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Frush DP, Vassileva J, Brambilla M, Mahesh M, Rehani M, Samei E, Applegate K, Bourland J, Ciraj-Bjenlac O, Dahlstrom D, Gershan V, Gilligan P, Godthelp B, Hjemly H, Kainberger F, Mikhail-Lette M, Holmberg O, Paez D, Schrandt S, Valentin A, Van Deventer T, Wakeford R. Recurrent medical imaging exposures for the care of patients: one way forward. Eur Radiol 2024; 34:6475-6487. [PMID: 38592419 DOI: 10.1007/s00330-024-10659-x] [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: 11/01/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 04/10/2024]
Abstract
Medical imaging is both valuable and essential in the care of patients. Much of this imaging depends on ionizing radiation with attendant responsibilities for judicious use when performing an examination. This responsibility applies in settings of both individual as well as multiple (recurrent) imaging with associated repeated radiation exposures. In addressing the roles and responsibilities of the medical communities in the paradigm of recurrent imaging, both the International Atomic Energy Agency (IAEA) and the American Association of Physicists in Medicine (AAPM) have issued position statements, each affirmed by other organizations. The apparent difference in focus and approach has resulted in a lack of clarity and continued debate. Aiming towards a coherent approach in dealing with radiation exposure in recurrent imaging, the IAEA convened a panel of experts, the purpose of which was to identify common ground and reconcile divergent perspectives. The effort has led to clarifying recommendations for radiation exposure aspects of recurrent imaging, including the relevance of patient agency and the provider-patient covenant in clinical decision-making. CLINICAL RELEVANCE STATEMENT: An increasing awareness, generating some lack of clarity and divergence in perspectives, with patients receiving relatively high radiation doses (e.g., ≥ 100 mSv) from recurrent imaging warrants a multi-stakeholder accord for the benefit of patients, providers, and the imaging community. KEY POINTS: • Recurrent medical imaging can result in an accumulation of exposures which exceeds 100 milli Sieverts. • Professional organizations have different perspectives on roles and responsibilities for recurrent imaging. • An expert panel reconciles differing perspectives for addressing radiation exposure from recurrent medical imaging.
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Affiliation(s)
- Donald Paul Frush
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA.
| | - Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Marco Brambilla
- Department of Medical Physics, University Hospital of Novara, Novara, Italy
| | - Mahadevappa Mahesh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Madan Rehani
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Ehsan Samei
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA
| | | | - John Bourland
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Vesna Gershan
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Paddy Gilligan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Barbara Godthelp
- Authority for Nuclear Safety and Radiation Protection, The Hague, The Netherlands
| | - Hakon Hjemly
- International Society of Radiographers and Radiological Technologists, London, UK
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Ola Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Suz Schrandt
- ExPPect, Founder & CEO, and Patients for Patient Safety US, Champion (Affiliate, WHO PFPS Network), Arlington, VA, USA
| | - Andreas Valentin
- Department of Internal Medicine With Cardiology & Intensive Care Medicine Clinic Donaustadt Vienna Health Care Group, Vienna, Austria
| | | | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Manchester, UK
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Pace E, Caruana CJ, Bosmans H, Cortis K, D'Anastasi M, Valentino G. An inventory of patient-image based risk/dose, image quality and body habitus/size metrics for adult abdomino-pelvic CT protocol optimisation. Phys Med 2024; 125:103434. [PMID: 39096718 DOI: 10.1016/j.ejmp.2024.103434] [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: 10/03/2023] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 08/05/2024] Open
Abstract
PURPOSE Patient-specific protocol optimisation in abdomino-pelvic Computed Tomography (CT) requires measurement of body habitus/size (BH), sensitivity-specificity (surrogates image quality (IQ) metrics) and risk (surrogates often dose quantities) (RD). This work provides an updated inventory of metrics available for each of these three categories of optimisation variables derivable directly from patient measurements or images. We consider objective IQ metrics mostly in the spatial domain (i.e., those related directly to sharpness, contrast, noise quantity/texture and perceived detectability as these are used by radiologists to assess the acceptability or otherwise of patient images in practice). MATERIALS AND METHODS The search engine used was PubMed with the search period being 2010-2024. The key words used were: 'comput* tomography', 'CT', 'abdom*', 'dose', 'risk', 'SSDE', 'image quality', 'water equivalent diameter', 'size', 'body composition', 'habit*', 'BMI', 'obes*', 'overweight'. Since BH is critical for patient specific optimisation, articles correlating RD vs BH, and IQ vs BH were reviewed. RESULTS The inventory includes 11 BH, 12 IQ and 6 RD metrics. 25 RD vs BH correlation studies and 9 IQ vs BH correlation studies were identified. 7 articles in the latter group correlated metrics from all three categories concurrently. CONCLUSIONS Protocol optimisation should be fine-tuned to the level of the individual patient and particular clinical query. This would require a judicious choice of metrics from each of the three categories. It is suggested that, for increased utility in clinical practice, more future optimisation studies be clinical task based and involve the three categories of metrics concurrently.
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Affiliation(s)
- Eric Pace
- Medical Physics, Faculty of Health Science, University of Malta, Msida MSD2080, Malta.
| | - Carmel J Caruana
- Medical Physics, Faculty of Health Science, University of Malta, Msida MSD2080, Malta
| | - Hilde Bosmans
- Medical Physics & Quality Assessment, Department of Imaging & Pathology, KU Leuven, Leuven, Belgium
| | - Kelvin Cortis
- Medical Imaging Department, Mater Dei Hospital, Msida MSD2090, Malta
| | - Melvin D'Anastasi
- Medical Imaging Department, Mater Dei Hospital, Msida MSD2090, Malta
| | - Gianluca Valentino
- Communications & Computer Engineering Department, Faculty of Information and Communication Technology, University of Malta, Msida MSD2080, Malta
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Kim HJ, Kim H, Lee S, Koh WU, Park SS, Ro Y. Reconsidering injection volume for caudal epidural block in young pediatric patients: a dynamic flow tracking experimental study. Reg Anesth Pain Med 2024; 49:355-360. [PMID: 37429622 DOI: 10.1136/rapm-2023-104409] [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: 02/06/2023] [Accepted: 06/24/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Caudal epidural block is a commonly used analgesic technique in pediatric patients. Ultrasound could be used to increase the accuracy of the block by visual confirmation of the drug-spreading. Therefore, we aimed to estimate the cephalad spread of injection volume by caudal route using dynamic ultrasound imaging in young pediatric patients. METHODS Forty patients, aged 6-24 months, undergoing foot surgery were included. After inducing general anesthesia, an angiocatheter was inserted into the sacral canal under ultrasound guidance. Thereafter, the probe was placed in the paramedian sagittal oblique position, and prepared 0.15% ropivacaine was injected, 1 mL at a time, up to 1.0 mL.kg-1. The ultrasound probe was moved cranially following the bulk flow of local anesthetics. Our primary outcome was the required volume of local anesthetics to reach each level of interlaminar space. RESULTS The dynamic flow tracking was available in 39 patients, and the required volume of the injectate to reach L5-S1, L4-L5, L3-L4, L2-L3, L1-L2, T12-L1, and T11-T12 was 0.125, 0.223, 0.381, 0.591, 0.797, 0.960, and 1.050 mL.kg-1, respectively. The required volume to reach the immediate upper spinal level was inconsistent across various spinal levels. CONCLUSIONS Local anesthetics of 0.223, 0.591, and 0.797 mL.kg-1 could provide sufficient analgesia for localized foot, knee, and hip surgeries, respectively. However, since the required volume of the local anesthetics could not be calculated linearly, the real-time dynamic flow tracking technique for the caudal epidural block is recommended in young pediatric patients. TRIAL REGISTRATIONS ClinicalTrials.gov (NCT04039295).
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Affiliation(s)
- Ha-Jung Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, International Saint Mary's Hospital, Catholic Kwandong University, Incheon, Korea (the Republic of)
| | - Won Uk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Soo-Sung Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
| | - Youngjin Ro
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea (the Republic of)
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Ahmad N, Dahlberg H, Jönsson H, Tarai S, Guggilla RK, Strand R, Lundström E, Bergström G, Ahlström H, Kullberg J. Voxel-wise body composition analysis using image registration of a three-slice CT imaging protocol: methodology and proof-of-concept studies. Biomed Eng Online 2024; 23:42. [PMID: 38614974 PMCID: PMC11015680 DOI: 10.1186/s12938-024-01235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Computed tomography (CT) is an imaging modality commonly used for studies of internal body structures and very useful for detailed studies of body composition. The aim of this study was to develop and evaluate a fully automatic image registration framework for inter-subject CT slice registration. The aim was also to use the results, in a set of proof-of-concept studies, for voxel-wise statistical body composition analysis (Imiomics) of correlations between imaging and non-imaging data. METHODS The current study utilized three single-slice CT images of the liver, abdomen, and thigh from two large cohort studies, SCAPIS and IGT. The image registration method developed and evaluated used both CT images together with image-derived tissue and organ segmentation masks. To evaluate the performance of the registration method, a set of baseline 3-single-slice CT images (from 2780 subjects including 8285 slices) from the SCAPIS and IGT cohorts were registered. Vector magnitude and intensity magnitude error indicating inverse consistency were used for evaluation. Image registration results were further used for voxel-wise analysis of associations between the CT images (as represented by tissue volume from Hounsfield unit and Jacobian determinant) and various explicit measurements of various tissues, fat depots, and organs collected in both cohort studies. RESULTS Our findings demonstrated that the key organs and anatomical structures were registered appropriately. The evaluation parameters of inverse consistency, such as vector magnitude and intensity magnitude error, were on average less than 3 mm and 50 Hounsfield units. The registration followed by Imiomics analysis enabled the examination of associations between various explicit measurements (liver, spleen, abdominal muscle, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), thigh SAT, intermuscular adipose tissue (IMAT), and thigh muscle) and the voxel-wise image information. CONCLUSION The developed and evaluated framework allows accurate image registrations of the collected three single-slice CT images and enables detailed voxel-wise studies of associations between body composition and associated diseases and risk factors.
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Affiliation(s)
- Nouman Ahmad
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Hugo Dahlberg
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hanna Jönsson
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sambit Tarai
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Robin Strand
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Elin Lundström
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Håkan Ahlström
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Antaros Medical, Mölndal, Sweden
| | - Joel Kullberg
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Antaros Medical, Mölndal, Sweden
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Alsubaie FH, Abujamea AH. Knowledge and Perception of Radiation Risk From Computed Tomography Scans Among Patients Attending an Emergency Department. Cureus 2024; 16:e52687. [PMID: 38384636 PMCID: PMC10879657 DOI: 10.7759/cureus.52687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
To evaluate the level of knowledge about radiation dose and possible risks related to computed tomography (CT) scans among patients visiting emergency departments (EDs), a survey was conducted over a two-month period. A total of 357 adult patients (44% men and 56% women) presenting for diagnostic imaging in the ED answered a survey consisting of 15 questions. The survey included questions about the participants' demographics and knowledge of radiation. Most of the respondents (58.5%) reported that the physician did not explain the potential risk of radiation before the procedure. In addition, more than half of the respondents (58.1%) expressed feeling anxious about the potential risk of radiation. Most respondents (84.9%) stated that the potential radiation risk did not affect their decision to proceed with the procedure. Overall, the findings highlight a lack of information about radiation and its potential risks provided to patients prior to the diagnostic procedure. Increasing awareness and understanding of the risks associated with these imaging modalities should be considered essential in modern communities. Efforts should be made to ensure that patients undergoing diagnostic imaging are aware of the radiation risks they may encounter.
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Affiliation(s)
- Faisal H Alsubaie
- Department of Family and Community Medicine, King Saud University/College of Medicine, Riyadh, SAU
| | - Abdullah H Abujamea
- Department of Radiology and Medical Imaging, King Saud University/College of Medicine, Riyadh, SAU
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Souza EG, Kruger K, Nascimento CD, Aguzzoli C, Hoff G, Moraes ACBK, Lund RG, Nascente PS, Cuevas-Suárez CE, Piva E, Carreno NLV. Development of Lead-Free Radiation Shielding Material Utilizing Barium Sulfate and Magnesium Oxide as Fillers in Addition Cure Liquid Silicone Rubber. Polymers (Basel) 2023; 15:4382. [PMID: 38006106 PMCID: PMC10675358 DOI: 10.3390/polym15224382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
The radiological protection has the purpose of safeguarding the physical well-being of the user, preventing exposure to detrimental levels of ionizing radiation. This study introduces a novel, cost-effective category of lead-free elastomeric material designed for radiation shielding. The filler compounds utilized are notably lighter than conventional lead-based materials, enhancing user ergonomics during application. They comprise of a blend of barium sulfate combined or not with magnesium oxide with addition-cure liquid silicone rubber. To ensure the effectiveness of the radiation shielding, X-ray transmission measurements were performed for the different thicknesses of the materials and the results compared with Monte Carlo simulations. Additionally, the physical properties of the new materials, such as density, homogeneity, tensile strength, viscosity, and wettability, were also evaluated. The findings indicate that both materials fulfill the requirement for application in radiation protection garments.
