acquired by dual-layer CT were retrospectively assessed. The patients were assigned to 2 groups of 53 and scanned with 250 and 180 mAs, respectively. Dose-length product values were retrieved, and noise, SNR, and contrast-to-noise ratio were calculated for each case. Two radiologists blinded to the reconstruction technique used evaluated image quality on a 5-point Likert scale. Statistical assessment was performed with ANOVA and the Wilcoxon test, adjusted for multiple comparisons. RESULTS Mean dose-length product values were 717.47 (SD, 41.52) mGy×cm and 520.74 (SD, 42) mGy×cm for the 250- and 180-mAs groups, respectively. Irrespective of the radiation dose, noise was significantly lower, SNR and contrast-to-noise ratio were significantly higher, and subjective analysis revealed significant superiority of 60-keV virtual monoenergetic images compared with conventional images (all P < .001). SNR, contrast-to-noise ratio, and subjective evaluation in 60-keV virtual monoenergetic images were not significantly different between the 2 scan groups (P > .05). Radiation dose parameters were significantly lower in the 180-mAs group compared with the 250-mAs group (P < .001). CONCLUSIONS Dual-layer CT 60-keV virtual monoenergetic images allowed a radiation dose reduction of 28% without image-quality loss in pediatric cranial CT.
Collapse
Affiliation(s)
- Zhengwu Tan
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Lan Zhang
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Xiaojie Sun
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Ming Yang
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Joyman Makamure
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Hongying Wu
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| | - Jing Wang
- From the Department of Radiology (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging (Z.T., L.Z., X.S., M.Y., J.M., H.W., J.W.), Wuhan, Hubei, China
| |
Collapse
|
30
|
Hect JL, McDowell MM, Fields D, Greene S. Relationship of cervical soft tissue injury and surgical predication following pediatric cervical spinal trauma and its sequelae on long-term neurologic outcome. World Neurosurg X 2023; 20:100235. [PMID: 37456687 PMCID: PMC10339037 DOI: 10.1016/j.wnsx.2023.100235] [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: 10/17/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Within the sample of 181 patients with cervical CT, CT identified unstable injury with a sensitivity of 100% and specificity of 95%. CT identified operable injury at the CCJ with 86% sensitivity and 91% specificity. CT was considered the gold standard for identification of fractures. Together, the presence of CT imaging suggestive of unstable injury or persistent neurologic complaint had a 100% sensitivity and 81% specificity. Finally, across all patients MRI had 100% sensitivity and 89% specificity for detection of unstable injury requiring surgery.
Collapse
Affiliation(s)
- Jasmine L. Hect
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Michael M. McDowell
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Daryl Fields
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Stephanie Greene
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| |
Collapse
|
31
|
Shim JH, Choi SY, Chang IH, Park SB. Dose Optimization Using a Deep Learning Tool in Various CT Protocols for Urolithiasis: A Physical Human Phantom Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1677. [PMID: 37763796 PMCID: PMC10538199 DOI: 10.3390/medicina59091677] [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: 08/06/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: We attempted to determine the optimal radiation dose to maintain image quality using a deep learning application in a physical human phantom. Materials and Methods: Three 5 × 5 × 5 mm3 uric acid stones were placed in a physical human phantom in various locations. Three tube voltages (120, 100, and 80 kV) and four current-time products (100, 70, 30, and 15 mAs) were implemented in 12 scans. Each scan was reconstructed with filtered back projection (FBP), statistical iterative reconstruction (IR, iDose), and knowledge-based iterative model reconstruction (IMR). By applying deep learning to each image, we took 12 more scans. Objective image assessments were calculated using the standard deviation of the Hounsfield unit (HU). Subjective image assessments were performed by one radiologist and one urologist. Two radiologists assessed the subjective assessment and found the stone under the absence of information. We used this data to calculate the diagnostic accuracy. Results: Objective image noise was decreased after applying a deep learning tool in all images of FBP, iDose, and IMR. There was no statistical difference between iDose and deep learning-applied FBP images (10.1 ± 11.9, 9.5 ± 18.5 HU, p = 0.583, respectively). At a 100 kV-30 mAs setting, deep learning-applied FBP obtained a similar objective noise in approximately one third of the radiation doses compared to FBP. In radiation doses with settings lower than 100 kV-30 mAs, the subject image assessment (image quality, confidence level, and noise) showed deteriorated scores. Diagnostic accuracy was increased when the deep learning setting was lower than 100 kV-30 mAs, except for at 80 kV-15 mAs. Conclusions: At the setting of 100 kV-30 mAs or higher, deep learning-applied FBP did not differ in image quality compared to IR. At the setting of 100 kV-30 mAs, the radiation dose can decrease by about one third while maintaining objective noise.
Collapse
Affiliation(s)
- Jae Hun Shim
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Republic of Korea
| |
Collapse
|
32
|
Greene AC, Mankarious MM, Patel A, Matzelle-Zywicki M, Kwon EG, Reyes L, Tsai AY, Santos MC, Moore MM, Kulaylat AN. Can magnetic resonance imaging replace computed tomography scans in the evaluation of pediatric post-appendectomy abscess? Surgery 2023; 174:703-708. [PMID: 37365084 DOI: 10.1016/j.surg.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Computed tomography scans have been used when cross-axial imaging is required to evaluate pediatric post-appendectomy abscesses. To reduce a source of radiation exposure, our institution converted to using contrast-enhanced magnetic resonance imaging to replace computed tomography scans in this clinical context. Our aim is to evaluate the performance of magnetic resonance imaging compared to computed tomography scans and associated clinical outcomes in this patient population. METHODS A contrast-enhanced comprehensive magnetic resonance imaging protocol was implemented to evaluate a post-appendectomy abscess in 2018. A retrospective chart review was performed from 2015 to 2022 for pediatric patients (<18 years old) with prior appendectomy and subsequent cross-sectional imaging to evaluate for an intraabdominal abscess. Patient characteristics and clinical parameters between the 2 modalities were abstracted and compared using standard univariate statistics. RESULTS There were a total of 72 post-appendectomy patients who received cross-axial imaging, which included 43 computed tomography scans and 29 magnetic resonance imaging during the study interval. Patient demographics were comparable between cohorts and rates of perforated appendicitis at the index operation (computed tomography: 79.1% vs magnetic resonance imaging: 86.2%). Missed abscess rate, abscess size, management technique, drainage culture results, readmission, and reoperation were similar between imaging modalities. Median request to scan time was longer for magnetic resonance imaging than computed tomography (191.5 vs 108 minutes, P = .04). The median duration of a comprehensive magnetic resonance imaging scan was 32 minutes (interquartile range 28-50.5 minutes). CONCLUSION Contrast-enhanced magnetic resonance imaging provides an alternative cross-sectional imaging modality to computed tomography scans to evaluate pediatric post-appendectomy abscesses.
