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Effective dose for kidney-ureter-bladder plain radiography, intravenous urography, and abdominal computed tomography scan: A phantom study. Appl Radiat Isot 2022; 187:110339. [DOI: 10.1016/j.apradiso.2022.110339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/07/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022]
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2
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Venkatesan AM, Oto A, Allen BC, Akin O, Alexander LF, Chong J, Froemming AT, Fulgham PF, Goldfarb S, Gettle LM, Maranchie JK, Patel BN, Schieda N, Schuster DM, Turkbey IB, Lockhart ME. ACR Appropriateness Criteria® Recurrent Lower Urinary Tract Infections in Females. J Am Coll Radiol 2020; 17:S487-S496. [PMID: 33153559 DOI: 10.1016/j.jacr.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Urinary tract infections (UTIs) in women are common, with an overall lifetime risk over >50%. UTIs are considered recurrent when they follow complete clinical resolution of a previous UTI and are usually defined as at least three episodes of infection within the preceding 12 months. An uncomplicated UTI is classified as a UTI without structural or functional abnormalities of the urinary tract and without relevant comorbidities. Complicated UTIs are those occurring in patients with underlying structural or medical problems. In women with recurrent uncomplicated UTIs, cystoscopy and imaging are not routinely used. In women suspected of having a recurrent complicated UTI, cystoscopy and imaging should be considered. CT urography or MR urography are usually appropriate for the evaluation of recurrent complicated lower urinary tract infections or for women who are nonresponders to conventional therapy, develop frequent reinfections or relapses, or have known underlying risk factors. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas; American Urological Association
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology
| | | | | | - Bhavik N Patel
- Stanford University Medical Center, Stanford, California
| | - Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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3
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Liu S, Nie P, Wang H, Guo J, Shang Q, Xu W, Feng W. Application of Digital Tomosynthesis in the Diagnosis of Urolithiasis: Comparison with MDCT. J Endourol 2020; 34:145-150. [DOI: 10.1089/end.2019.0327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Shifeng Liu
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hong Wang
- Dermatology Department, Qing Dao No. 6 People's Hospital, Qingdao, China
| | - Jian Guo
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qingjun Shang
- Department of Tumor Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Weihua Feng
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Oravec D, Flynn MJ, Zauel R, Rao S, Yeni YN. Digital tomosynthesis based digital volume correlation: A clinically viable noninvasive method for direct measurement of intravertebral displacements using images of the human spine under physiological load. Med Phys 2019; 46:4553-4562. [PMID: 31381174 DOI: 10.1002/mp.13750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/17/2019] [Accepted: 07/26/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE We have developed a clinically viable method for measurement of direct, patient-specific intravertebral displacements using a novel digital tomosynthesis based digital volume correlation technique. These displacements may be used to calculate vertebral stiffness under loads induced by a patient's body weight; this is particularly significant because, among biomechanical variables, stiffness is the strongest correlate of bone strength. In this proof of concept study, we assessed the feasibility of the method through a preliminary evaluation of the accuracy and precision of the method, identification of a range of physiological load levels for which displacements are measurable, assessment of the relationship of measured displacements with microcomputed tomography based standards, and demonstration of the in vivo application of the technique. METHODS Five cadaveric T11 vertebrae were allocated to three groups in order to study (a) the optimization of digital volume correlation algorithm input parameters, (b) accuracy and precision of the method and the ability to measure displacements at a range of physiological load levels, and (c) the correlation between displacements measured using tomosynthesis based digital volume correlation vs. high resolution microcomputed tomography based digital volume correlation and large scale finite element models. Tomosynthesis images of one patient (Female, 60 yr old) were used to calculate displacement maps, and in turn stiffness, using images acquired in both standing and standing-with-weight (8 kg) configurations. RESULTS We found that displacements were accurate (2.28 µm total error) and measurable at physiological load levels (above 267 N) with a linear response to applied load. Calculated stiffness among three tested vertebral bodies was within an acceptable range relative to reported values for vertebral stiffness (5651-13260 N/mm). Displacements were in good qualitative and quantitative agreement with both microcomputed tomography based finite element (r2 = 0.762, P < 0.001) and digital volume correlation (r2 = 0.799, P < 0.001) solutions. For one patient tested twice, once standing and once holding weights, results demonstrated excellent qualitative reproducibility of displacement distributions with superior endplate displacements increasing by 22% with added weight. CONCLUSIONS The results of this work collectively suggest the feasibility of the method for in vivo measurement of intravertebral displacements and stiffness in humans. These findings suggest that digital volume correlation using digital tomosynthesis imaging may be useful in understanding the mechanical response of bone to disease and may further enhance our ability to assess fracture risk and treatment efficacy for the spine.
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Affiliation(s)
- Daniel Oravec
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, USA
| | - Michael J Flynn
- Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Roger Zauel
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, USA
| | - Sudhaker Rao
- Department of Endocrinology, Henry Ford Hospital, Detroit, MI, USA
| | - Yener N Yeni
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, USA
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Abstract
Recent advances in computed tomography, X-ray-based imaging, and ultrasonography have improved the accuracy of urinary stone detection and differentiation of stone composition while minimizing radiation exposure. Dual-energy computed tomography and digital tomosynthesis show promise in predicting mineral composition to optimize medical and surgical therapy. Electromagnetic tracking may enhance the use of ultrasonography to achieve percutaneous renal access for nephrolithotomy. This article reviews innovations in imaging technology in the contemporary management of urinary stone disease.
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Held K. NCRP 54th Annual Meeting, Radiation Protection Responsibility in Medicine: Diagnostic X-ray Imaging Session Q & A (Questions for Alan G. Lurie, Cynthia H. McCollough, and J. Anthony Seibert). HEALTH PHYSICS 2019; 116:170-174. [PMID: 30585959 DOI: 10.1097/hp.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Kathryn Held
- NCRP, 7910 Woodmont Avenue, Suite 400, Bethesda, MD 20814
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Jehangir M, Mallory C, Medverd JR. Digital tomosynthesis for detection of ingested foreign objects in the emergency department: a case of razor blade ingestion. Emerg Radiol 2019; 26:249-252. [PMID: 30613929 DOI: 10.1007/s10140-018-01664-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/07/2018] [Indexed: 01/08/2023]
Abstract
A 46-year-old schizophrenic male presented to the emergency department (ED) after deliberate ingestion of an undetermined number of open razor blades. Abdominal radiograph revealed one razor blade but raised suspicion of a second blade which was subsequently confirmed by digital tomosynthesis (DTS), seen as two razor blades superimposed upon each other placed at slightly different angles. A careful search was made during endoscopy and the two razor blades were retrieved from the stomach and duodenum, respectively. This case illustrates the use of digital tomosynthesis as a smart, timely, cost-effective, and low-dose alternative to conventional computed tomography (CT) that can be conveniently employed in the ED for foreign body localization.