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Affiliation(s)
- Everton G Souza
- Graduate Program in Electronic and Computer Engineering, Catholic University of Pelotas, Pelotas 96015-560, Brazil
| | - Kaiser Kruger
- Graduate Program in Electronic and Computer Engineering, Catholic University of Pelotas, Pelotas 96015-560, Brazil
| | - Chiara D Nascimento
- Graduate Program in Electronic and Computer Engineering, Catholic University of Pelotas, Pelotas 96015-560, Brazil
| | - Cesar Aguzzoli
- Graduate Program in Materials Science and Engineering, University of Caxias do Sul, Caxias 95070-560, Brazil
| | - Gabriela Hoff
- Medical Physics and Radioprotection Service, Clinical Hospital of Porto Alegre, Porto Alegre 90035-903, Brazil
| | | | - Rafael G Lund
- School of Dentistry, Federal University of Pelotas, Pelotas 96010-560, Brazil
- Graduate Program in Materials Science and Engineering, Technology Development Center, Federal University of Pelotas, Pelotas 96010-610, Brazil
| | | | - Carlos E Cuevas-Suárez
- Department of Dentistry Surgery, Autonomous University of Hidalgo, Pachuca de Soto 42080, México
| | - Evandro Piva
- School of Dentistry, Federal University of Pelotas, Pelotas 96010-560, Brazil
- Graduate Program in Materials Science and Engineering, Technology Development Center, Federal University of Pelotas, Pelotas 96010-610, Brazil
| | - Neftali L V Carreno
- Graduate Program in Materials Science and Engineering, Technology Development Center, Federal University of Pelotas, Pelotas 96010-610, Brazil
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Sakafu L, Kiango V, Khasim Z, Shoo A, Ndossa M, Kagaruki G, Manyama D, Magandi J, Lee AY. Radiation safety in an era of diagnostic radiology growth in Africa: Lessons learned from Tanzania. Clin Imaging 2023; 102:65-70. [PMID: 37625349 DOI: 10.1016/j.clinimag.2023.08.006] [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: 07/05/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE As radiology continues to grow in low- and middle-income countries (LMICs), radiation exposure and risk to patients and staff will concurrently increase. This study aims to assess the knowledge of radiation safety among medical staff in Tanzania. METHODS A survey was distributed to 350 staff members at a national referral hospital in Tanzania over a 7-month period (February-August 2021). This consisted of a structured questionnaire evaluating participants' knowledge and awareness ionizing radiation and radiation safety. Chi-square and Fisher's exact tests were used to determine the association between independent and dependent categorical variables. RESULTS A total of 300 surveys were completed (86% response rate). Mean age was 31 and 53% of participants were female. The majority (89%) were clinical staff employed in direct patient care. Most reported having heard of radiation protection (85%) but only 61% reported receiving training in radiation protection. Regarding radiation knowledge, 73% correctly answered how to protect oneself from radiation and 74% knew which medical staff were at greater risk of radiation exposure. However, only 32% correctly answered which imaging tests emit more radiation and only 53% correctly answered which age group was at greatest risk of radiation effects. Non-clinical staff had a significantly lower radiation awareness than clinical staff, with 69.7% reporting having heard about radiation protection, compared to 88.3% of clinical staff (p = 0.004). Female participants were more knowledgeable of radiation risks in pregnancy (p = 0.002). More early career staff reported receiving radiation protection training (64.5%) compared to those with >5 years work experience (53.9%), though this difference was not statistically significant (p = 0.09). When stratifying radiation knowledge by high (score of 80-100%), moderate (60-79.9%) and low (<60%), 20% of participants scored high, 47% moderate, and 33% low. CONCLUSION Most staff had low to moderate knowledge on radiation safety. Our findings highlight the importance of education on ionizing radiation as medical imaging continues to rise in Africa.
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Affiliation(s)
- Lulu Sakafu
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania.
| | - Violet Kiango
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Zuwena Khasim
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Aikankira Shoo
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Mariam Ndossa
- Department of Radiology, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Gibson Kagaruki
- National Institute of Medical Research (NIMR), Mbeya, Tanzania
| | - Deogratius Manyama
- Department of Surgery, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Julieth Magandi
- Department of Surgery, Muhimbili National Hospital-Mloganzila, Dar es Salaam, Tanzania
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States of America
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Stein T, Schuermann T, Bamberg F, Mueller-Peltzer K. [Explaining radiation dose exposure : The role of the banana equivalent dose compared to the effective dose in patient communication]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:679-687. [PMID: 37639026 DOI: 10.1007/s00117-023-01196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Communicating the amount and effects of ionizing radiation to patients prior to an examination using x‑rays is associated with challenges: first, calculating the expected dose prior to the examination and, second, quantifying and illustrating cancer risks. Analogies, such as comparing radiation exposure to accident risks, have limitations and may evoke unease. This study explores and compares two new approaches to discuss radiation exposure from common clinical examinations with patients: effective dose and exposure based on radioactive potassium-40 intake from the ingestion of bananas, the banana equivalent dose (BED). MATERIALS AND METHODS The effective doses of the diagnostic reference levels (DRL) for computed tomography (CT) and X-ray examinations in adults were calculated using mean conversion factors for specific anatomic body regions. For the BED calculation of the diagnostic reference levels, the radiation dose from a conventional banana ingested over 50 years per becquerel was calculated. The outcomes were juxtaposed against an equivalent number of bananas and its respective radiation doses. RESULTS The calculated doses, namely effective dose and BED, of the German DRL can serve as a reliable metric to discuss radiation exposure from medical imaging with patients prior to an examination. CONCLUSION This is the first study to calculate the effective doses of the current DRL and to compare these with the pseudoscientific unit BED. While the BED serves as an interesting illustration to metaphorize radiation exposure, it is recommended to use the calculated effective dose of the DRL as the basis for educational consultations with patients.
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Affiliation(s)
- T Stein
- Abteilung für Diagnostik und Interventionelle Radiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
| | - T Schuermann
- Abteilung für Diagnostik und Interventionelle Radiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - F Bamberg
- Abteilung für Diagnostik und Interventionelle Radiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - K Mueller-Peltzer
- Abteilung für Diagnostik und Interventionelle Radiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
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Fardid R, Janipour S, Haddadi G, Mahdavi M, Sharifzadeh S, Lotfi M, Rostamyari M. Evaluation of the relationship between γ-H2AX biomarker levels and dose received after radiation exposure in abdominal-pelvic and chest CT scans. J Cancer Res Ther 2023; 19:1392-1397. [PMID: 37787314 DOI: 10.4103/jcrt.jcrt_950_21] [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] [Indexed: 10/04/2023]
Abstract
Background As one of the most informative diagnostic radiation instruments, computed tomography (CT) has seen considerable improvement since its implementation in the 1970s; however, the possibility of low-dose radiation risk after CT procedures is still challenging and little is known about the biological effects of CT exposure on patients. As a result, this research aimed to look at the biological and cytogenetic effects of low-dose abdominal-pelvic and chest CT scans on adults, focusing on the number of γ-H2AX foci formation. Materials and Methods Blood tests were taken before and 10 min after CT exams on patients aged 25-55 who were undergoing abdominal-pelvic and chest CT exams with very low-ionizing radiation exposure (TLD doses of 15.67-63.45 mGy). Blood lymphocytes that had been isolated, fixed, and stained were dyed with γ-H2AX antibodies. Finally, the percentage of phosphorylation of histone H2AX as an indicator of double-strand breaks was determined using a cytometry technique. Results Our findings showed that after CT examination, the mean value of γ-H2AX foci in patients increased (P < 0.0001). A statistically significant correlation between dose radiation and the number of γ-H2AX foci was also found (P = 0.047, r = 0.4731). The current study also found a pattern of elevated γ-H2AX foci in patients over 40 years of age relative to younger patients. Conclusion A Significant activation of γ-H2AX foci was found in lymphocytes of peripheral blood samples of patients after CT compared to before CT scan. This increase in γ-H2AX foci levels in blood cells may be a useful quantitative biomarker of low-level radiation exposure in humans.
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Affiliation(s)
- Reza Fardid
- Department of Radiology, School of Paramedical Sciences; Ionizing and Non-Ionizing Radiation Protection Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Janipour
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golamhassan Haddadi
- Department of Radiology, School of Paramedical Sciences; Ionizing and Non-Ionizing Radiation Protection Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maziyar Mahdavi
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Sharifzadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrzad Lotfi
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maliheh Rostamyari
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Patra A, Saha A, Bhattacharya K. Efficient Storage and Encryption of 32-Slice CT Scan Images Using Phase Grating. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2023; 48:1757-1770. [PMID: 35765311 PMCID: PMC9226269 DOI: 10.1007/s13369-022-06986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
Medical images are treated as sensitive as it carries patients' confidential information and hence must be protected from unauthorized access. So, a strong encryption mechanism is a primary criterion to transmit these images over the internet to protect them from intruders. In many existing algorithms, noise affection in the extracted images is high, hence not suitable for medical data encryption. Here, we present a new method using phase grating to multiplex as well as encrypting 32 cross-sectional CT scan images (slices) in a single canvas for optimization of storage space and improvement of security. The entire process is divided into a few steps. Before transmission, the main canvas is encrypted with the help of a random phase matrix. The main canvas is further encrypted by the transposition method to enhance security. After decryption, inverse Fourier transform is applied at the proper location of the decrypted canvas to extract the images from the spectra. Quality is measured with peak-signal-to-noise ratio and correlation coefficient methods. Here, it is greater than 38 and the correlation coefficient is close to 1 for all images, thereby indicating of good quality of extracted images. The effect of three common cyber-attacks (viz. known-plaintext attack, chosen-plaintext attack, and chosen-ciphertext attack) is also presented here. The correlation coefficient during cyber-attacks is found to be close to zero, which implies the robustness of the algorithm against cyber-attacks. Finally, a comparison with existing techniques shows the effectiveness of the proposed method.
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Affiliation(s)
- Anirban Patra
- Department of ECE, JIS College of Engineering, Kalyani, India
- Department of Applied Optics and Photonics, University of Calcutta, Kolkata, India
| | - Arijit Saha
- Department of ECE, B P Poddar Institute of Management and Technology, Kolkata, India
| | - Kallol Bhattacharya
- Department of Applied Optics and Photonics, University of Calcutta, Kolkata, India
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Grandt CL, Brackmann LK, Poplawski A, Schwarz H, Marini F, Hankeln T, Galetzka D, Zahnreich S, Mirsch J, Spix C, Blettner M, Schmidberger H, Marron M. Identification of lncRNAs involved in response to ionizing radiation in fibroblasts of long-term survivors of childhood cancer and cancer-free controls. Front Oncol 2023; 13:1158176. [PMID: 37182169 PMCID: PMC10174438 DOI: 10.3389/fonc.2023.1158176] [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: 02/03/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Long non-coding ribonucleic acids (lncRNAs) are involved in the cellular damage response following exposure to ionizing radiation as applied in radiotherapy. However, the role of lncRNAs in radiation response concerning intrinsic susceptibility to late effects of radiation exposure has not been examined in general or in long-term survivors of childhood cancer with and without potentially radiotherapy-related second primary cancers, in particular. Methods Primary skin fibroblasts (n=52 each) of long-term childhood cancer survivors with a first primary cancer only (N1), at least one second primary neoplasm (N2+), as well as tumor-free controls (N0) from the KiKme case-control study were matched by sex, age, and additionally by year of diagnosis and entity of the first primary cancer. Fibroblasts were exposed to 0.05 and 2 Gray (Gy) X-rays. Differentially expressed lncRNAs were identified with and without interaction terms for donor group and dose. Weighted co-expression networks of lncRNA and mRNA were constructed using WGCNA. Resulting gene sets (modules) were correlated to the radiation doses and analyzed for biological function. Results After irradiation with 0.05Gy, few lncRNAs were differentially expressed (N0: AC004801.4; N1: PCCA-DT, AF129075.3, LINC00691, AL158206.1; N2+: LINC02315). In reaction to 2 Gy, the number of differentially expressed lncRNAs was higher (N0: 152, N1: 169, N2+: 146). After 2 Gy, AL109976.1 and AL158206.1 were prominently upregulated in all donor groups. The co-expression analysis identified two modules containing lncRNAs that were associated with 2 Gy (module1: 102 mRNAs and 4 lncRNAs: AL158206.1, AL109976.1, AC092171.5, TYMSOS, associated with p53-mediated reaction to DNA damage; module2: 390 mRNAs, 7 lncRNAs: AC004943.2, AC012073.1, AC026401.3, AC092718.4, MIR31HG, STXBP5-AS1, TMPO-AS1, associated with cell cycle regulation). Discussion For the first time, we identified the lncRNAs AL158206.1 and AL109976.1 as involved in the radiation response in primary fibroblasts by differential expression analysis. The co-expression analysis revealed a role of these lncRNAs in the DNA damage response and cell cycle regulation post-IR. These transcripts may be targets in cancer therapy against radiosensitivity, as well as provide grounds for the identification of at-risk patients for immediate adverse reactions in healthy tissues. With this work we deliver a broad basis and new leads for the examination of lncRNAs in the radiation response.
