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Viswanathan M, Gu W, Blanch RJ, Groves LL. Cataracts after Ophthalmic and Nonophthalmic Trauma Exposure in Service Members, U.S. Armed Forces. Mil Med 2024; 189:e1009-e1015. [PMID: 37930775 DOI: 10.1093/milmed/usad414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/11/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
ABSTRACT IntroductionWe aimed to identify injury-related risk factors for secondary cataract incidence after eye and brain injury and polytrauma. We also examined the effect of direct and indirect eye injury management on cataract diagnosis and treatment. Prevention or mitigation strategies require knowledge of the causes and types of combat injuries, which will enable more appropriate targeting of resources toward prevention and more efficient management of such injuries. MATERIALS AND METHODS Data were gathered from the Military Health System using the Military Health System Management and Analysis Reporting Tool (M2) between 2017 and 2021 from inpatient and outpatient Service Members (SMs) (active duty and National Guard). The date of the first cataract diagnosis was tracked to estimate the annual incidence rate, and it was longitudinally linked to any prior diagnosis of ocular trauma (OT), traumatic brain injury (TBI), or polytrauma to calculate the relative risk. International Classification of Disease codes, 10th Revision, were used to identify those diagnosed with cataracts, TBI, and polytrauma. Defense and Veterans Eye Injury and Vision Registry data were used to examine SMs who sustained ocular injuries from 2003-2020 and who may have had cataract surgery following a cataract diagnosis. RESULTS The relative risk of traumatic cataract formation from OT, TBI, and polytrauma are 5.71 (95% CI, 5.05-6.42), 2.32 (95% CI, 2.03-2.63), and 8.95 (95% CI, 6.23-12.38), respectively. Traumatic cataracts in SMs more commonly result from open-globe injuries (70%) than closed-globe injuries (30%). By specific sub-injury type, traumatic cataracts occur most frequently from intraocular foreign bodies (22%). More than 400 patients in the cohort suffered from TBI and traumatic cataracts, more than 300 from OT and cataracts, and more than 20 from polytrauma and cataracts. The battlefield is the riskiest environment for trauma exposure, with 62% of OT occurring in combat. There was a statistically significant difference between the mean visual acuity value before cataract surgery (M = 1.17, SD = 0.72) and the mean visual acuity value after cataract surgery (M = 0.44, SD = 0.66, P < .001). CONCLUSION Traumatic cataracts often occur in SMs who sustain ocular injuries. New to the literature is that relationships exist between traumatic cataract formation and nonglobe trauma, specifically TBI and polytrauma. Ocular injury calls for an ophthalmic examination. A low threshold should exist for routine ocular exam consultation in the setting of TBI and polytrauma. Separately, polytrauma patients should undergo a review of systems questions, particularly questions about the ocular and visual pathways. A positive response to screening warrants further investigation of possible ocular pathology, including traumatic cataract formation. Cataract surgery is an effective treatment in improving the vision of SMs who suffer from traumatic cataracts. Constant effort must be made to limit occurrences of occupation-related traumatic cataracts.
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Affiliation(s)
- Mariia Viswanathan
- Vision Center of Excellence, Defense Health Agency, Research and Engineering, Bethesda, MD 20889-5629, USA
| | - Weidong Gu
- Vision Center of Excellence, Defense Health Agency, Research and Engineering, Bethesda, MD 20889-5629, USA
| | - Richard J Blanch
- Academic Department of Military Surgery and Trauma, Royal Centre for Defense Medicine, Birmingham B15 2GW, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK
| | - Lucas L Groves
- Blanchfield Army Community Hospital, US Army, Fort Campbell, KY 42223, USA
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Constantine S, Salter A, Louise J, Anderson PJ. The Adelaide Facial Bone Rule: A simple prediction model and clinical guideline for the presence of facial fractures using CT brain scans in victims of minor trauma. Injury 2024; 55:111302. [PMID: 38220564 DOI: 10.1016/j.injury.2023.111302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/17/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Facial fractures bleed, resulting in high-density fluid in the sinuses (haemosinus) on computed tomography (CT) scans. A CT brain scan includes most maxillary sinuses in the scan field, which should allow detection of haemosinus as an indirect indicator of a facial fracture without the need for an additional CT facial bone scan, yet no robust evidence for this exists in the literature. The aim of this study was to determine whether the presence of haemosinus on a CT brain scan, alone or in combination with other clinical information, can predict the presence of facial fractures. METHODS 1231 adult patients, who had both brain and facial CT scans performed on the same day, were selected from a seven year period. Patients were eligible if scans were requested for trauma. Brain and facial scans were reviewed separately for the presence of facial fractures, haemosinus, emphysema and intra-cranial haemorrhage. Prediction modelling was used to assess whether findings from brain scans could be used to identify patients requiring further CT scanning. FINDINGS The full prediction model included four predictors and showed excellent discrimination (AUROC 0.982; 95 % CI 0.971 - 0.993). A simplified model, more suitable for clinical implementation, used only facial fractures and haemosinus as predictors. This model showed only marginally poorer discrimination (AUROC 0.964; 95 % CI 0.945 - 0.983) and excellent performance on other measures. CONCLUSION Based on the excellent performance of the simplified prediction model, we present the Adelaide Facial Bone Rule: The absence of blood in the sinuses or facial fractures on a CT brain scan means a CT facial bone scan does not need to be routinely performed in the setting of clinically-determined minor trauma.