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Affiliation(s)
- Maham Jehangir
- Department of Radiology, Harborview Medical Center, University of Washington, 325 9th Ave, Seattle, WA, 98104, USA.
| | - Christopher Mallory
- School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Jonathan R Medverd
- Department of Radiology, Harborview Medical Center, University of Washington, 325 9th Ave, Seattle, WA, 98104, USA
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Wollin DA, Kaplan AG, Preminger GM, Ferraro PM, Nouvenne A, Tasca A, Croppi E, Gambaro G, Heilberg IP. Defining metabolic activity of nephrolithiasis - Appropriate evaluation and follow-up of stone formers. Asian J Urol 2018; 5:235-242. [PMID: 30364613 PMCID: PMC6197397 DOI: 10.1016/j.ajur.2018.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/10/2018] [Accepted: 04/11/2018] [Indexed: 11/24/2022] Open
Abstract
Considering the variation in metabolic evaluation and medical management of kidney stone disease, this consensus review was created to discuss the metabolic activity of nephrolithiasis, define the difference between single and recurrent stone formers, and develop a schema for metabolic and radiologic follow-up. A systematic review of the literature was performed to identify studies of metabolic evaluation and follow-up of patients with nephrolithiasis. Both single and recurrent stone formers share many similarities in metabolic profiles. The study group determined that based on an assessment of risk for stone recurrence and metabolic activity, single and recurrent stone formers should be evaluated comprehensively, including two 24 h urine studies on a random diet. Targeted medication and dietary recommendations are effective for many patients in reducing the risk of stone recurrence. Follow-up of those with stone disease should be obtained depending on the level of metabolic activity of the patient, the risk of chronic kidney disease and the risk of osteoporosis/osteopenia. A standard scheme includes a baseline metabolic profile, a repeat study 3-6 months after initiation of treatment, and then yearly when stable, with abdominal imaging obtained every 1-2 years.
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Affiliation(s)
- Daniel A. Wollin
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Adam G. Kaplan
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Glenn M. Preminger
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Pietro Manuel Ferraro
- Columbus-Gemelli University Hospital, Division of Nephrology, Department of Medical Sciences, Rome, Italy
| | - Antonio Nouvenne
- University of Parma, Department of Clinical and Experimental Medicine, Parma, Italy
| | - Andrea Tasca
- S. Bortolo Hospital, Department of Urology, Vicenza, Italy
| | - Emanuele Croppi
- Columbus-Gemelli University Hospital, Division of Nephrology, Department of Medical Sciences, Rome, Italy
| | - Giovanni Gambaro
- Columbus-Gemelli University Hospital, Division of Nephrology, Department of Medical Sciences, Rome, Italy
| | - Ita P. Heilberg
- Universidade Federal de São Paulo, Nephrology Division, São Paulo, Brazil
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Comparison of radiographs, tomosynthesis and CT with metal artifact reduction for the detection of hip prosthetic loosening. Eur Radiol 2018; 29:1258-1266. [DOI: 10.1007/s00330-018-5717-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/18/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023]
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10
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Urolithiasis: Comparison of diagnostic performance of digital tomosynthesis and ultrasound. Which one to choose and when? Eur J Radiol 2018; 105:25-31. [PMID: 30017289 DOI: 10.1016/j.ejrad.2018.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 05/05/2018] [Accepted: 05/15/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of digital tomosynthesis (DT) in detecting urolithiasis and compare it with ultrasonography (USG), keeping standard volumetric multi-detector computed tomography (MDCT) as the reference. MATERIALS AND METHODS This prospective analytical study was approved by our institutional ethical committee. A total of 66 patients were enrolled who had either clinical suspicion of urolithiasis or history of recurrent urolithiasis. All patients underwent DT, USG and MDCT within 24 h. In all these three investigations, the calculi were categorised according to their location and size by two radiologists. Sensitivity, specificity, positive and negative predictive values of DT and USG were calculated with MDCT as a reference standard. RESULTS Our study comprised of 66 patients (36 males and 30 females with age range of 19-73 years). A total of 121 calculi were assessed with 52 calculi <5 mm in size, 32 calculi measuring 5-10 mm and 37 calculi >10 mm. Kappa test of agreement was used to assess the interobserver agreement for all observations. The measurement of agreement kappa value was 1. The overall sensitivity of DT and USG in detecting urolithaisis was 50% (p value <0.001) and 50.4% (p value 0.005) respectively. No statistically significant difference was noted between USG and DT in detecting urolithiasis. The sensitivity of DT and USG in detecting renal calculi was 47.1% and 50.9% respectively and the sensitivity of DT and USG in detecting ureteric calculi was 74.9% and 39.2% respectively. We observed statistically significant difference between USG and DT in detecting ureteric calculi. CONCLUSION In our study, there was no statistically significant difference noted between USG and DT in diagnosis of urolithiasis. DT performed significantly better than USG in detecting ureteric calculi with a higher sensitivity. Hence, we are tempted to opine that DT may be preferred over USG for initial evaluation of patients with suspected ureteric calculi. However considering the strength of ultrasound in demonstrating associated signs as hydroureteronephosis, we are still of the opinion, that both DT and USG should be used as complementary techniques in resolving these common clinical screnarios.
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Wollin DA, Gupta RT, Young B, Cone E, Kaplan A, Marin D, Patel BN, Mazurowski MA, Scales CD, Ferrandino MN, Preminger GM, Lipkin ME. Abdominal Radiography With Digital Tomosynthesis: An Alternative to Computed Tomography for Identification of Urinary Calculi? Urology 2018; 120:56-61. [PMID: 30006268 DOI: 10.1016/j.urology.2018.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the accuracy of plain abdominal radiography (kidneys, ureter, and bladder [KUB]) with digital tomosynthesis (DT) to noncontrast computed tomography (NCCT), the gold standard imaging modality for urinary stones. Due to radiation and cost concerns, KUB is often used for diagnosis and follow-up of nephrolithiasis. DT, a novel technique that produces high-quality radiographs with less radiation and/or cost than low-dose NCCT, has not been assessed in this situation. MATERIALS AND METHODS Seven fresh tissue cadavers were implanted with stones of known size and/or composition and imaged with KUB, DT, and NCCT. Four blinded readers (2 urologists, 2 radiologists) evaluated KUBs for presence and/or location of calculi. They then re-evaluated with addition of tomograms to assess additional value. After a memory extinction period, readers evaluated NCCT images. Accuracy of detection was determined using nearest-neighbor match with generalized linear mixed modeling. RESULTS Total of 59 stones were identified on reference read. Overall, NCCT and DT were both superior to KUB alone (P < .001) while the difference between DT and NCCT was not significant (P = .06). When evaluating uric acid stones, NCCT and DT outperformed KUB (P < .01 and P < .05, respectively) while DT and NCCT were similar (P = .16). Intrarenal stones were better evaluated on DT and NCCT (P < .001 compared to KUB), while DT and NCCT were similar (P = 1.00). Accuracy was lower than anticipated across modalities due to use of the cadaver model. CONCLUSION Our study demonstrates DT is superior to KUB for identification of intrarenal calculi and could replace routine use of KUB or NCCT for detecting renal stones, even those composed of uric acid.