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Affiliation(s)
- Caine Lucas Grandt
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
- *Correspondence: Caine Lucas Grandt,
| | - Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heike Schwarz
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Federico Marini
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Hankeln
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Danuta Galetzka
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Johanna Mirsch
- Radiation Biology and DNA Repair, Technical University of Darmstadt, Darmstadt, Germany
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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12
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Min JJ, Youn K, Oh S, Sung KH, Lee KM, Park MS. Development and Validation of a Mobile Application for Measuring Tibial Torsion. J Bone Joint Surg Am 2022; 104:2095-2100. [PMID: 36126146 DOI: 10.2106/jbjs.22.00414] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibial torsion lacks a single and reliable method for its measurement. While physical examination, computed tomography (CT), and EOS imaging are used complementarily, three-dimensional (3D) CT is the most widely used method for intuitive documentation and visualization. However, concern regarding the associated radiation hazard limits its use in the evaluation of pediatric patients. Moreover, EOS machines are too expensive and too large to be placed in every clinic requiring the measurement of tibial torsion. Therefore, a new method for 3D reconstruction is needed. In the present study, we tested the validity and reliability of a novel reconstruction tool for the lower leg. METHODS A statistical shape model and Laplacian constraint were adopted for the development of a new reconstruction tool for measuring tibial torsion. Tibial torsion measurements based on a 3D reconstruction application and CT images for 36 patients were evaluated for intraobserver and interobserver reliability. Tibial torsion measurements for 75 patients were compared for validation. RESULTS A 3D reconstruction system for the lower leg was developed as a mobile application and was installed in a portable device for easy access in the clinical setting. In terms of interobserver reliability, the intraclass correlation coefficient among 3 clinicians was 0.896 (95% confidence interval [CI], 0.828 to 0.941). The correlation coefficient between tibial torsion measured with use of 3D CT and that measured with the mobile application was 0.865 (p < 0.001). CONCLUSIONS The mobile application showed excellent reliability and validity for measuring tibial torsion. Concurrent utilization with mobile application for the femur allows visualization of the rotational profile of the leg without the need for CT or EOS. LEVEL OF EVIDENCE Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jae Jung Min
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | | | - Seungtak Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea.,Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, South Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea.,Didim, Inc., Gyeonggi, South Korea.,Department of Orthopaedic Surgery, College of Medicine, Seoul National University, Seoul, South Korea
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Cao CF, Ma KL, Shan H, Liu TF, Zhao SQ, Wan Y, Jun-Zhang, Wang HQ. CT Scans and Cancer Risks: A Systematic Review and Dose-response Meta-analysis. BMC Cancer 2022; 22:1238. [PMID: 36451138 PMCID: PMC9710150 DOI: 10.1186/s12885-022-10310-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is still uncertainty on whether ionizing radiation from CT scans can increase the risks of cancer. This study aimed to identify the association of cumulative ionizing radiation from CT scans with pertaining cancer risks in adults. METHODS Five databases were searched from their inception to November 15, 2020. Observational studies reporting cancer risks from CT scans in adults were included. The main outcome included quantified cancer risks as cancer case numbers in exposed/unexposed adult participants with unified converted measures to odds ratio (OR) for relative risk, hazard ratio. Global background radiation (2.4 mSv per year) was used as control for lifetime attribution risk (LAR), with the same period from incubation after exposure until survival to 100 years. RESULTS 25 studies were included with a sum of 111,649,943 participants (mean age: 45.37 years, 83.4% women), comprising 2,049,943 actual participants from 6 studies with an average follow-up period as 30.1 years (range, 5 to 80 years); 109,600,000 participants from 19 studies using LAR. The cancer risks for adults following CT scans were inordinately increased (LAR adults, OR, 10.00 [95% CI, 5.87 to 17.05]; actual adults, OR, 1.17 [95%CI, 0.89 to 1.55]; combined, OR, 5.89 [95%CI, 3.46 to 10.35]). Moreover, cancer risks elevated with increase of radiation dose (OR, 33.31 [95% CI, 21.33 to 52.02]), and multiple CT scan sites (OR, 14.08 [95% CI, 6.60 to 30.05]). The risk of solid malignancy was higher than leukemia. Notably, there were no significant differences for age, gender, country, continent, study quality and studying time phrases. CONCLUSIONS Based on 111.6 million adult participants from 3 continents (Asia, Europe and America), this meta-analysis identifies an inordinately increase in cancer risks from CT scans for adults. Moreover, the cancer risks were positively correlated with radiation dose and CT sites. The meta-analysis highlights the awareness of potential cancer risks of CT scans as well as more reasonable methodology to quantify cancer risks in terms of life expectancy as 100 years for LAR. PROSPERO TRIAL REGISTRATION NUMBER CRD42019133487.
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Affiliation(s)
- Chun-Feng Cao
- grid.203458.80000 0000 8653 0555Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160 Chongqing, People’s Republic of China
| | - Kun-Long Ma
- grid.203458.80000 0000 8653 0555Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160 Chongqing, People’s Republic of China
| | - Hua Shan
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
| | - Tang-Fen Liu
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
| | - Si-Qiao Zhao
- grid.412262.10000 0004 1761 5538Department of Orthopedics, No.1 Hospital of Xi’an City, Northwestern University, Xi’an, 710002 Shaanxi Province People’s Republic of China
| | - Yi Wan
- grid.233520.50000 0004 1761 4404Department of Health Services, Fourth Military Medical University, Xi’an, 710032 No.169 West Changle Road, Shaanxi Province People’s Republic of China
| | - Jun-Zhang
- grid.489934.bBaoji Central Hospital, 8 Jiangtan Road, Baoji, 721008 Shaanxi Province People’s Republic of China ,grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi Province People’s Republic of China
| | - Hai-Qiang Wang
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi’an, 712046 Shaanxi Province People’s Republic of China
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Low melting point MCP-69, MCP-96, MCP-137, and MCP-200 alloys for radiation protection in radiological and therapeutic processes. RADIATION MEDICINE AND PROTECTION 2022. [DOI: 10.1016/j.radmp.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Necarsulmer J, Reed S, Arhin M, Shastri D, Quig N, Yap E, Ho J, Sasaki-Adams D. Cumulative Radiation Exposure in Aneurysmal Subarachnoid Hemorrhage: A Single-Institution Analysis. World Neurosurg 2022; 165:e432-e437. [PMID: 35738532 DOI: 10.1016/j.wneu.2022.06.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Diagnosis and management of aneurysmal subarachnoid hemorrhage (aSAH) depend heavily on imaging modalities that repeatedly expose patients to ionizing radiation. There is limited literature on cumulative radiation exposure in this patient population, which is a problem compounded by wide variation among institutions. The present study quantifies the cumulative cranial exposure to ionizing radiation resulting from diagnostic medical imaging and medical procedures during initial hospitalization for ruptured aSAH at a single academic institution and estimates the risk of future adverse events related to radiation injury. METHODS We performed a retrospective observational study of adults who presented to our institution during a nearly 3-year period with acute-onset aSAH, which was confirmed with diagnostic imaging, and had the aneurysm treated with either surgical clip ligation or endovascular embolization. RESULTS A total of 131 patients met the inclusion criteria. Eighty-eight patients (67%) were treated with endovascular embolization and 43 (32%) were treated with clip ligation. We found the average radiation dose to the head during the incident hospitalization for aSAH to be 4.40 Gy (95% confidence interval, 3.91-4.89). Angiography and interventional radiology procedures accounted for most of this exposure. CONCLUSIONS Most patients were exposed to levels of ionizing radiation that put them at considerable risk of deterministic radiation injury. Providers should be aware of the potential consequences of acute and long-term radiation exposure in this patient population, so they can monitor and counsel individuals accordingly and take steps to safely limit radiation exposure during aSAH management.
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Affiliation(s)
- Julie Necarsulmer
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Samuel Reed
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Martin Arhin
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Darshan Shastri
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Nathan Quig
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Edward Yap
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - James Ho
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA; Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Deanna Sasaki-Adams
- Department of Neurosurgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
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16
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Ha TN, Kamarova S, Youens D, Wright C, McRobbie D, Doust J, Slavotinek J, Bulsara MK, Moorin R. Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003-2015. BMJ Open 2022; 12:e059242. [PMID: 35649618 PMCID: PMC9161060 DOI: 10.1136/bmjopen-2021-059242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE High use of CT scanning has raised concern due to the potential ionising radiation exposure. This study examined trends of CT during admission to tertiary hospitals and its associations with length of stay (LOS), readmission and mortality. DESIGN Retrospective observational study from 2003 to 2015. SETTING West Australian linked administrative records at individual level. PARTICIPANTS 2 375 787 episodes of tertiary hospital admission in adults aged 18+ years. MAIN OUTCOME MEASURES LOS, 30-day readmissions and mortality stratified by CT use status (any, multiple (CTs to multiple areas during episode), and repeat (repeated CT to the same area)). METHODS Multivariable regression models were used to calculate adjusted rate of CT use status. The significance of changes since 2003 in the outcomes (LOS, 30-day readmission and mortality) was compared among patients with specific CT imaging status relative to those without. RESULTS Between 2003 and 2015, while the rate of CT increased 3.4% annually, the rate of repeat CTs significantly decreased -1.8% annually and multiple CT showed no change. Compared with 2003 while LOS had a greater decrease in those with any CT, 30-day readmissions had a greater increase among those with any CT, while the probability of mortality remained unchanged between the any CT/no CT groups. A similar result was observed in patients with multiple and repeat CT scanning, except for a significant increase in mortality in the recent years in the repeat CT group. CONCLUSION The observed pattern of increase in CT utilisation is likely to be activity-based funding policy-driven based on the discordance between LOS and readmissions. Meanwhile, the repeat CT reduction aligns with a more selective strategy of use based on clinical severity. Future research should incorporate in-hospital and out-of-hospital CT to better understand overall CT trends and potential shifts between settings over time.
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Affiliation(s)
- Thi Ninh Ha
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Sviatlana Kamarova
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - David Youens
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Cameron Wright
- Health Systems and Health Economics, Curtin University School of Public Health, Perth, Western Australia, Australia
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Division of Internal Medicine, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Donald McRobbie
- The University of Adelaide School of Physical Sciences, Adelaide, South Australia, Australia
| | - Jenny Doust
- Centre for Longitudinal and Life Course Research, The University of Queensland, Herston, Queensland, Australia
| | - John Slavotinek
- SA Medical Imaging, SA Health and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Max K Bulsara
- Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Rachael Moorin
- Health Economics and Data Analytics, School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Kim E, Boyd B. Diagnostic Imaging of Pregnant Women and Fetuses: Literature Review. Bioengineering (Basel) 2022; 9:236. [PMID: 35735479 PMCID: PMC9220222 DOI: 10.3390/bioengineering9060236] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 01/21/2023] Open
Abstract
Healthcare providers have acknowledged the dangers of radiation exposure to embryonic and fetal health, yet diagnostic imaging of pregnant women is increasing. Literature that pertains to the topic of interest was reviewed to collect tertiary data. The purpose of this literature review was to present the various radiation risks for pregnant women and the fetus depending on the gestational age of the pregnancy. The specific effects of radiation on pregnant women and the fetus, X-ray risks depending on the gestational age of the pregnancy, and other potential health effects when performing diagnostic imaging procedures on pregnant women were discussed in this review. In addition, ethical issues have been considered by improving overall communication to minimize unnecessary radiation exposure to pregnant women and fetuses.
