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Nicolò M, Adraman A, Risoli C, Menta A, Renda F, Tadiello M, Palmieri S, Lechiara M, Colombi D, Grazioli L, Natale MP, Scardino M, Demeco A, Foresti R, Montanari A, Barbato L, Santarelli M, Martini C. Comparing Visual and Software-Based Quantitative Assessment Scores of Lungs' Parenchymal Involvement Quantification in COVID-19 Patients. Diagnostics (Basel) 2024; 14:985. [PMID: 38786283 PMCID: PMC11120036 DOI: 10.3390/diagnostics14100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/27/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: Computed tomography (CT) plays a paramount role in the characterization and follow-up of COVID-19. Several score systems have been implemented to properly assess the lung parenchyma involved in patients suffering from SARS-CoV-2 infection, such as the visual quantitative assessment score (VQAS) and software-based quantitative assessment score (SBQAS) to help in managing patients with SARS-CoV-2 infection. This study aims to investigate and compare the diagnostic accuracy of the VQAS and SBQAS with two different types of software based on artificial intelligence (AI) in patients affected by SARS-CoV-2. (2) Methods: This is a retrospective study; a total of 90 patients were enrolled with the following criteria: patients' age more than 18 years old, positive test for COVID-19 and unenhanced chest CT scan obtained between March and June 2021. The VQAS was independently assessed, and the SBQAS was performed with two different artificial intelligence-driven software programs (Icolung and CT-COPD). The Intraclass Correlation Coefficient (ICC) statistical index and Bland-Altman Plot were employed. (3) Results: The agreement scores between radiologists (R1 and R2) for the VQAS of the lung parenchyma involved in the CT images were good (ICC = 0.871). The agreement score between the two software types for the SBQAS was moderate (ICC = 0.584). The accordance between Icolung and the median of the visual evaluations (Median R1-R2) was good (ICC = 0.885). The correspondence between CT-COPD and the median of the VQAS (Median R1-R2) was moderate (ICC = 0.622). (4) Conclusions: This study showed moderate and good agreement upon the VQAS and the SBQAS; enhancing this approach as a valuable tool to manage COVID-19 patients and the combination of AI tools with physician expertise can lead to the most accurate diagnosis and treatment plans for patients.
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Affiliation(s)
- Marco Nicolò
- Department of Diagnostic Imaging, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Altin Adraman
- Department of Neuroradiology, University Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Camilla Risoli
- Department of Radiological Function, “Guglielmo da Saliceto” Hospital, Via Taverna 49, 29121 Piacenza, Italy
| | - Anna Menta
- Department of Diagnostic Imaging, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Francesco Renda
- Department of Radiology—Diagnostic Imaging, ASST Rhodense, Viale Forlanini 95, 20024 Garbagnate Milanese, Italy
| | - Michele Tadiello
- Department of Diagnostic Imaging, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Sara Palmieri
- Department of Diagnostic Imaging, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Marco Lechiara
- Department of Diagnostic Imaging, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Davide Colombi
- Department of Radiological Function, “Guglielmo da Saliceto” Hospital, Via Taverna 49, 29121 Piacenza, Italy
| | - Luigi Grazioli
- Department of Diagnostic Imaging, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Matteo Pio Natale
- Department of Respiratory Disease, University of Foggia, Via Antonio Gramsci 89, 71122 Foggia, Italy;
| | - Matteo Scardino
- Department of Radiology, A.O.U. Città della Salute e della Scienza di Torino, Via Zuretti 29, 10126 Torino, Italy;
| | - Andrea Demeco
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.)
| | - Ruben Foresti
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.)
| | - Attilio Montanari
- Diagnostics for Images Unit and Interventional Radiology, AST Pesaro Urbino, Piazzale Cinelli 1, 61121 San Salvatore, Italy;
| | - Luca Barbato
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Sant’Andrea University Hospital, Via Di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Mirko Santarelli
- Medical Physics Unit, “Sapienza” University of Rome, Sant’Andrea University Hospital, Via Di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.)
- Diagnostics for Images Unit and Interventional Radiology, AST Pesaro Urbino, Piazzale Cinelli 1, 61121 San Salvatore, Italy;
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, “Sapienza” University of Rome, Sant’Andrea University Hospital, Via Di Grottarossa, 1035-1039, 00189 Rome, Italy
- Medical Physics Unit, “Sapienza” University of Rome, Sant’Andrea University Hospital, Via Di Grottarossa, 1035-1039, 00189 Rome, Italy
- Diagnostic Department, Parma University Hospital, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy
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Robatjazi M, Moayed M, Baghani HR, Molazadeh M, Shomoossi N. Evaluation of organ dose using size-specific dose estimation (SSDE) and related cancer risk due to chest CT scan during the COVID-19 pandemic. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:27-37. [PMID: 38185693 DOI: 10.1007/s00411-023-01056-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
This study aimed to estimate lung and breast doses for individual patients using the size-specific dose estimate (SSDE) method, as well as calculating effective doses, in patients who underwent chest CT scans during the COVID-19 pandemic. Cancer risk incidence was estimated using excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) models from the Biological Effects of Ionizing Radiation Report VII (BEIR-VII). Data from about 570 patients who underwent CT scans for COVID-19 screening were utilized for this study. Using the header of the CT images in a Python script, SSDE and effective dose were calculated for each patient. The SSDE obtained by water equivalent effective diameter (wSSDE) was considered as lung and breast dose, and applied in organ-specific cancer risk estimation. The mean wSSDE value for females (13.3 mGy) was slightly higher than that for males (13.1 mGy), but the difference was not statistically significant (P value = 0.41). No significant differences were observed between males and females in terms of calculated EAR and ERR for lung cancer at 5 and 30 years after exposure (P value = 0.47, 0.46, respectively). Similarly, there was no significant difference in lung cancer LAR values between females and males (P value = 0.48). The results also indicated a decrease in LAR values for both lung and breast cancers with increasing exposure age. In accordance with the ALARA (as low as reasonably achievable) principle, it is important for medical staff and the general public to consider the benefits of CT imaging in detecting such infections. Additionally, imaging medical physicists and CT scan experts should optimize imaging protocols and strike a balance between image quality for detecting abnormalities and radiation dose, all while adhering to the ALARA principle.
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Affiliation(s)
- Mostafa Robatjazi
- Department of Medical Physics and Radiological Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Non-Communicable Disease Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mahdis Moayed
- Department of Medical Physics and Radiological Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Mikaeil Molazadeh
- Department of Medical Physics, Tabriz University of Medical Sciences, Tabriz, Iran
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3
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Steuwe A, Kamp B, Afat S, Akinina A, Aludin S, Bas EG, Berger J, Bohrer E, Brose A, Büttner SM, Ehrengut C, Gerwing M, Grosu S, Gussew A, Güttler F, Heinrich A, Jiraskova P, Kloth C, Kottlors J, Kuennemann MD, Liska C, Lubina N, Manzke M, Meinel FG, Meyer HJ, Mittermeier A, Persigehl T, Schmill LP, Steinhardt M, The Racoon Study Group, Antoch G, Valentin B. Standardization of a CT Protocol for Imaging Patients with Suspected COVID-19-A RACOON Project. Bioengineering (Basel) 2024; 11:207. [PMID: 38534481 DOI: 10.3390/bioengineering11030207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
CT protocols that diagnose COVID-19 vary in regard to the associated radiation exposure and the desired image quality (IQ). This study aims to evaluate CT protocols of hospitals participating in the RACOON (Radiological Cooperative Network) project, consolidating CT protocols to provide recommendations and strategies for future pandemics. In this retrospective study, CT acquisitions of COVID-19 patients scanned between March 2020 and October 2020 (RACOON phase 1) were included, and all non-contrast protocols were evaluated. For this purpose, CT protocol parameters, IQ ratings, radiation exposure (CTDIvol), and central patient diameters were sampled. Eventually, the data from 14 sites and 534 CT acquisitions were analyzed. IQ was rated good for 81% of the evaluated examinations. Motion, beam-hardening artefacts, or image noise were reasons for a suboptimal IQ. The tube potential ranged between 80 and 140 kVp, with the majority between 100 and 120 kVp. CTDIvol was 3.7 ± 3.4 mGy. Most healthcare facilities included did not have a specific non-contrast CT protocol. Furthermore, CT protocols for chest imaging varied in their settings and radiation exposure. In future, it will be necessary to make recommendations regarding the required IQ and protocol parameters for the majority of CT scanners to enable comparable IQ as well as radiation exposure for different sites but identical diagnostic questions.
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Affiliation(s)
- Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Benedikt Kamp
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Alena Akinina
- Clinic and Outpatient Clinic for Radiology, University Hospital Halle (Saale), 06120 Halle, Germany
| | - Schekeb Aludin
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
| | - Elif Gülsah Bas
- Department of Diagnostic and Interventional Radiology, University Hospital of Marburg, 35043 Marburg, Germany
| | - Josephine Berger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany
| | - Evelyn Bohrer
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus Liebig University, Klinikstr. 33, 35392 Giessen, Germany
| | - Alexander Brose
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus Liebig University, Klinikstr. 33, 35392 Giessen, Germany
| | - Susanne Martina Büttner
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Constantin Ehrengut
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Liebigstraße 20, 04103 Leipzig, Germany
| | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, 48149 Münster, Germany
| | - Sergio Grosu
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 Munich, Germany
| | - Alexander Gussew
- Clinic and Outpatient Clinic for Radiology, University Hospital Halle (Saale), 06120 Halle, Germany
| | - Felix Güttler
- Department of Radiology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Andreas Heinrich
- Department of Radiology, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany
| | - Petra Jiraskova
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Jonathan Kottlors
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | | | - Christian Liska
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - Nora Lubina
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - Mathias Manzke
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057 Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Schillingallee 36, 18057 Rostock, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Liebigstraße 20, 04103 Leipzig, Germany
| | - Andreas Mittermeier
- Department of Radiology, LMU University Hospital, LMU Munich, 81377 Munich, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Lars-Patrick Schmill
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
| | - Manuel Steinhardt
- Institute of Diagnostic and Interventional Radiology, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
| | | | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Birte Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
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Thrall JH, Brink JA, Zalis ME. The Environmental, Social, Governance Movement and Radiology: Opportunities and Strategy. J Am Coll Radiol 2024; 21:265-270. [PMID: 37495034 DOI: 10.1016/j.jacr.2023.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/20/2022] [Accepted: 02/07/2023] [Indexed: 07/28/2023]
Abstract
The environmental, social, governance (ESG) movement has come to health care organizations, in part through the Biden administration's challenge to them to reduce greenhouse gas emissions by 50% by 2030 and achieve net zero emissions by 2050, in support of more robust environmental sustainability. Radiology practices should become knowledgeable about ESG concepts and look for opportunities that are meaningful and achievable to support their host organizations' ESG efforts. Examples of initiatives to support improved environmental sustainability include selecting the least energy intensive imaging method for a given diagnosis, shutting down equipment in standby mode, sourcing energy from renewable sources, and reducing waste through recycling. Optimizing imaging protocols can reduce radiation exposure to patients, energy used per examination, and the use of other resources such as iodinated contrast media, an environmental pollutant. Achieving socially equitable access to services for ethnic and racial minorities remains a challenge in the US health care system. Extending hours of operation for screening services to include nights and weekends can provide options for patients who otherwise must take time away from work with loss of income. With respect to governance, more transparency in leadership selection and greater opportunities for participation by women and racial/ethnic minorities in the leadership of professional organizations should be supported in radiology. To succeed in ESG initiatives, radiology practice leaders should consider appointing a lead person and a multifunctional team that includes broad representation from the radiology workplace. The team should work to identify opportunities that are realistic and achievable within their institutional contexts.