Collapse
Affiliation(s)
- Alicia C Greene
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA. https://twitter.com/AliciaGreeneDO
| | - Marc M Mankarious
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA. https://twitter.com/MarcMMankarious
| | - Akshilkumar Patel
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA
| | - Madeline Matzelle-Zywicki
- The Pennsylvania State University College of Medicine, Hershey, PA. https://twitter.com/maddie_mzywicki
| | - Eustina G Kwon
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA. https://twitter.com/eustina_k
| | - Lilia Reyes
- Division of Pediatric Emergency Medicine, Penn State Children's Hospital, Hershey, PA
| | - Anthony Y Tsai
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA. https://twitter.com/antsai
| | - Mary C Santos
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA
| | - Michael M Moore
- Department of Radiology, Nemours Children's Hospital, Wilmington, DE
| | - Afif N Kulaylat
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA.
| |
Collapse
|
33
|
Miao M, Cai H, Wang Z, Hu L, Bian J, Cai H. Suprapatellar pouch effusion is associated with an increased risk of neglected osteochondral fractures in primary acute traumatic patellar dislocation: a consecutive series of 113 children. J Orthop Surg Res 2023; 18:627. [PMID: 37633950 PMCID: PMC10464257 DOI: 10.1186/s13018-023-04130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the risk factors of neglected osteochondral fractures in primary acute traumatic patellar dislocation in the pediatric population. METHODS A total of 113 patients with primary acute traumatic patellar dislocation for whom coincident osteochondral fractures could not be confirmed by X-ray examination at initial diagnosis between January 2010 and February 2022 were retrospectively analyzed. Medical history, physical examination, and radiographic images were recorded in detail. The greatest dimension of the suprapatellar pouch (SP) effusion on radiograph was measured. Computed tomography and magnetic resonance imaging were used to confirm the presence of neglected osteochondral fractures and measure the fragment size. Potential risk factors were calculated and correlated with reference to the neglected osteochondral fractures and fragment size using multivariate linear regression analysis. RESULTS Weight, walking ability, effusion grade, and SP measurement had a significant correlation with neglected osteochondral fractures in primary acute traumatic patellar dislocation (p = 0.046; p < 0.001; p = 0.048; p < 0.001). The cutoff point was 53.5 kg for weight and 18.45 mm for SP measurement. In the neglected fractures group, SP measurement was statistically significant with larger fragment size (beta value = 0.457; p < 0.001), and the cutoff point was 26.2 mm. CONCLUSIONS SP effusion is not only associated with an increased risk of neglected osteochondral fractures in primary acute traumatic patellar dislocation but also with larger fragment size. Knee radiograph, medical history, and physical examination can predict the need for further imaging examination and even surgery in primary acute traumatic patellar dislocation.
Collapse
Affiliation(s)
- Mingyuan Miao
- Department of Orthopedic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haoqi Cai
- Department of Orthopedic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhigang Wang
- Department of Orthopedic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jingxia Bian
- Department of Orthopedic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haiqing Cai
- Department of Orthopedic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
34
|
Bucolo GM, Ascenti V, Barbera S, Fontana F, Aricò FM, Piacentino F, Coppola A, Cicero G, Marino MA, Booz C, Vogl TJ, D'Angelo T, Venturini M, Ascenti G. Virtual Non-Contrast Spectral CT in Renal Masses: Is It Time to Discard Conventional Unenhanced Phase? J Clin Med 2023; 12:4718. [PMID: 37510833 PMCID: PMC10380803 DOI: 10.3390/jcm12144718] [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: 05/29/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Dual-layer Dual-Energy CT (dl-DECT) allows one to create virtual non-contrast (VNC) reconstructions from contrast-enhanced CT scans, with a consequent decrease of the radiation dose. This study aims to assess the reliability of VNC for the diagnostic evaluation of renal masses in comparison with true non-contrast (TNC) images. The study cohort included 100 renal masses in 40 patients who underwent dl-DECT between June and December 2021. Attenuation values and standard deviations were assessed through the drawing of regions of interest on TNC and VNC images reconstructed from corticomedullary and nephrographic phases. A Wilcoxon signed-rank test was performed in order to assess equivalence of data and Spearman's Rho correlation coefficient to evaluate correlations between each parameter. The diagnostic accuracy of VNC was estimated through the performance of receiver operating characteristic (ROC) curve analysis. Differences between attenuation values were, respectively, 74%, 18%, 5% and 3% (TNC-VNCcort), and 74%, 15%, 9% and 2% (TNC-VNCneph). The Wilcoxon signed-rank test demonstrated the equivalence of attenuation values between the TNC and VNC images. The diagnostic performance of VNC images in the depiction of kidney simple cysts remains high compared to TNC (VNCcort-AUC: 0.896; VNCneph-AUC: 0.901, TNC-AUC: 0.903). In conclusion, quantitative analysis of attenuation values showed a strong agreement between VNC and TNC images in the evaluation of renal masses.