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Affiliation(s)
- Daniel A Wollin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
| | - Rajan T Gupta
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC; Department of Radiology, Duke University Medical Center, Durham, NC
| | - Brian Young
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Eugene Cone
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Adam Kaplan
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Bhavik N Patel
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiology, Stanford University, Palo Alto, CA
| | - Maciej A Mazurowski
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | - Charles D Scales
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Michael E Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
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Suyama Y, Yamada Y, Yamaguchi H, Someya G, Otsuka S, Murayama Y, Shinmoto H, Jinzaki M, Ogawa K. The added value of tomosynthesis in endoscopic retrograde cholangiography with radiography for the detection of choledocholithiasis. Br J Radiol 2018; 91:20180115. [PMID: 29630390 DOI: 10.1259/bjr.20180115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The diagnostic performance of endoscopic retrograde cholangiography (ERC) with radiography is imperfect. We assessed the value of adding tomosynthesis to ERC with radiography for the detection of choledocholithiasis. METHODS This study included 102 consecutive patients (choledocholithiasis/non-choledocholithiasis, n = 57/45), who underwent both radiography and tomosynthesis for ERC in the same examination and were not diagnosed with malignancy. The reference standard for the existence of choledocholithiasis was confirmed by endoscopic stone extraction during ERC, intraoperative cholangiography, or follow up with magnetic resonance cholangiopancreatography (n = 78, 11, and 13, respectively). A gastroenterologist and a radiologist independently evaluated the radiographs and the combination of tomosynthesis and radiographic images in a blinded and randomised manner. Receiver operating characteristic analysis was used for statistical analysis. RESULTS The areas under the receiver operating characteristic curve for combined tomosynthesis and radiography were significantly higher than those for radiography alone for both readers: Reader 1/Reader 2, 0.929/0.956 [95% confidence interval (CI), 0.861-0.965/0.890-0.983) vs 0.803/0.769 (95% confidence interval, 0.707-0.873/0.668-0.846), respectively (p = 0.0047/< 0.0001). CONCLUSION Adding tomosynthesis to radiography improved the diagnostic performance of ERC for detection of choledocholithiasis. Advances in knowledge: Adding tomosynthesis to radiography improves detection of choledocholithiasis and tomosynthesis images can be obtained easily after radiographs and repeated immediately.
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Affiliation(s)
- Yohsuke Suyama
- 1 Department of Radiology, Keio University School of Medicine , Shinjuku-ku, Tokyo , Japan.,2 Department of Radiology, Nippon Koukan Hospital , Kawasaki-shi, Kanagawa , Japan.,3 Department of Radiology, National Defense Medical College , Tokorozawa-shi, Saitama , Japan
| | - Yoshitake Yamada
- 1 Department of Radiology, Keio University School of Medicine , Shinjuku-ku, Tokyo , Japan.,2 Department of Radiology, Nippon Koukan Hospital , Kawasaki-shi, Kanagawa , Japan
| | - Hideki Yamaguchi
- 2 Department of Radiology, Nippon Koukan Hospital , Kawasaki-shi, Kanagawa , Japan
| | - Gou Someya
- 4 Department of Gastroenterology and Hepatology, Nippon Koukan Hospital , Kawasaki-shi, Kanagawa , Japan
| | - Seiji Otsuka
- 4 Department of Gastroenterology and Hepatology, Nippon Koukan Hospital , Kawasaki-shi, Kanagawa , Japan
| | - Yoshitami Murayama
- 2 Department of Radiology, Nippon Koukan Hospital , Kawasaki-shi, Kanagawa , Japan
| | - Hiroshi Shinmoto
- 3 Department of Radiology, National Defense Medical College , Tokorozawa-shi, Saitama , Japan
| | - Masahiro Jinzaki
- 1 Department of Radiology, Keio University School of Medicine , Shinjuku-ku, Tokyo , Japan
| | - Kenji Ogawa
- 2 Department of Radiology, Nippon Koukan Hospital , Kawasaki-shi, Kanagawa , Japan
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Choi S, Lee H, Lee D, Choi S, Lee CL, Kwon W, Shin J, Seo CW, Kim HJ. Development of a chest digital tomosynthesis R/F system and implementation of low-dose GPU-accelerated compressed sensing (CS) image reconstruction. Med Phys 2018; 45:1871-1888. [PMID: 29500855 DOI: 10.1002/mp.12843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/17/2017] [Accepted: 02/14/2018] [Indexed: 01/31/2023] Open
Abstract
PURPOSE This work describes the hardware and software developments of a prototype chest digital tomosynthesis (CDT) R/F system. The purpose of this study was to validate the developed system for its possible clinical application on low-dose chest tomosynthesis imaging. METHODS The prototype CDT R/F system was operated by carefully controlling the electromechanical subsystems through a synchronized interface. Once a command signal was delivered by the user, a tomosynthesis sweep started to acquire 81 projection views (PVs) in a limited angular range of ±20°. Among the full projection dataset of 81 images, several sets of 21 (quarter view) and 41 (half view) images with equally spaced angle steps were selected to represent a sparse view condition. GPU-accelerated and total-variation (TV) regularization strategy-based compressed sensing (CS) image reconstruction was implemented. The imaged objects were a flat-field using a copper filter to measure the noise power spectrum (NPS), a Catphan® CTP682 quality assurance (QA) phantom to measure a task-based modulation transfer function (MTFTask ) of three different cylinders' edge, and an anthropomorphic chest phantom with inserted lung nodules. The authors also verified the accelerated computing power over CPU programming by checking the elapsed time required for the CS method. The resultant absorbed and effective doses that were delivered to the chest phantom from two-view digital radiographic projections, helical computed tomography (CT), and the prototype CDT system were compared. RESULTS The prototype CDT system was successfully operated, showing little geometric error with fast rise and fall times of R/F x-ray pulse less than 2 and 10 ms, respectively. The in-plane NPS presented essential symmetric patterns as predicted by the central slice theorem. The NPS images from 21 PVs were provided quite different pattern against 41 and 81 PVs due to aliased noise. The voxel variance values which summed all NPS intensities were inversely proportional to the number of PVs, and the CS method gave much lower voxel variance by the factors of 3.97-6.43 and 2.28-3.36 compared to filtered backprojection (FBP) and 20 iterations of simultaneous algebraic reconstruction technique (SART). The spatial frequencies of the f50 at which the MTFTask reduced to 50% were 1.50, 1.55, and 1.67 cycles/mm for FBP, SART, and CS methods, respectively, in the case of Bone 20% cylinder using 41 views. A variety of ranges of TV reconstruction parameters were implemented during the CS method and we could observe that the NPS and MTFTask preserved best when the regularization and TV smoothing parameters α and τ were in a range of 0.001-0.1. For the chest phantom data, the signal difference to noise ratios (SDNRs) were higher in the proposed CS scheme images than in the FBP and SART, showing the enhanced rate of 1.05-1.43 for half view imaging. The total averaged reconstruction time during 20 iterations of the CS scheme was 124.68 s, which could match-up a clinically feasible time (<3 min). This computing time represented an enhanced speed 386 times greater than CPU programming. The total amounts of estimated effective doses were 0.12, 0.53 (half view), and 2.56 mSv for two-view radiographs, the prototype CDT system, and helical CT, respectively, showing 4.49 times higher than conventional radiography and 4.83 times lower than a CT exam, respectively. CONCLUSIONS The current work describes the development and performance assessment of both hardware and software for tomosynthesis applications. The authors observed reasonable outcomes by showing a potential for low-dose application in CDT imaging using GPU acceleration.