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Affiliation(s)
- Sarah Constantine
- Department of Radiology, The Queen Elizabeth Hospital, Department of Medicine, University of Adelaide, 28 Woodville Road, Woodville South SA 5011, Australia.
| | - Amy Salter
- School of Public Health, Level 4, 50 Rundle Mall, Rundle Mall Plaza, North Terrace, The University of Adelaide, Adelaide SA 5005
| | - Jennie Louise
- Women's and Children's Hospital Research Centre, Biostatistics Unit, South Australian Health and Medical Research Institute, Level 7, Women's and Children's Hospital, 72 King William Rd, North Adelaide SA 5006
| | - Peter J Anderson
- Senior Consultant Craniofacial Surgeon, Facial Fracture Service, Royal Adelaide Hospital, Port Road, Adelaide SA 5000; Affiliate Professor, Faculty of Health Sciences, University of Adelaide, North Terrace, Adelaide SA 5000
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De Luca F, Kits A, Martin Muñoz D, Aspelin Å, Kvist O, Österman Y, Diaz Ruiz S, Skare S, Falk Delgado A. Elective one-minute full brain multi-contrast MRI versus brain CT in pediatric patients: a prospective feasibility study. BMC Med Imaging 2024; 24:23. [PMID: 38267889 PMCID: PMC10809606 DOI: 10.1186/s12880-024-01196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Brain CT can be used to evaluate pediatric patients with suspicion of cerebral pathology when anesthetic and MRI resources are scarce. This study aimed to assess if pediatric patients referred for an elective brain CT could endure a diagnostic fast brain MRI without general anesthesia using a one-minute multi-contrast EPI-based sequence (EPIMix) with comparable diagnostic performance. METHODS Pediatric patients referred for an elective brain CT between March 2019 and March 2020 were prospectively included and underwent EPIMix without general anesthesia in addition to CT. Three readers (R1-3) independently evaluated EPIMix and CT images on two separate occasions. The two main study outcomes were the tolerance to undergo an EPIMix scan without general anesthesia and its performance to classify a scan as normal or abnormal. Secondary outcomes were assessment of disease category, incidental findings, diagnostic image quality, diagnostic confidence, and image artifacts. Further, a side-by-side evaluation of EPIMix and CT was performed. The signal-to-noise ratio (SNR) was calculated for EPIMix on T1-weighted, T2-weighted, and ADC images. Descriptive statistics, Fisher's exact test, and Chi-squared test were used to compare the two imaging modalities. RESULTS EPIMix was well tolerated by all included patients (n = 15) aged 5-16 (mean 11, SD 3) years old. Thirteen cases on EPIMix and twelve cases on CT were classified as normal by all readers (R1-3), while two cases on EPIMix and three cases on CT were classified as abnormal by one reader (R1), (R1-3, p = 1.00). There was no evidence of a difference in diagnostic confidence, image quality, or the presence of motion artifacts between EPIMix and CT (R1-3, p ≥ 0.10). Side-by-side evaluation (R2 + R4 + R5) reviewed all scans as lacking significant pathological findings on EPIMix and CT images. CONCLUSIONS Full brain MRI-based EPIMix sequence was well tolerated without general anesthesia with a diagnostic performance comparable to CT in elective pediatric patients. TRIAL REGISTRATION This study was approved by the Swedish Ethical Review Authority (ethical approval number/ID Ethical approval 2017/2424-31/1). This study was a clinical trial study, with study protocol published at ClinicalTrials.gov with Trial registration number NCT03847051, date of registration 18/02/2019.
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Affiliation(s)
- Francesca De Luca
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
| | - Annika Kits
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Martin Muñoz
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Aspelin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ola Kvist
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Yords Österman
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Diaz Ruiz
- Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Lund University, Lund, Sweden
| | - Stefan Skare
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Falk Delgado
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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Abay B, Sankeshwar JC, Kamel H. Decreasing Lens Irradiation on Brain Imaging: A Multi-CT Scanner Quality Improvement Project. Cureus 2023; 15:e47357. [PMID: 38022074 PMCID: PMC10657156 DOI: 10.7759/cureus.47357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS Cataracts, a leading global cause of blindness, are associated with ionising radiation exposure. This audit aimed to enhance lens exclusion during non-contrast head computed tomography (CT) scans at Newham University Hospital (NUH) using two CT scanners. METHODS A retrospective audit of non-contrast head CT scans at NUH excluded scans for trauma and imaging of orbital structures. A one-week audit in April 2023 assessed lens exclusion, compared to the Royal College of Radiologists (RCR) standards. A total of 101 consecutive scans were analysed and 63 (62%) scans were included in the final study. Thirty-eight percent of the scans were excluded according to the exclusion criteria of head, neck and facial traumas, orbital infections and papilledema. Results were presented, followed by a three-month radiographer re-education period, emphasizing gantry tilt and patient positioning. A reaudit in August 2023 evaluated outcomes. For the reaudit, 183 consecutive scans were analysed, with 131 (72%) scans included in the final study and 52 (28%) scans excluded according to the same exclusion criteria as the first audit. RESULTS Lens exclusion in non-contrast head CT scans improved significantly from 0/63 (0%) compliance to 19/131 (14.50%) (p=0005) compliance with the standards. Variability in radiographer practices, 'near misses' and time constraints were identified as challenges. Staff turnover impacted compliance. CONCLUSION This audit has shed light on a critical aspect of patient care in the field of radiology. This research underscores the importance of rigorous and standardised protocols in radiological procedures, particularly when it comes to protecting the lens of the eye. By enhancing lens exclusion during non-contrast head CT scans, we have taken a significant step in mitigating the risk associated with ionising radiation exposure. Although substantial improvements were made, achieving the RCR audit standard remained elusive. Ongoing re-education, reaudits and a multidisciplinary approach are necessary to optimise radiographer adherence and reduce ionising radiation exposure to the lens during head CT scans. This quality improvement project proves that continued emphasis on gantry tilt and patient positioning in radiographer education and training can make a significant difference in patient safety. As we move forward, let us remember that even small improvements can make a big difference in safeguarding the health and well-being of patients.