Collapse
Affiliation(s)
- Giuseppe M Bucolo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Velio Ascenti
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Simone Barbera
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Francesco M Aricò
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| | - Christian Booz
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Thomas J Vogl
- Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, 98122 Messina, Italy
| |
Collapse
|
35
|
Averbeck D. Low-Dose Non-Targeted Effects and Mitochondrial Control. Int J Mol Sci 2023; 24:11460. [PMID: 37511215 PMCID: PMC10380638 DOI: 10.3390/ijms241411460] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Non-targeted effects (NTE) have been generally regarded as a low-dose ionizing radiation (IR) phenomenon. Recently, regarding long distant abscopal effects have also been observed at high doses of IR) relevant to antitumor radiation therapy. IR is inducing NTE involving intracellular and extracellular signaling, which may lead to short-ranging bystander effects and distant long-ranging extracellular signaling abscopal effects. Internal and "spontaneous" cellular stress is mostly due to metabolic oxidative stress involving mitochondrial energy production (ATP) through oxidative phosphorylation and/or anaerobic pathways accompanied by the leakage of O2- and other radicals from mitochondria during normal or increased cellular energy requirements or to mitochondrial dysfunction. Among external stressors, ionizing radiation (IR) has been shown to very rapidly perturb mitochondrial functions, leading to increased energy supply demands and to ROS/NOS production. Depending on the dose, this affects all types of cell constituents, including DNA, RNA, amino acids, proteins, and membranes, perturbing normal inner cell organization and function, and forcing cells to reorganize the intracellular metabolism and the network of organelles. The reorganization implies intracellular cytoplasmic-nuclear shuttling of important proteins, activation of autophagy, and mitophagy, as well as induction of cell cycle arrest, DNA repair, apoptosis, and senescence. It also includes reprogramming of mitochondrial metabolism as well as genetic and epigenetic control of the expression of genes and proteins in order to ensure cell and tissue survival. At low doses of IR, directly irradiated cells may already exert non-targeted effects (NTE) involving the release of molecular mediators, such as radicals, cytokines, DNA fragments, small RNAs, and proteins (sometimes in the form of extracellular vehicles or exosomes), which can induce damage of unirradiated neighboring bystander or distant (abscopal) cells as well as immune responses. Such non-targeted effects (NTE) are contributing to low-dose phenomena, such as hormesis, adaptive responses, low-dose hypersensitivity, and genomic instability, and they are also promoting suppression and/or activation of immune cells. All of these are parts of the main defense systems of cells and tissues, including IR-induced innate and adaptive immune responses. The present review is focused on the prominent role of mitochondria in these processes, which are determinants of cell survival and anti-tumor RT.
Collapse
Affiliation(s)
- Dietrich Averbeck
- Laboratory of Cellular and Molecular Radiobiology, PRISME, UMR CNRS 5822/IN2P3, IP2I, Lyon-Sud Medical School, University Lyon 1, 69921 Oullins, France
| |
Collapse
|
36
|
Inoue Y, Itoh H, Nagahara K, Hata H, Mitsui K. Relationships of Radiation Dose Indices with Body Size Indices in Adult Body Computed Tomography. Tomography 2023; 9:1381-1392. [PMID: 37489478 PMCID: PMC10366833 DOI: 10.3390/tomography9040110] [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: 06/11/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
We investigated the relationships between radiation dose indices and body size indices in adult body computed tomography (CT). A total of 3200 CT scans of the thoracic, abdominal, abdominopelvic, or thoraco-abdominopelvic regions performed using one of four CT scanners were analyzed. Volume CT dose index (CTDIvol) and dose length product (DLP) were compared with various body size indices derived from CT images (water-equivalent diameter, WED; effective diameter, ED) and physical measurements (weight, weight/height, body mass index, and body surface area). CTDIvol showed excellent positive linear correlations with WED and ED. CTDIvol also showed high linear correlations with physical measurement-based indices, whereas the correlation coefficients were lower than for WED and ED. Among the physical measurement-based indices, weight/height showed the strongest correlations, followed by weight. Compared to CTDIvol, the correlation coefficients with DLP tended to be lower for WED, ED, and weight/height and higher for weight. The standard CTDIvol values at 60 kg and dose increase ratios with increasing weight, estimated using the regression equations, differed among scanners. Radiation dose indices closely correlated with body size indices such as WED, ED, weight/height, and weight. The relationships between dose and body size differed among scanners, indicating the significance of dose management considering body size.
Collapse
Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| | - Hiroyasu Itoh
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan
| | - Kazunori Nagahara
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan
| | - Hirofumi Hata
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0375, Japan
| | - Kohei Mitsui
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| |
Collapse
|
37
|
Smoll NR, Brady Z, Scurrah KJ, Lee C, Berrington de González A, Mathews JD. Computed tomography scan radiation and brain cancer incidence. Neuro Oncol 2023; 25:1368-1376. [PMID: 36638155 PMCID: PMC10326490 DOI: 10.1093/neuonc/noad012] [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: 05/18/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Computed tomography (CT) scans make substantial contributions to low-dose ionizing radiation exposures, raising concerns about excess cancers caused by diagnostic radiation. METHODS Deidentified medicare records for all Australians aged 0-19 years between 1985-2005 were linked to national death and cancer registrations to 2012. The National Cancer Institute CT program was used to estimate radiation doses to the brain from CT exposures in 1985-2005, Poisson regression was used to model the dependence of brain cancer incidence on brain radiation dose, which lagged by 2 years to minimize reverse causation bias. RESULTS Of 10 524 842 young Australians, 611 544 were CT-exposed before the age of 20 years, with a mean cumulative brain dose of 44 milligrays (mGy) at an average follow-up of 13.5 years after the 2-year lag period. 4472 were diagnosed with brain cancer, of whom only 237 had been CT-exposed. Brain cancer incidence increased with radiation dose to the brain, with an excess relative risk of 0.8 (95% CI 0.57-1.06) per 100 mGy. Approximately 6391 (95% CI 5255, 8155) persons would need to be exposed to cause 1 extra brain cancer. CONCLUSIONS For brain tumors that follow CT exposures in childhood by more than 2 years, we estimate that 40% (95% CI 29%-50%) are attributable to CT Radiation and not due to reverse causation. However, because of relatively low rates of CT exposure in Australia, only 3.7% (95% CI 2.3%-5.4%) of all brain cancers are attributable to CT scans. The population-attributable fraction will be greater in countries with higher rates of pediatric scanning.