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Affiliation(s)
- Sunghoon Choi
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Haenghwa Lee
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Donghoon Lee
- Department of Radiation Convergence Engineering, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Seungyeon Choi
- Department of Radiation Convergence Engineering, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Chang-Lae Lee
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Woocheol Kwon
- Department of Radiology, Wonju Severance Christian Hospital, 20 Ilsan-ro, Wonju, 26426, Korea
| | - Jungwook Shin
- LISTEM Corporation, 94 Donghwagongdan-ro, Munmak-eup, Wonju, Korea
| | - Chang-Woo Seo
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
| | - Hee-Joung Kim
- Department of Radiological Science, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea.,Department of Radiation Convergence Engineering, Yonsei University, 1 Yonseidae-gil, Wonju, 26493, Korea
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14
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Liu S, Wang H, Feng W, Hu X, Guo J, Shang Q, Li Z, Yu H. The value of X-ray digital tomosynthesis in the diagnosis of urinary calculi. Exp Ther Med 2018; 15:1749-1753. [PMID: 29434761 DOI: 10.3892/etm.2017.5531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/07/2017] [Indexed: 11/06/2022] Open
Abstract
Urinary calculus is a common and recurrent condition that affects kidney function. The present study evaluated the use of digital tomosynthesis (DTS) and Kidneys-Ureters-Bladder (KUB) radiography as methods of diagnosing urinary calculi. Unenhanced multidetector computed tomography (UMDCT) was used in the diagnosis of calculi. KUB radiography and DTS procedures were conducted on patients prior to and following bowel preparation to detect kidney, ureteral and bladder calculi. Differences in diagnostic performance of KUB radiography and DTS imaging on prepared and unprepared bowel were evaluated using the χ2 test. The consistency of diagnostic results between two examining physicians was analyzed using the κ test. A total of 138 calculi from 80 patients were detected via UMDCT. The calculi detection rates of KUB prior to and following bowel preparation were 47.8 and 66.7% respectively, and the calculi detection rate of DTS prior to and following bowel preparation were 94.2 and 96.4%, respectively. The detection rates of calculi >5 mm via KUB prior to and following bowel preparation were 56.6 and 73.5% respectively, and in DTS they were 100% prior to and following bowel preparation. Economically, DTS performed on the unprepared bowel was the most cost effective, followed by DTS on the prepared bowel, KUB on the unprepared bowel and KUB on the prepared bowel. Therefore, the current study concluded that DTS may be an appropriate first-line imaging technique in patients with urinary calculi.
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Affiliation(s)
- Shifeng Liu
- Center for Interventional Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Hong Wang
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Weihua Feng
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Xiaokun Hu
- Center for Interventional Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Jian Guo
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Qingjun Shang
- Department of Tumor Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Zixiang Li
- Center for Interventional Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
| | - Hongsheng Yu
- Department of Tumor-Comprehensive Treatment, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, P.R. China
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Bahílo Mateu P, Budía Alba A, Liatsikos E, Trassierra Villa M, López-Acón JD, de Guzmán Ordaz D, Boronat Tormo F. Is extracorporeal shock wave lithotripsy a current treatment for urolithiasis? A systematic review. Actas Urol Esp 2017; 41:426-434. [PMID: 28336203 DOI: 10.1016/j.acuro.2017.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Technological advances have prompted a change in the management of urolithiasis. Endourological techniques are gaining importance because they are highly effective treatments. The aim of this study was to answer the question of whether extracorporeal shock wave lithotripsy (ESWL) is still a competitive alternative compared with other therapeutic modalities. ACQUISITION OF EVIDENCE We conducted a literature search of articles published in the past 5 years. We identified 12 randomized and comparative studies and assessed the methodology and results of the study variables. We performed a narrative synthesis of the included studies. To summarise the variables, we used the mean and standard deviation for continuous variables and absolute numbers and percentages for the qualitative variables. ANALYSIS OF THE EVIDENCE Of the studies reviewed, 7 evaluated the various treatments for nephrolithiasis and 5 evaluated the treatments for ureteral lithiasis. At the renal level, a stone-free rate of 33.33-91.5% at 3 months was reached with ESWL, while a rate of 90.4-100% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. At the ureteral level, a stone-free rate of 73.5-82.2% at 3 months was reached with ESWL, while a rate of 79-94.1% was achieved with the other endourological techniques, without finding statistically significant differences in the studies. CONCLUSION There is a lack of homogeneity among the published studies. ESWL is a minimally invasive treatment that with an appropriate technique and patient selection achieves high effectiveness, thus maintaining an important role at this time.
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Affiliation(s)
- P Bahílo Mateu
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - A Budía Alba
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - M Trassierra Villa
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J D López-Acón
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - D de Guzmán Ordaz
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - F Boronat Tormo
- Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España
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Abstract
The prevalence of urinary stones in the United States has been described as 1 in 11 persons reporting a history of stones. Imaging plays a crucial role in diagnosis, management, and follow-up for these patients and imaging technology over the last 100 years has advanced as the disease prevalence has increased. CT remains the gold standard for imaging urolithiasis and changes in this technology, with the addition of multidetector CT and dual-energy CT, as well as the changes in utilization of CT, have decreased the radiation dose encountered by patients and allowed for improved stone detection. The use of digital tomography has been introduced for follow-up of recurrent stone formers offering the potential to lower radiation exposure over the course of a patient's lifelong treatment. However, there is still a demand for improved imaging techniques to detect smaller stones and stones in larger patients at lower radiation doses as well as the continued need for the judicious use of all imaging modalities for healthcare cost containment and patient safety.
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Affiliation(s)
- Joanne Dale
- 1 Department of Urology, Duke University Medical Center , Durham, North Carolina
| | - Rajan T Gupta
- 1 Department of Urology, Duke University Medical Center , Durham, North Carolina.,2 Department of Radiology, Duke University Medical Center , Durham, North Carolina
| | - Daniele Marin
- 2 Department of Radiology, Duke University Medical Center , Durham, North Carolina
| | - Michael Lipkin
- 1 Department of Urology, Duke University Medical Center , Durham, North Carolina
| | - Glenn Preminger
- 1 Department of Urology, Duke University Medical Center , Durham, North Carolina
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Abstract
BACKGROUND Urolithiasis is a widespread disease. Diagnostic imaging plays an important role in the evaluation and management of patients with suspected urolithiasis. Furthermore, modern imaging methods may provide information on stone location, size, fragility and composition aiding the urologist to determine the appropriate treatment modality. PURPOSE Based on the current literature and guidelines, this review reports on the various new and established diagnostic imaging modalities. RESULTS Ultrasound should always be the initial imaging modality. Following ultrasound, noncontrast CT-principally using a low-dose protocol-is the imaging modality of choice in the evaluation of patients with acute flank pain and suspected urolithiasis. New imaging modalities like dual energy CT, Uro Dyna CT and digital tomosynthesis are currently under investigation but not yet part of daily clinical practice. Magnetic resonance imaging can be used to detect obstruction caused by urinary stones but is not a first-line imaging modality.