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Affiliation(s)
- Berk Abay
- General Surgery, Barts Health NHS Trust, London, GBR
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Hackenbroch C, Strobel JRB, Lorenz KJ, Beer M, Schüle S. Dose development in sinonasal imaging over the last decade - a retrospective patient study. Head Face Med 2023; 19:28. [PMID: 37430304 PMCID: PMC10332007 DOI: 10.1186/s13005-023-00378-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/01/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Computed tomography (CT) has become the primary imaging modality for visualization of the paranasal sinuses. In this retrospective, single center patient study the radiation dose development in the past 12 years in CT imaging of the paranasal sinuses was assessed. METHODS The computed tomography dose index (CTDIVol) and dose length product (DLP) of a total of 1246 patients (average age: 41 ± 18 years, 361 females, 885 males) were evaluated, who received imaging of the paranasal sinuses either for chronic sinusitis diagnostic, preoperatively or posttraumatically. Scans were performed on three different CT scanners (Somatom Definition AS, Somatom Definition AS+, Somatom Force, all from Siemens Healthineers) and on one CBCT (Morita) ranging from 2010 to 2022. Reconstruction techniques were filtered back projection and three generations of iterative reconstruction (IRIS, SAFIRE, ADMIRE, all from Siemens Healthineers). Group comparisons were performed using either parametrical (ANOVA) or non-parametrical tests (Kruskal-Wallis Test), where applicable. RESULTS Over the past 12 years, there was a 73%, 54%, and 66% CTDIVol reduction and a significant (p < 0.001) 72%, 33%, and 67% DLP reduction in assessing the paranasal sinuses for chronic sinusitis, preoperatively and posttraumatically, respectively. CONCLUSION Technological developments in CT imaging, both hardware and software based, have led to a significant reduction in dose exposure in recent years. Particularly in imaging of the paranasal sinuses, the reduction of radiation exposure is of great interest due to the often young patient age and radiation-sensitive organs in the area of radiation exposure.
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Affiliation(s)
- Carsten Hackenbroch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany.
- Department of Radiology, University Hospital of Ulm, Ulm, Baden-Wurttemberg, Germany.
| | - Joachim Rudolf Balthasar Strobel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany
| | - Kai Johannes Lorenz
- Department of Otorhinolaryngology and Head and Neck Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Rhineland-Palatinate, Germany
| | - Meinrad Beer
- Department of Radiology, University Hospital of Ulm, Ulm, Baden-Wurttemberg, Germany
| | - Simone Schüle
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany
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Nagayama Y, Iwashita K, Maruyama N, Uetani H, Goto M, Sakabe D, Emoto T, Nakato K, Shigematsu S, Kato Y, Takada S, Kidoh M, Oda S, Nakaura T, Hatemura M, Ueda M, Mukasa A, Hirai T. Deep learning-based reconstruction can improve the image quality of low radiation dose head CT. Eur Radiol 2023; 33:3253-3265. [PMID: 36973431 DOI: 10.1007/s00330-023-09559-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/06/2022] [Accepted: 02/06/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To evaluate the image quality of deep learning-based reconstruction (DLR), model-based (MBIR), and hybrid iterative reconstruction (HIR) algorithms for lower-dose (LD) unenhanced head CT and compare it with those of standard-dose (STD) HIR images. METHODS This retrospective study included 114 patients who underwent unenhanced head CT using the STD (n = 57) or LD (n = 57) protocol on a 320-row CT. STD images were reconstructed with HIR; LD images were reconstructed with HIR (LD-HIR), MBIR (LD-MBIR), and DLR (LD-DLR). The image noise, gray and white matter (GM-WM) contrast, and contrast-to-noise ratio (CNR) at the basal ganglia and posterior fossa levels were quantified. The noise magnitude, noise texture, GM-WM contrast, image sharpness, streak artifact, and subjective acceptability were independently scored by three radiologists (1 = worst, 5 = best). The lesion conspicuity of LD-HIR, LD-MBIR, and LD-DLR was ranked through side-by-side assessments (1 = worst, 3 = best). Reconstruction times of three algorithms were measured. RESULTS The effective dose of LD was 25% lower than that of STD. Lower image noise, higher GM-WM contrast, and higher CNR were observed in LD-DLR and LD-MBIR than those in STD (all, p ≤ 0.035). Compared with STD, the noise texture, image sharpness, and subjective acceptability were inferior for LD-MBIR and superior for LD-DLR (all, p < 0.001). The lesion conspicuity of LD-DLR (2.9 ± 0.2) was higher than that of HIR (1.2 ± 0.3) and MBIR (1.8 ± 0.4) (all, p < 0.001). Reconstruction times of HIR, MBIR, and DLR were 11 ± 1, 319 ± 17, and 24 ± 1 s, respectively. CONCLUSION DLR can enhance the image quality of head CT while preserving low radiation dose level and short reconstruction time. KEY POINTS • For unenhanced head CT, DLR reduced the image noise and improved the GM-WM contrast and lesion delineation without sacrificing the natural noise texture and image sharpness relative to HIR. • The subjective and objective image quality of DLR was better than that of HIR even at 25% reduced dose without considerably increasing the image reconstruction times (24 s vs. 11 s). • Despite the strong noise reduction and improved GM-WM contrast performance, MBIR degraded the noise texture, sharpness, and subjective acceptance with prolonged reconstruction times relative to HIR, potentially hampering its feasibility.