Collapse
Affiliation(s)
- Nicolas R Smoll
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
| | - Zoe Brady
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
- Department of Radiology and Nuclear Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Katrina J Scurrah
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - John D Mathews
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
| |
Collapse
|
38
|
Moon J. The relationship between radiofrequency-electromagnetic radiation from cell phones and brain tumor: The brain tumor incidence trends in South Korea. ENVIRONMENTAL RESEARCH 2023; 226:115657. [PMID: 36906274 DOI: 10.1016/j.envres.2023.115657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION The aim of this study is to investigate the relationship between the nationwide cell phone subscription rate and the nationwide incidence of brain tumors in South Korea. The nationwide cell phone subscription rate was used as a proxy for the RF-EMR exposure assessment. METHODS The data for cell phone subscriptions per 100 persons from 1985 to 2019 were found in the Statistics, International Telecom Union (ITU). The brain tumor incidence data from 1999 to 2018 provided by the South Korea Central Cancer Registry operated by the National Cancer Center were used. RESULTS In South Korea, the subscription rate increased from 0 per 100 persons in 1991 to 57 per 100 persons in 2000. The subscription rate became 97 per 100 persons in 2009 and 135 per 100 persons in 2019. For the correlation coefficient between cell phone subscription rate before 10 years and ASIR per 100,000, a positive correlation coefficient with a statistical significance was reported in 3 benign brain tumors (International Classification of Diseases, ICD-10 code, D32, D33, and D32.0) and in 3 malignant brain tumors (ICD-10 code, C71.0, C71.1, and C71.2). Positive correlation coefficients with a statistical significance in malignant brain tumors ranged from 0.75 (95% CI 0.46-0.90) for C71.0 to 0.85 (95% CI 0.63-0.93) for C71.1. DISCUSSION In consideration of the fact that the main route for RF-EMR exposure has been through the frontotemporal side of the brain (the location of both ears), the positive correlation coefficient with a statistical significance in the frontal lobe (C71.1) and temporal lobe (C71.2) can be understood. Statistically insignificant results from recent cohort and large population international studies and contrasting results from many previous case-control studies could indicate a difficulty in identifying a factor as a determinant of a disease in ecological study design.
Collapse
Affiliation(s)
- Jinyoung Moon
- Department of Occupational and Environmental Medicine, Inha University Hospital, Inhang-ro 27, Jung-gu, Incheon, 22332, South Korea; Department of Environmental Health Science, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, South Korea.
| |
Collapse
|
39
|
Farrell ND, Dooley JH, Sheffer BW, Sawyer JR, Kelly DM. Radiation exposure in multiple hereditary exostoses: A retrospective review. J Orthop 2023; 40:87-90. [PMID: 37234093 PMCID: PMC10206377 DOI: 10.1016/j.jor.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
Background Exposure to ionizing radiation in patients with Multiple Hereditary Exostoses (MHE) is inevitable and necessary for the diagnosis and treatment of MHE. Radiation exposure has many potentially dangerous consequences, including the increased risk of developing cancer. This is especially concerning in the pediatric patient population since children are more likely to develop adverse effects from radiation than adults. This study aimed to quantify radiation exposure over a five-year period among patients diagnosed with MHE since such information is not currently available in the literature. Methods Diagnostic radiographs, computed tomography (CT) scans, nuclear medicine studies, and intraoperative fluoroscopy exposures were analyzed for radiation exposure in 37 patients diagnosed with MHE between 2015 and 2020. Results Thirty-seven patients with MHE underwent 1200 imaging studies, 976 of which were related to MHE and 224 unrelated to MHE. The mean estimated MHE cumulative radiation dose per patient was 5.23 mSv. Radiographs related to MHE contributed the most radiation. Patients from the ages of 10- to 24-years-old received the most imaging studies and exposure to ionizing radiation, especially compared to those under age 10 (P = 0.016). The 37 patients also received a total of 53 surgical-excision procedures, with a mean of 1.4 procedures per person. Conclusions MHE patients are exposed to increased levels of ionizing radiation secondary to serial diagnostic imaging, with those ages 10-24 years old being exposed to significantly higher doses of radiation. Because pediatric patients are more sensitive to radiation exposure and are at an overall higher risk, the use of radiographs should always be justified in those patients.
Collapse
Affiliation(s)
- Nolan D. Farrell
- The University of Tennessee Health Science Center — Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Jennings H. Dooley
- Northwestern University Feinberg School of Medicine, Department of Orthopaedic Surgery, Chicago, IL, USA
| | - Benjamin W. Sheffer
- The University of Tennessee Health Science Center — Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Jeffrey R. Sawyer
- The University of Tennessee Health Science Center — Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Derek M. Kelly
- The University of Tennessee Health Science Center — Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| |
Collapse
|
40
|
Bohang SAM, Sohaimi N. An Overview on the Alignment of Radiation Protection in Computed Tomography with Maqasid al-Shari'ah in the Context of al-Dharuriyat. Malays J Med Sci 2023; 30:60-72. [PMID: 37425388 PMCID: PMC10325131 DOI: 10.21315/mjms2023.30.3.5] [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: 07/26/2021] [Accepted: 01/08/2022] [Indexed: 07/11/2023] Open
Abstract
The increasing utilisation of computed tomography (CT) in the medical field has raised a greater concern regarding the radiation-induced health effects as CT imposes high radiation risks on the exposed individual. Adherence to radiation protection measures in CT as endorsed by regulatory bodies; justification, optimisation and dose limit, is essential to minimise radiation risks. Islam values every human being and Maqasid al-Shari'ah helps to protect human beings through its sacred principles which aim to fulfil human beings' benefits (maslahah) and prevent mischief (mafsadah). Alignment of the concept of radiation protection in CT within the framework of al-Dharuriyat; protection of faith or religion (din), protection of life (nafs), protection of lineage (nasl), protection of intellect ('aql) and protection of property (mal) is essential. This strengthens the concept and practices of radiation protection in CT among radiology personnel, particularly Muslim radiographers. The alignment provides supplementary knowledge towards the integration of knowledge fields between Islamic worldview and radiation protection in medical imaging, particularly in CT. This paper is hoped to set a benchmark for future studies on the integration of knowledge between the Islamic worldview and radiation protection in medical imaging in terms of other classifications of Maqasid al-Shari'ah; al-Hajiyat and al-Tahsiniyat.