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Affiliation(s)
- Eunhye Kim
- Department of Health Safety Convergence Science, Korea University, Seoul 02481, Korea;
| | - Brenda Boyd
- Department of Radiation Science, Loma Linda University, Loma Linda, CA 92350, USA
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18
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Yuen MM, Prabhat AM, Mazurek MH, Chavva IR, Crawford A, Cahn BA, Beekman R, Kim JA, Gobeske KT, Petersen NH, Falcone GJ, Gilmore EJ, Hwang DY, Jasne AS, Amin H, Sharma R, Matouk C, Ward A, Schindler J, Sansing L, de Havenon A, Aydin A, Wira C, Sze G, Rosen MS, Kimberly WT, Sheth KN. Portable, low-field magnetic resonance imaging enables highly accessible and dynamic bedside evaluation of ischemic stroke. SCIENCE ADVANCES 2022; 8:eabm3952. [PMID: 35442729 PMCID: PMC9020661 DOI: 10.1126/sciadv.abm3952] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/08/2022] [Indexed: 05/26/2023]
Abstract
Brain imaging is essential to the clinical management of patients with ischemic stroke. Timely and accessible neuroimaging, however, can be limited in clinical stroke pathways. Here, portable magnetic resonance imaging (pMRI) acquired at very low magnetic field strength (0.064 T) is used to obtain actionable bedside neuroimaging for 50 confirmed patients with ischemic stroke. Low-field pMRI detected infarcts in 45 (90%) patients across cortical, subcortical, and cerebellar structures. Lesions as small as 4 mm were captured. Infarcts appeared as hyperintense regions on T2-weighted, fluid-attenuated inversion recovery and diffusion-weighted imaging sequences. Stroke volume measurements were consistent across pMRI sequences and between low-field pMRI and conventional high-field MRI studies. Low-field pMRI stroke volumes significantly correlated with stroke severity and functional outcome at discharge. These results validate the use of low-field pMRI to obtain clinically useful imaging of stroke, setting the stage for use in resource-limited environments.
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Affiliation(s)
- Matthew M. Yuen
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Anjali M. Prabhat
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Mercy H. Mazurek
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Isha R. Chavva
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Anna Crawford
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Bradley A. Cahn
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer A. Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin T. Gobeske
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Nils H. Petersen
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Guido J. Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Emily J. Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - David Y. Hwang
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Adam S. Jasne
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Hardik Amin
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Richa Sharma
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Adrienne Ward
- Neuroscience Intensive Care Unit, Yale New Haven Hospital, New Haven, CT, USA
| | - Joseph Schindler
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Lauren Sansing
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Ani Aydin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Charles Wira
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gordon Sze
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Matthew S. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - W. Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
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Schooler GR, Cravero JP, Callahan MJ. Assessing and conveying risks and benefits of imaging in neonates using ionizing radiation and sedation/anesthesia. Pediatr Radiol 2022; 52:616-621. [PMID: 34283256 DOI: 10.1007/s00247-021-05138-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Abstract
Neonates represent a unique subset of the pediatric population that requires special attention and careful thought when implementing advanced cross-sectional imaging with CT or MRI. The ionizing radiation associated with CT and the sedation/anesthesia occasionally required for MRI present risks that must be balanced against the perceived benefit of the imaging examination in the unique and particularly susceptible neonatal population. We review the perceived risks of ionizing radiation and the more concrete risks of sedation/anesthesia in term and preterm neonates in the context of an imaging paradigm. When the expected diagnostic yield from CT and MRI is similar, and sedation is required for MRI but not for CT, CT likely has the higher benefit-to-risk ratio in the neonate. However, despite the risks, the most appropriate imaging modality should always be chosen after thoughtful consideration is given to each unique patient and informed discussions including radiology, anesthesia, neonatology and the parents/caregivers are pursued.
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Affiliation(s)
- Gary R Schooler
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
| | - Joseph P Cravero
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Castillo Tafur JC, Furdock RJ, Sattar A, Liu RW. The Optimized Oxford Hip Skeletal Maturity System Proves Resilient to Rotational Variation. J Pediatr Orthop 2022; 42:186-189. [PMID: 35089879 DOI: 10.1097/bpo.0000000000002064] [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: 02/07/2023]
Abstract
BACKGROUND The recently described optimized Oxford skeletal maturity system utilizes anteroposterior (AP) hip radiographs to accurately, rapidly, and reliably estimate skeletal maturity. However, in the real-world setting, significant positional variation in AP hip radiographs may influence the accuracy of optimized Oxford skeletal age estimates. We sought to evaluate the consistency of skeletal age estimations using the optimized Oxford system between differently rotated radiographs. METHODS Thirty normal computerized tomography scans of males (15 children, 9 to 15 y) and females (15 children, 8 to 14 y) were obtained retrospectively, converted into 3D reconstructions, and then used to produce simulated hip radiographs in five different rotational positions. The optimized Oxford system was applied to the 150 simulated AP hip radiographs (5 differently rotated views of 30 hips) to produce a skeletal age estimate for each. RESULTS Rotational position did not have a statistically significant effect on the skeletal age (P=0.84) using 1-way repeated measures analysis of variance. Of the 5 radiographic parameters in the optimized Oxford system, only greater trochanter height showed significant rotational variation after Greenhouse-Geisser correction (F2.58, 74.68=5.98, P<0.001). However, post hoc analyses showed that the greater trochanter height obtained at the most centered position was not different from the other 4 rotational positions (P>0.05 for all). CONCLUSION The optimized Oxford skeletal maturity system is resilient to rotational variation. Mildly to moderately rotated radiographs obtained in the modern clinical setting can be used for skeletal age estimation by this method, broadening the clinical usage of this system. LEVEL OF EVIDENCE Level III-diagnostic study.
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Affiliation(s)
- Julio C Castillo Tafur
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
| | - Ryan J Furdock
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
| | - Abdus Sattar
- Center for Clinical Research, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Raymond W Liu
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital at Case Western Reserve University School of Medicine
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21
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22
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Smith-Bindman R, Yu S, Wang Y, Kohli MD, Chu P, Chung R, Luong J, Bos D, Stewart C, Bista B, Alejandrez Cisneros A, Delman B, Einstein AJ, Flynn M, Romano P, Seibert JA, Westphalen AC, Bindman A. An Image Quality-informed Framework for CT Characterization. Radiology 2022; 302:380-389. [PMID: 34751618 PMCID: PMC8805663 DOI: 10.1148/radiol.2021210591] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
Background Lack of standardization in CT protocol choice contributes to radiation dose variation. Purpose To create a framework to assess radiation doses within broad CT categories defined according to body region and clinical imaging indication and to cluster indications according to the dose required for sufficient image quality. Materials and Methods This was a retrospective study using Digital Imaging and Communications in Medicine metadata. CT examinations in adults from January 1, 2016 to December 31, 2019 from the University of California San Francisco International CT Dose Registry were grouped into 19 categories according to body region and required radiation dose levels. Five body regions had a single dose range (ie, extremities, neck, thoracolumbar spine, combined chest and abdomen, and combined thoracolumbar spine). Five additional regions were subdivided according to dose. Head, chest, cardiac, and abdomen each had low, routine, and high dose categories; combined head and neck had routine and high dose categories. For each category, the median and 75th percentile (ie, diagnostic reference level [DRL]) were determined for dose-length product, and the variation in dose within categories versus across categories was calculated and compared using an analysis of variance. Relative median and DRL (95% CI) doses comparing high dose versus low dose categories were calculated. Results Among 4.5 million examinations, the median and DRL doses varied approximately 10 times between categories compared with between indications within categories. For head, chest, abdomen, and cardiac (3 266 546 examinations [72%]), the relative median doses were higher in examinations assigned to the high dose categories than in examinations assigned to the low dose categories, suggesting the assignment of indications to the broad categories is valid (head, 3.4-fold higher [95% CI: 3.4, 3.5]; chest, 9.6 [95% CI: 9.3, 10.0]; abdomen, 2.4 [95% CI: 2.4, 2.5]; and cardiac, 18.1 [95% CI: 17.7, 18.6]). Results were similar for DRL doses (all P < .001). Conclusion Broad categories based on image quality requirements are a suitable framework for simplifying radiation dose assessment, according to expected variation between and within categories. © RSNA, 2021 See also the editorial by Mahesh in this issue.
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Affiliation(s)
- Rebecca Smith-Bindman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Sophronia Yu
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Yifei Wang
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Marc D. Kohli
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Philip Chu
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Robert Chung
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Jason Luong
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Denise Bos
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Carly Stewart
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Biraj Bista
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Alejandro Alejandrez Cisneros
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Bradley Delman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Andrew J. Einstein
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Michael Flynn
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Patrick Romano
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - J. Anthony Seibert
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Antonio C. Westphalen
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
| | - Andrew Bindman
- From the Department of Radiology and Biomedical Imaging (R.S.B.,
S.Y., Y.W., M.D.K., P.C., R.C., J.L., C.S.), Department of Epidemiology and
Biostatistics (R.S.B., A.B.), Philip R. Lee Institute for Health Policy Studies
(R.S.B., A.B.), and Department of Medicine (A.B.), University of California San
Francisco (UCSF), UCSF Mission Bay Campus, Mission Hall: Global Health and
Clinical Sciences Building, 550 16th St, 2nd Floor, Box 0560, San Francisco, CA
94158; Department of Demography, University of California Berkeley, Berkeley,
Calif (R.C.); Institute of Diagnostic and Interventional Radiology and
Neuroradiology, University Hospital Essen, Essen, Germany (D.B.); Department of
Radiology and Biomedical Imaging, University of California Irvine, Irvine, Calif
(B.B.); UCSF Medical School, San Francisco, Calif (A.A.C.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (B.D.);
Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of
Medicine, and Department of Radiology, Columbia University Irving Medical Center
and New York–Presbyterian Hospital, New York, NY (A.J.E.); Department of
Radiology and Public Health Sciences, Henry Ford Health System, Detroit, Mich
(M.F.); Department of Nuclear Engineering and Radiological Science, University
of Michigan, Ann Arbor, Mich (M.F.); Department of Medicine and Pediatrics
(P.R.) and Department of Radiology (J.A.S.), University of California Davis
Health, Sacramento, Calif; and Department of Radiology, University of
Washington, Seattle, WA (A.C.W.)
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23
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Sheth KN, Yuen MM, Mazurek MH, Cahn BA, Prabhat AM, Salehi S, Shah JT, By S, Welch EB, Sofka M, Sacolick LI, Kim JA, Payabvash S, Falcone GJ, Gilmore EJ, Hwang DY, Matouk C, Gordon-Kundu B, Rn AW, Petersen N, Schindler J, Gobeske KT, Sansing LH, Sze G, Rosen MS, Kimberly WT, Kundu P. Bedside detection of intracranial midline shift using portable magnetic resonance imaging. Sci Rep 2022; 12:67. [PMID: 34996970 PMCID: PMC8742125 DOI: 10.1038/s41598-021-03892-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022] Open
Abstract
Neuroimaging is crucial for assessing mass effect in brain-injured patients. Transport to an imaging suite, however, is challenging for critically ill patients. We evaluated the use of a low magnetic field, portable MRI (pMRI) for assessing midline shift (MLS). In this observational study, 0.064 T pMRI exams were performed on stroke patients admitted to the neuroscience intensive care unit at Yale New Haven Hospital. Dichotomous (present or absent) and continuous MLS measurements were obtained on pMRI exams and locally available and accessible standard-of-care imaging exams (CT or MRI). We evaluated the agreement between pMRI and standard-of-care measurements. Additionally, we assessed the relationship between pMRI-based MLS and functional outcome (modified Rankin Scale). A total of 102 patients were included in the final study (48 ischemic stroke; 54 intracranial hemorrhage). There was significant concordance between pMRI and standard-of-care measurements (dichotomous, κ = 0.87; continuous, ICC = 0.94). Low-field pMRI identified MLS with a sensitivity of 0.93 and specificity of 0.96. Moreover, pMRI MLS assessments predicted poor clinical outcome at discharge (dichotomous: adjusted OR 7.98, 95% CI 2.07–40.04, p = 0.005; continuous: adjusted OR 1.59, 95% CI 1.11–2.49, p = 0.021). Low-field pMRI may serve as a valuable bedside tool for detecting mass effect.
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Affiliation(s)
- Kevin N Sheth
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA.
| | - Matthew M Yuen
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Mercy H Mazurek
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Bradley A Cahn
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Anjali M Prabhat
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | | | - Jill T Shah
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | | | | | | | | | - Jennifer A Kim
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | | | - Guido J Falcone
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Emily J Gilmore
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - David Y Hwang
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Barbara Gordon-Kundu
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Adrienne Ward Rn
- Neuroscience Intensive Care Unit, Yale New Haven Hospital, New Haven, CT, USA
| | - Nils Petersen
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Joseph Schindler
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Kevin T Gobeske
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Lauren H Sansing
- Department of Neurology, Yale School of Medicine, 15 York Street, LLCI Room 1003C, P.O. Box 208018, New Haven, CT, 06520, USA
| | - Gordon Sze
- Department of Neuroradiology, Yale School of Medicine, New Haven, CT, USA
| | - Matthew S Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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24
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Prabhat AM, Crawford AL, Mazurek MH, Yuen MM, Chavva IR, Ward A, Hofmann WV, Timario N, Qualls SR, Helland J, Wira C, Sze G, Rosen MS, Kimberly WT, Sheth KN. Methodology for Low-Field, Portable Magnetic Resonance Neuroimaging at the Bedside. Front Neurol 2021; 12:760321. [PMID: 34956049 PMCID: PMC8703196 DOI: 10.3389/fneur.2021.760321] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023] Open
Abstract
Neuroimaging is a critical component of triage and treatment for patients who present with neuropathology. Magnetic resonance imaging and non-contrast computed tomography are the gold standard for diagnosis and prognostication of patients with acute brain injuries. However, these modalities require intra-hospital transport to strict, access-controlled environments, which puts critically ill patients at risk for complications and secondary injuries. A novel, portable MRI (pMRI) device that can be deployed at the patient's bedside provides a needed solution. In a dual-center investigation, Yale New Haven Hospital has obtained regular neuroimaging on patients using the pMRI as part of routine clinical care in the Emergency Department and Intensive Care Unit (ICU) since August of 2020. Massachusetts General Hospital has begun using pMRI in the Neuroscience Intensive Care Unit since January 2021. This technology has expanded the population of patients who can receive MRI imaging by increasing accessibility and timeliness for scan completion by eliminating the need for transport and increasing the potential for serial monitoring. Here we describe our methods for screening, coordinating, and executing pMRI exams and provide further detail on how to scan specific patient populations.