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Affiliation(s)
- James H Thrall
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Subcommittee Chair, ACR Centennial Committee; Chair, Ethics in Publishing Subcommittee, ACR Publications Committee.
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Chief, Enterprise Imaging, Mass General Brigham Health System; Radiologist-in-Chief, Massachusetts General Hospital
| | - Michael E Zalis
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Lead, Imaging Sustainability Task Force, Mass General Brigham Health System
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5
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Oliveira Bernardo M, Karout L, Morgado F, Ebrahimian S, Sarmet Santos A, Amorim C, Muniz Filho H, Moscatelli A, Francisco Muglia V, Schroeder H, Moulin Sales D, Gandolpho Henschel R, Giovanni Valese B, Kiipper F, Cesar Cavalcanti P, Lucena R, Jornada T, de Paula V, Zago M, Varella R, Anes M, Márcio Alves Pinheiro A, Claúdio de Moura Carvalho L, Santana de Melo Tapajos J, Antonio de Almeida F, Applegate K, Paulo G, Roberto Costa P. Establishing national clinical diagnostic reference levels and achievable doses for CT examinations in Brazil: A prospective study. Eur J Radiol 2023; 169:111191. [PMID: 37976761 DOI: 10.1016/j.ejrad.2023.111191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Diagnostic reference levels (DRL) and achievable doses (AD) are important tools for radiation dose optimization. Therefore, a prospective study was performed which aimed to establish a multi-parametric, clinical indication based - DRL(DRLCI) and clinical indication - AD (ADCI) for adult CT in Brazil. METHODS The prospective study included 4787 patients (50 ± 18 years old; male:female 2041:2746) at 13 Brazilian sites that have been submitted to head, paranasal sinus, cervical spine, chest, or abdomen-pelvis CT between January and October 2021 for 13 clinical indications. The sites provided the following information: patient age, gender, weight, height, body mass index[BMI], clinical indications, scanner information(vendor, model, detector configuration), scan parameters (number of scan phases, kV, mA, pitch) and dose-related quantities (CT dose index volume- CTDIvol, dose length product- DLP). Median(AD) and 75th(DRL) percentile CTDIvol and DLP values were estimated for each body region and clinical indications. Non-normal data were analyzed with the Kruskal-Wallis test. RESULTS In majority of Brazilian sites, body region and clinical indications based DRLs were at or lower than the corresponding DRLs in the US and higher than Europe. Although radiation doses varied significantly for patients in different body mass index groups (p < 0.001), within each body region, there were no differences in radiation doses for different clinical indications (p > 0.1). Radiation doses for 7/13 clinical indications were higher using iterative reconstruction technique than for the filtered back projection. CONCLUSIONS There was substantial variation in Brazil DRLCI across different institutions with higher doses compared to the European standards. There was also a lack of clinical indication-based protocol and dose optimization based on different clinical indications for the same body region.
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Affiliation(s)
| | - Lina Karout
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Shadi Ebrahimian
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA.
| | | | - Clarissa Amorim
- Complexo Hospitalar de Niterói, Niterói, Rio de Janeiro, Brazil.
| | | | | | - Valdair Francisco Muglia
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | - Henrique Schroeder
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, Brazil.
| | | | | | | | | | | | - Ronaldo Lucena
- Unimed Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Tiago Jornada
- Hospital das Clínicas de Recife, Recife, Pernambuco, Brazil.
| | - Valnir de Paula
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Marcel Zago
- DIX Diagnóstico por Imagem, Santa Maria, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ricardo Varella
- Hospital Unimed de Vitória, Vitória, Espírito Santo, Brazil.
| | - Mauricio Anes
- Hospital das Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | | | | | | | | | - Kimberly Applegate
- University of Kentucky College of Medicine, Department of Radiology, Lexington, KY, USA.
| | - Graciano Paulo
- Escola Superior de Tecnologia da Saúde do Instituto Politécnico de Coimbra, Coimbra, Portugal.
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Schwartz FR, Clark DP, Rigiroli F, Kalisz K, Wildman-Tobriner B, Thomas S, Wilson J, Badea CT, Marin D. Evaluation of the impact of a novel denoising algorithm on image quality in dual-energy abdominal CT of obese patients. Eur Radiol 2023; 33:7056-7065. [PMID: 37083742 PMCID: PMC10902821 DOI: 10.1007/s00330-023-09644-7] [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: 11/23/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Evaluate a novel algorithm for noise reduction in obese patients using dual-source dual-energy (DE) CT imaging. METHODS Seventy-nine patients with contrast-enhanced abdominal imaging (54 women; age: 58 ± 14 years; BMI: 39 ± 5 kg/m2, range: 35-62 kg/m2) from seven DECT (SOMATOM Flash or Force) were retrospectively included (01/2019-12/2020). Image domain data were reconstructed with the standard clinical algorithm (ADMIRE/SAFIRE 2), and denoised with a comparison (ME-NLM) and a test algorithm (rank-sparse kernel regression). Contrast-to-noise ratio (CNR) was calculated. Four blinded readers evaluated the same original and denoised images (0 (worst)-100 (best)) in randomized order for perceived image noise, quality, and their comfort making a diagnosis from a table of 80 options. Comparisons between algorithms were performed using paired t-tests and mixed-effects linear modeling. RESULTS Average CNR was 5.0 ± 1.9 (original), 31.1 ± 10.3 (comparison; p < 0.001), and 8.9 ± 2.9 (test; p < 0.001). Readers were in good to moderate agreement over perceived image noise (ICC: 0.83), image quality (ICC: 0.71), and diagnostic comfort (ICC: 0.6). Diagnostic accuracy was low across algorithms (accuracy: 66, 63, and 67% (original, comparison, test)). The noise received a mean score of 54, 84, and 66 (p < 0.05); image quality 59, 61, and 65; and the diagnostic comfort 63, 68, and 68, respectively. Quality and comfort scores were not statistically significantly different between algorithms. CONCLUSIONS The test algorithm produces quantitatively higher image quality than current standard and existing denoising algorithms in obese patients imaged with DECT and readers show a preference for it. CLINICAL RELEVANCE STATEMENT Accurate diagnosis on CT imaging of obese patients is challenging and denoising algorithms can increase the diagnostic comfort and quantitative image quality. This could lead to better clinical reads. KEY POINTS • Improving image quality in DECT imaging of obese patients is important for accurate and confident clinical reads, which may be aided by novel denoising algorithms using image domain data. • Accurate diagnosis on CT imaging of obese patients is especially challenging and denoising algorithms can increase quantitative and qualitative image quality. • Image domain algorithms can generalize well and can be implemented at other institutions.
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Affiliation(s)
- Fides R Schwartz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA.
| | - Darin P Clark
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University, Durham, NC, USA
| | - Francesca Rigiroli
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Kevin Kalisz
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Benjamin Wildman-Tobriner
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | - Sarah Thomas
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
| | | | - Cristian T Badea
- Quantitative Imaging and Analysis Lab, Department of Radiology, Duke University, Durham, NC, USA
| | - Daniele Marin
- Department of Radiology, Duke University Health System, 2301 Erwin Road, Box 3808, Durham, NC, 27110, USA
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7
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Saeed MK, Alshamrani HA, Abdullah YM, Ali ASAM, Almalki Y, Alqfail KA. Chest CT utilization in COVID-19: a dosimetric and diagnostic-quality study. RADIATION PROTECTION DOSIMETRY 2023; 199:1257-1263. [PMID: 37295952 DOI: 10.1093/rpd/ncad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 05/13/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
The purpose of this study is to look at the variations in chest computed tomography (CT) use, radiation dose and image quality in the 2019 novel coronavirus (COVID-19) pneumonia patients in Saudi Arabia. This is a retrospective study of 402 patients with COVID-19, who were treated between February and October 2021. Radiation dose was estimated using metrics of volume CT dose index (CTDIvol) and size-specific dose estimate (SSDE). The imaging performance of the CT scanners was evaluated by measuring different parameters, such as resolution and CT number uniformity, with an ACR-CT accreditation phantom. Expert radiologists assessed the diagnostic quality and occurrence of artefacts. For all of the image quality parameters tested, the majority of the scanner sites (80%) were found to be within the suggested acceptance limits. Ground-glass opacities were the most common finding in our patient sample (54%). On chest CT exams with typical appearance of COVID-19 pneumonia, the most respiratory motion artefacts (56.3%) were present, followed by those with indeterminate appearance (32.2%). There were significant differences in CT utilization, CTDIvol and SSDE across the collaborated sites. The use of CT scans and radiation doses varied in the COVID-19 patients, highlighting the optimizations of CT protocols at participating sites.