Collapse
Affiliation(s)
- Siti Aisyah Munirah Bohang
- Department of Diagnostic Imaging and Radiotherapy, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
| | - Norhanna Sohaimi
- Department of Diagnostic Imaging and Radiotherapy, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
| |
Collapse
|
41
|
Spadafora M, Sannino P, Mansi L, Mainolfi C, Capasso R, Di Giorgio E, Fiordoro S, Imbimbo S, Masone F, Evangelista L. Algorithm for Reducing Overall Biological Detriment Caused by PET/CT: an Age-Based Study. Nucl Med Mol Imaging 2023; 57:137-144. [PMID: 37181801 PMCID: PMC10172419 DOI: 10.1007/s13139-023-00788-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/16/2023] [Accepted: 01/28/2023] [Indexed: 02/09/2023] Open
Abstract
Purpose This study is to use a simple algorithm based on patient's age to reduce the overall biological detriment associated with PET/CT. Materials and Methods A total of 421 consecutive patients (mean age 64 ± 14 years) undergoing PET for various clinical indications were enrolled. For each scan, effective dose (ED in mSv) and additional cancer risk (ACR) were computed both in a reference condition (REF) and after applying an original algorithm (ALGO). The ALGO modified the mean dose of FDG and the PET scan time parameters; indeed, a lower dose and a longer scan time were reported in the younger, while a higher dose and a shorter scan time in the older patients. Moreover, patients were classified by age bracket (18-29, 30-60, and 61-90 years). Results The ED was 4.57 ± 0.92 mSv in the REF condition. The ACR were 0.020 ± 0.016 and 0.0187 ± 0.013, respectively, in REF and ALGO. The ACR for the REF and ALGO conditions were significantly reduced in males and females, although it was more evident in the latter gender (all p < 0.0001). Finally, the ACR significantly reduced from the REF condition to ALGO in all three age brackets (all p < 0.0001). Conclusion Implementation of ALGO protocols in PET can reduce the overall ACR, mainly in young and female patients.
Collapse
Affiliation(s)
| | | | - Luigi Mansi
- CIRPS, Interuniversity Research Center for Sustainability, Rome, Italy
- IOS–Medicina Futura, Acerra, Naples, Italy
| | - Ciro Mainolfi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | | | | | | | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| |
Collapse
|
42
|
Abalo KD, Malekzadeh-Milani S, Hascoët S, Dreuil S, Feuillet T, Damon C, Bouvaist H, Bouzguenda I, Cohen S, Dauphin C, Di Filippo S, Douchin S, Godart F, Guérin P, Helms P, Karsenty C, Lefort B, Mauran P, Ovaert C, Piéchaud JF, Thambo JB, Lee C, Little MP, Bonnet D, Bernier MO, Rage E. Lympho-hematopoietic malignancies risk after exposure to low dose ionizing radiation during cardiac catheterization in childhood. Eur J Epidemiol 2023:10.1007/s10654-023-01010-7. [PMID: 37191831 DOI: 10.1007/s10654-023-01010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Abstract
Pediatric patients with congenital heart disease (CHD) often undergo low dose ionizing radiation (LDIR) from cardiac catheterization (CC) for the diagnosis and/or treatment of their disease. Although radiation doses from a single CC are usually low, less is known about the long-term radiation associated cancer risks. We aimed to assess the risk of lympho-hematopoietic malignancies in pediatric CHD patients diagnosed or treated with CC. A French cohort of 17,104 children free of cancer who had undergone a first CC from 01/01/2000 to 31/12/2013, before the age of 16 was set up. The follow-up started at the date of the first recorded CC until the exit date, i.e., the date of death, the date of first cancer diagnosis, the date of the 18th birthday, or the 31/12/2015, whichever occurred first. Poisson regression was used to estimate the LDIR associated cancer risk. The median follow-up was 5.9 years, with 110,335 person-years. There were 22,227 CC procedures, yielding an individual active bone marrow (ABM) mean cumulative dose of 3.0 milligray (mGy). Thirty-eight incident lympho-hematopoietic malignancies were observed. When adjusting for attained age, gender and predisposing factors to cancer status, no increased risk was observed for lympho-hematopoietic malignancies RR/mGy = 1.00 (95% CI: 0.88; 1.10). In summary, the risk of lympho-hematopoietic malignancies and lymphoma was not associated to LDIR in pediatric patients with CHD who undergo CC. Further epidemiological studies with greater statistical power are needed to improve the assessment of the dose-risk relationship.