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Affiliation(s)
- Anjali M Prabhat
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Anna L Crawford
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Mercy H Mazurek
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Matthew M Yuen
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Isha R Chavva
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Adrienne Ward
- Neuroscience Intensive Care Unit, Yale New Haven Hospital, New Haven, CT, United States
| | - William V Hofmann
- Neuroscience Intensive Care Unit, Yale New Haven Hospital, New Haven, CT, United States
| | - Nona Timario
- Neuroscience Intensive Care Unit, Yale New Haven Hospital, New Haven, CT, United States
| | - Stephanie R Qualls
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Juliana Helland
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, United States
| | - Charles Wira
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Gordon Sze
- Department of Neuroradiology, Yale School of Medicine, New Haven, CT, United States
| | - Matthew S Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.,Department of Radiology, Harvard Medical School, Boston, MA, United States.,Department of Physics, Harvard University, Cambridge, MA, United States
| | | | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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25
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Park W, Yiu C, Liu Y, Wong TH, Huang X, Zhou J, Li J, Yao K, Huang Y, Li H, Li J, Jiao Y, Shi R, Yu X. High Channel Temperature Mapping Electronics in a Thin, Soft, Wireless Format for Non-Invasive Body Thermal Analysis. BIOSENSORS 2021; 11:bios11110435. [PMID: 34821651 PMCID: PMC8615861 DOI: 10.3390/bios11110435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022]
Abstract
Hemodynamic status has been perceived as an important diagnostic value as fundamental physiological health conditions, including decisive signs of fatal diseases like arteriosclerosis, can be diagnosed by monitoring it. Currently, the conventional hemodynamic monitoring methods highly rely on imaging techniques requiring inconveniently large numbers of operation procedures and equipment for mapping and with a high risk of radiation exposure. Herein, an ultra-thin, noninvasive, and flexible electronic skin (e-skin) hemodynamic monitoring system based on the thermal properties of blood vessels underneath the epidermis that can be portably attached to the skin for operation is introduced. Through a series of thermal sensors, the temperatures of each subsection of the arrayed sensors are observed in real-time, and the measurements are transmitted and displayed on the screen of an external device wirelessly through a Bluetooth module using a graphical user interface (GUI). The degrees of the thermal property of subsections are indicated with a spectrum of colors that specify the hemodynamic status of the target vessel. In addition, as the sensors are installed on a soft substrate, they can operate under twisting and bending without any malfunction. These characteristics of e-skin sensors exhibit great potential in wearable and portable diagnostics including point-of-care (POC) devices.
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Affiliation(s)
- Wooyoung Park
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Chunki Yiu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Yiming Liu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Tsz Hung Wong
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Xingcan Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Jingkun Zhou
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Jian Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Kuanming Yao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Ya Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Hu Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Jiyu Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Yanli Jiao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Rui Shi
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Xinge Yu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
- Correspondence:
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26
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Portable, bedside, low-field magnetic resonance imaging for evaluation of intracerebral hemorrhage. Nat Commun 2021; 12:5119. [PMID: 34433813 PMCID: PMC8387402 DOI: 10.1038/s41467-021-25441-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/05/2021] [Indexed: 02/07/2023] Open
Abstract
Radiological examination of the brain is a critical determinant of stroke care pathways. Accessible neuroimaging is essential to detect the presence of intracerebral hemorrhage (ICH). Conventional magnetic resonance imaging (MRI) operates at high magnetic field strength (1.5-3 T), which requires an access-controlled environment, rendering MRI often inaccessible. We demonstrate the use of a low-field MRI (0.064 T) for ICH evaluation. Patients were imaged using conventional neuroimaging (non-contrast computerized tomography (CT) or 1.5/3 T MRI) and portable MRI (pMRI) at Yale New Haven Hospital from July 2018 to November 2020. Two board-certified neuroradiologists evaluated a total of 144 pMRI examinations (56 ICH, 48 acute ischemic stroke, 40 healthy controls) and one ICH imaging core lab researcher reviewed the cases of disagreement. Raters correctly detected ICH in 45 of 56 cases (80.4% sensitivity, 95%CI: [0.68-0.90]). Blood-negative cases were correctly identified in 85 of 88 cases (96.6% specificity, 95%CI: [0.90-0.99]). Manually segmented hematoma volumes and ABC/2 estimated volumes on pMRI correlate with conventional imaging volumes (ICC = 0.955, p = 1.69e-30 and ICC = 0.875, p = 1.66e-8, respectively). Hematoma volumes measured on pMRI correlate with NIH stroke scale (NIHSS) and clinical outcome (mRS) at discharge for manual and ABC/2 volumes. Low-field pMRI may be useful in bringing advanced MRI technology to resource-limited settings.
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27
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Moorthy S. How Safe Are Radiation Doses in Diagnostic Radiology? A Historical Perspective and Review of Current Evidence. Indian J Radiol Imaging 2021; 31:653-660. [PMID: 34790311 PMCID: PMC8590548 DOI: 10.1055/s-0041-1735927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The "no dose is safe" linear no-threshold (LNT) model forms the basis for radiation safety in radiology practice. This model has its origins in observations of germline mutations in fruit flies exposed to X-rays. After World War II, quantitative risk estimates of radiation injury are primarily derived from the atomic bomb survivor Life Span Study. Current understanding of tissue response to radiation has raised doubts about the validity of LNT model at low doses encountered in the practice of diagnostic radiology. This article traces the evolution of basic radiation safety concepts and provides a bird's eye view of the Life Span Study and other studies which throw light on the matter. The arguments for an alternative, threshold, or even hermetic models of dose response are examined. The relevance of these developments to the nuclear power industry is also outlined.
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Affiliation(s)
- Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences and Research Centre, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkara, Kochi, Kerala, India
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28
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Bottari G, Stellacci G, Ferorelli D, Dell’Erba A, Aricò M, Benevento M, Palladino G, Solarino B. Imaging Appropriateness in Pediatric Radiology during COVID-19 Pandemic: A Retrospective Comparison with No COVID-19 Period. CHILDREN-BASEL 2021; 8:children8060463. [PMID: 34205841 PMCID: PMC8227712 DOI: 10.3390/children8060463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 12/15/2022]
Abstract
During the COVID-19 pandemic, the number of accesses to the Pediatric Emergency Department (pED) in Italy sharply decreased by 30%. The purpose of this study is to evaluate how this novel setting impacted on management of children with trauma, and the use and appropriateness of imaging studies in such patients at the pED. All imaging studies performed in patients with trauma at the pED of a tertiary children's Hospital during the first wave of the COVID-19 pandemic (between March and May 2020) were reviewed, in comparison with a control time interval (March to May 2019). In the pre-COVID control era, 669 imaging studies documented bone fractures in 145/568 children (25.5%). In the COVID-era, 79/177 (44.6%) pediatric patients showed bone fractures on 193 imaging studies. Comparative analysis shows a 71% decrease in imaging studies, and the proportion of negative imaging studies (with no evidence of bone fractures) dropped in 2020 by 19% compared to the 2019 control era (p < 0.001). The sharp decrease of negative studies suggests that the rate of appropriateness was higher during COVID-era, suggesting some attitude toward defensive medicine in the previous control year, as a result of some degree of imaging inappropriateness. The impact of a pandemic on emergency medicine may offer a unique opportunity to revisit diagnostic and therapeutic protocols in pediatrics.
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Affiliation(s)
- Giampiero Bottari
- Department of Interdisciplinary Medicine (DIM), Institute of Legal Medicine, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.F.); (A.D.); (M.B.); (B.S.)
- Correspondence:
| | - Giandomenico Stellacci
- Department of Pediatric Radiology, Giovanni XXIII Pediatric Hospital, Via G. Amendola 207, 70126 Bari, Italy; (G.S.); (G.P.)
| | - Davide Ferorelli
- Department of Interdisciplinary Medicine (DIM), Institute of Legal Medicine, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.F.); (A.D.); (M.B.); (B.S.)
| | - Alessandro Dell’Erba
- Department of Interdisciplinary Medicine (DIM), Institute of Legal Medicine, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.F.); (A.D.); (M.B.); (B.S.)
| | - Maurizio Aricò
- COVID-19 Management Crisis Unit, Giovanni XXIII Pediatric Hospital, Via G. Amendola 207, 70126 Bari, Italy;
| | - Marcello Benevento
- Department of Interdisciplinary Medicine (DIM), Institute of Legal Medicine, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.F.); (A.D.); (M.B.); (B.S.)
| | - Giuseppe Palladino
- Department of Pediatric Radiology, Giovanni XXIII Pediatric Hospital, Via G. Amendola 207, 70126 Bari, Italy; (G.S.); (G.P.)
| | - Biagio Solarino
- Department of Interdisciplinary Medicine (DIM), Institute of Legal Medicine, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy; (D.F.); (A.D.); (M.B.); (B.S.)
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Adambounou K, Kambiré F, Adigo AMY, Akoha S, Adjenou K. Analyse de la justification de l'irradiation médicale pédiatrique liée à la Tomodensitométrie (TDM) à Lomé (Togo). J Med Imaging Radiat Sci 2021; 52:277-285. [PMID: 33952436 DOI: 10.1016/j.jmir.2021.03.034] [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: 02/02/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the justification of medical irradiation related to CT scans performed in children in Lome. MATERIALS AND METHODS Descriptive cross-sectional study of CT scans performed from 1 September to 30 November 2019 in children aged 0 to 18 years. The analysis of the justification was made particularly on the formulation of the clinical indication, the consistency of the clinical indication with the requested CT and the conformity of the clinical indication with the Good Practice Guide (GPG) medical imaging examinations of the French Society of Radiology (SFR) and French Nuclear Medicine Society (SFMN). RESULTS The 175 CT scans included were dominated by cerebral CT (72.57%) followed by abdominal-pelvic CT (8%). Boys-dominated children (sex ratio=1.19) had an average age of 10.47+/-5.9. Prescribers composed of medical specialists (49.14%), general practitioner (31.43%) and paramedics (5%), requested in 21.14% of cases an imaging examination not or less irradiant before the CT. Clinical indication formulation was good in 70.86%, acceptable in 26.86%, and poor in 1.71%. This was consistent with the exam requested in 99.43% and conform with the GPG of the SFR in 48.57%. The more consistent the indications were with GPG, the more pathological the results were. Approximately 53% of the CT scans performed were not a priori justified. CONCLUSION Pediatric medical irradiation related to CT at Lome was in more than half of the cases a priori unjustified. Efforts must be made by practitioners to ensure that paediatric medical irradiation is judicious in Togo.
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Affiliation(s)
- Kokou Adambounou
- Laboratoire de Biophysique et Imagerie médicale, Université de Lomé, 01 BP 1515 Lomé 01, Togo; Service de Radiologie et Imagerie médicale, CHU Campus de Lomé, 03 BP 30284, Togo.
| | - Fulbert Kambiré
- Laboratoire de Biophysique et Imagerie médicale, Université de Lomé, 01 BP 1515 Lomé 01, Togo
| | | | - Setondé Akoha
- Service de Radiologie et Imagerie médicale, CHU Campus de Lomé, 03 BP 30284, Togo
| | - Komlanvi Adjenou
- Service de Radiologie et Imagerie médicale, CHU Campus de Lomé, 03 BP 30284, Togo
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Frush DP, Sorantin E. Radiation use in diagnostic imaging in children: approaching the value of the pediatric radiology community. Pediatr Radiol 2021; 51:532-543. [PMID: 33743037 DOI: 10.1007/s00247-020-04924-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 01/15/2023]
Abstract
Medical imaging is foundational in the care of children, and much of the medical imaging province depends on ionizing radiation: radiography, fluoroscopy, CT and nuclear imaging. Many considerations for this imaging in children are distinct in the domains of appropriate radiation use, other factors that determine examination quality, the opportunities to engage and educate through networking, and the translation of research efforts. Given these needs, it is worth approaching the contributions and their impact by the pediatric radiology community, especially to the enhancement of this value in the care of children.