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Affiliation(s)
- Mohammed K Saeed
- Department of Radiological Sciences, Faculty of Applied Medical Sciences, Najran University, Najran 1988, Saudi Arabia
| | - Hassan A Alshamrani
- Department of Radiological Sciences, Faculty of Applied Medical Sciences, Najran University, Najran 1988, Saudi Arabia
| | - Youssef M Abdullah
- Department of Radiological Science and Medical Imaging, College of Applied Medical Sciences, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| | - Ali Sid Ahmed M Ali
- Faculty of Science and Technology, Al Neelain University, Medical Physics Department, Khartoum 12702, Sudan
| | - Y Almalki
- College of Medicine, Najran University, P.O Box 1988, Najran, Saudi Arabia
| | - Khaled A Alqfail
- College of Medicine, Najran University, P.O Box 1988, Najran, Saudi Arabia
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Suliman II, Khouqeer GA, Ahmed NA, Abuzaid MM, Sulieman A. Low-Dose Chest CT Protocols for Imaging COVID-19 Pneumonia: Technique Parameters and Radiation Dose. Life (Basel) 2023; 13:life13040992. [PMID: 37109522 PMCID: PMC10146316 DOI: 10.3390/life13040992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
Chest computed tomography (CT) plays a vital role in the early diagnosis, treatment, and follow-up of COVID-19 pneumonia during the pandemic. However, this raises concerns about excessive exposure to ionizing radiation. This study aimed to survey radiation doses in low-dose chest CT (LDCT) and ultra-low-dose chest CT (ULD) protocols used for imaging COVID-19 pneumonia relative to standard CT (STD) protocols so that the best possible practice and dose reduction techniques could be recommended. A total of 564 articles were identified by searching major scientific databases, including ISI Web of Science, Scopus, and PubMed. After evaluating the content and applying the inclusion criteria to technical factors and radiation dose metrics relevant to the LDCT protocols used for imaging COVID-19 patients, data from ten articles were extracted and analyzed. Technique factors that affect the application of LDCT and ULD are discussed, including tube current (mA), peak tube voltage (kVp), pitch factor, and iterative reconstruction (IR) algorithms. The CTDIvol values for the STD, LDCT, and ULD chest CT protocols ranged from 2.79-13.2 mGy, 0.90-4.40 mGy, and 0.20-0.28 mGy, respectively. The effective dose (ED) values for STD, LDCT, and ULD chest CT protocols ranged from 1.66-6.60 mSv, 0.50-0.80 mGy, and 0.39-0.64 mSv, respectively. Compared with the standard (STD), LDCT reduced the dose reduction by a factor of 2-4, whereas ULD reduced the dose reduction by a factor of 8-13. These dose reductions were achieved by applying scan parameters and techniques such as iterative reconstructions, ultra-long pitches, and fast spectral shaping with a tin filter. Using LDCT, the cumulative radiation dose of serial CT examinations during the acute period of COVID-19 may have been inferior or equivalent to that of conventional CT.
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Affiliation(s)
- Ibrahim I Suliman
- Department of Physics, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11642, Saudi Arabia
- Deanship of Scientific Research, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11642, Saudi Arabia
| | - Ghada A Khouqeer
- Department of Physics, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11642, Saudi Arabia
| | - Nada A Ahmed
- Faculty of Science, Taibah University, Al Madinah Al Munawwarah 42353, Saudi Arabia
| | - Mohamed M Abuzaid
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Abdelmoneim Sulieman
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
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Coşkun M, Çilengir AH, Çetinoğlu K, Horoz M, Sinci A, Demircan B, Uluç E, Gelal F. Did radiation exposure increase with chest computed tomography use among different ages during the COVID-19 pandemic? A multi-center study with 42028 chest computed tomography scans. Diagn Interv Radiol 2023; 29:373-378. [PMID: 36988026 PMCID: PMC10679709 DOI: 10.5152/dir.2022.211043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/28/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine whether radiation exposure increased among different ages with chest computed tomography (CT) use during the coronavirus disease-2019 (COVID-19) pandemic. METHODS Patients with chest CT scans in an 8-month period of the pandemic between March 15, 2020, and November 15, 2020, and the same period of the preceding year were included in the study. Indications of chest CT scans were obtained from the clinical notes and categorized as infectious diseases, neoplastic disorders, trauma, and other diseases. Chest CT scans for infectious diseases during the pandemic were compared with those with the same indications in 2019. The dose-length product values were obtained from the protocol screen individually. RESULTS The total number of chest CT scans with an indication of infectious disease was 21746 in 2020 and 4318 in 2019. Total radiation exposure increased by 573% with the use of chest CT for infectious indications but decreased by 19% for neoplasia, 12% for trauma, and 43% for other reasons. The mean age of the patients scanned in 2019 was significantly higher than those scanned during the pandemic (64.6 vs. 50.3 years). A striking increase was seen in the 10-59 age group during the pandemic (P < 0.001). The highest increase was seen in the 20-29 age group, being 18.6 fold. One death was recorded per 58 chest CT scans during the pandemic. Chest CT use was substantially higher at the beginning of the pandemic. CONCLUSION Chest CT was excessively used during the COVID-19 pandemic. Young and middle-aged people were exposed more than others. The impact of COVID-19-pandemic-related radiation exposure on public health should be followed carefully in future years.
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Affiliation(s)
- Mehmet Coşkun
- Clinic of Radiology, University of Health Science Turkey, Dr. Behçet Uz Children Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | | | - Kenan Çetinoğlu
- Clinic of Radiology, Merkezefendi State Hospital, Manisa, Turkey
| | - Merve Horoz
- Clinic of Radiology, Çiğli Regional Training and Research Hospital, İzmir, Turkey
| | - Ayberk Sinci
- Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Betül Demircan
- Clinic of Pediatrics, Bakırçay University Çiğli Regional Training and Research Hospital, İzmir, Turkey
| | - Engin Uluç
- Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
| | - Fazıl Gelal
- Department of Radiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
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Bonacossa de Almeida CE, Harbron RW, Valle Bahia PR, Murta Dovales AC. The impact of the COVID-19 pandemic on the use of diagnostic imaging examinations in the Brazilian unified healthcare system (SUS). HEALTH POLICY AND TECHNOLOGY 2023; 12:100725. [PMID: 36683762 PMCID: PMC9839386 DOI: 10.1016/j.hlpt.2023.100725] [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] [Indexed: 01/15/2023]
Abstract
Objectives To assess the impact of the COVID-19 pandemic on the volumes of use of diagnostic imaging examinations in the Brazilian Unified Health System (SUS), the only healthcare provider for approximately 160 million people. Methods We collected the monthly numbers of diagnostic imaging examinations in the years 2019, 2020, and 2021 from a database provided by SUS. Data were collected by specific type of examination across different imaging modalities, both for the outpatient (elective and emergency) and inpatient settings. Results There was a large reduction in the annual volume of almost all types of diagnostic imaging examinations in SUS in 2020, compared to 2019. Decreases were generally greater among outpatients than in the hospital setting, in which the annual volume of use of most modalities was similar or even higher in 2021 than in the pre-pandemic period. Computed tomography (CT) was the only modality for which use increased in 2020 compared to 2019. In contrast to other types of examinations, the use of chest CT was much higher in both 2020 and 2021 than in the preceding years. The relative changes in diagnostic imaging use in SUS started around March-April 2020, when the pandemic began to get worse in Brazil, and tended to correlate to COVID-19 incidence in Brazil over the following months. Conclusions The COVID-19 pandemic had a large impact on the use of diagnostic imaging examinations in the SUS. Policies and actions are needed to alleviate the resulting potential adverse health effects and to optimize the use of diagnostic tests in the future.
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Affiliation(s)
- Carlos Eduardo Bonacossa de Almeida
- Instituto de Radioproteção e Dosimetria, Comissão Nacional de Energia Nuclear, Av. Salvador Allende 3773, Barra da Tijuca, Rio de Janeiro, RJ, 22783-127, Brazil
| | - Richard W Harbron
- Institute of Health & Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, United Kingdom
- Radiation Protection Group, European Organisation for Nuclear Research (CERN), 1211 Geneva 23, Switzerland
| | - Paulo Roberto Valle Bahia
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, Cidade Universitária, Rio de Janeiro, RJ, 21941-913, Brazil
| | - Ana Cristina Murta Dovales
- Instituto de Radioproteção e Dosimetria, Comissão Nacional de Energia Nuclear, Av. Salvador Allende 3773, Barra da Tijuca, Rio de Janeiro, RJ, 22783-127, Brazil
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Cao B, Iredell J, Middleton P, Young N. Chest CT in COVID-19 patients: A clinical need. J Med Radiat Sci 2023; 70:40-45. [PMID: 36593758 PMCID: PMC9977662 DOI: 10.1002/jmrs.642] [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] [Received: 06/16/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused by the coronavirus SARS-CoV-2 has resulted in a global healthcare crisis. The provision of computed tomography (CT) imaging services by radiology departments for COVID-19 patients poses multiple challenges. Consequently, it is important to explore the clinical need and indications for thoracic CT and whether they subsequently alter patient management. METHODS We report our experience in this single-centre retrospective cohort study of all confirmed COVID-19 cases admitted during the peak of the 'Delta' variant wave in Australia, and who underwent a chest CT. Clinical indication and patient management plan pre- and post-CT were ascertained. RESULTS A total of 92 out of 1403 patients who were admitted with COVID-19 underwent a thoracic CT (73 CT pulmonary angiogram (CTPA), 14 CT Chest and five high-resolution CT (HRCT) studies). 72.8% of studies were to evaluate for pulmonary emboli, 16.2% for assessment of COVID-19 pneumonia complications, 5.4% for tuberculosis and 6.5% for other indications. 21 (23%) of these studies resulted in a change in management with two patients having a major change in management (thrombolysis, CT-guided aspiration). Management was altered due to diagnosis of pulmonary embolism (PE), pneumonia, cryptogenic organising pneumonia and other reasons. Of 73 CTPA studies, 11 (15%) patients had evidence of PE. CONCLUSION In our centre, thoracic CT in COVID-19 patients were predominantly for the evaluation of PE with other indications being for COVID-19 complications and other cardiopulmonary pathologies. 23% of studies subsequently altered patient management, suggesting there is good clinical need for CT chests for these indications.
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Affiliation(s)
- Brooke Cao
- Westmead HospitalSydneyNew South WalesAustralia
| | - Jonathan Iredell
- Infectious Diseases & MicrobiologyWestmead HospitalSydneyNew South WalesAustralia
| | - Peter Middleton
- Respiratory & Sleep MedicineWestmead HospitalSydneyNew South WalesAustralia
| | - Noel Young
- Radiology DepartmentWestmead HospitalSydneyNew South WalesAustralia,Faculty of Medicine, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
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COVID-19 and vaccination impact on radiology departments provided by Dose Archiving and Communication System. Eur Radiol 2023:10.1007/s00330-023-09426-1. [PMID: 36754891 PMCID: PMC9908501 DOI: 10.1007/s00330-023-09426-1] [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] [Received: 07/18/2022] [Revised: 11/06/2022] [Accepted: 01/02/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To study the impact of COVID-19 on chest CT practice during the different waves using Dose Archiving and Communication System (DACS). METHODS Retrospective study including data from 86,136 chest CT acquisitions from 27 radiology centers (15 private; 12 public) between January 1, 2020, and October 13, 2021, using a centralized DACS. Daily chest CT activity and dosimetry information such as dose length product (DLP), computed tomography dose index (CTDI), and acquisition parameters were collected. Pandemic indicators (daily tests performed, incidence, and hospital admissions) and vaccination rates were collected from a governmental open-data platform. Descriptive statistics and correlation analysis were performed. RESULTS For the first two waves, strong positive and significant correlations were found between all pandemic indicators and total chest CT activity, as high as R = 0.7984 between daily chest CT activity and hospital admissions during the second wave (p < 0.0001). We found differences between public hospitals and private imaging centers during the first wave, with private centers demonstrating a negative correlation between daily chest CT activity and hospital admissions (-0.2819, p = 0.0019). Throughout the third wave, simultaneously with the rise of vaccination rates, total chest CT activity decreased with significant negative correlations with pandemic indicators, such as R = -0.7939 between daily chest CTs and daily incidence (p < 0.0001). Finally, less than 5% of all analyzed chest CTs could be considered as low dose. CONCLUSIONS During the first waves, COVID-19 had a strong impact on chest CT practice which was lost with the arrival of vaccination. Low-dose protocols remained marginal. KEY POINTS • There was a significant correlation between the number of daily chest CTs and pandemic indicators throughout the first two waves. It was lost during the third wave due to vaccination arrival. • Differences were observed between public and private centers, especially during the first wave, less during the second, and were lost during the third. • During the first three waves of COVID-19 pandemic, few CT helical acquisitions could be considered as low dose with only 3.8% of the acquisitions according to CTDIvol and 4.3% according to DLP.