Collapse
Affiliation(s)
- Kossi D Abalo
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE/SESANE/Laboratory of Epidemiology, BP 17, Fontenay-aux-Roses, 92262, France
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital universitaire Necker-Enfants malades, Université de Paris Cité, Paris, France
| | - Sébastien Hascoët
- Cardiology department, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Serge Dreuil
- Institute for Radiological Protection and Nuclear Safety, (IRSN), PSE-SANTE/SER/UEM, BP 17, Fontenay-aux-Roses, 92262, France
| | | | - Cecilia Damon
- Institute for Radiological Protection and Nuclear Safety, (IRSN), DTR/D3NSI/SVDDA/CVD, BP 17, Fontenay-aux-Roses, 92262, France
| | - Hélène Bouvaist
- Cardiopédiatrie, hôpital couple enfant, CHU Grenoble Alpes, Grenoble cedex 9, 38043, France
| | - Ivan Bouzguenda
- Pediatric and congenital cardiology, Interventional cardiology, INTERCARD Clinique La Louvière, Lille, France
| | - Sarah Cohen
- Cardiology department, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Claire Dauphin
- Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvie Di Filippo
- Paediatric and Congential Cardiology Department, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Douchin
- Cardiopédiatrie, hôpital couple enfant, CHU Grenoble Alpes, Grenoble cedex 9, 38043, France
| | - François Godart
- Service de Cardiologie Infantile et Congénitale, Institut Coeur Poumon, Lille Cedex, 59037, France
| | - Patrice Guérin
- CHU Nantes, INSERM, Nantes Université, Clinique Cardiologique et des Maladies Vasculaires, Institut du Thorax, Nantes, 1413, CIC, France
| | - Pauline Helms
- Unit of Cardiopediatrics, University Hospital of Strasbourg, Strasbourg, France
| | - Clément Karsenty
- Pediatric and Congenital Cardiology, Institut des Maladies Métaboliques et Cardiovasculaires, Children's Hospital, INSERM U1048, Université de Toulouse, Toulouse, I2MC, France
| | - Bruno Lefort
- Institut des Cardiopathies Congénitales, CHRU Tours, 49 boulevard Béranger, Tours, 37000, France
| | - Pierre Mauran
- Unité de cardiologie pédiatrique et congénitale, American Memorial Hospital, CHU de Reims, 47 rue Cognacq-Jay, Reims Cedex, 51092, France
| | - Caroline Ovaert
- Cardiologie pédiatrique et congénitale, AP-HM et INSERM 1251, Aix-Marseille Université, Timone enfants, Marseille, France
| | | | - Jean-Benoît Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Pessac, 33600, France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Damien Bonnet
- M3C-Necker, Hôpital universitaire Necker-Enfants malades, Université de Paris Cité, Paris, France
| | - Marie-Odile Bernier
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE/SESANE/Laboratory of Epidemiology, BP 17, Fontenay-aux-Roses, 92262, France
| | - Estelle Rage
- Institute for Radiological Protection and Nuclear Safety (IRSN), PSE-SANTE/SESANE/Laboratory of Epidemiology, BP 17, Fontenay-aux-Roses, 92262, France.
| |
Collapse
|
43
|
Inoue Y. Radiation Dose Management in Computed Tomography: Introduction to the Practice at a Single Facility. Tomography 2023; 9:955-966. [PMID: 37218938 DOI: 10.3390/tomography9030078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
Although the clinical benefits of computed tomography (CT) are undoubtedly high, radiation doses received by patients are also relatively high; therefore, radiation dose management is mandatory to optimize CT radiation doses and prevent excessive radiation events. This article describes CT dose management practice at a single facility. Many imaging protocols are used in CT depending on the clinical indications, scan region, and CT scanner; thus, managing the protocols is the first step for optimization. The appropriateness of the radiation dose for each protocol and scanner is verified, while answering whether the dose is the minimum to obtain diagnostic-quality images. Moreover, examinations with exceptionally high doses are identified, and the cause and clinical validity of the high dose are assessed. Daily imaging practice should follow standardized procedures, avoiding operator-dependent errors, and information required for radiation dose management should be recorded at each examination. The imaging protocols and procedures are reviewed for continuous improvement based on regular dose analysis and multidisciplinary team collaboration. The participation of many staff members in the dose management process is expected to contribute to promoting radiation safety through increased staff awareness.
Collapse
Affiliation(s)
- Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| |
Collapse
|
44
|
Fujii K, Inoue Y, Itoh H, Sasa R, Hata H, Mitsui K. Size-specific dose estimates in pediatric brain CT in relation to age and weight. RADIATION PROTECTION DOSIMETRY 2023:7133666. [PMID: 37083027 DOI: 10.1093/rpd/ncad133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/24/2023] [Accepted: 03/21/2023] [Indexed: 05/03/2023]
Abstract
The size-specific dose estimate (SSDE) is used for radiation dose management in computed tomography (CT) and represents patient's absorbed dose more accurately than volume CT dose index. The relationship between SSDE and age or weight was investigated using 980 pediatric brain CT scans. Monolinear, power, and bilinear functions were fitted to the plots of SSDE against age or weight, and SSDE was estimated using the obtained functions. SSDE showed a biphasic increase with increasing age and weight: a rapid initial increase and subsequent a slow increase. Bilinear and power functions were successfully fitted to the plots, and mean estimation errors were close to 0, irrespective of the age or weight group. The standard SSDE values estimated from the obtained functions agreed well with the median values for each age or weight group. The curve-fitting method is expected to aid radiation dose management for pediatric brain CT using SSDE.