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Affiliation(s)
- Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Koya Iwashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Natsuki Maruyama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hiroyuki Uetani
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Makoto Goto
- Department of Central Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Daisuke Sakabe
- Department of Central Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Takafumi Emoto
- Department of Central Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kengo Nakato
- Department of Central Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Shinsuke Shigematsu
- Department of Central Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Yuki Kato
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Sentaro Takada
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masahiro Hatemura
- Department of Central Radiology, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
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Tarkiainen J, Nadhum M, Heikkilä A, Rinta-Kiikka I, Joutsen A. RADIATION DOSE OF THE EYE LENS IN CT EXAMINATIONS OF THE BRAIN IN CLINICAL PRACTICE-THE EFFECT OF RADIOGRAPHER TRAINING TO OPTIMISE GANTRY TILT AND SCAN LENGTH. RADIATION PROTECTION DOSIMETRY 2023; 199:391-398. [PMID: 36691891 PMCID: PMC10077499 DOI: 10.1093/rpd/ncad002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Lenses are always exposed to radiation in brain computed tomography (CT) scans. However, the lens dose can be reduced by excluding lens from scanning area by optimising gantry tilt and scan length. The object of this study is to retrospectively analyse if the optimisation by gantry tilt and scan length have been adequate in the CT scan of the brain, and to prospectively analyse the effect of radiographer training to the quality of the CT examinations. This study was conducted in two parts. In all, 329 brain CTs performed in the Tampere University Hospital from 2017 to 2019 were revised retrospectively. The prospective part included 51 brain CT studies conducted in October 2021. Dose to the eye of the lens was modelled using CT-Expo using zero-degree beam angle and scan lengths to expose the lens either to the primary or scattered radiation. Non-zero gantry tilt had been used in a large proportion of the CT examinations in the retrospective setting, 84.8%. However, the lenses were successfully excluded from the scan area in only 1.8% of the examinations. In the prospective part, the gantry tilt was used in 98% of the studies and the proportion of successful examinations rose from 1.8 to 11.8%. The lens dose decreased significantly when the eyes were excluded from the imaging area. The modelled lens dose in the large retrospective part was 25.9 mGy (17.8-49.2 mGy) when the eyes were included and 1.5 mGy (0.4-1.9 mGy) when the eyes were excluded. The lens dose was similar in the small prospective part. Despite the gantry tilt is widely used, unnecessary lens irradiation occurs extensively because of suboptimal gantry tilt and scan length. The training of radiographers reduces the radiation exposure to the lens by more optimal gantry tilt and scan length.