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Garg M, Devkota S, Prabhakar N, Debi U, Kaur M, Sehgal IS, Dhooria S, Bhalla A, Sandhu MS. Ultra-Low Dose CT Chest in Acute COVID-19 Pneumonia: A Pilot Study from India. Diagnostics (Basel) 2023; 13:diagnostics13030351. [PMID: 36766456 PMCID: PMC9914217 DOI: 10.3390/diagnostics13030351] [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] [Received: 12/03/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
The rapid increase in the number of CT acquisitions during the COVID-19 pandemic raised concerns about increased radiation exposure to patients and the resultant radiation-induced health risks. It prompted researchers to explore newer CT techniques like ultra-low dose CT (ULDCT), which could improve patient safety. Our aim was to study the utility of ultra-low dose CT (ULDCT) chest in the evaluation of acute COVID-19 pneumonia with standard-dose CT (SDCT) chest as a reference standard. This was a prospective study approved by the institutional review board. 60 RT-PCR positive COVID-19 patients with valid indication for CT chest underwent SDCT and ULDCT. ULDCT and SDCT were compared in terms of objective (noise and signal-to-noise ratio) and subjective (noise, sharpness, artifacts and diagnostic confidence) image quality, various imaging patterns of COVID-19, CT severity score and effective radiation dose. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of ULDCT for detecting lung lesions were calculated by taking SDCT as a reference standard. The mean age of subjects was 47.2 ± 10.7 years, with 66.67% being men. 90% of ULDCT scans showed no/minimal noise and sharp images, while 93.33% had image quality of high diagnostic confidence. The major imaging findings detected by SDCT were GGOs (90%), consolidation (76.67%), septal thickening (60%), linear opacities (33.33%), crazy-paving pattern (33.33%), nodules (30%), pleural thickening (30%), lymphadenopathy (30%) and pleural effusion (23.33%). Sensitivity, specificity and diagnostic accuracy of ULDCT for detecting most of the imaging patterns were 100% (p < 0.001); except for GGOs (sensitivity: 92.59%, specificity: 100%, diagnostic accuracy: 93.33%), consolidation (sensitivity: 100%, specificity: 71.43%, diagnostic accuracy: 93.33%) and linear opacity (sensitivity: 90.00%, specificity: 100%, diagnostic accuracy: 96.67%). CT severity score (range: 15-25) showed 100% concordance on SDCT and ULDCT, while effective radiation dose was 4.93 ± 1.11 mSv and 0.26 ± 0.024 mSv, respectively. A dose reduction of 94.38 ± 1.7% was achieved with ULDCT. Compared to SDCT, ULDCT chest yielded images of reasonable and comparable diagnostic quality with the advantage of significantly reduced radiation dose; thus, it can be a good alternative to SDCT in the evaluation of COVID-19 pneumonia.
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Affiliation(s)
- Mandeep Garg
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
- Correspondence:
| | - Shritik Devkota
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Uma Debi
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Maninder Kaur
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Inderpaul S. Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Ye Z, Qi M, Zhao Y, Wei W, Xu XG. ESTIMATION OF FETAL AND PEDIATRIC DOSES FROM CHEST CT EXAMINATIONS USING VIRTUALDOSE SOFTWARE. RADIATION PROTECTION DOSIMETRY 2023; 199:52-60. [PMID: 36373995 DOI: 10.1093/rpd/ncac225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 09/28/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Pregnant women and children sometimes had to undergo chest computed tomography (CT) scans during the Corona Virus Disease 2019 (COVID-19) pandemic. This study estimated the fetal and pediatric doses from chest CT scans. Organ doses and effective doses were calculated using the VirtualDose-CT software. Two groups of computational human phantoms, pregnant females and pediatric patients were used in this study. The results of doses normalized to volumetric CT Dose Index (CTDIvol) can be used universally for other dosimetry studies. Based on our calculations and international survey data of CTDIvol, fetal absorbed doses from COVID-19-related chest CT were found to be 0.04-0.36, 0.05-0.44 and 0.07-0.61 mGy for 3, 6 and 9 months of pregnancy, respectively. When the scan range is extended to the abdominal region, fetal doses increase by almost 4-fold. Effective doses for COVID-19-related chest CT were 1.62-13.77, 1.58-13.46, 1.57-13.33 and 1.29-10.98 mSv for the newborn, 1-, 5- and 10-y-old children, respectively. In addition, the effects of specific axial scan ranges exceeding the thorax region were evaluated. Although doses from chest CT scans are small, such data allow radiologists and patients to be informed of the dose levels and ways to avoid unnecessary radiation.
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Affiliation(s)
- Zirui Ye
- School of Nuclear Science and Technology, University of Science and Technology of China, Hefei 230026, China
- Institute of Nuclear Medical Physics, University of Science and Technology of China, Hefei 230026, China
| | - Miao Qi
- School of Nuclear Science and Technology, University of Science and Technology of China, Hefei 230026, China
- Institute of Nuclear Medical Physics, University of Science and Technology of China, Hefei 230026, China
| | - Yingming Zhao
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Wei Wei
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - X George Xu
- School of Nuclear Science and Technology, University of Science and Technology of China, Hefei 230026, China
- Institute of Nuclear Medical Physics, University of Science and Technology of China, Hefei 230026, China
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei 230001, China
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Radiation Exposure and Lifetime Attributable Risk of Cancer Incidence and Mortality from Low- and Standard-Dose CT Chest: Implications for COVID-19 Pneumonia Subjects. Diagnostics (Basel) 2022; 12:diagnostics12123043. [PMID: 36553050 PMCID: PMC9777015 DOI: 10.3390/diagnostics12123043] [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] [Received: 10/14/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Since the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an unprecedented increase in the acquisition of chest computed tomography (CT) scans. Nearly 616 million people have been infected by COVID-19 worldwide to date, of whom many were subjected to CT scanning. CT exposes the patients to hazardous ionizing radiation, which can damage the genetic material in the cells, leading to stochastic health effects in the form of heritable genetic mutations and increased cancer risk. These probabilistic, long-term carcinogenic effects of radiation can be seen over a lifetime and may sometimes take several decades to manifest. This review briefly describes what is known about the health effects of radiation, the lowest dose for which there exists compelling evidence about increased radiation-induced cancer risk and the evidence regarding this risk at typical CT doses. The lifetime attributable risk (LAR) of cancer from low- and standard-dose chest CT scans performed in COVID-19 subjects is also discussed along with the projected number of future cancers that could be related to chest CT scans performed during the COVID-19 pandemic. The LAR of cancer Incidence from chest CT has also been compared with those from other radiation sources, daily life risks and lifetime baseline risk.
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Tawk S, Mansour W, Sleiman D, Gemayel S, Lozom E, El Mendelek K, Saliba N, Mourad C. Submillisievert CT chest for COVID-19 patients in a rural hospital with limited resources. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC8894825 DOI: 10.1186/s43055-022-00737-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background This is a secondary analysis of prospectively acquired data approved by the hospital institutional board committee. We performed a retrospective chart review of 463 patients who underwent a CT Chest for suspected COVID-19 infection between April 1st, 2020, and March 31st, 2021. Patients were grouped based on the CT chest obtained protocol: ultra-low dose or full dose. The likelihood of suspicion of COVID-19 infection was classified on a Likert scale based on the probability of pulmonary involvement. For each group, the sensitivity and specificity of CT were compared to nasopharyngeal swab as standard of reference. The median dose length product and duration of apnea were compared between both groups using two-tailed Mann–Whitney U test. The aim of this study is to share our experience of reducing radiation dose in COVID-19 patients by using an ultra-low dose CT chest protocol on a 16 row multidetector CT scan in a hospital with limited resources. Results Two hundred sixty-nine patients underwent a full dose CT and 194 patients an ultra-low dose CT. In the former group, the median dose length product was 341.11 mGy*cm [Interquartile range (IQR), 239.1–443.2] and the median duration of apnea was 13.29 s [IQR, 10.85–15.73]. In the latter group, the median dose length product was 30.8 mGy*cm [IQR, 28.9–32.7] and median duration of apnea was 8.27 s [IQR, 7.69–8.85]. The sensitivity of the ultra-low dose CT was 91.2% and that of the full dose was 94%. Conclusion A 90% reduction in estimated dose and 38% reduction in apnea duration could be achieved using an ultra-low dose CT chest protocol on a 16-row MDCT without significant loss in the sensitivity of CT to detect COVID-related parenchymal involvement.
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Abstract
Coronavirus disease 2019 (COVID-19) is a viral disease that causes life-threatening health problems during acute illness, causing a pandemic and millions of deaths. Although computed tomography (CT) was used as a diagnostic tool for COVID-19 in the early period of the pan demic due to the inaccessibility or long duration of the polymerase chain reaction tests, cur rent studies have revealed that CT scan should not be used to diagnose COVID-19. However, radiologic findings are vital in assessing pneumonia severity and investigating complications in patients with COVID-19. Long-term symptoms, also known as long COVID, in people recovering from COVID-19 affect patients' quality of life and cause global health problems. Herein, we aimed to summarize the lessons learned in COVID-19 pneumonia, the challenges in diagnosing the disease and complications, and the prospects for future studies.