Collapse
Affiliation(s)
- Kaoru Fujii
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| | - Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| | - Hiroyasu Itoh
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0329, Japan
| | - Ryosuke Sasa
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0329, Japan
| | - Hirofumi Hata
- Department of Radiology, Kitasato University Hospital, Sagamihara 252-0329, Japan
| | - Kohei Mitsui
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
| |
Collapse
|
45
|
Wang YRJ, Wang P, Adams LC, Sheybani ND, Qu L, Sarrami AH, Theruvath AJ, Gatidis S, Ho T, Zhou Q, Pribnow A, Thakor AS, Rubin D, Daldrup-Link HE. Low-count whole-body PET/MRI restoration: an evaluation of dose reduction spectrum and five state-of-the-art artificial intelligence models. Eur J Nucl Med Mol Imaging 2023; 50:1337-1350. [PMID: 36633614 PMCID: PMC10387227 DOI: 10.1007/s00259-022-06097-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To provide a holistic and complete comparison of the five most advanced AI models in the augmentation of low-dose 18F-FDG PET data over the entire dose reduction spectrum. METHODS In this multicenter study, five AI models were investigated for restoring low-count whole-body PET/MRI, covering convolutional benchmarks - U-Net, enhanced deep super-resolution network (EDSR), generative adversarial network (GAN) - and the most cutting-edge image reconstruction transformer models in computer vision to date - Swin transformer image restoration network (SwinIR) and EDSR-ViT (vision transformer). The models were evaluated against six groups of count levels representing the simulated 75%, 50%, 25%, 12.5%, 6.25%, and 1% (extremely ultra-low-count) of the clinical standard 3 MBq/kg 18F-FDG dose. The comparisons were performed upon two independent cohorts - (1) a primary cohort from Stanford University and (2) a cross-continental external validation cohort from Tübingen University - in order to ensure the findings are generalizable. A total of 476 original count and simulated low-count whole-body PET/MRI scans were incorporated into this analysis. RESULTS For low-count PET restoration on the primary cohort, the mean structural similarity index (SSIM) scores for dose 6.25% were 0.898 (95% CI, 0.887-0.910) for EDSR, 0.893 (0.881-0.905) for EDSR-ViT, 0.873 (0.859-0.887) for GAN, 0.885 (0.873-0.898) for U-Net, and 0.910 (0.900-0.920) for SwinIR. In continuation, SwinIR and U-Net's performances were also discreetly evaluated at each simulated radiotracer dose levels. Using the primary Stanford cohort, the mean diagnostic image quality (DIQ; 5-point Likert scale) scores of SwinIR restoration were 5 (SD, 0) for dose 75%, 4.50 (0.535) for dose 50%, 3.75 (0.463) for dose 25%, 3.25 (0.463) for dose 12.5%, 4 (0.926) for dose 6.25%, and 2.5 (0.534) for dose 1%. CONCLUSION Compared to low-count PET images, with near-to or nondiagnostic images at higher dose reduction levels (up to 6.25%), both SwinIR and U-Net significantly improve the diagnostic quality of PET images. A radiotracer dose reduction to 1% of the current clinical standard radiotracer dose is out of scope for current AI techniques.
Collapse
Affiliation(s)
- Yan-Ran Joyce Wang
- Department of Radiology, School of Medicine, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA.
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94304, USA.
| | - Pengcheng Wang
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, China
| | - Lisa Christine Adams
- Department of Radiology, School of Medicine, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Natasha Diba Sheybani
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94304, USA
| | - Liangqiong Qu
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94304, USA
| | - Amir Hossein Sarrami
- Department of Radiology, School of Medicine, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Ashok Joseph Theruvath
- Department of Radiology, School of Medicine, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Tina Ho
- Department of Radiology, School of Medicine, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Quan Zhou
- Department of Radiology, School of Medicine, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA
| | - Allison Pribnow
- Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94304, USA
| | - Avnesh S Thakor
- Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94304, USA
| | - Daniel Rubin
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94304, USA
- Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94304, USA
| | - Heike E Daldrup-Link
- Department of Radiology, School of Medicine, Stanford University, 725 Welch Road, Stanford, CA, 94304, USA.
- Department of Pediatrics, Pediatric Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, 94304, USA.
| |
Collapse
|
46
|
Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
Collapse
Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
| |
Collapse
|
47
|
Do All Pediatric Femoral Shaft Fractures Need a Computed Tomography Scan of the Ipsilateral Femoral Neck? Calculating the Incidence of Concomitant Femoral Neck and Shaft Fractures. J Pediatr Orthop 2023; 43:e204-e208. [PMID: 36563087 DOI: 10.1097/bpo.0000000000002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In adults, the incidence of ipsilateral femoral neck fractures in the setting of femoral shaft fractures is reported to be as high as 9%; however, scant literature exists on the same clinical scenario in pediatric/adolescent populations. Therefore, the purpose of this study was to investigate the incidence of ipsilateral femoral neck fracture in the setting of femoral shaft fractures in children and adolescents treated in pediatric hospitals across the United States. METHODS The Pediatric Health Information System database was queried for patients aged 18 years or younger who were treated for a femoral neck, femoral shaft, and pertrochanteric femur fractures through an emergency department, inpatient, ambulatory surgery, or observation visit. Patients were identified using ICD-9 and ICD-10 diagnosis codes. Data from 49 pediatric hospitals between the years 2002 and 2020 were included. Incidence was calculated as the number of cases including the event divided by the total number of cases. RESULTS A total of 90,146 records were identified from a cohort of 55,733,855 (0.16%). Distal femur fractures, pathologic fractures, and periprosthetic fractures were excluded, resulting in 65,651 unique cases. Of the 65,651 cases, 7104 (11%) were identified as isolated neck fractures. The combined incidence of femoral neck or pertrochanteric femur fractures in the setting of a femoral shaft fracture was 82.3 per 10,000 cases (0.82%). Only 283 cases of concomitant femoral neck and shaft fractures were found among 55,169 femoral shaft fractures (0.5%). CONCLUSIONS The incidence of ipsilateral femoral neck or pertrochanteric femur fractures in the setting of a femoral shaft fracture is 82.3 per 10,000 patients (0.82%) based on data from Pediatric Health Information System-participating institutions. The incidence of femoral neck/pertrochanteric femur fractures and femoral shaft fractures in children and adolescents is more than 10 times lower than reported for adults; therefore, the routine use of advanced diagnostic imaging in pediatric patients with femoral shaft fractures should be considered cautiously. LEVEL OF EVIDENCE Level IV; cross-sectional analysis.