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Abstract
Kidney stone imaging is an important diagnostic tool and initial step in deciding which therapeutic options to use for the management of kidney stones. Guidelines provided by the American College of Radiology, American Urological Association, and European Association of Urology differ regarding the optimal initial imaging modality to use to evaluate patients with suspected obstructive nephrolithiasis. Noncontrast CT of the abdomen and pelvis consistently provides the most accurate diagnosis but also exposes patients to ionizing radiation. Traditionally, ultrasonography has a lower sensitivity and specificity than CT, but does not require use of radiation. However, when these imaging modalities were compared in a randomized controlled trial they were found to have equivalent diagnostic accuracy within the emergency department. Both modalities have advantages and disadvantages. Kidney, ureter, bladder (KUB) plain film radiography is most helpful in evaluating for interval stone growth in patients with known stone disease, and is less useful in the setting of acute stones. MRI provides the possibility of 3D imaging without exposure to radiation, but it is costly and currently stones are difficult to visualize. Further developments are expected to enhance each imaging modality for the evaluation and treatment of kidney stones in the near future. A proposed algorithm for imaging patients with acute stones in light of the current guidelines and a randomized controlled trial could aid clinicians.
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Affiliation(s)
- Wayne Brisbane
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, Washington 98195, USA
| | - Michael R Bailey
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1013 NE 40th Street, Seattle, Washington 98105, USA
| | - Mathew D Sorensen
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, Washington 98195, USA.,Division of Urology, Department of Veteran Affairs Medical Center, 1660S Columbian Way, Seattle, Washington 98108, USA
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Dobbins JT, McAdams HP, Sabol JM, Chakraborty DP, Kazerooni EA, Reddy GP, Vikgren J, Båth M. Multi-Institutional Evaluation of Digital Tomosynthesis, Dual-Energy Radiography, and Conventional Chest Radiography for the Detection and Management of Pulmonary Nodules. Radiology 2016; 282:236-250. [PMID: 27439324 DOI: 10.1148/radiol.2016150497] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board-approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3-20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3-4 mm, >4 mm to 6 mm, >6 mm to 8 mm, and >8 mm to 20 mm). Results Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P < .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P < .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P < .001; 95% CI: 1.15, 1.32). There were no differences in any specificity measures. DE imaging did not significantly affect nodule detection when paired with either conventional chest radiography or tomosynthesis. Conclusion Tomosynthesis outperformed conventional chest radiography for lung nodule detection and determination of case management; DE imaging did not show significant differences over conventional chest radiography or tomosynthesis alone. These findings indicate performance likely achievable with a range of reader expertise. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- James T Dobbins
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - H Page McAdams
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - John M Sabol
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Dev P Chakraborty
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Ella A Kazerooni
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Gautham P Reddy
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Jenny Vikgren
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
| | - Magnus Båth
- From the Carl E. Ravin Advanced Imaging Laboratory; Depts of Radiology, Biomedical Engineering, and Physics; and Medical Physics Graduate Program, Duke Univ Medical Ctr, 2424 Erwin Rd, Suite 302, Durham, NC 27705 (J.T.D.); Carl E. Ravin Advanced Imaging Laboratory and Dept of Radiology, Duke Univ Medical Ctr, Durham, NC (H.P.M.); GE Healthcare, Waukesha, Wis (J.M.S.); Dept of Radiology, Univ of Pittsburgh, Pittsburgh, Pa (D.P.C.); Dept of Radiology, Univ of Michigan, Ann Arbor, Mich (E.A.K.); Dept of Radiology, Univ of Washington, Seattle, Wash (G.P.R.); Dept of Radiology, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (J.V.); Dept of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Academy at Univ of Gothenburg, Gothenburg, Sweden (M.B.); and Dept of Medical Physics and Biomedical Engineering, Sahlgrenska Univ Hospital, Gothenburg, Sweden (M.B.)
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Tomosynthesis of the thoracic spine: added value in diagnosing vertebral fractures in the elderly. Eur Radiol 2016; 27:491-497. [PMID: 27246721 DOI: 10.1007/s00330-016-4392-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/26/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
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Mazzei MA, Guerrini S, Mazzei FG, Cioffi Squitieri N, Notaro D, de Donato G, Galzerano G, Sacco P, Setacci F, Volterrani L, Setacci C. Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications. World J Radiol 2016; 8:530-536. [PMID: 27247719 PMCID: PMC4882410 DOI: 10.4329/wjr.v8.i5.530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 12/29/2015] [Accepted: 02/17/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To validate the feasibility of digital tomosynthesis of the abdomen (DTA) combined with contrast enhanced ultrasound (CEUS) in assessing complications after endovascular aortic aneurysm repair (EVAR) by using computed tomography angiography (CTA) as the gold standard.
METHODS: For this prospective study we enrolled 163 patients (123 men; mean age, 65.7 years) referred for CTA for EVAR follow-up. CTA, DTA and CEUS were performed at 1 and 12 mo in all patients, with a maximum time interval of 2 d.
RESULTS: Among 163 patients 33 presented complications at CTA. DTA and CTA correlated for the presence of complications in 32/33 (96.96%) patients and for the absence of complications in 127/130 (97.69%) patients; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DTA were 97%, 98%, 91%, 99%, and 98%, respectively. CEUS and CTA correlated for the presence of complications in 19/33 (57.57%) patients and for the absence of complications in 129/130 (99.23%) patients; the sensitivity, specificity, PPV, NPV and accuracy of CEUS were 58%, 99%, 95%, 90%, and 91%, respectively. Sensitivity, specificity and accuracy of combining DTA and CEUS together in detecting EVAR complications were 77%, 98% and 95%, respectively.
CONCLUSION: Combining DTA and CEUS in EVAR follow-up has the potential to limit the use of CTA only in doubtful cases.
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Machida H, Yuhara T, Tamura M, Ishikawa T, Tate E, Ueno E, Nye K, Sabol JM. Whole-Body Clinical Applications of Digital Tomosynthesis. Radiographics 2016; 36:735-50. [DOI: 10.1148/rg.2016150184] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Daldrup-Link HE, Sammet C, Hernanz-Schulman M, Barsness KA, Cahill AM, Chung E, Doria AS, Darge K, Krishnamurthy R, Lungren MP, Moore S, Olivieri L, Panigrahy A, Towbin AJ, Trout A, Voss S. White Paper on P4 Concepts for Pediatric Imaging. J Am Coll Radiol 2016; 13:590-597.e2. [PMID: 26850380 PMCID: PMC4860067 DOI: 10.1016/j.jacr.2015.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 12/21/2022]
Abstract
Over the past decade, innovations in the field of pediatric imaging have been based largely on single-center and retrospective studies, which provided limited advances for the benefit of pediatric patients. To identify opportunities for potential "quantum-leap" progress in the field of pediatric imaging, the ACR-Pediatric Imaging Research (PIR) Committee has identified high-impact research directions related to the P4 concept of predictive, preventive, personalized, and participatory diagnosis and intervention. Input from 237 members of the Society for Pediatric Radiology was clustered around 10 priority areas, which are discussed in this article. Needs within each priority area have been analyzed in detail by ACR-PIR experts on these topics. By facilitating work in these priority areas, we hope to revolutionize the care of children by shifting our efforts from unilateral reaction to clinical symptoms, to interactive maintenance of child health.