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Affiliation(s)
- Furkan Ufuk
- Department of Radiology, School of Medicine, University of Pamukkale, Denizli, Turkey
| | - Recep Savaş
- Department of Radiology, School of Medicine, University of Ege, Izmir, Turkey
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Mendes HR, Silva JC, Marcondes M, Tomal A. Optimization of image quality and dose in adult and pediatric chest radiography via Monte Carlo simulation and experimental methods. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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19
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Estimation of effective and organ dose from chest CT. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Čiva LM, Beganović A, Busuladžić M, Jusufbegović M, Awad-Dedić T, Vegar-Zubović S. Dose Descriptors and Assessment of Risk of Exposure-Induced Death in Patients Undergoing COVID-19 Related Chest Computed Tomography. Diagnostics (Basel) 2022; 12:diagnostics12082012. [PMID: 36010362 PMCID: PMC9407529 DOI: 10.3390/diagnostics12082012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/14/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
For more than two years, coronavirus disease 19 (COVID-19) has represented a threat to global health and lifestyles. Computed tomography (CT) imaging provides useful information in patients with COVID-19 pneumonia. However, this diagnostic modality is based on exposure to ionizing radiation, which is associated with an increased risk of radiation-induced cancer. In this study, we evaluated the common dose descriptors, CTDIvol and DLP, for 1180 adult patients. This data was used to estimate the effective dose, and risk of exposure-induced death (REID). Awareness of the extensive use of CT as a diagnostic tool in the management of COVID-19 during the pandemic is vital for the evaluation of radiation exposure parameters, dose reduction methods development and radiation protection.
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Affiliation(s)
- Lejla M. Čiva
- Sarajevo Medical School, University Sarajevo School of Science and Technology, 71210 Ilidža, Bosnia and Herzegovina
| | - Adnan Beganović
- Radiation Protection and Medical Physics Department, Sarajevo University Clinical Center, 71000 Sarajevo, Bosnia and Herzegovina
- Faculty of Science, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
- Correspondence:
| | - Mustafa Busuladžić
- Faculty of Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Merim Jusufbegović
- Radiology Clinic, Sarajevo University Clinical Center, 71000 Sarajevo, Bosnia and Herzegovina
| | - Ta’a Awad-Dedić
- Healthcare Center of Sarajevo Canton, 71000 Sarajevo, Bosnia and Herzegovina
| | - Sandra Vegar-Zubović
- Radiology Clinic, Sarajevo University Clinical Center, 71000 Sarajevo, Bosnia and Herzegovina
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Hammer MM, Raptis CA, Henry TS, Bhalla S. COVID-19 in the Radiology Literature: A Look Back. Radiol Cardiothorac Imaging 2022; 4:e220102. [PMID: 35935812 PMCID: PMC9341167 DOI: 10.1148/ryct.220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Mark M. Hammer
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R., S.B.); and Department of Radiology, Duke University School of Medicine, Durham, NC (T.S.H.)
| | - Constantine A. Raptis
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R., S.B.); and Department of Radiology, Duke University School of Medicine, Durham, NC (T.S.H.)
| | - Travis S. Henry
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R., S.B.); and Department of Radiology, Duke University School of Medicine, Durham, NC (T.S.H.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.A.R., S.B.); and Department of Radiology, Duke University School of Medicine, Durham, NC (T.S.H.)
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22
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Vaz A, Pedrazzani BM, Ledesma JA, Yagui A, Schelin HR. Effect of lateral decubitus acquisition in accuracy and lung severity estimation of chest computed tomography in children with suspected COVID-19. EINSTEIN-SAO PAULO 2022; 20:eAO0061. [PMID: 35894371 PMCID: PMC9299577 DOI: 10.31744/einstein_journal/2022ao0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/18/2022] [Indexed: 11/05/2022] Open
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Impact of the COVID pandemic on emergency department CT utilization: where do we go from here? Emerg Radiol 2022; 29:879-885. [PMID: 35729442 PMCID: PMC9212207 DOI: 10.1007/s10140-022-02071-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/13/2022] [Indexed: 11/21/2022]
Abstract
Purpose To analyze the impact of the coronavirus disease (COVID) pandemic on emergency department (ED) computed tomography (CT) utilization. Methods A retrospective observational study was conducted assessing seven hospitals’ ED imaging volumes between Jan. 6, 2019, and Feb. 27, 2021. Weekly CT utilization is reported as CTs ordered per 100 ED visits. Utilization was ascertained in aggregate and by body area. Interrupted time series analysis was performed to assess significance of utilization change. Prespecified sensitivity analysis was performed for influenza-like or COVID-like illness (ILI/CLI). Results Weekly ED CT utilization increased from 35.9 CTs per 100 visits (95% confidence interval [95% CI] 35.8–36.1) to 41.8 per 100 visits (95% CI 41.7–42.0) in pre- and post-pandemic periods. Weekly ED CT chest utilization increased immediately following the pandemic declaration (+ 0.52 chest CTs per 100 ED visits, 95% CI 0.01–1.03, p < 0.05) and compared to pre-pandemic period (+ 0.02 per 100 ED visits, 95% CI 0.02–0.05, p < 0.02). For both CT abdomen/pelvis and CT head, there was neither an immediate effect (+ 0.34 CT-AP per 100 ED visits, 95% CI − 0.74 to 1.44, p = 0.89; − 0.42 CT-H per 100 ED visits, 95% CI − 1.53 to 0.70, p = 0.46) nor a change in weekly CT utilization (+ 0.03 CT-AP per 100 ED visits, 95% CI − 0.01 to 0.05, p = 0.09; + 0.03 CT-H per 100 ED visits, 95% CI − 0.01 to 0.06, p = 0.10). Conclusion These data may help formulate future strategies for resource utilization and imaging operations as we envision a future with COVID and other federal mandates affecting imaging utilization and appropriateness. Supplementary Information The online version contains supplementary material available at 10.1007/s10140-022-02071-z.
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Inoue A, Takahashi H, Ibe T, Ishii H, Kurata Y, Ishizuka Y, Batsaikhan B, Hamamoto Y. Application of the advanced lung cancer inflammation index for patients with coronavirus disease 2019 pneumonia: Combined risk prediction model with lung cancer inflammation index, computed tomography and chest radiograph. Exp Ther Med 2022; 23:388. [PMID: 35495600 PMCID: PMC9019768 DOI: 10.3892/etm.2022.11315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
The purpose of the present study was to evaluate the feasibility of applying the advanced lung cancer inflammation index (ALI) in patients with coronavirus disease 2019 (COVID-19) and to establish a combined ALI and radiologic risk prediction model for disease exacerbation. The present study included patients diagnosed with COVID-19 infection in our single institution from March to October 2020. Patients without clinical information and/or chest computed tomography (CT) upon admission were excluded. A radiologist assessed the CT severity score and abnormality on chest radiograph. The combined ALI and radiologic risk prediction model was developed via random forest classification. Among 79 patients (age, 43±19 years; male/female, 45:34), 72 experienced improvement and seven patients experienced exacerbation after admission. Significant differences were observed between the improved and exacerbated groups in the ALI (median, 47.6 vs. 13.2; P=0.011), frequency of chest radiograph abnormality (24.7 vs. 83.3%; P<0.001), and chest CT score (CCTS; median, 1 vs. 9; P<0.001). For the accuracy of predicting exacerbation, the receiver-operating characteristic curve analysis demonstrated an area under the curve of 0.79 and 0.92 for the ALI and CCTS, respectively. The combined ALI and radiologic risk prediction model had a sensitivity of 1.00 and a specificity of 0.81. Overall, ALI alone and CCTS alone modestly predicted the exacerbation of COVID-19, and the combined ALI and radiologic risk prediction model exhibited decent sensitivity and specificity.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science Seta, Otsu, Shiga 520‑2192, Japan
| | | | - Tatsuya Ibe
- Department of Plumonary Medicine, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
| | - Hisashi Ishii
- Department of Plumonary Medicine, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
| | - Yuhei Kurata
- Department of Plumonary Medicine, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
| | - Yoshikazu Ishizuka
- Department of Radiology, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
| | - Bolorkhand Batsaikhan
- Department of Radiological Science, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo 116‑8551, Japan
| | - Yoichiro Hamamoto
- Department of Plumonary Medicine, National Hospital Organization Nishisaitama‑Chuo National Hospital, Tokorozawa, Saitama 359‑1151, Japan
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Reduced Chest Computed Tomography Scan Length for Patients Positive for Coronavirus Disease 2019: Dose Reduction and Impact on Diagnostic Utility. J Comput Assist Tomogr 2022; 46:576-583. [PMID: 35405727 PMCID: PMC9296570 DOI: 10.1097/rct.0000000000001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
METHODS This study used the Personalized Rapid Estimation of Dose in CT (PREDICT) tool to estimate patient-specific organ doses from CT image data. The PREDICT is a research tool that combines a linear Boltzmann transport equation solver for radiation dose map generation with deep learning algorithms for organ contouring. Computed tomography images from 74 subjects in the Medical Imaging Data Resource Center-RSNA International COVID-19 Open Radiology Database data set (chest CT of adult patients positive for COVID-19), which included expert annotations including "infectious opacities," were analyzed. First, the full z-scan length of the CT image data set was evaluated. Next, the z-scan length was reduced from the left hemidiaphragm to the top of the aortic arch. Generic dose reduction based on dose length product (DLP) and patient-specific organ dose reductions were calculated. The percentage of infectious opacities excluded from the reduced z-scan length was used to quantify the effect on diagnostic utility. RESULTS Generic dose reduction, based on DLP, was 69%. The organ dose reduction ranged from approximately equal to 18% (breasts) to approximately equal to 64% (bone surface and bone marrow). On average, 12.4% of the infectious opacities were not included in the reduced z-coverage, per patient, of which 5.1% were above the top of the arch and 7.5% below the left hemidiaphragm. CONCLUSIONS Limiting z-scan length of chest CTs reduced radiation dose without significantly compromising diagnostic utility in COVID-19 patients. The PREDICT demonstrated that patient-specific organ dose reductions varied from generic dose reduction based on DLP.
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IAEA support to the radiation protection of patients in the time of the COVID-19 global pandemic. HEALTH AND TECHNOLOGY 2022; 12:637-641. [PMID: 35399290 PMCID: PMC8975616 DOI: 10.1007/s12553-022-00659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 11/15/2022]
Abstract
The IAEA contribution to the radiation protection of patients during the global COVID-19 pandemic included a webinar on the use of CT and optimization for COVID-19 pneumonia, a survey with 137 responses from 84 sites across five continents, and a study on the CT utilization, protocols and patient doses with data from 62 healthcare sites from 34 countries. This paper outlines the main results of these efforts, which have been presented in the scientific literature and in several national trainings and international meetings.