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Affiliation(s)
| | - Miia Nadhum
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Annele Heikkilä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Atte Joutsen
- Department of Medical Physics, Medical Imaging Center, Pirkanmaa Hospital District, Tampere, Finland
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Feuerriegel GC, Ritschl LM, Sollmann N, Palla B, Leonhardt Y, Maier L, Gassert FT, Karampinos DC, Makowski MR, Zimmer C, Wolff KD, Probst M, Fichter AM, Burian E. Imaging of traumatic mandibular fractures in young adults using CT-like MRI: a feasibility study. Clin Oral Investig 2023; 27:1227-1233. [PMID: 36208329 PMCID: PMC9985557 DOI: 10.1007/s00784-022-04736-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess and compare the diagnostic performance of CT-like images based on a three- dimensional (3D) T1-weighted spoiled gradient-echo sequence (3D T1 GRE) with CT in patients with acute traumatic fractures of the mandible. MATERIALS AND METHODS Subjects with acute mandibular fractures diagnosed on conventional CT were prospectively recruited and received an additional 3 T MRI with a CT-like 3D T1 GRE sequence. The images were assessed by two radiologists with regard to fracture localization, degree of dislocation, and number of fragments. Bone to soft tissue contrast, diagnostic confidence, artifacts, and overall image quality were rated using a five-point Likert-scale. Agreement of measurements was assessed using an independent t-test. RESULTS Fourteen subjects and 22 fracture sites were included (26 ± 3.9 years; 4 females, 10 males). All traumatic fractures were accurately detected on CT-like MRI (n = 22, κ 1.00 (95% CI 1.00-1.00)). There was no statistically significant difference in the assessment of the fracture dislocation (axial mean difference (MD) 0.06 mm, p = 0.93, coronal MD, 0.08 mm, p = 0.89 and sagittal MD, 0.04 mm, p = 0.96). The agreement for the fracture classification as well as the inter- and intra-rater agreement was excellent (range κ 0.92-0.98 (95% CI 0.96-0.99)). CONCLUSION Assessment of mandibular fractures was feasible and accurate using CT-like MRI based on a 3D T1 GRE sequence and is comparable to conventional CT. CLINICAL RELEVANCE For the assessment of acute mandibular fractures, CT-like MRI might become a useful alternative to CT in order to reduce radiation exposure particularly in young patients.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Benjamin Palla
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, USA
| | - Yannik Leonhardt
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lisa Maier
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Florian T Gassert
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Monika Probst
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Egon Burian
- Department of Diagnostic and Interventional Radiology, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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9
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Karhanová M, Čivrný J, Kalitová J, Schovánek J, Pašková B, Schreiberová Z, Hübnerová P. Computed tomography and magnetic resonance imaging of the orbit in the diagnosis and treatment of thyroid-associated orbitopathy - experience from practice. A Review. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2023; 79:283-292. [PMID: 38086700 DOI: 10.31348/2023/10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO). Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included. Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.
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10
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Schüle S, Strobel JRB, Lorenz KJ, Beer M, Hackenbroch C. Tin filter compared to low kV protocols - optimizing sinonasal imaging in computed tomography. PLoS One 2023; 18:e0279907. [PMID: 36607911 PMCID: PMC9821404 DOI: 10.1371/journal.pone.0279907] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Paranasal sinus imaging due to chronic inflammatory disease is one of the most common examinations in head and neck radiology with CT imaging considered the current gold standard. In this phantom study we analyzed different low dose CT protocols in terms of image quality, radiation exposure and subjective evaluation in order to establish an optimized scanning protocol. METHODS In a phantom study, an Alderson phantom was scanned using 12 protocols between 70-120 kV and 25-200 mAs with and without tin filtration. For all datasets, iterative reconstruction was used. Data were objectively evaluated (image noise, (dose-weighted) contrast-to-noise ratio) and for subjective evaluation an online survey using a Likert scale was performed to reach a large group of clinically experienced reader (n = 62). The protocol was considered diagnostically insufficient if the median score was 4 and above and if more than 10% of raters scored 4 and above on the Likert scale. For an interreader agreement an ICC was calculated. To compare clinical value in relation to the applied dose and the objective image parameters, we calculated a figure of merit (FOM) and ranked the protocols accordingly. RESULTS There was an overall moderate agreement between the 62 readers for the 12 examined CT protocols. In this phantom study, protocols with 100 kV with spectral shaping and 50-100 mAs obtained the best results for its combination of dose, image quality and clinical information value for diagnosing sinusitis (FOM 1st- 2nd place) with the 70 kV and 50 mAs as a good alternative as well (Sinusitis: FOM shared 2nd). For preoperative planning, where a higher dose is necessary, 100 kV with spectral shaping and 100 mAs achieved the overall best results (FOM 1st place) with 70 kV and 50 mAs ranking 4th. CONCLUSION 100-kV protocols with spectral shaping or low kV protocols (70 kV) with a similarly low dose showed the best figure of merit for imaging sinonasal disease and preoperative planning. With modern scanner technology available, spectral shaping or low KV protocols should be used for sinusitis imaging.
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Affiliation(s)
- Simone Schüle
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany
| | - Joachim Rudolf Balthasar Strobel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany
| | - Kai Johannes Lorenz
- Department of Otorhinolaryngology and Head and Neck Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Rhineland-Palatinate, Germany
| | - Meinrad Beer
- Department of Radiology, University Hospital of Ulm, Ulm, Baden-Wurttemberg, Germany
| | - Carsten Hackenbroch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany
- Department of Radiology, University Hospital of Ulm, Ulm, Baden-Wurttemberg, Germany
- * E-mail:
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11
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Study of the Natural Crystalline Lens Characteristics Using Dual-Energy Computed Tomography. Diagnostics (Basel) 2022; 12:diagnostics12112857. [PMID: 36428915 PMCID: PMC9689271 DOI: 10.3390/diagnostics12112857] [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: 09/22/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
There is a paucity of radiologic literature regarding age-related cataract, and little is known about any differences in the imaging appearance of the natural crystalline lens on computed tomography (CT) exams among different demographic groups. In this retrospective review of 198 eyes in 103 adults who underwent dual-energy computed tomography (DECT) exams of the head, regions of interest spanning 3−5 mm were placed over the center of the lens, and the x-ray attenuation of each lens was recorded in Hounsfield Units (HU) at 3 energy levels: 40 keV, 70 keV, and 190 keV. Generalized estimating equations (GEEs) were used to assess the association of clinical or demographic data with lens attenuation. The mean HU values were significantly lower for the older vs. younger group at 40 keV (GEE p-value = 0.022), but there was no significant difference at higher energy levels (p > 0.05). Mean HU values were significantly higher for females vs. males and non-whites vs. non-Hispanic whites at all 3 energy levels in bivariate and multivariable analyses (all p-value < 0.05). There was no significant association between lens attenuation and either diabetes or smoking status. The crystalline lens of females and non-whites had higher attenuation on DECT which may suggest higher density or increased concentration of materials like calcium and increased potential for cataract formation. Given the large scope of cataracts as a cause of visual impairment and the racial disparities that exist in its detection and treatment, further investigation into the role of opportunistic imaging to detect cataract formation is warranted.