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Affiliation(s)
- Heike E Daldrup-Link
- Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California.
| | - Christina Sammet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | | | - Ellen Chung
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Kassa Darge
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Matthew P Lungren
- Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California
| | - Sheila Moore
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - Andrew Trout
- Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Stephan Voss
- Children's Hospital of Boston, Boston, Massachusetts
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Cabrera FJ, Kaplan AG, Youssef RF, Tsivian M, Shin RH, Scales CD, Preminger GM, Lipkin ME. Digital Tomosynthesis: A Viable Alternative to Noncontrast Computed Tomography for the Follow-Up of Nephrolithiasis? J Endourol 2016; 30:366-70. [PMID: 27078715 DOI: 10.1089/end.2015.0271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Digital tomosynthesis (DT) is a new X-ray-based imaging technique that allows image enhancement with minimal increase in radiation exposure. The purpose of this study was to compare DT with noncontrast computed tomography (NCCT) and to evaluate its potential role for the follow-up of patients with nephrolithiasis in a nonemergent setting. METHODS A retrospective review of patients with nephrolithiasis at our institution that underwent NCCT and DT from July 2012 to September 2013 was performed. Renal units (RUs) that did not undergo treatment or stone passage were randomly assigned to two blinded readers, who recorded stone count, size area (mm(2)), maximum stone length (mm), and location, for both DT and NCCT. Mean differences per RU were compared. Potential variables affecting stone detection rate, including stone size and body mass index (BMI), were evaluated. Interobserver agreement was determined using the intraclass correlation coefficient to measure the consistency of measurements made by the readers. RESULTS DT and NCCT demonstrated similar stone detection rates in terms of stone counts and stone area mm(2). Of the 79 RUs assessed, 41 RUs showed exact stone counts on DT and NCCT. The mean difference in stone area was 16.5 mm(2) (-4.6 to 38.5), p = 0.121. The mean size of the largest stone on NCCT and DT was 9.27 and 8.87 mm, respectively. Stone size and BMI did not cause a significant difference in stone detection rates. Interobserver agreement showed a strong correlation between readers and adequate reproducibility. CONCLUSION We found DT to be a comparable imaging modality to NCCT for the detection of intrarenal stones, without a significant effect from stone size and BMI and adequate reproducibility between multiple readers. DT appears to be an ideal alternative for following patients with nephrolithiasis due to its acceptable stone detection rates, low radiation exposure, and decreased cost compared to NCCT.
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Affiliation(s)
- Fernando J Cabrera
- 1 Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Adam G Kaplan
- 1 Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Ramy F Youssef
- 2 Department of Urologic Surgery, University of California , Irvine, Orange, California
| | - Matvey Tsivian
- 1 Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Richard H Shin
- 1 Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Charles D Scales
- 1 Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina.,3 Duke Clinical Research Institute, Duke University , Durham, North Carolina
| | - Glenn M Preminger
- 1 Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
| | - Michael E Lipkin
- 1 Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
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Villa L, Giusti G, Knoll T, Traxer O. Imaging for Urinary Stones: Update in 2015. Eur Urol Focus 2015; 2:122-129. [PMID: 28723526 DOI: 10.1016/j.euf.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Imaging is essential for the diagnosis and the clinical decision-making process of patients with urinary stones. OBJECTIVE To assess the benefits and limitations of various imaging techniques by specifically focusing on different phases of stone patients' management. EVIDENCE ACQUISITION PubMed and Web of Science databases were used to identify studies published in the last 10 yr on this argument. Search terms included 'urolithiasis', nephrolithiasis', or 'urinary stones' in combination (AND) with the terms 'imaging', 'computer tomography', 'ultrasonography', 'intravenous pyelogram', or 'radiation exposure'. Study selection was based on an independent peer-review process of all the authors after the structured data search. EVIDENCE SYNTHESIS Noncontrast-enhanced computer tomography (CT) provides the highest value of diagnostic accuracy for urinary stones. Stone composition can be specifically assessed through the use of dual-energy CT. When information about the anatomy of the renal collecting system is required or alternative pathologies are suspected, CT with contrast injection is recommended. Low-dose protocols allowed a drastic reduction of the effective dose administered to the patient, thus limiting the biological risk due to ionising radiations. Other strategies to contain the radiation exposure include the dual-split bolus dual energy CT and the adaptive statistical image reconstruction. Abdomen ultrasound may be a valid alternative as an initial approach since it does not change the outcome of patients compared with CT, and should be the imaging of choice in children and pregnant women. CONCLUSIONS Noncontrast-enhanced CT is the most accurate imaging technique to identify urinary stones. Abdomen ultrasound seems to be a valid alternative in the initial evaluation of urinary colic. New low-dose protocols and strategies have been developed to contain radiation exposure, which is a major issue especially in specific circumstances. PATIENT SUMMARY Noncontrast-enhanced computer tomography has been increasingly used for the diagnosis and management of urinary stones. Low-dose protocols as well as alternative imaging should be considered by clinicians in specific circumstances to minimise radiation exposure.
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Affiliation(s)
- Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Guido Giusti
- Department of Urology, IRCCS Ospedale San Raffaele Ville Turro, Milan, Italy
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tuebingen, Sindelfingen, Germany
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Pierre et Marie Curie University, Paris, France
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Chen TT, Wang C, Ferrandino MN, Scales CD, Yoshizumi TT, Preminger GM, Lipkin ME. Radiation Exposure during the Evaluation and Management of Nephrolithiasis. J Urol 2015; 194:878-85. [DOI: 10.1016/j.juro.2015.04.118] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Tony T. Chen
- School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Chu Wang
- Division of Radiation Safety, Duke University Medical Center, Durham, North Carolina
| | - Michael N. Ferrandino
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Charles D. Scales
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Terry T. Yoshizumi
- Division of Radiation Safety, Duke University Medical Center, Durham, North Carolina
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Glenn M. Preminger
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael E. Lipkin
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Shan J, Tucker AW, Gaalaas LR, Wu G, Platin E, Mol A, Lu J, Zhou O. Stationary intraoral digital tomosynthesis using a carbon nanotube X-ray source array. Dentomaxillofac Radiol 2015; 44:20150098. [PMID: 26090933 PMCID: PMC5120569 DOI: 10.1259/dmfr.20150098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/09/2015] [Accepted: 06/17/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Intraoral dental tomosynthesis and closely related tuned-aperture CT (TACT) are low-dose three-dimensional (3D) imaging modalities that have shown improved detection of multiple dental diseases. Clinical interest in implementing these technologies waned owing to their time-consuming nature. Recently developed carbon nanotube (CNT) X-ray sources allow rapid multi-image acquisition without mechanical motion, making tomosynthesis a clinically viable technique. The objective of this investigation was to evaluate the feasibility of and produce high-quality images from a digital tomosynthesis system employing CNT X-ray technology. METHODS A test-bed stationary intraoral tomosynthesis unit was constructed using a CNT X-ray source array and a digital intraoral sensor. The source-to-image distance was modified to make the system comparable in image resolution to current two-dimensional intraoral radiography imaging systems. Anthropomorphic phantoms containing teeth with simulated and real caries lesions were imaged using a dose comparable to D-speed film dose with a rectangular collimation. Images were reconstructed and analysed. RESULTS Tomosynthesis images of the phantom and teeth specimen demonstrated perceived image quality equivalent or superior to standard digital images with the added benefit of 3D information. The ability to "scroll" through slices in a buccal-lingual direction significantly improved visualization of anatomical details. In addition, the subjective visibility of dental caries was increased. CONCLUSIONS Feasibility of the stationary intraoral tomosynthesis is demonstrated. The results show clinical promise and suitability for more robust observer and clinical studies.