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May M, Heiss R, Koehnen J, Wetzl M, Wiesmueller M, Treutlein C, Braeuer L, Uder M, Kopp M. Personalized Chest Computed Tomography: Minimum Diagnostic Radiation Dose Levels for the Detection of Fibrosis, Nodules, and Pneumonia. Invest Radiol 2022; 57:148-156. [PMID: 34468413 PMCID: PMC8826613 DOI: 10.1097/rli.0000000000000822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the minimum diagnostic radiation dose level for the detection of high-resolution (HR) lung structures, pulmonary nodules (PNs), and infectious diseases (IDs). MATERIALS AND METHODS A preclinical chest computed tomography (CT) trial was performed with a human cadaver without known lung disease with incremental radiation dose using tin filter-based spectral shaping protocols. A subset of protocols for full diagnostic evaluation of HR, PN, and ID structures was translated to clinical routine. Also, a minimum diagnostic radiation dose protocol was defined (MIN). These protocols were prospectively applied over 5 months in the clinical routine under consideration of the individual clinical indication. We compared radiation dose parameters, objective and subjective image quality (IQ). RESULTS The HR protocol was performed in 38 patients (43%), PN in 21 patients (24%), ID in 20 patients (23%), and MIN in 9 patients (10%). Radiation dose differed significantly among HR, PN, and ID (5.4, 1.2, and 0.6 mGy, respectively; P < 0.001). Differences between ID and MIN (0.2 mGy) were not significant (P = 0.262). Dose-normalized contrast-to-noise ratio was comparable among all groups (P = 0.087). Overall IQ was perfect for the HR protocol (median, 5.0) and decreased for PN (4.5), ID-CT (4.3), and MIN-CT (2.5). The delineation of disease-specific findings was high in all dedicated protocols (HR, 5.0; PN, 5.0; ID, 4.5). The MIN protocol had borderline IQ for PN and ID lesions but was insufficient for HR structures. The dose reductions were 78% (PN), 89% (ID), and 97% (MIN) compared with the HR protocols. CONCLUSIONS Personalized chest CT tailored to the clinical indications leads to substantial dose reduction without reducing interpretability. More than 50% of patients can benefit from such individual adaptation in a clinical routine setting. Personalized radiation dose adjustments with validated diagnostic IQ are especially preferable for evaluating ID and PN lesions.
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Affiliation(s)
- Matthias May
- From the Department of Radiology, University Hospital Erlangen
| | - Rafael Heiss
- From the Department of Radiology, University Hospital Erlangen
| | - Julia Koehnen
- From the Department of Radiology, University Hospital Erlangen
| | - Matthias Wetzl
- From the Department of Radiology, University Hospital Erlangen
| | | | | | - Lars Braeuer
- Institute of Anatomy, Chair II, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- From the Department of Radiology, University Hospital Erlangen
| | - Markus Kopp
- From the Department of Radiology, University Hospital Erlangen
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The Role of Ionizing Radiation for Diagnosis and Treatment against COVID-19: Evidence and Considerations. Cells 2022; 11:cells11030467. [PMID: 35159277 PMCID: PMC8834503 DOI: 10.3390/cells11030467] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 million people infected and more than 5 million deaths, numbers that are escalating on a daily basis. Frontline health workers and scientists diligently fight to alleviate life-threatening symptoms and control the spread of the disease. There is an urgent need for better triage of patients, especially in third world countries, in order to decrease the pressure induced on healthcare facilities. In the struggle to treat life-threatening COVID-19 pneumonia, scientists have debated the clinical use of ionizing radiation (IR). The historical literature dating back to the 1940s contains many reports of successful treatment of pneumonia with IR. In this work, we critically review the literature for the use of IR for both diagnostic and treatment purposes. We identify details including the computed tomography (CT) scanning considerations, the radiobiological basis of IR anti-inflammatory effects, the supportive evidence for low dose radiation therapy (LDRT), and the risks of radiation-induced cancer and cardiac disease associated with LDRT. In this paper, we address concerns regarding the effective management of COVID-19 patients and potential avenues that could provide empirical evidence for the fight against the disease.
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Mahajan A, NiveditaChakrabarty, Shukla S. A narrative review on radiation risk from imaging for COVID-19: Breaking the myths and the mithya. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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Khashoo R, Vimalesvaran S, Tewari D, Khashu S, Khashu M. Indiscriminate use of CT Chest Imaging during the COVID-19 Pandemic. Clin Radiol 2022; 77:316-317. [PMID: 35181120 PMCID: PMC8801904 DOI: 10.1016/j.crad.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
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Bernardo M, Homayounieh F, Cuter MCR, Bellegard LM, Oliveira Junior HM, Buril GO, de Melo Tapajós JS, Sales DM, de Moura Carvalho LC, Alves Pinto D, Varella R, Tapajós LL, Ebrahimian S, Vassileva J, Kalra MK, Khoury HJ. CHEST CT USAGE IN COVID-19 PNEUMONIA: MULTICENTER STUDY ON RADIATION DOSES AND DIAGNOSTIC QUALITY IN BRAZIL. RADIATION PROTECTION DOSIMETRY 2021; 197:135-145. [PMID: 34875692 PMCID: PMC8903326 DOI: 10.1093/rpd/ncab171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/15/2021] [Accepted: 05/08/2021] [Indexed: 06/13/2023]
Abstract
We assessed variations in chest CT usage, radiation dose and image quality in COVID-19 pneumonia. Our study included all chest CT exams performed in 533 patients from 6 healthcare sites from Brazil. We recorded patients' age, gender and body weight and the information number of CT exams per patient, scan parameters and radiation doses (volume CT dose index-CTDIvol and dose length product-DLP). Six radiologists assessed all chest CT exams for the type of pulmonary findings and classified CT appearance of COVID-19 pneumonia as typical, indeterminate, atypical or negative. In addition, each CT was assessed for diagnostic quality (optimal or suboptimal) and presence of artefacts. Artefacts were frequent (367/841), often related to respiratory motion (344/367 chest CT exams with artefacts) and resulted in suboptimal evaluation in mid-to-lower lungs (176/344) or the entire lung (31/344). There were substantial differences in CT usage, patient weight, CTDIvol and DLP across the participating sites.
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A novel Gray-Scale spatial exploitation learning Net for COVID-19 by crawling Internet resources. Biomed Signal Process Control 2021; 73:103441. [PMID: 34899960 PMCID: PMC8645252 DOI: 10.1016/j.bspc.2021.103441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/07/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022]
Abstract
Today, the earth planet suffers from the decay of active pandemic COVID-19 which motivates scientists and researchers to detect and diagnose the infected people. Chest X-ray (CXR) image is a common utility tool for detection. Even the CXR suffers from low informative details about COVID-19 patches; the computer vision helps to overcome it through grayscale spatial exploitation analysis. In turn, it is highly recommended to acquire more CXR images to increase the capacity and ability to learn for mining the grayscale spatial exploitation. In this paper, an efficient Gray-scale Spatial Exploitation Net (GSEN) is designed by employing web pages crawling across cloud computing environments. The motivation of this work are i) utilizing a framework methodology for constructing consistent dataset by web crawling to update the dataset continuously per crawling iteration; ii) designing lightweight, fast learning, comparable accuracy, and fine-tuned parameters gray-scale spatial exploitation deep neural net; iii) comprehensive evaluation of the designed gray-scale spatial exploitation net for different collected dataset(s) based on web COVID-19 crawling verse the transfer learning of the pre-trained nets. Different experiments have been performed for benchmarking both the proposed web crawling framework methodology and the designed gray-scale spatial exploitation net. Due to the accuracy metric, the proposed net achieves 95.60% for two-class labels, and 92.67% for three-class labels, respectively compared with the most recent transfer learning Google-Net, VGG-19, Res-Net 50, and Alex-Net approaches. Furthermore, web crawling utilizes the accuracy rates improvement in a positive relationship to the cardinality of crawled CXR dataset.
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Lee JH, Hong H, Kim H, Lee CH, Goo JM, Yoon SH. CT Examinations for COVID-19: A Systematic Review of Protocols, Radiation Dose, and Numbers Needed to Diagnose and Predict. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1505-1523. [PMID: 36238884 PMCID: PMC9431975 DOI: 10.3348/jksr.2021.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
Purpose Although chest CT has been discussed as a first-line test for coronavirus disease 2019 (COVID-19), little research has explored the implications of CT exposure in the population. To review chest CT protocols and radiation doses in COVID-19 publications and explore the number needed to diagnose (NND) and the number needed to predict (NNP) if CT is used as a first-line test. Materials and Methods We searched nine highly cited radiology journals to identify studies discussing the CT-based diagnosis of COVID-19 pneumonia. Study-level information on the CT protocol and radiation dose was collected, and the doses were compared with each national diagnostic reference level (DRL). The NND and NNP, which depends on the test positive rate (TPR), were calculated, given a CT sensitivity of 94% (95% confidence interval [CI]: 91%-96%) and specificity of 37% (95% CI: 26%-50%), and applied to the early outbreak in Wuhan, New York, and Italy. Results From 86 studies, the CT protocol and radiation dose were reported in 81 (94.2%) and 17 studies (19.8%), respectively. Low-dose chest CT was used more than twice as often as standard-dose chest CT (39.5% vs.18.6%), while the remaining studies (44.2%) did not provide relevant information. The radiation doses were lower than the national DRLs in 15 of the 17 studies (88.2%) that reported doses. The NND was 3.2 scans (95% CI: 2.2-6.0). The NNPs at TPRs of 50%, 25%, 10%, and 5% were 2.2, 3.6, 8.0, 15.5 scans, respectively. In Wuhan, 35418 (TPR, 58%; 95% CI: 27710-56755) to 44840 (TPR, 38%; 95% CI: 35161-68164) individuals were estimated to have undergone CT examinations to diagnose 17365 patients. During the early surge in New York and Italy, daily NNDs changed up to 5.4 and 10.9 times, respectively, within 10 weeks. Conclusion Low-dose CT protocols were described in less than half of COVID-19 publications, and radiation doses were frequently lacking. The number of populations involved in a first-line diagnostic CT test could vary dynamically according to daily TPR; therefore, caution is required in future planning.