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12
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Čivrný J, Karhanová M, Hübnerová P, Schovánek J, Heřman M. MRI in the assessment of thyroid-associated orbitopathy activity. Clin Radiol 2022; 77:925-934. [PMID: 36116966 DOI: 10.1016/j.crad.2022.08.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
Management of patients with thyroid-associated orbitopathy (also called Graves' disease) is dependent on the assessment of the disease activity. Evaluation of disease activity is based on ophthalmological examination. Magnetic resonance imaging (MRI) is an auxiliary method that may help quantify the activity and is also helpful in obtaining anatomical information concerning muscle thickness, exophthalmos, or optic neuropathy. We present a review of MRI techniques of the orbits with emphasis on the evaluation of disease activity. The most convincing seems to be the group of T2-weighted techniques such as conventional T2 weighting, T2 relaxometry, and T2 mapping. Dynamic contrast-enhanced MRI is another promising method.
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Affiliation(s)
- J Čivrný
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic.
| | - M Karhanová
- Department of Ophthalmology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - P Hübnerová
- Department of Ophthalmology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - J Schovánek
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - M Heřman
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic
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13
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Lierová A, Milanová M, Pospíchal J, Novotný J, Storm J, Andrejsová L, Šinkorová Z. BIOLOGICAL EFFECTS OF LOW-DOSE RADIATION FROM CT IMAGING. RADIATION PROTECTION DOSIMETRY 2022; 198:514-520. [PMID: 36005951 DOI: 10.1093/rpd/ncac091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/21/2022] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
The dramatic rise in diagnostic procedures, radioisotope-based scans and intervention procedures has created a very valid concern regarding the long-term biological consequences from exposure to low doses of ionizing radiation. Despite its unambiguous medical benefits, additional knowledge on the health outcome of its use is essential. This review summarizes the available information regarding the biological consequences of low-dose radiation (LDR) exposure in humans (e.g. cytogenetic changes, cancer risk and radiation-induced cataracts. However, LDR studies remain relatively new and thus an encompassing view of its biological effects and relevant mechanisms in the human body is still needed.
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Affiliation(s)
- Anna Lierová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
- Department of Clinical Subspecialties, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Marcela Milanová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Jan Pospíchal
- Department of Clinical Subspecialties, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Jan Novotný
- Department of Clinical Subspecialties, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Jaroslav Storm
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
- Department of Clinical Subspecialties, Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic
| | - Lenka Andrejsová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Zuzana Šinkorová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
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14
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Cheng KL, Huang JY, Weng JH, Chiou JY, Lan CT, Tung KC. 18F-FDG PET/CT Did Not Increase the Risk of Cataract Occurrence in Oncology Patients: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137651. [PMID: 35805310 PMCID: PMC9265417 DOI: 10.3390/ijerph19137651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/11/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
This study aimed to evaluate the risk of cataract formation associated with radiation exposure from 18F-FDG PET/CT in oncology patients, using data from Taiwan’s National Health Insurance Research Database. The exposed group (Group E) consisted of oncology patients receiving 18F-FDG PET/CT within the first year of a cancer diagnosis. The comparison group (Group C) included subjects who had never been exposed to 18F-FDG PET/CT radiation and were propensity score-matched by date of enrolment, age, sex, cancer type, associated comorbidities, and CT utilization. Multiple Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of cataract risk due to radiation exposure, while adjusting for potential confounding factors. A total of 703 patients and 1406 matched subjects were in Groups E and C, respectively. The incidence of cataract formation was not significantly higher among subjects in Group E (adjusted HR = 1.264; 95% confidence interval [CI] = 0.845–1.891). Our results revealed that 18F-FDG PET/CT was not a significant risk factor for developing cataracts in oncology patients.