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MESH Headings
- Alveolar Process/diagnostic imaging
- Dental Caries/diagnostic imaging
- Dental Materials/chemistry
- Dental Restoration, Permanent
- Feasibility Studies
- Humans
- Image Processing, Computer-Assisted/methods
- Imaging, Three-Dimensional/methods
- Maxilla/diagnostic imaging
- Nanotubes, Carbon
- Phantoms, Imaging
- Radiation Dosage
- Radiographic Image Enhancement/methods
- Radiography, Dental, Digital/instrumentation
- Radiography, Dental, Digital/methods
- Tomography, X-Ray Computed/instrumentation
- Tomography, X-Ray Computed/methods
- Tooth/diagnostic imaging
- X-Ray Film
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Affiliation(s)
- J Shan
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A W Tucker
- Xintek Inc., Research Triangle Park, NC, USA
| | - L R Gaalaas
- University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - G Wu
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Platin
- University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - A Mol
- University of North Carolina School of Dentistry, Chapel Hill, NC, USA
| | - J Lu
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - O Zhou
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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30
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Dendumrongsup T, Plumb AA, Halligan S, Fanshawe TR, Altman DG, Mallett S. Multi-reader multi-case studies using the area under the receiver operator characteristic curve as a measure of diagnostic accuracy: systematic review with a focus on quality of data reporting. PLoS One 2014; 9:e116018. [PMID: 25541977 PMCID: PMC4277459 DOI: 10.1371/journal.pone.0116018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/02/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We examined the design, analysis and reporting in multi-reader multi-case (MRMC) research studies using the area under the receiver-operating curve (ROC AUC) as a measure of diagnostic performance. METHODS We performed a systematic literature review from 2005 to 2013 inclusive to identify a minimum 50 studies. Articles of diagnostic test accuracy in humans were identified via their citation of key methodological articles dealing with MRMC ROC AUC. Two researchers in consensus then extracted information from primary articles relating to study characteristics and design, methods for reporting study outcomes, model fitting, model assumptions, presentation of results, and interpretation of findings. Results were summarized and presented with a descriptive analysis. RESULTS Sixty-four full papers were retrieved from 475 identified citations and ultimately 49 articles describing 51 studies were reviewed and extracted. Radiological imaging was the index test in all. Most studies focused on lesion detection vs. characterization and used less than 10 readers. Only 6 (12%) studies trained readers in advance to use the confidence scale used to build the ROC curve. Overall, description of confidence scores, the ROC curve and its analysis was often incomplete. For example, 21 (41%) studies presented no ROC curve and only 3 (6%) described the distribution of confidence scores. Of 30 studies presenting curves, only 4 (13%) presented the data points underlying the curve, thereby allowing assessment of extrapolation. The mean change in AUC was 0.05 (-0.05 to 0.28). Non-significant change in AUC was attributed to underpowering rather than the diagnostic test failing to improve diagnostic accuracy. CONCLUSIONS Data reporting in MRMC studies using ROC AUC as an outcome measure is frequently incomplete, hampering understanding of methods and the reliability of results and study conclusions. Authors using this analysis should be encouraged to provide a full description of their methods and results.
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Affiliation(s)
| | - Andrew A. Plumb
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Thomas R. Fanshawe
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom
| | - Douglas G. Altman
- Centre for Statistics in Medicine, Wolfson College, Oxford University, Oxford, United Kingdom
| | - Susan Mallett
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, United Kingdom
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Shan J, Tucker AW, Lee YZ, Heath MD, Wang X, Foos DH, Lu J, Zhou O. Stationary chest tomosynthesis using a carbon nanotube x-ray source array: a feasibility study. Phys Med Biol 2014; 60:81-100. [PMID: 25478786 DOI: 10.1088/0031-9155/60/1/81] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chest tomosynthesis is a low-dose, quasi-3D imaging modality that has been demonstrated to improve the detection sensitivity for small lung nodules, compared to 2D chest radiography. The purpose of this study is to investigate the feasibility and system requirements of stationary chest tomosynthesis (s-DCT) using a spatially distributed carbon nanotube (CNT) x-ray source array, where the projection images are collected by electronically activating individual x-ray focal spots in the source array without mechanical motion of the x-ray source, detector, or the patient. A bench-top system was constructed using an existing CNT field emission source array and a flat panel detector. The tube output, beam quality, focal spot size, system in-plane and in-depth resolution were characterized. Tomosynthesis slices of an anthropomorphic chest phantom were reconstructed for image quality assessment. All 75 CNT sources in the source array were shown to operate reliably at 80 kVp and 5 mA tube current. Source-to-source consistency in the tube current and focal spot size was observed. The incident air kerma reading per mAs was measured as 74.47 uGy mAs(-1) at 100 cm. The first half value layer of the beam was 3 mm aluminum. An average focal spot size of 2.5 × 0.5 mm was measured. The system MTF was measured to be 1.7 cycles mm(-1) along the scanning direction, and 3.4 cycles mm(-1) perpendicular to the scanning direction. As the angular coverage of 11.6°-34°, the full width at half maximum of the artifact spread function improved greatly from 9.5 to 5.2 mm. The reconstructed tomosynthesis slices clearly show airways and pulmonary vascular structures in the anthropomorphic lung phantom. The results show the CNT source array is capable of generating sufficient dose for chest tomosynthesis imaging. The results obtained so far suggest an s-DCT using a distributed CNT x-ray source array is feasible.
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Affiliation(s)
- Jing Shan
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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32
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Radiation dose and cancer risk in patients undergoing multiple radiographs in intravenous urography X-ray examinations. Radiat Phys Chem Oxf Engl 1993 2014. [DOI: 10.1016/j.radphyschem.2013.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Digital Tomosynthesis: A New Technique for Imaging Nephrolithiasis. Specific Organ Doses and Effective Doses Compared With Renal Stone Protocol Noncontrast Computed Tomography. Urology 2014; 83:282-7. [DOI: 10.1016/j.urology.2013.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/12/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022]
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The utility of digital linear tomosynthesis imaging of total hip joint arthroplasty with suspicion of loosening: a prospective study in 40 patients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:594631. [PMID: 24078921 PMCID: PMC3776365 DOI: 10.1155/2013/594631] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/24/2013] [Accepted: 07/26/2013] [Indexed: 11/24/2022]
Abstract
Aim. The clinical utility of digital linear tomosynthesis in musculoskeletal applications has been validated in only a few reports. Technical performance and utility in hip prosthesis imaging have been discussed in technical reports, but no clinical evaluation has been reported. The purpose of the current study was to assess the added clinical utility of digital linear tomosynthesis compared to radiography in loosening of total hip joint arthroplasty. Materials and Methods. In a prospective study, radiography and digital tomosynthesis were performed in 40 consecutive patients with total hip arthroplasty referred for suspect prosthesis loosening. Tomosynthesis images were compared to anterior-posterior (AP) and cross-table lateral radiographs regarding demarcation and extent of demineralization and osteolysis. Further noted were skeletal fractures, cement fractures, fragmentation, and artifacts interfering with the diagnosis. Results. Tomosynthesis was superior to radiography with sharper delineation of demineralization and osteolysis in the AP projection. A limitation was the inability to generate lateral tomosynthesis images, with inferior assessment of the area anterior and posterior to the acetabular cup compared to cross-table radiographs. Artifacts interfering with diagnosis were found in one hip. Conclusion. Tomosynthesis improved evaluation of total hip arthroplasty in the AP projection but was limited by the lack of lateral projections.