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Bai L, Zhou J, Shen C, Cai S, Guo Y, Huang X, Jia G, Niu G. Assessment of radiation doses and image quality of multiple low-dose CT exams in COVID-19 clinical management. CHINESE JOURNAL OF ACADEMIC RADIOLOGY 2021; 4:257-261. [PMID: 34642650 PMCID: PMC8498979 DOI: 10.1007/s42058-021-00083-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 08/22/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE The Corona Virus Disease 2019 (COVID-19) was first reported in December 2019 from an outbreak of unexplained pneumonia in Wuhan (Hubei, China) that subsequently spread rapidly around the world. Because of the public health emergency, chest CT has been widely used for sensitive detection and diagnosis, monitoring the changes of lesions and also for treatment evaluation. The purpose of this study was to investigate radiation dose and image quality of chest CT scans received by COVID-19 patients and to evaluate the oncogenic risk of multiple chest CT examinations. METHODS A retrospective review of 33 patients with RT-PCR confirmed COVID-19 infection was performed from January 31, 2020 to February 19, 2020. The date of each CT exam and respective radiation dose for each exam was recorded for all patients. Multiple pulmonary CT scans were obtained during diagnosis and treatment procedure. Scan frequency, total scan times, radiation dose, and image quality were determined. RESULTS Thirty-three patients (15 males and 18 females, age 21-82 years) with confirmed COVID-19 pneumonia underwent a total of 143 chest CT scans. The number of CT scans per patient was 4 ± 1, with a range of 2-6. The time interval between two consecutive chest CT scans was 3 ± 1 days. The average effective dose from a single chest CT scan was 1.21 ± 0.10 mSv, with a range of 1.02-1.44 mSv. The average cumulative effective dose per patient was 5.25 ± 1.52 mSv, with a range of 2.24-7.48 mSv. The maximum cumulative effective dose was 7.48 mSv for six CT examinations during COVID-19 treatment. Based on subjective image quality analysis, the visual scoring of CT findings was 11.23 ± 1.35 points out of 15 points. CONCLUSIONS The frequency, total number and image quality of chest CT scans should be reviewed carefully to guarantee minimally required CT scans during the COVID-19 management.
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Affiliation(s)
- Lu Bai
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 Shaanxi China
| | - Jie Zhou
- Department of Radiology, Xi’an Chest Hospital, Xi’an, Shaanxi China
| | - Cong Shen
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 Shaanxi China
| | - Shubo Cai
- Department of Radiology, Xi’an Chest Hospital, Xi’an, Shaanxi China
| | - Youmin Guo
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 Shaanxi China
| | - Xunan Huang
- School of Computer Science and Technology, Xidian University, No. 2 South Taibai Rd, Xi’an, 710071 Shaanxi China
| | - Guang Jia
- School of Computer Science and Technology, Xidian University, No. 2 South Taibai Rd, Xi’an, 710071 Shaanxi China
| | - Gang Niu
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061 Shaanxi China
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Abtahi SH, Nouri H, Moradian S, Yazdani S, Ahmadieh H. Eye Disorders in the Post-COVID Era. J Ophthalmic Vis Res 2021; 16:527-530. [PMID: 34840673 PMCID: PMC8593548 DOI: 10.18502/jovr.v16i4.9740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is an Editorial and does not have an abstract. Please download the PDF or view the article HTML.
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Affiliation(s)
- Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Forner D, Noel CW, Grant A, Hong P, Corsten M, Wu V, Taylor SM, Trites JRB, Rigby MH. Management of Peritonsillar Abscesses in Adults: Survey of Otolaryngologists in Canada and the United States. OTO Open 2021; 5:2473974X211044081. [PMID: 34541442 PMCID: PMC8445538 DOI: 10.1177/2473974x211044081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The management of peritonsillar abscess (PTA) has evolved over time. We sought to define contemporary practice patterns for the diagnosis and treatment of PTA. Study Design Cross-sectional survey. Setting The 15-question survey was distributed to members of the Canadian Society of Otolaryngology–Head and Neck Surgery (CSO) and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). Methods An iterative, consensus-based process was used for survey development. Primary outcomes were to determine methods of diagnosis and first-line treatments for PTA. Exploratory, secondary outcomes were analyzed using multivariable logistic regression models. Results The survey response rate was 12.6% (n = 1176). Most participants were attending staff (86%) in a community hospital setting (60%) and had been in practice for more than 20 years (38%). Most respondents (78%) indicated that at least half of the time, cross-sectional imaging had already been performed before they were consulted. Half of respondents (49%) indicated that they perform incision and drainage of the abscess as first-line treatment, while few (16%) provide medical management alone. In exploratory analysis, participants from the AAO-HNS had higher odds of imaging already being performed before consultation (odds ratio [OR], 11.7; 95% CI, 4.6-29.4) and increased odds of using medical management alone as a first-line treatment (OR, 2.4; 95% CI, 1.3-4.2) compared to respondents from the CSO. Conclusion There is wide practice variation in the diagnosis and management of acute, uncomplicated PTA among otolaryngologists in Canada and the United States. The use of cross-sectional imaging and medical management alone may differ between countries of practice.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.,Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amy Grant
- Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.,Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada.,IWK Health Center, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R B Trites
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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Bernardo MO, Homayounieh F, Ebrahimian S, de Melo Tapajós JS, de Moura Carvalho LC, Varella R, Khoury HJ, Kalra MK. PRACTICAL CHALLENGES WITH IMAGING COVID-19 IN BRAZIL: MITIGATION IN AND BEYOND THE PANDEMIC. RADIATION PROTECTION DOSIMETRY 2021; 195:92-98. [PMID: 34386818 PMCID: PMC8385955 DOI: 10.1093/rpd/ncab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED Computed tomography (CT) provides useful information in patients with known or suspected COVID-19 infection. However, there are substantial variations and challenges in scanner technologies and scan practices that have negative effect on the image quality and can increase radiation dose associated with CT. OBJECTIVE In this article, we present major issues and challenges with use of CT at five Brazilian CT facilities for imaging patients with known or suspected COVID-19 infection and offer specific mitigating strategies. METHODS Observational, retrospective and prospective study of five CT facilities from different states and regions of Brazil, with approval of research and ethics committees. RESULTS The most important issues include frequent use of CT, lack of up-to-date and efficient scanner technologies, over-scanning and patient off-centring. Mitigating strategies can include updating scanner technology and improving scan practices.
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Affiliation(s)
- Mônica O Bernardo
- Pontificia University Catholic of São Paulo, São Paulo, Brazil
- Hospital Miguel Soeiro—UNIMED, Sorocaba, São Paulo, Brazil
| | - Fatemeh Homayounieh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shadi Ebrahimian
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Helen Jamil Khoury
- Hospital das Clínicas—Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Won T, Lee AK, Choi HD, Lee C. Radiation dose from computed tomography scans for Korean pediatric and adult patients. JOURNAL OF RADIATION PROTECTION AND RESEARCH 2021; 46:98-105. [PMID: 38894707 PMCID: PMC11185358 DOI: 10.14407/jrpr.2021.00010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 06/21/2024]
Abstract
Background In recent events of the Coronavirus Disease 2019 (COVID-19) pandemic, CT scans are being globally used as a complement to the reverse-transcription polymerase chain reaction (RT-PCR) tests. It will be important to be aware of major organ dose levels, which are more relevant quantity to derive potential long-term adverse effect, for Korean pediatric and adult patients undergoing CT for COVID-19. Materials and Methods We calculated organ dose conversion coefficients for Korean pediatric and adult CT patients directly from Korean pediatric and adult computational phantoms combined with Monte Carlo radiation transport techniques. We then estimated major organ doses delivered to the Korean child and adult patients undergoing CT for COVID-19 combining the dose conversion coefficients and the international survey data. We also compared our Korean dose conversion coefficients with those from Caucasian reference pediatric and adult phantoms. Results and discussion Based on the dose conversion coefficients we established in this study and the international survey data of COVID-19-related CT scans, we found that Korean 7-year-old child and adult males may receive about 4 - 32 mGy and 3 - 21 mGy of lung dose, respectively. We learned that the lung dose conversion coefficient for the Korean child phantom was up to 1.5-fold greater than that for the Korean adult phantom. We also found no substantial difference in dose conversion coefficients between Korean and Caucasian phantoms. Conclusion We estimated radiation dose delivered to the Korean child and adult phantoms undergoing COVID-19-related CT examinations. The dose conversion coefficients derived for different CT scan types can be also used universally for other dosimetry studies concerning Korean CT scans. We also confirmed that the Caucasian-based CT organ dose calculation tools may be used for the Korean population with reasonable accuracy.
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Affiliation(s)
- Tristan Won
- Winston Churchill High School, Potomac, MD 20854
| | - Ae-Kyoung Lee
- Electronics and Telecommunications Research Institute, Daejeon, South Korea
| | - Hyung-do Choi
- Electronics and Telecommunications Research Institute, Daejeon, South Korea
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850
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Choi H, Chang W, Kim JH, Ahn C, Lee H, Kim HY, Cho J, Lee YJ, Kim YH. Dose reduction potential of vendor-agnostic deep learning model in comparison with deep learning-based image reconstruction algorithm on CT: a phantom study. Eur Radiol 2021; 32:1247-1255. [PMID: 34390372 PMCID: PMC8364308 DOI: 10.1007/s00330-021-08199-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/11/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022]
Abstract
Objectives To compare the dose reduction potential (DRP) of a vendor-agnostic deep learning model (DLM, ClariCT.AI) with that of a vendor-specific deep learning–based image reconstruction algorithm (DLR, TrueFidelity™). Methods Computed tomography (CT) images of a multi-sized image quality phantom (Mercury v4.0) were acquired under six radiation dose levels (0.48/0.97/1.93/3.87/7.74/15.47 mGy) and were reconstructed using filtered back projection (FBP) and three strength levels of the DLR (low/medium/high). The FBP images were denoised using the DLM. For all DLM and DLR images, the detectability index (d′) (a task-based detection performance metric) was obtained, under various combinations of three target sizes (10/5/1 mm), five inlets (CT value difference with the background; −895/50/90/335/1000 HU), five phantom diameters (36/31/26/21/16 cm), and six radiation dose levels. Dose reduction potential (DRP) measures the dose reduction made by using DLM or DLR, while yielding d′ equivalent to that of FBP at full dose. Results The DRPs of the DLM, DLR-low, DLR-medium, and DLR-high were 86% (81–88%), 60% (46–67%), 76% (60–81%), and 87% (78–92%), respectively. For 10-mm targets, the DRP of the DLM (87%) was higher than that of all DLR algorithms (58–86%). However, for smaller targets (5 mm/1 mm), the DRPs of the DLR-high (89/88%) were greater than those of the DLM (87/84%). Conclusion The dose reduction potential of the vendor-agnostic DLM was shown to be comparable to that of the vendor-specific DLR at high strength and superior to those of the DLRs at medium and low strengths. Key Points • DRP of the vendor-agnostic model was comparable to that of high-strength vendor-specific model and superior to those of medium- and low-strength models. • Under various radiation dose levels, the deep learning model shows higher detectability indexes compared to FBP. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08199-9.