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Affiliation(s)
- Kai-Lun Cheng
- Department of Veterinary Medicine, National Chung Hsing University, 250 Kuo Kuang Road, Taichung 40227, Taiwan;
- Department of Medical Imaging, Chung Shan Medical University Hospital, 110 Jianguo North Road, Taichung 40201, Taiwan
- School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan
| | - Jing-Yang Huang
- Center for Health Data Science, Chung Shan Medical University Hospital, 110 Jianguo North Road, Taichung 40201, Taiwan;
- Institute of Medicine, College of Medicine, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan
| | - Jui-Hung Weng
- Department of Nuclear Medicine, Chung Shan Medical University Hospital, 110 Jianguo North Road, Taichung 40201, Taiwan;
- School of Medicine, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan;
| | - Chyn-Tair Lan
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, 110 Jianguo North Road, Taichung 40201, Taiwan;
| | - Kwong-Chung Tung
- Department of Veterinary Medicine, National Chung Hsing University, 250 Kuo Kuang Road, Taichung 40227, Taiwan;
- Correspondence:
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15
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Eley KA, Delso G. Imaging of Bone in the Head and Neck Region, is There More Than CT? CURRENT RADIOLOGY REPORTS 2022; 10:69-82. [PMID: 35463479 PMCID: PMC9013214 DOI: 10.1007/s40134-022-00396-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 01/22/2023]
Abstract
Purpose of Review The objective of this review is to document the advances in non-ionising imaging alternatives to CT for the head and neck. Recent Findings The main alternative to CT for imaging bone of the head and neck region is MRI, particularly techniques which incorporate gradient echo imaging (Black Bone technique) and ultra-short or zero-echo time imaging. Since these techniques can provide high resolution isometric voxels, they can be used to provide multi-planar reformats and, following post processing, 3D reconstructed images of the craniofacial skeleton. As expected, the greatest advancements in recent years have been focused on enhanced image processing techniques and attempts to address the difficulties encountered at air-bone interfaces. Summary This article will review the imaging techniques and recent advancements which are bringing non-ionising alternatives to CT imaging of the bone of the head and neck region into the realm of routine clinical application.
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Affiliation(s)
- Karen A. Eley
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ UK
| | - Gaspar Delso
- MR Applications & Workflow, GE Healthcare, Barcelona, Spain
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16
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Main Applications and Recent Research Progresses of Additive Manufacturing in Dentistry. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5530188. [PMID: 35252451 PMCID: PMC8894006 DOI: 10.1155/2022/5530188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 12/16/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022]
Abstract
In recent ten years, with the fast development of digital and engineering manufacturing technology, additive manufacturing has already been more and more widely used in the field of dentistry, from the first personalized surgical guides to the latest personalized restoration crowns and root implants. In particular, the bioprinting of teeth and tissue is of great potential to realize organ regeneration and finally improve the life quality. In this review paper, we firstly presented the workflow of additive manufacturing technology. Then, we summarized the main applications and recent research progresses of additive manufacturing in dentistry. Lastly, we sketched out some challenges and future directions of additive manufacturing technology in dentistry.
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17
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Lee S, Jang SL, Kim S, Lee J, Hyeong S, Choi J. Feasibility of low-dose CT protocols for evaluating the sinonasal cavity and reducing radiation exposure in dogs. Vet Radiol Ultrasound 2022; 63:414-421. [PMID: 35188314 DOI: 10.1111/vru.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Abstract
With the increasing use of radiation therapy for treatment of canine sinonasal neoplasia, there is a need for developing low-dose CT protocols to help minimize radiation exposure. The purpose of this study was to assess the trade-off between image quality and reduced radiation exposure of a low-dose CT technique in the canine sinonasal cavity. In this prospective, experimental study, CT images of the sinonasal cavities from 10 normal Beagles were acquired using high-dose (130 kVp) or low-dose (110 kVp, 80 kVp) protocol. Radiation dose and image quality were compared. Radiation exposure measured by the volume-weighted CT dose index and dose-length product was reduced by 36% at 110 kVp and 74% at 80 kVp respectively, compared to the corresponding values at 130 kVp (P = 0.000). Low-dose protocol resulted in higher image noise and reduced signal-to-noise ratio and contrast-to-noise ratio than 130 kVp in most evaluated regions of interest (P < 0.05). CT numbers of the contrast-enhanced structures were highest at 80 kVp (P = 0.000). Conspicuity of most sinonasal structures was similar for high dose and both lower dose protocols. The results of this study indicate that 80 or 110 kVp can be used for sinonasal CT examinations to reduce radiation exposure to the patient without compromising image quality.
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Affiliation(s)
- Suhyun Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Seo-Lyn Jang
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Soyeon Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Juryeong Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Seongjae Hyeong
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
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18
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Yuan MK, Chang SC, Yuan MC, Foo NP, Chan SH, Wang SY, Lin CL, Hsu CY, Kao CH. Pediatric Nuclear Medicine Examinations and Subsequent Risk of Neoplasm: A Nationwide Population-Based Cohort Study. Front Med (Lausanne) 2022; 8:764849. [PMID: 34988089 PMCID: PMC8720959 DOI: 10.3389/fmed.2021.764849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/01/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: To evaluate the association between radiation exposure from repeated nuclear medicine (NM) examinations and the subsequent risk of neoplasm in pediatric patients. Methods: From 2000 to 2017, participants under 18 years of age who underwent NM scanning were identified using the Health and Welfare Data Science Center (HWDC) dataset, which was extracted from the Taiwan National Health Insurance Research Database (NHIRD). Both the exposed cohort and unexposed subjects were followed up with until the presence of any malignancy arose, including malignant brain, lymphoid and hematopoietic tumors and benign brain or other central nervous tumors. Results: There were 35,292 patients in the exposed cohort and 141,152 matched subjects in the non-exposed group. The exposed cohort had an overall higher IR (IR: incidence rate, per 100,000 person-years) of any malignancy and benign central nervous tumor than the non-exposed group [IR, 16.9 vs. 1.54; adjusted hazard ratio (HR), 10.9; 95% CI, 6.53–18.2]. Further stratifying the number of NM examinations into 1-2, 3-4, and 5 or more times revealed that the IR of pediatric neoplasms increased gradually with the increased frequency of NM examinations (IR, 11.5; adjusted HR, 7.5; 95% CI, 4.29–13.1; IR, 25.8; adjusted HR, 15.9; 95% CI, 7.00–36.1; IR, 93.8; adjusted HR, 56.4; 95% CI, 28.8–110.3). Conclusion: NM examination is significantly associated with a higher risk of pediatric neoplasms, according to our population-based data. Thorough radiation protection and dose reduction in pediatric NM procedures should be an issue of concern.