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Astroza GM, Neisius A, Wang AJ, Nguyen G, Toncheva G, Wang C, Januzis N, Lowry C, Ferrandino MN, Neville AN, Yoshizumi TT, Preminger GM, Lipkin ME. Radiation exposure in the follow-up of patients with urolithiasis comparing digital tomosynthesis, non-contrast CT, standard KUB, and IVU. J Endourol 2013; 27:1187-91. [PMID: 23734577 DOI: 10.1089/end.2013.0255] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the effective doses (EDs) associated with imaging modalities for follow-up of patients with urolithiasis, including stone protocol non-contrast computed tomography (NCCT), kidney, ureter, and bladder radiograph (KUB), intravenous urogram (IVU), and digital tomosynthesis (DT). METHODS A validated Monte-Carlo simulation-based software PCXMC 2.0 (STUK) designed for estimation of patient dose from medical X-ray exposures was used to determine the ED for KUB, IVU (KUB scout plus three tomographic images), and DT (two scouts and one tomographic sweep). Simulations were performed using a two-dimensional stationary field onto the corresponding body area of the built-in digital phantom, with actual kVp, mAs, and geometrical parameters of the protocols. The ED for NCCT was determined using an anthropomorphic male phantom that was placed prone on a 64-slice GE Healthcare volume computed tomography (VCT) scanner. High-sensitivity metal oxide semiconductor field effect transistors dosimeters were placed at 20 organ locations and used to measure organ radiation doses. RESULTS The ED for a stone protocol NCCT was 3.04±0.34 mSv. The ED for a KUB was 0.63 and 1.1 mSv for the additional tomographic film. The total ED for IVU was 3.93 mSv. The ED for DT performed with two scouts and one sweep (14.2°) was 0.83 mSv. CONCLUSIONS Among the different imaging modalities for follow-up of patients with urolithiasis, DT was associated with the least radiation exposure (0.83 mSv). This ED corresponds to a fifth of NCCT or IVU studies. Further studies are needed to demonstrate the sensitivity and specificity of DT for the follow-up of nephrolithiasis patients.
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Affiliation(s)
- Gaston M Astroza
- 1 Division of Urologic Surgery, Duke University Medical Center , Durham, North Carolina
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36
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Lipkin ME, Preminger GM. Imaging techniques for stone disease and methods for reducing radiation exposure. Urol Clin North Am 2012. [PMID: 23177634 DOI: 10.1016/j.ucl.2012.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Imaging plays a critical role in the evaluation of patients with urolithiasis. It is essential for the diagnosis of stones and provides important information to aide in determining the appropriate treatment of renal or ureteral calculi. Imaging for urolithiasis has evolved over the past 30 years. Currently, noncontrast computed tomography remains the first-line imaging modality for the evaluation of patients with suspected urolithiasis. Proper imaging modality selection helps to minimize radiation exposure. Following the principles of As Low As Reasonably Achievable in the operating room can help reduce the amount of radiation patients are exposed to from fluoroscopy.
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Affiliation(s)
- Michael E Lipkin
- Department of Urology, Duke University Medical Center, DUMC 3167, Durham, NC 27710, USA.
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What the Radiologist Needs to Know About Urolithiasis: Part 1???Pathogenesis, Types, Assessment, and Variant Anatomy. AJR Am J Roentgenol 2012; 198:W540-7. [DOI: 10.2214/ajr.10.7285] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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39
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King JM, Elbakri IA, Reed M. Antiscatter grid use in pediatric digital tomosynthesis imaging. J Appl Clin Med Phys 2011; 12:3641. [PMID: 22089021 PMCID: PMC5718745 DOI: 10.1120/jacmp.v12i4.3641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 06/07/2011] [Indexed: 11/23/2022] Open
Abstract
The objective of this study was to assess the effect of antiscatter grid use on tomosynthesis image quality. We performed an observer study that rated the image quality of digital tomosynthesis scout radiographs and slice images of a Leeds TO.20 contrast‐detail test object embedded in acrylic with and without a grid. We considered 10, 15, 20 and 25 cm of acrylic to represent the wide range of patient thicknesses encountered in pediatric imaging. We also acquired and rated images without a grid at an increased patient dose. The readers counted the total number of visible details in each image as a measure of relative image quality. We observed that the antiscatter grid improves tomosynthesis image quality compared to the grid‐out case, which received image quality scores similar to grid‐in radiography. Our results suggest that, in order to achieve the best image quality in exchange for the increase in patient dose, it may often be appropriate to include an antiscatter grid for pediatric tomosynthesis imaging, particularly if the patient thickness is greater than 10 cm. PACS number: 87.57.‐s
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Affiliation(s)
- Jenna M King
- Division of Medical Physics, CancerCare Manitoba, Winnipeg, Manitoba, Canada
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Tomosynthesis in pulmonary cystic fibrosis with comparison to radiography and computed tomography: a pictorial review. Insights Imaging 2011; 3:81-9. [PMID: 22696001 PMCID: PMC3292643 DOI: 10.1007/s13244-011-0137-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/24/2011] [Accepted: 10/19/2011] [Indexed: 11/01/2022] Open
Abstract
The purpose of this pictorial review is to illustrate chest imaging findings of cystic fibrosis (CF) using tomosynthesis (digital tomography), in comparison to radiography and computed tomography (CT). CF is a chronic systemic disease where imaging has long been used for monitoring chest status. CT exposes the patient to a substantially higher radiation dose than radiography, rendering it unsuitable for the often needed repeated examinations of these patients. Tomosynthesis has recently appeared as an interesting low dose alternative to CT, with an effective dose of approximately 0.08 mSv for children and 0.12 mSv for adults. Tomosynthesis is performed on the same X-ray system as radiography, adding only about 1 min to the normal examination time. Typical pulmonary changes in CF such as mucus plugging, bronchial wall thickening, and bronchiectases are shown in significantly better detail with tomosynthesis than with traditional radiography. In addition, the cost for a tomosynthesis examination is low compared to CT. To reduce the radiation burden of patients with CF it is important to consider low dose alternatives to CT, especially in the paediatric population. Tomosynthesis has a lower radiation dose than CT and gives a superior visualisation of pulmonary CF changes compared to radiography. It is important to further determine the role of tomosynthesis for monitoring disease progression in CF.
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Current world literature. Curr Opin Urol 2011; 21:166-72. [PMID: 21285721 DOI: 10.1097/mou.0b013e328344100a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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