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Affiliation(s)
- Donald P Frush
- Pediatric Radiology, Duke University Medical Center, Room #2568, 40 Duke Medicine Circle, Red Zone, Duke South Box 3808, Durham, NC, 27710, USA.
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Graz, Austria
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Yamashita K, Higashino K, Hayashi H, Takegami K, Hayashi F, Tsuruo Y, Sairyo K. Direct measurement of radiation exposure dose to individual organs during diagnostic computed tomography examination. Sci Rep 2021; 11:5435. [PMID: 33686232 PMCID: PMC7940429 DOI: 10.1038/s41598-021-85060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Ionizing radiation from Computed tomography (CT) examinations and the associated health risks are growing concerns. The purpose of this study was to directly measure individual organ doses during routine clinical CT scanning protocols and to evaluate how these measurements vary with scanning conditions. Optically stimulated luminescence (OSL) dosimeters were surgically implanted into individual organs of fresh non-embalmed whole-body cadavers. Whole-body, head, chest, and abdomen CT scans were taken of 6 cadavers by simulating common clinical methods. The dosimeters were extracted and the radiation exposure doses for each organ were calculated. Average values were used for analysis. Measured individual organ doses for whole-body routine CT protocol were less than 20 mGy for all organs. The measured doses of surface/shallow organs were higher than those of deep organs under the same irradiation conditions. At the same tube voltage and tube current, all internal organ doses were significantly higher for whole-body scans compared with abdominal scans. This study could provide valuable information on individual organ doses and their trends under various scanning conditions. These data could be referenced and used when considering CT examination in daily clinical situations.
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Affiliation(s)
- Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan.
| | - Kosaku Higashino
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Hiroaki Hayashi
- Department of Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Kazuki Takegami
- Department of Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Fumio Hayashi
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
| | - Yoshihiro Tsuruo
- Department of Anatomy, Tokushima University, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, Tokushima, 770-8503, Japan
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McLeavy CM, Chunara MH, Gravell RJ, Rauf A, Cushnie A, Staley Talbot C, Hawkins RM. The future of CT: deep learning reconstruction. Clin Radiol 2021; 76:407-415. [PMID: 33637310 DOI: 10.1016/j.crad.2021.01.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/14/2021] [Indexed: 12/23/2022]
Abstract
There have been substantial advances in computed tomography (CT) technology since its introduction in the 1970s. More recently, these advances have focused on image reconstruction. Deep learning reconstruction (DLR) is the latest complex reconstruction algorithm to be introduced, which harnesses advances in artificial intelligence (AI) and affordable supercomputer technology to achieve the previously elusive triad of high image quality, low radiation dose, and fast reconstruction speeds. The dose reductions achieved with DLR are redefining ultra-low-dose into the realm of plain radiographs whilst maintaining image quality. This review aims to demonstrate the advantages of DLR over other reconstruction methods in terms of dose reduction and image quality in addition to being able to tailor protocols to specific clinical situations. DLR is the future of CT technology and should be considered when procuring new scanners.
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Affiliation(s)
- C M McLeavy
- Department of Radiology, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK
| | - M H Chunara
- Department of Radiology, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK
| | - R J Gravell
- Department of Radiology, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK
| | - A Rauf
- Department of Urology, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK
| | - A Cushnie
- Department of Radiology, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK
| | - C Staley Talbot
- Department of Radiology, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK
| | - R M Hawkins
- Department of Radiology, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK.
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Appiah V, Taylor S, Vaulet T, Howarth N, Gevenois PA, Tack D. Are referral guidelines for CT examinations addressing all clinical scenarios? A comparison of EURO-2000 Guidelines and ESR iGuide. Eur Radiol 2021; 31:6605-6611. [PMID: 33569623 DOI: 10.1007/s00330-021-07736-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/29/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the proportion of clinical scenarios covered by EURO-2000 Guidelines and ESR iGuide, and assess compliance with both guidelines. METHODS The clinical indication on archived request forms for head, chest, abdomen-pelvis, and spine CT examinations performed in three hospitals in January 2018 was retrospectively matched with EURO-2000 Guidelines and ESR iGuide. For clinical scenarios addressed in the guidelines, the compliance with the guidelines was assessed. Analysis was performed on pooled data from the three centres and further stratified by centre, body region, and prescriber's specialisation. The differences in categorical data distributions between centres, body regions, and prescribers' specialisations were assessed with paired McNemar's χ2 tests. RESULTS A total of 6,812 requests for 7,217 CT examinations were analysed. Sixty-five percent of clinical situations that lead to prescribing CT examinations were addressed in EURO-2000 Guidelines compared with 81% for ESR iGuide. Proportions of clinical scenarios covered by the guidelines were statistically different between centres and body regions (p < 0.001) and varied according to prescribers' specialisations (p ranging from < 0.001 to 0.531). Both EURO-2000 Guidelines and ESR iGuide encompassed more clinical scenarios in certain body regions, favouring, e.g. spine and head over abdomen and chest. The proportion of "unjustified examinations" was greater according to EURO-2000 Guidelines (46%) than ESR iGuide (23%) (p < 0.001). CONCLUSIONS Both EURO-2000 Guidelines and ESR iGuide do not address numerous common clinical scenarios. The proportions of scenarios addressed differ according to the centre, body region, and prescribers' specialisation. Any estimation of compliance with referral guidelines is therefore of relative significance. KEY POINTS • ESR iGuide performs better than earlier EURO-2000 Guidelines for the coverage of all possible clinical scenarios leading to CT referrals. • Differences in coverage of clinical scenarios by both referral guidelines are observed for different body regions and/or prescribers' subspecialties. • As referral guidelines are incomplete, any estimation of justified or unjustified CT requests is of relative significance.
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Affiliation(s)
- Vartika Appiah
- Department of Radiology, Epicura Hospital, Rue Louis Caty, 136, B.7331, Baudour, Belgium
| | - Stephen Taylor
- Department of Radiology, Hôpital Ambroise Paré, Mons, Belgium
| | - Thibaut Vaulet
- ESAT Stadius Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven (KUL), Leuven, Belgium
| | - Nigel Howarth
- Department of Radiology, Clinique des Grangettes, Chêne-Bougeries, Switzerland
| | - Pierre Alain Gevenois
- Department of Radiology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Denis Tack
- Department of Radiology, Epicura Hospital, Rue Louis Caty, 136, B.7331, Baudour, Belgium.
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Jeukens CRLPN, Boere H, Wagemans BAJM, Nelemans PJ, Nijssen EC, Smith-Bindman R, Wildberger JE, Sailer AM. Probability of receiving a high cumulative radiation dose and primary clinical indication of CT examinations: a 5-year observational cohort study. BMJ Open 2021; 11:e041883. [PMID: 33455933 PMCID: PMC7813417 DOI: 10.1136/bmjopen-2020-041883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE High radiation exposure is a concern because of the association with cancer. The objective was to determine the probability of receiving a high radiation dose from CT (from one or more examinations within a 5-year period) and to assess the clinical context by evaluating clinical indications in the high-dose patient group. DESIGN Observational cohort study. Effective radiation dose received from one or more CT examinations within a predefined 5-year calendar period was assessed for each patient. SETTING Hospital setting. PARTICIPANTS All patients undergoing a diagnostic CT examination between July 2013 and July 2018 at the Maastricht University Medical Center. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the probability of receiving a high effective dose, defined as ≥100 mSv, from one or more CT examinations within 5 years as derived from a time-to-event analysis. Secondary outcomes were the clinical indication for the initial scan of patients receiving a high effective dose. RESULTS 100 672 CT examinations were performed among 49 978 patients including 482 (1%) who received a high radiation dose. The estimated probability of a high effective dose from a single examination is low (0.002% (95% CI 0.00% to 0.01%)). The 4.5-year probability of receiving a high cumulative effective dose was 1.9% (95% CI 1.6% to 2.2%) for women and 1.5% (95% CI 1.3% to 1.7%) for men. The probability was highest in age categories between 51 and 74 years. A total of 2711 (5.5%) of patients underwent more than six CT examinations, and the probability of receiving a high effective dose was 16%. Among patients who received a high effective dose, most indications (80%) were oncology related. CONCLUSIONS The probability of receiving a high radiation dose from CT examinations is small but not negligible. In the majority (80%) of high effective dose receiving patients, the indication for the initial CT scan was oncology related.
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Affiliation(s)
- Cécile R L P N Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hub Boere
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Bart A J M Wagemans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Estelle C Nijssen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM, School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Department of Obstetrics Gynecology and Reproductive Sciences, Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Anna M Sailer
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Leventer-Roberts M, Lev Bar-Or R, Gofer I, Rosenbaum Z, Hoshen M, Feldman B, Balicer R. Choosing Wisely: Determining performance of unjustified imaging in a large healthcare system. Int J Clin Pract 2021; 75:e13644. [PMID: 32748452 DOI: 10.1111/ijcp.13644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 07/24/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS The Choosing Wisely Campaign identifies procedures and treatments that lack clinical justification for routine use according to expert opinion and evidence-based medicine. This study describes the rates and features of two such examples over a 10-year period. METHODS This is a cross-sectional rolling cohort study between 2008 and 2017 in Clalit Health Services, the largest healthcare delivery system in Israel, with seven main hospitals and over 4.5 million members nationwide. All adult members who visited a Clalit Emergency Department (ED), and all children members who visited a Clalit ED for abdominal pain or appendicitis were eligible to be included in this study. Our measures were routine chest radiograph (CXR) in the context of pre-admission assessment for adults and abdominal computed tomography (CT) to rule out appendicitis for children. RESULTS Of the 3 689 869 adult visits without a clinical indication for a CXR, 9.1% or 337 058 of them received a chest radiograph. Of the 35 973 children visits for presumed appendicitis, 7.2% of them had no imaging performed, 82.3% had an ultrasound (US), 6.9% had an US followed by a CT, and 3.6% or 1293 of them received a CT. There were several independent risk factors such as BMI, hospital, sex, year and diagnosis that are associated with having imaging that is not clinically indicated. CONCLUSIONS Overall, this study found that diagnostic imaging practices are applied inconsistently by hospital and by population. Intervention efforts should be focused on subpopulations at greatest risk to further reduce exposure to such imaging.
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Affiliation(s)
- Maya Leventer-Roberts
- Clalit Research Institute, Tel Aviv, Israel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ilan Gofer
- Clalit Research Institute, Tel Aviv, Israel
| | | | | | | | - Ran Balicer
- Clalit Research Institute, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hayashi S, Nishida T, Kuriki S, Chang LS, Aochi K, Meren E, Sakamoto T, Tomita R, Higaki Y, Osugi N, Sugimoto A, Takahashi K, Mukai K, Matsumoto K, Nakamatsu D, Yamamoto M, Fukui K, Takenaka M, Hosono M, Inada M. Radiation exposure dose of fluoroscopy-guided gastrointestinal procedures: A single-center retrospective study. Endosc Int Open 2020; 8:E1872-E1877. [PMID: 33269323 PMCID: PMC7695514 DOI: 10.1055/a-1287-9066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Fluoroscopy-guided gastrointestinal procedures (FGPs) are increasingly common. However, the radiation exposure (RE) to patients undergoing FGPs is still unclear. We examined the actual RE of FGPs. Patients and methods This retrospective, single-center cohort study included consecutive FGPs, including endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), enteral stenting, balloon-assisted enteroscopy, tube placement, endoscopic injection sclerotherapy (EIS), esophageal balloon dilatation and repositioning for sigmoid volvulus, from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm 2 ), and fluoroscopy time (FT, min) for each procedure. Results In total, 3831 patients were enrolled. Overall, 2778 ERCPs were performed. The median AK, DAP, and FT were as follows: ERCP: 109 mGy, 13.3 Gycm 2 and 10.0 min; self-expandable enteral stenting (SEMS): 62 mGy, 12.4 Gycm 2 and 10.4 min; tube placement: 40 mGy, 13.8 Gycm 2 and 11.1 min; balloon-assisted enteroscopy: 43 mGy, 22.4 Gycm 2 and 18.2 min; EUS cyst drainage (EUS-CD): 96 mGy, 18.3 Gycm 2 and 10.4 min; EIS: 36 mGy, 8.1 Gycm 2 and 4.4 min; esophageal balloon dilatation: 9 mGy, 2.2 Gycm 2 and 1.8 min; and repositioning for sigmoid volvulus: 7 mGy, 4.7 Gycm 2 and 1.6 min. Conclusion This large series reporting actual RE doses of various FGPs could serve as a reference for future prospective studies.