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Affiliation(s)
- Hyunsu Choi
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Won Chang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Jong Hyo Kim
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Department of Transdisciplinary Studies, Program in Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Chulkyun Ahn
- Department of Transdisciplinary Studies, Program in Biomedical Radiation Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Heejin Lee
- Department of Applied bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Hae Young Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jungheum Cho
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro-173-beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
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Yurdaisik I, Nurili F, Aksoy SH, Agirman AG, Aktan A. IONIZING RADIATION EXPOSURE IN PATIENTS WITH COVID-19: MORE THAN NEEDED. RADIATION PROTECTION DOSIMETRY 2021; 194:135-143. [PMID: 34151376 PMCID: PMC8344538 DOI: 10.1093/rpd/ncab092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/13/2021] [Accepted: 05/25/2021] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the ionizing radiation exposure in patients with Coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS This was a retrospective study in which all patients presented with suggestive symptoms of COVID-19 were included. The study was carried out in a university-affiliated private hospital in Istanbul, Turkey. Biological radiation dose exposure (cumulative effective dose: CED) was evaluated in millisievert (mSv) units. RESULTS A total of 1410 patients were included in the study. Of all study subjects, 804 patients (57%) underwent only one chest computed tomography (CT) procedure. Six hundred and six patients (43%) had two or more chest CT procedures. Median CED was 6.02 (min-max:1.67-16.27) mSv. The number of patients who were exposed to ≤ 5 mSv were 149 (24.6%), whereas 457 patients (75.4%) were exposed to >5 mSv. CONCLUSION The radiation exposure in COVID-19 patients seems unjustifiably high. Awareness should be increased as to the proper use of chest CT in COVID-19 as per to the society recommendations.
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Affiliation(s)
- Isil Yurdaisik
- Department of Radiology, Istinye University, Gaziosmanpasa Medical Park Hospital, 34250 Istanbul, Turkey
| | - Fuat Nurili
- Department of Radiology, Memorial Sloan Ketteting Cancer Center, Interventional Radiology, New York, NY 10065, USA
| | - Suleyman Hilmi Aksoy
- Department of Radiology, Galata University, Hisar Intercontinental Hospital, 34768 Istanbul, Turkey
| | - Ayse Gul Agirman
- Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, 34668 Istanbul, Turkey
| | - Ahmet Aktan
- Department of Radiology, Yalova Private Hospital, 77100 Yalova, Turkey
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Sideris GA, Nikolakea M, Karanikola AE, Konstantinopoulou S, Giannis D, Modahl L. Imaging in the COVID-19 era: Lessons learned during a pandemic. World J Radiol 2021. [DOI: 10.4329/wjr.v13.i6.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Sideris GA, Nikolakea M, Karanikola AE, Konstantinopoulou S, Giannis D, Modahl L. Imaging in the COVID-19 era: Lessons learned during a pandemic. World J Radiol 2021; 13:192-222. [PMID: 34249239 PMCID: PMC8245753 DOI: 10.4329/wjr.v13.i6.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.
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Affiliation(s)
- Georgios Antonios Sideris
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, United States
- Radiology Working Group, Society of Junior Doctors, Athens 11527, Greece
| | - Melina Nikolakea
- Radiology Working Group, Society of Junior Doctors, Athens 11527, Greece
| | | | - Sofia Konstantinopoulou
- Division of Pulmonary Medicine, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi W13-01, United Arab Emirates
| | - Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Lucy Modahl
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, United States
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Vassileva J, Holmberg O. Radiation protection perspective to recurrent medical imaging: what is known and what more is needed? Br J Radiol 2021; 94:20210477. [PMID: 34161167 DOI: 10.1259/bjr.20210477] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This review summarises the current knowledge about recurrent radiological imaging and associated cumulative doses to patients. The recent conservative estimates are for around 0.9 million patients globally who cumulate radiation doses above 100 mSv, where evidence exists for cancer risk elevation. Around one in five is estimated to be under the age of 50. Recurrent imaging is used for managing various health conditions and chronic diseases such as malignancies, trauma, end-stage kidney disease, cardiovascular diseases, Crohn's disease, urolithiasis, cystic pulmonary disease. More studies are needed from different parts of the world to understand the magnitude and appropriateness. The analysis identified areas of future work to improve radiation protection of individuals who are submitted to frequent imaging. These include access to dose saving imaging technologies; improved imaging strategies and appropriateness process; specific optimisation tailored to the clinical condition and patient habitus; wider utilisation of the automatic exposure monitoring systems with an integrated option for individual exposure tracking in standardised patient-specific risk metrics; improved training and communication. The integration of the clinical and exposure history data will support improved knowledge about radiation risks from low doses and individual radiosensitivity. The radiation protection framework will need to respond to the challenge of recurrent imaging and high individual doses. The radiation protection perspective complements the clinical perspective, and the risk to benefit analysis must account holistically for all incidental and long-term benefits and risks for patients, their clinical history and specific needs. This is a step toward the patient-centric health care.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
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Kalra MK, Rehani MM. Five-star rating system for acceptable quality and dose in CT. Eur Radiol 2021; 31:9161-9163. [PMID: 34114057 DOI: 10.1007/s00330-021-08112-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022]
Abstract
KEY POINTS • Recent papers have shown examples of the methodology involved in integrating image quality with radiation dose and assessing acceptable quality dose (AQD).• As a further step in that direction, translating a 5-point score into a 5-star rating shall be helpful for wider and uniform application and shall be in line with the popular use of the 5-star rating.
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Affiliation(s)
- Mannudeep K Kalra
- Massachusetts General Hospital, 55 Fruit Str, Boston, MA, 02114, USA
| | - Madan M Rehani
- Massachusetts General Hospital, 55 Fruit Str, Boston, MA, 02114, USA. .,Radiology Department, Massachusetts General Hospital, 175 Cambridge Str., Suite 244, Boston, MA, 02114, USA.
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Abstract
The CT manifestation of COVID-19 patients is now well known and essentially reflects pathological changes in the lungs. Actually, there is insufficient knowledge on the long-term outcomes of this new disease, and several chest CTs might be necessary to evaluate the outcomes. The aim of this study is to evaluate the radiation dose for chest CT scans in COVID-19 patients compared to a cohort with pulmonary infectious diseases at the same time of the previous year to value if there is any modification of exposure dose. The analysis of our data shows an increase in the overall mean dose in COVID-19 patients compared with non-COVID-19 patients. In our results, the higher dose increase occurs in the younger age groups (+86% range 21–30 years and +67% range 31–40 years). Our results show that COVID-19 patients are exposed to a significantly higher dose of ionizing radiation than other patients without COVID infectious lung disease, and especially in younger age groups, although some authors have proposed the use of radiotherapy in these patients, which is yet to be validated. Our study has limitations: the use of one CT machine in a single institute and a limited number of patients.
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The Usefulness of Chest CT Imaging in Patients With Suspected or Diagnosed COVID-19: A Review of Literature. Chest 2021; 160:652-670. [PMID: 33861993 PMCID: PMC8056836 DOI: 10.1016/j.chest.2021.04.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT scan findings, use of chest CT imaging in various acute and subacute settings, and its usefulness in predicting chronic disease have been defined better. We performed a review of published data on CT scans in patients with COVID-19. A summary of the range of imaging findings, from typical to less common abnormalities, is provided. Familiarity with these findings may facilitate the diagnosis and management of this disease. A comparison of sensitivity and specificity of chest CT imaging with reverse-transcriptase polymerase chain reaction testing highlights the potential role of CT imaging in difficult-to-diagnose cases of COVID-19. The usefulness of CT imaging to assess prognosis, to guide management, and to identify acute pulmonary complications associated with SARS-CoV-2 infection is highlighted. Beyond the acute stage, it is important for clinicians to recognize pulmonary parenchymal abnormalities, progressive fibrotic lung disease, and vascular changes that may be responsible for persistent respiratory symptoms. A large collection of multi-institutional images were included to elucidate the CT scan findings described.
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Impact of the COVID-19 pandemic on the activity of the Radiological Emergency Department: the experience of the Maggiore della Carità Hospital in Novara. Emerg Radiol 2021; 28:705-711. [PMID: 33813649 PMCID: PMC8019476 DOI: 10.1007/s10140-021-01928-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/22/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE During the first peak of the COVID-19 pandemic, the activity of Emergency Departments worldwide changed dramatically, focusing on diagnosis and care of the Sars-Cov-2 associated disease. These major changes also involved the activity of the Emergency Radiology Department (ERD). This study aimed to analyse the impact of the COVID-19 pandemic on imaging studies, both in terms of the amount, frequency and subspecialty of different imaging modalities requested to the ERD of the Maggiore della Carità Hospital in Novara (Italy). METHODS To this end, our observational study took into account the imaging studies requested by the emergency department during three-time spans. These were defined as phase 0 (pre-pandemic), phase 1 (pandemic peak with complete lockdown) and phase 2 (post-pandemic peak with partial lifting of restrictive measures), as derived from Italian urgent decrees by the President of the Council of Ministers (DPCM) which established the duration and entity of the lockdown measures throughout the pandemic. The dataset was processed and then compared with Pearson's chi-squared test. RESULTS During the pandemic peak, our data showed a significant drop in the total number of studies requested and a significant rise in computed tomography (CT) studies. In particular, a statistically significant increase in chest CT studies was found, probably due to the high sensitivity of this imaging method in identifying pulmonary involvement during respiratory tract infection of possible viral etiology (SARS-Cov-2). Moreover, we observed a statistically significant decrease of X-ray (XR) and ultrasound (US) studies during phase 1 compared to phase 0 and phase 2 probably due to a reduction in the numbers of ER visits for minor traumas given the mobility restrictions and people hesitancy in visiting the ER due to fear of contagion. CONCLUSIONS We can conclude that the activity of the ERD was heavily impacted by the SARS-Cov-2 pandemic. Further studies will be needed to estimate the impact of the pandemic on public health in terms of excess mortality related to delayed diagnosis and care of non-COVID diseases.
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van der Heyden B. The potential application of dual-energy subtraction radiography for COVID-19 pneumonia imaging. Br J Radiol 2021; 94:20201384. [PMID: 33733827 PMCID: PMC8010552 DOI: 10.1259/bjr.20201384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
X-ray imaging plays a crucial role in the confirmation of COVID-19 pneumonia. Chest X-ray radiography and CT are two major imaging techniques that are currently adopted in the diagnosis of COVID-19 pneumonia. However, dual-energy subtraction radiography is hardly discussed as potential COVID-19 imaging application. More advanced X-ray radiography equipment often supports dual-energy subtraction X-ray radiography. Dual-energy subtraction radiography enables the calculation of pseudo-radiographs, in which bones are removed and only soft-tissues are highlighted. In this commentary, the author would like to draw the attention to the potential use of dual-energy subtraction X-ray radiography (i.e. soft-tissue pseudo-radiography) for the assessment and the longitudinal follow-up of COVID-19 pneumonia.
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Affiliation(s)
- Brent van der Heyden
- KULeuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
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Affiliation(s)
- Choonsik Lee
- From the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD 20850
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