Collapse
|
48
|
Togher CJ, Ferrise T, Sahli H, Sebag JA, Butterfield J, Shane AM, Reeves C. Identifying the Potential Role of Regional Bone Mineral Density on the Degree of Malleolar Involvement in Acute Ankle Fractures. J Foot Ankle Surg 2023; 62:333-337. [PMID: 36210259 DOI: 10.1053/j.jfas.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 02/03/2023]
Abstract
Ankle fractures are a common traumatic lower extremity injury and are generally classified and characterized by the rotational mechanism of injury. At each malleolus (i.e., posterior, medial, and lateral) a fracture can occur or a ligamentous injury may be sustained. The purpose of this retrospective study was to determine if bone mineral density is a contributing factor on the number of fractured malleoli versus soft tissue injury in adult ankle fractures. Data was obtained from a registry of ankle fractures that were operatively treated by the foot and ankle team throughout our institutional facilities, from July 2017 to August 2019, and in which a preoperative computerized tomography scan was performed. Regional bone mineral density (BMD) was measured by calculating the average Hounsfield Unit (HU) on axial computerized tomography images of the distal fibula and tibia. The average HU was then compared to the number of fractured malleoli. One hundred eight patients met the study criteria. We identified statistically significant relationships between decreased BMD with increasing age (p < .01) and the male gender (p < .01). After adjusting for the covariates age and gender, no statistically significant relationship was identified between BMD and the number of malleoli involved in a given ankle fracture (p = .11). These findings suggest that while more investigation is required for ankle fracture patterns and BMD evaluation, increased age and biologic female gender is significantly related to decreased BMD as identified via HU.
Collapse
Affiliation(s)
| | - Thomas Ferrise
- Advent Health East Orlando Podiatric Surgery Residency, Orlando, FL
| | | | - Joshua A Sebag
- Coastal Orthopedic & Sports Medicine Center, Port Saint Lucie, FL
| | | | - Amber M Shane
- Orlando Foot and Ankle Clinic-Upperline Health, Orlando, FL
| | | |
Collapse
|
49
|
Kamrava B, Shah VN, Torres L, Sidani C, Saigal G, Hoffer ME, Szczupak MB. Utilization of computed tomography in pediatric temporal fractures: A dose reduction approach. Am J Otolaryngol 2023; 44:103768. [PMID: 36628910 DOI: 10.1016/j.amjoto.2022.103768] [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: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES METHODS: Retrospective chart review was performed of pediatric patients who underwent CT brain as part of a trauma pan-scan and dedicated temporal bone CT in the setting of head trauma. The original CT images were re-reviewed by two board certified Neuroradiologists in a blinded manner to determine the presence or absence of temporal bone fracture and if present, fracture line involvement of the 5 critical temporal bone anatomic structures. The dose length product (DLP), a measure of approximate total radiation dose delivered during CT scan (mGy-cm), was noted from the data available. RESULTS There were 24 temporal bone fractures in a total of 29 patients (4 with bilateral fractures). There were 21 of 24 fractures that were correctly identified on trauma pan-scan CT with dedicated temporal bone CT considered as the diagnostic gold standard. There was a combined sensitivity and specificity of 91 % and 100 % respectively. The sensitivity and specificity in identifying involvement of critical structures were as follows: carotid canal (100 % and 100 %); ossicular chain (75 % and 100 %); tegmen tympani (60 % and 97.9 %); facial nerve canal (25 % and 100 %); otic capsule (N/A and 98.5 %). The median DLP for trauma pan-scan CT and temporal bone CT were 627 mGy-cm and 267 mGy-cm respectively. CONCLUSION Dedicated TBCT is not required to accurately diagnose and characterize temporal bone fractures seen on trauma pan-scan CT. The radiation exposure of concurrent or subsequent dedicated temporal bone imaging is equal to approximately one half of the original trauma pan-scan CT.
Collapse
Affiliation(s)
- Brandon Kamrava
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Viraj N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Leonardo Torres
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Charif Sidani
- Department of Diagnostic Radiology, Baptist Health South Florida, Coral Gables, FL, USA
| | - Gaurav Saigal
- Department of Diagnostic Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael E Hoffer
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mikhaylo B Szczupak
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
50
|
Ohene-Botwe B, Schandorf C, Inkoom S, Faanu A. Estimation of organ-specific cancer and mortality risks associated with common indication-specific CT examinations of the abdominopelvic region. J Med Imaging Radiat Sci 2023; 54:135-144. [PMID: 36646547 DOI: 10.1016/j.jmir.2022.12.003] [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: 09/07/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION There is a paucity of large-scale studies reporting organ doses and cancer risks in patients who undergo indication-specific CT examinations. This study estimated organ-specific lifetime attributable risk (LAR) of cancer incidence and mortality among patients who underwent indication-based computed tomography (CT) examinations [(involving abdominopelvic lesion, kidney stones and computed tomography-intravenous urography (CT-IVU)] in about 70% of the functioning CT facilities in Ghana. METHODS With a total of 1,100 data sets, organ doses were first determined using the National Cancer Institute Dosimetry System for CT (NCICTX) software version 2.1, and LAR values were predicted using the BEIR VII model. RESULTS The estimated radiation-induced colon cancer risks were likely in 39.4-59.8 out of 100,000 patients who underwent CT because of abdominopelvic lesion. The risk was even higher in CT-IVU examinations (53.3-66.4 patients in 100,000 procedures) but was relatively less (16.8-26.3 patients) in kidney stone procedures. Accordingly, the risk of radiation-induced colon mortality was more common in CT-IVU than in kidney stone procedures (22.7-28.2 versus 7.2-12.5 patients in 100,000 procedures). CONCLUSION These results call for further optimisation actions for indication-specific CT examinations to appropriately reduce the potential risk levels for patients' protection and safety.
Collapse
Affiliation(s)
- Benard Ohene-Botwe
- Department of Midwifery and Radiography, School of Health & Psychological Sciences, City, University of London, London, United Kingdom.; Radiography Department, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu Campus, Accra, Ghana.
| | - Cyril Schandorf
- Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Ghana, Legon
| | - Stephen Inkoom
- Medical Physics Department, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Ghana; Radiation Protection Institute (RPI), Ghana Atomic Energy Commission, Accra, Ghana
| | - Augustine Faanu
- Radiological and Non-ionizing Radiation Directorate, Nuclear Regulatory Authority, Accra, Ghana; Department of Nuclear Safety and Security, School of Nuclear and Allied Sciences, University of Ghana, Atomic Campus, Accra, Ghana, Legon
| |
Collapse
|