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Affiliation(s)
- Shiro Hayashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
- Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Osaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Shinji Kuriki
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Li-sa Chang
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kazuki Aochi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Emi Meren
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Tatsuya Sakamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Ryo Tomita
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Yu Higaki
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Naoto Osugi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Aya Sugimoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kei Takahashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kaori Mukai
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Masahi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Koji Fukui
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masami Inada
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
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Enhanced Computed Tomography-Based Radiomics Signature Combined With Clinical Features in Evaluating Nuclear Grading of Renal Clear Cell Carcinoma. J Comput Assist Tomogr 2020; 44:730-736. [PMID: 32558771 DOI: 10.1097/rct.0000000000001041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of the study was to explore the value of enhanced computed tomography (CT)-based radiomics signature combined with clinical features in evaluating nuclear grading of clear cell renal cell carcinoma (ccRCC). METHODS One hundred one patients with ccRCC were classified into low- and high-grade group, and the data were divided into training set and verification set. Radiomics signatures were constructed in the training set in enhanced 3 stages and the combination of them. The predictive nomogram was constructed. The classification efficiency and the clinical practicability of the integrated radiomics model were evaluated. RESULTS The classification efficiency of enhanced 3-stage integrated histology model was higher than that of each single-phase model. The predictive nomogram incorporated the best radiomics signature, and the independent clinical risk factors showed good performance. A decision curve analysis curve shows that the net benefit of the combined model. CONCLUSIONS It is feasible to evaluate the nuclear grading of ccRCC based on enhanced CT radiomics signature combined with clinical features.
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Sheth KN, Mazurek MH, Yuen MM, Cahn BA, Shah JT, Ward A, Kim JA, Gilmore EJ, Falcone GJ, Petersen N, Gobeske KT, Kaddouh F, Hwang DY, Schindler J, Sansing L, Matouk C, Rothberg J, Sze G, Siner J, Rosen MS, Spudich S, Kimberly WT. Assessment of Brain Injury Using Portable, Low-Field Magnetic Resonance Imaging at the Bedside of Critically Ill Patients. JAMA Neurol 2020; 78:2769858. [PMID: 32897296 PMCID: PMC7489395 DOI: 10.1001/jamaneurol.2020.3263] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/17/2020] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Neuroimaging is a key step in the clinical evaluation of brain injury. Conventional magnetic resonance imaging (MRI) systems operate at high-strength magnetic fields (1.5-3 T) that require strict, access-controlled environments. Limited access to timely neuroimaging remains a key structural barrier to effectively monitor the occurrence and progression of neurological injury in intensive care settings. Recent advances in low-field MRI technology have allowed for the acquisition of clinically meaningful imaging outside of radiology suites and in the presence of ferromagnetic materials at the bedside. OBJECTIVE To perform an assessment of brain injury in critically ill patients in intensive care unit settings, using a portable, low-field MRI device at the bedside. DESIGN, SETTING, AND PARTICIPANTS This was a prospective, single-center cohort study of 50 patients admitted to the neuroscience or coronavirus disease 2019 (COVID-19) intensive care units at Yale New Haven Hospital in New Haven, Connecticut, from October 30, 2019, to May 20, 2020. Patients were eligible if they presented with neurological injury or alteration, no contraindications for conventional MRI, and a body habitus not exceeding the scanner's 30-cm vertical opening. Diagnosis of COVID-19 was determined by positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction nasopharyngeal swab result. EXPOSURES Portable MRI in an intensive care unit room. MAIN OUTCOMES AND MEASURES Demographic, clinical, radiological, and treatment data were collected and analyzed. Brain imaging findings are described. RESULTS Point-of-care MRI examinations were performed on 50 patients (16 women [32%]; mean [SD] age, 59 [12] years [range, 20-89 years]). Patients presented with ischemic stroke (n = 9), hemorrhagic stroke (n = 12), subarachnoid hemorrhage (n = 2), traumatic brain injury (n = 3), brain tumor (n = 4), and COVID-19 with altered mental status (n = 20). Examinations were acquired at a median of 5 (range, 0-37) days after intensive care unit admission. Diagnostic-grade T1-weighted, T2-weighted, T2 fluid-attenuated inversion recovery, and diffusion-weighted imaging sequences were obtained for 37, 48, 45, and 32 patients, respectively. Neuroimaging findings were detected in 29 of 30 patients who did not have COVID-19 (97%), and 8 of 20 patients with COVID-19 (40%) demonstrated abnormalities. There were no adverse events or complications during deployment of the portable MRI or scanning in an intensive care unit room. CONCLUSIONS AND RELEVANCE This single-center series of patients with critical illness in an intensive care setting demonstrated the feasibility of low-field, portable MRI. These findings demonstrate the potential role of portable MRI to obtain neuroimaging in complex clinical care settings.
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Affiliation(s)
- Kevin N. Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Mercy H. Mazurek
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew M. Yuen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Bradley A. Cahn
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Jill T. Shah
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Adrienne Ward
- Neuroscience Intensive Care Unit, Yale New Haven Hospital, New Haven, Connecticut
| | - Jennifer A. Kim
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Emily J. Gilmore
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Guido J. Falcone
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Nils Petersen
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin T. Gobeske
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Firas Kaddouh
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - David Y. Hwang
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph Schindler
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Lauren Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Rothberg
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
- Hyperfine Research Inc, Guilford, Connecticut
| | - Gordon Sze
- Department of Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan Siner
- Division of Pulmonology and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew S. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown
| | - Serena Spudich
- Division of Neurology Infections & Global Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - W. Taylor Kimberly
- Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston
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Acharya PT, Parentes V, Frush DP, Reid JR. Radiation in Pediatric Imaging: A Primer for Pediatricians. Pediatr Ann 2020; 49:e370-e373. [PMID: 32929511 DOI: 10.3928/19382359-20200825-01] [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: 11/20/2022]
Abstract
Medical imaging in children makes up a considerable percentage of all imaging procedures performed in the United States. Although in recent years there has been a 15% to 20% reduction in the exposure to ionizing radiation from medical imaging in the US population, the total number of computed tomography (CT) scans has increased from 2006 to 2016, and about 85% of all medical ionizing radiation in children is due to CT. [Pediatr Ann. 2020;49(9):e370-e373.].
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Boice J, Dauer LT, Kase KR, Mettler FA, Vetter RJ. Evolution of radiation protection for medical workers. Br J Radiol 2020; 93:20200282. [PMID: 32496817 PMCID: PMC7446021 DOI: 10.1259/bjr.20200282] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/05/2022] Open
Abstract
Within a few months of discovery, X-rays were being used worldwide for diagnosis and within a year or two for therapy. It became clear very quickly that while there were immense benefits, there were significant associated hazards, not only for the patients, but also for the operators of the equipment. Simple radiation protection measures were implemented within a decade or two and radiation protection for physicians and other operators has continued to evolve over the last century driven by cycles of widening uses, new technologies, realization of previously unidentified effects, development of recommendations and regulations, along with the rise of related societies and professional organizations. Today, the continue acceleration of medical radiation uses in diagnostic imaging and in therapeutic modalities not imagined at the turn of this century, such as positron emission tomography, calls for constant vigilance and flexibility to provide adequate protection for the growing numbers of medical radiation workers.
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Affiliation(s)
- John Boice
- National Council on Radiation Protection and Measurements, Bethesda, MD, USA
| | - Lawrence T Dauer
- Departments of Medical Physics and Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Fred A Mettler
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque,, NM, USA
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Naseri M, Shahsavan M, Salahshour F, Peiman S, Allameh SF, Farzanehfar S, Emami-Ardekani AR, Pouraliakbar H, Abbasi M. EFFECTIVE DOSE FOR RADIOLOGICAL PROCEDURES IN AN EMERGENCY DEPARTMENT: A CROSS-SECTIONAL STUDY. RADIATION PROTECTION DOSIMETRY 2020; 189:63-68. [PMID: 32140712 DOI: 10.1093/rpd/ncaa013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/05/2019] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
The extent of radiation exposure in emergency settings is not well documented; here, the corresponding effective dose (ED) is provided. In 500 patients admitted in row to the emergency department, ED was compared in patients according to complaints and their visiting physicians. Out of all, 220 patients aged 43.5 ± 22.2 years (admission: 2.0 ± 1.6 days) had at least an imaging. The main reasons for admission were trauma (10.5%) and then orthopedic problems (8.6%). EDs from CT and radiography were 1.66 ± 3.59 and 0.71 ± 1.67 mSv, respectively (from all 2.29 ± 4.12). Patients with abdominal (5.8 ± 5.2 mSv; p < 0.002) and pelvic (12.0 ± 6.3 mSv; p < 0.007) complaints received higher ED from CT and radiography and, also, patients visited by surgeons (7.94 ± 6.9 mSv). CT scan was the main source for ED to patients. Irrespective of the final diagnosis, patients with abdominopelvic complaints and those visited by surgeons are at higher exposure risk.
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Affiliation(s)
- Maryam Naseri
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shahsavan
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, Imam-Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Peiman
- Department of Internal Medicine, Imam-Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farshad Allameh
- Department of Internal Medicine, Imam-Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Farzanehfar
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Emami-Ardekani
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrshad Abbasi
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Smith-Bindman R, Chu P, Wang Y, Chung R, Lopez-Solano N, Einstein AJ, Solberg L, Cervantes LF, Yellen-Nelson T, Boswell W, Delman BN, Duong PA, Goode AR, Kasraie N, Lee RK, Neill R, Pahwa A, Pike P, Roehm J, Schindera S, Starkey J, Suntharalingam S, Jeukens CRLPN, Miglioretti DL. Comparison of the Effectiveness of Single-Component and Multicomponent Interventions for Reducing Radiation Doses in Patients Undergoing Computed Tomography: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:666-675. [PMID: 32227142 PMCID: PMC7105953 DOI: 10.1001/jamainternmed.2020.0064] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/08/2020] [Indexed: 12/27/2022]
Abstract
Importance Computed tomography (CT) radiation doses vary across institutions and are often higher than needed. Objective To assess the effectiveness of 2 interventions to reduce radiation doses in patients undergoing CT. Design, Setting, and Participants This randomized clinical trial included 864 080 adults older than 18 years who underwent CT of the abdomen, chest, combined abdomen and chest, or head at 100 facilities in 6 countries from November 1, 2015, to September 21, 2017. Data analysis was performed from October 4, 2017, to December 14, 2018. Interventions Imaging facilities received audit feedback alone comparing radiation-dose metrics with those of other facilities followed by the multicomponent intervention, including audit feedback with targeted suggestions, a 7-week quality improvement collaborative, and best-practice sharing. Facilities were randomly allocated to the time crossing from usual care to the intervention. Main Outcomes and Measures Primary outcomes were the proportion of high-dose CT scans and mean effective dose at the facility level. Secondary outcomes were organ doses. Outcomes after interventions were compared with those before interventions using hierarchical generalized linear models adjusting for temporal trends and patient characteristics. Results Across 100 facilities, 864 080 adults underwent 1 156 657 CT scans. The multicomponent intervention significantly reduced proportions of high-dose CT scans, measured using effective dose. Absolute changes in proportions of high-dose scans were 1.1% to 7.9%, with percentage reductions in the proportion of high-dose scans of 4% to 30% (abdomen: odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001; chest: OR, 0.92; 95% CI, 0.86-0.99; P = .03; combined abdomen and chest: OR, 0.49; 95% CI, 0.41-0.59; P < .001; and head: OR, 0.71; 95% CI, 0.66-0.76; P < .001). Reductions in the proportions of high-dose scans were greater when measured using organ doses. The absolute reduction in the proportion of high-dose scans was 6.0% to 17.2%, reflecting 23% to 58% reductions in the proportions of high-dose scans across anatomical areas. Mean effective doses were significantly reduced after multicomponent intervention for abdomen (6% reduction, P < .001), chest (4%, P < .001), and chest and abdomen (14%, P < .001) CT scans. Larger reductions in mean organ doses were 8% to 43% across anatomical areas. Audit feedback alone reduced the proportions of high-dose scans and mean dose, but reductions in observed dose were smaller. Radiologist's satisfaction with CT image quality was unchanged and high during all periods. Conclusions and Relevance For imaging facilities, detailed feedback on CT radiation dose combined with actionable suggestions and quality improvement education significantly reduced doses, particularly organ doses. Effects of audit feedback alone were modest. Trial Registration ClinicalTrials.gov Identifier: NCT03000751.
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Affiliation(s)
- Rebecca Smith-Bindman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | - Philip Chu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Yifei Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Robert Chung
- Department of Demography, University of California, Berkeley
| | - Naomi Lopez-Solano
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Andrew J. Einstein
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Department of Radiology, Columbia University Irving Medical Center, New York, New York
- New York–Presbyterian Hospital, New York, New York
| | - Leif Solberg
- HealthPartners Institute, Minneapolis, Minnesota
| | | | | | - William Boswell
- Department of Radiology, City of Hope National Medical Center, Duarte, California
| | - Bradley N. Delman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Phuong-Anh Duong
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Allen R. Goode
- Department of Radiology and Medical Imaging, University of Virginia Health System, Virginia
| | - Nima Kasraie
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Ryan K. Lee
- Department of Radiology, Einstein Healthcare Network, New York, New York
| | - Rebecca Neill
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Anokh Pahwa
- Department of Radiology Sciences, Olive View UCLA Medical Center, Los Angeles, California
| | | | - Jodi Roehm
- Center for Diagnostic Imaging, St Louis Park, Minnesota
| | | | - Jay Starkey
- St Luke's International Hospital, Chuo, Tokyo, Japan
| | | | - Cécile R. L. P. N. Jeukens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
- Kaiser Permanente Washington Health Research Institute, Seattle
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I S, C A, H S, P T, T F. Comparisons of Hounsfield Unit Linearity between Images Reconstructed using an Adaptive Iterative Dose Reduction (AIDR) and a Filter Back-Projection (FBP) Techniques. J Biomed Phys Eng 2020; 10:215-224. [PMID: 32337189 PMCID: PMC7166214 DOI: 10.31661/jbpe.v0i0.1912-1013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022]
Abstract
Background: The HU linearity is an essential parameter in a quantitative imaging and the treatment planning systems of radiotherapy. Objective: This study aims to evaluate the linearity of Hounsfield unit (HU) in applying the adaptive iterative dose reduction (AIDR)
on CT scanner and its comparison to the filtered back-projection (FBP). Material and Methods: In this experimental phantom study, a TOS-phantom was scanned using a Toshiba Alexion 6 CT scanner. The images were reconstructed
using the FBP and AIDR. Measurements of HU and noise values were performed on images of the “HU linearity” module of the TOS-phantom.
The module had five embedded objects, i.e., air, polypropylene, nylon, acrylic, and Delrin. On each object, a circle area of 4.32
cm2 was drawn and used to measure HU and noise values. The R2 of the relation between mass densities vs. HU values was used to
measure HU linearities at four different tube voltages. The Mann-Whitney U test was used to compare unpaired data and p-value < 0.05 was considered statistically significant. Results: The AIDR method produced a significant smaller image noise than the FBP method (p-value < 0.05).
There were no significant differences in HU values of images reconstructed using FBP and AIDR methods (p-value > 0.05).
The HU values acquired by the methods showed the same linearity marked by coinciding linear lines with the same R2 value (> 0.999). Conclusion: AIDR methods produce the HU linearity as FBP methods with a smaller image noise level.
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Affiliation(s)
- Suyudi I
- BSc, Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Indonesia
| | - Anam C
- PhD, Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Indonesia
| | - Sutanto H
- PhD, Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Indonesia
| | - Triadyaksa P
- PhD, Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Indonesia
| | - Fujibuchi T
- PhD, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Japan
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Prospective molecular and morphological assessment of testicular prepubertal-type teratomas in postpubertal men. Mod Pathol 2020; 33:713-721. [PMID: 31695156 DOI: 10.1038/s41379-019-0404-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 01/01/2023]
Abstract
In 2016, the World Health Organization classification system of testicular tumors included the new entity prepubertal-type teratoma based on its morphological and molecular profile, and the realization that these tumors may occur in postpubertal men. For treatment and prognostic purposes, it is important to distinguish prepubertal-type teratoma from the usual postpubertal-type teratoma, because the former is benign unlike the latter. The distinction may be challenging. In this study, we investigated clinical, morphological, and molecular criteria for distinguishing prepubertal-type teratoma from postpubertal-type teratoma in a prospective series of pure testicular teratomas. All cases of pure teratoma in postpubertal men assessed at Barts Health NHS Trust or in consultation since the introduction of routine investigation of chromosome 12p status in 2010 were reviewed. Morphological features suggestive of prepubertal-type teratoma were observed in 14 out of 35 cases. All underwent molecular testing and none displayed 12p amplification. Mean tumor size was 16 mm (range 7-28 mm). None had associated germ cell neoplasia in situ or significant atrophy. Four incorporated a well-differentiated neuroendocrine tumor, 1-2 mm in size. Of the ten patients with follow-up information, none have recurred or metastasized. Twenty-one of the 35 cases were diagnosed as postpubertal-type teratoma, mean tumor size 40 mm (range 6-90 mm). One case underwent molecular testing: a tumor of pure skeletal muscle differentiation and possessed 12p amplification. Three cases presented with clinical metastases. Eight cases contained immature areas, ten cases had associated germ cell neoplasia in situ, and 17 cases had severe atrophy of the parenchyma. One case with neither germ cell neoplasia in situ nor atrophy showed necrosis. We conclude that both morphological and molecular features are of help in differentiating prepubertal-type teratoma from postpubertal-type teratoma. In nearly all postpubertal-type teratomas, molecular testing was unnecessary, and merely confirmed the morphological impression in the prepubertal-type teratomas. Our study confirmed the high incidence of well-differentiated neuroendocrine tumors in the prepubertal-type.
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Zygmont ME, Neill R, Dharmadhikari S, Duong PAT. Achieving CT Regulatory Compliance: A Comprehensive and Continuous Quality Improvement Approach. Curr Probl Diagn Radiol 2020; 49:306-311. [PMID: 32178932 DOI: 10.1067/j.cpradiol.2020.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/16/2019] [Accepted: 01/23/2020] [Indexed: 11/22/2022]
Abstract
Computed tomography (CT) represents one of the largest sources of radiation exposure to the public in the United States. Regulatory requirements now mandate dose tracking for all exams and investigation of dose events that exceed set dose thresholds. Radiology practices are tasked with ensuring quality control and optimizing patient CT exam doses while maintaining diagnostic efficacy. Meeting regulatory requirements necessitates the development of an effective quality program in CT. This review provides a template for accreditation compliant quality control and CT dose optimization. The following paper summarizes a large health system approach for establishing a quality program in CT and discusses successes, challenges, and future needs.
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Affiliation(s)
- Matthew E Zygmont
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
| | - Rebecca Neill
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA; Environmental Health and Safety Office, Emory University, Atlanta, GA
| | - Shalmali Dharmadhikari
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA; Environmental Health and Safety Office, Emory University, Atlanta, GA
| | - Phuong-Anh T Duong
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT
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Acquisition time, radiation dose, subjective and objective image quality of dual-source CT scanners in acute pulmonary embolism: a comparative study. Eur Radiol 2020; 30:2712-2721. [PMID: 32025830 DOI: 10.1007/s00330-019-06650-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/04/2019] [Accepted: 12/19/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To compare the scan acquisition time, radiation dose, subjective and objective image quality of two dual-source CT scanners (DSCT) for detection of acute pulmonary embolism. METHODS Two hundred twenty-one scans performed on the 2nd-generation DSCT and 354 scans on the 3rd-generation DSCT were included in this large retrospective study. In a randomized blinded design, two radiologists independently reviewed the scans using a 5-point Likert scale. Radiation dose and objective image quality parameters were calculated. RESULTS Mean acquisition time was significantly lower in the 3rd-generation DSCT (2.81 s ± 0.1 in comparison with 9.7 s ± 0.15 [mean ± SD] respectively; p < 0.0001) with the 3rd generation 3.4 times faster. The mean subjective image quality score was 4.33/5 and 4/5 for the 3rd- and 2nd-generation DSCT respectively (p < 0.0001) with strong interobserver reliability agreement. DLP, CTDIvol, and ED were significantly lower in the 3rd than the 2nd generation (175.6 ± 63.7 mGy cm; 5.3 ± 1.9 mGy and 2.8 ± 1.2 mSv in comparison with 266 ± 255 mGy.cm; 7.8 ± 2.2 mGy and 3.8 ± 4.3 mSv). Noise was significantly lower in the 3rd generation (p < 0.01). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM), a dose-insensitive index for CNR, were significantly higher in the 3rd-generation DSCT (33.5 ± 23.4; 29.0 ± 21.3 and 543.7 ± 1037 in comparison with 23.4 ± 17.7; 19.4 ± 16.0 and 170.5 ± 284.3). CONCLUSION Objective and subjective image quality are significantly higher on the 3rd-generation DSCT with significantly lower mean acquisition time and radiation dose. KEY POINTS • The 3rd-generation DSCT scanner provides an improved image quality, less perceived artifacts, and lower radiation dose in comparison with the 2nd-generation DSCT, when operating in dual-energy (DE) mode. • The 3.4-times-faster 3rd-generation DSCT scanner can be of particular value in patients with chronic lung diseases or breathing difficulties that prevent adequate breathhold.
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Papadimitroulas P, Balomenos A, Kopsinis Y, Loudos G, Alexakos C, Karnabatidis D, Kagadis GC, Kostou T, Chatzipapas K, Visvikis D, Mountris KA, Jaouen V, Katsanos K, Diamantopoulos A, Apostolopoulos D. A Review on Personalized Pediatric Dosimetry Applications Using Advanced Computational Tools. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019. [DOI: 10.1109/trpms.2018.2876562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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48
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Saade-Lemus S, Degnan AJ, Acord MR, Srinivasan AS, Reid JR, Servaes SE, States LJ, Anupindi SA. Whole-body magnetic resonance imaging of pediatric cancer predisposition syndromes: special considerations, challenges and perspective. Pediatr Radiol 2019; 49:1506-1515. [PMID: 31620850 DOI: 10.1007/s00247-019-04431-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/16/2019] [Accepted: 05/15/2019] [Indexed: 02/06/2023]
Abstract
Cancer predisposition syndromes increase the incidence of tumors during childhood and are associated with significant morbidity and mortality. Imaging is paramount for ensuring early detection of neoplasms, impacting therapeutic interventions and potentially improving outcome. While conventional imaging techniques involve considerable exposure to ionizing radiation, whole-body MRI is a radiation-free modality that allows continuous imaging of the entire body and has increasingly gained relevance in the surveillance, diagnosis, staging and monitoring of pediatric patients with cancer predisposition syndromes. Nevertheless, widespread implementation of whole-body MRI faces several challenges as a screening tool. Some of these challenges include developing clinical indications, variability in protocol specifications, image interpretation as well as coding and billing practices. These factors impact disease management, patient and family experience and research collaborations. In this discussion we review the aforementioned special considerations and the potential direction that might help overcome these challenges and promote more widespread use of whole-body MRI in children with cancer predisposition syndromes.
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Affiliation(s)
- Sandra Saade-Lemus
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Andrew J Degnan
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael R Acord
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Abhay S Srinivasan
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Janet R Reid
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Sabah E Servaes
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Lisa J States
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
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Ayoub WS, Steggerda J, Yang JD, Kuo A, Sundaram V, Lu SC. Current status of hepatocellular carcinoma detection: screening strategies and novel biomarkers. Ther Adv Med Oncol 2019; 11:1758835919869120. [PMID: 31523283 PMCID: PMC6732860 DOI: 10.1177/1758835919869120] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/22/2019] [Indexed: 12/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality
worldwide. Delayed diagnosis is a major factor responsible for the poor
prognosis of HCC. Several advances have been made in the field of liver imaging
with the use of novel imaging contrasts, improving current imaging techniques
with contrast-enhanced computed tomography (CT) and magnetic resonance imaging
(MRI), introduction of new technologies such as contrast liver ultrasound, and
development of novel biomarkers with the goal of early detection of HCC and
improving outcomes of patients with HCC. This review focuses on current
surveillance strategies and development of biomarkers with the goal of early
detection of HCC.
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Affiliation(s)
- Walid S Ayoub
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Justin Steggerda
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ju Dong Yang
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander Kuo
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Vinay Sundaram
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shelly C Lu
- Cedars-Sinai Medical Center, Davis Building, Room #2097, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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50
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Abstract
BACKGROUND More than half of children evaluated as outpatients for abdominal pain are diagnosed with constipation. X-ray use in this scenario is variable: less than 5% in clinic settings, greater than 70% in emergency departments. X-rays increase misdiagnosis rate, remain costly, and involve radiation exposure. OBJECTIVES The aim of this study was to assess the use of plain radiographs by pediatric emergency medicine (PEM) providers in the diagnostic evaluation and management of pediatric constipation. METHODS A cross-sectional survey of PEM providers was performed. Survey participants were subscribers to the American Academy of Pediatrics Section on Emergency Medicine Listserv. To assess diagnostic and therapeutic approaches, participants were presented a case of pediatric constipation meeting Rome III clinical criteria. Participants also categorized frequency of x-ray use, reasons for obtaining, estimated diagnostic utility, and elements of institutional standard approach. Descriptive statistical analyses were performed. RESULTS Three hundred five of 1272 Listserv members (24%) responded. Ninety-nine percent elected to treat for constipation in a case meeting Rome III clinical criteria; one third (31%) would obtain plain radiographs for this same scenario. Plain radiographs were viewed as somewhat (59%) or minimally (29%) value-added in the evaluation of suspected pediatric constipation. Obtaining family buy-in (44%) was the most common reason for utilizing plain radiographs. Frequency of use varied across geographic regions and with participant and hospital characteristics. CONCLUSIONS This survey suggests that many PEM providers obtain radiographs to convince families of the diagnosis of constipation. This is not a viable management plan given the risks of radiation as well as costs. There remains room for improvement as we attempt to reduce use of radiation in the evaluation of common pediatric illnesses.
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