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Affiliation(s)
- Mei-Kang Yuan
- Department of Radiology, An Nan Hospital, China Medical University, Tainan, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Shih-Chieh Chang
- Division of Chest Medicine, Department of Internal Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.,Department of Critical Care Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.,Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mei-Chun Yuan
- Department of Information Management, Meiho University, Pingtung, Taiwan
| | - Ning-Ping Foo
- Department of Emergency Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Shan-Ho Chan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Shyh-Yau Wang
- Department of Radiology, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Cheng-Li Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Shohji T, Kuriyama K, Yanano N, Maeda E, Katoh Y. SIMPLE METHOD OF MEASURING SSDE FOR HEAD CT: FACILITATING PRE-CT SCAN DOSE CALCULATION USING SPECIALIZED HEAD SCAN BAND. RADIATION PROTECTION DOSIMETRY 2021; 197:1-11. [PMID: 34718785 DOI: 10.1093/rpd/ncab149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/06/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
In this study, scaled scan band was developed to provide size-specific dose estimation (SSDE) values based on head circumference of patients undergoing computed tomography (CT) scans. The scan band was tested in 40 consecutive head CT examinations. The accuracy of the specialized scan band method was determined by comparing SSDEband with SSDE293,forehead, SSDEmean and SSDEcenter. SSDE293,forehead was used as the control value. The results of the linear fit of SSDEband, SSDEmean and SSDEcenter against SSDE293, forehead, were R2 = 0.958, R2 = 0.984 and R2 = 0.936, respectively. There was no significant difference between SSDEband, SSDEmean and SSDEcenter for SSDE293,forehead. Use of the proposed scan band method makes it possible to accurately determine the required radiation dose before a CT examination is performed.
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Affiliation(s)
- Tomokazu Shohji
- Department of Radiology, The Jikei University Hospital, 3-19-18 Nishi-Shimbashi, Minato-ku, Tokyo 105-8471, Japan
| | - Kazuki Kuriyama
- Department of Radiology, Jikei University Kashiwa, Hospital, 163-1 Kashiwashita, Kashiwa-shi, Chiba 277-8567, Japan
| | - Nobutaka Yanano
- Department of Radiology, Jikei University Kashiwa, Hospital, 163-1 Kashiwashita, Kashiwa-shi, Chiba 277-8567, Japan
| | - Eriko Maeda
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yo Katoh
- Department of Radiological Sciences, Tokyo Metropolitan University, 7-2-10 Higashi-Ogu, Arakawa-ku, Tokyo 116-8551, Japan
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20
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Anam C, Kusuma Dewi W, Masdi M, Haryanto F, Fujibuchi T, Dougherty G. Investigation of Eye Lens Dose Estimate based on AAPM Report 293 in Head Computed Tomography. J Biomed Phys Eng 2021; 11:563-572. [PMID: 34722401 PMCID: PMC8546161 DOI: 10.31661/jbpe.v0i0.2104-1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
Background: Estimation of eye lens dose is important in head computed tomography (CT) examination since the eye lens is a sensitive organ to ionizing radiation. Objective: The purpose of this study is to compare estimations of eye lens dose in head CT examinations using local size-specific dose estimate (SSDE) based on size-conversion
factors of the American Association of Physicists in Medicine (AAPM) Report No. 293 with those based on size-conversion factors of the AAPM Report No. 220. Material and Methods: This experimental study is conducted on a group of patients who had undergone nasopharyngeal CT examination. Due to the longitudinal (z-axis) dose fluctuation,
the average global SSDE and average local SSDE (i.e. particular slices where the eyes are located) were investigated. All estimates were compared to the measurement
results using thermo-luminescent dosimeters (TLDs). The estimated and measured doses were implemented for 14 patients undergoing nasopharyngeal CT examination. Results: It was found that the percentage differences of the volume CT dose index (CTDIvol), average global SSDE based on AAPM No. 220 (SSDEo,g), average local SSDE based
on AAPM No. 220 (SSDEo,l), average global SSDE based on AAPM No. 293 (SSDEn,g) and average local SSDE based on AAPM No. 293 (SSDEn,l) against the measured TLD doses
were 22.5, 21.7, 15.0, 9.3, and 2.1%, respectively. All comparisons between dose estimates and TLD measurements gave p-values less than 0.001, except for SSDEn,l (p-value = 0.566). Conclusion: SSDE based on AAPM Report No. 293 can be used to accurately estimate eye lens radiation doses by performing the calculations on a number of specific slices containing the eyes.
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Affiliation(s)
- Choirul Anam
- PhD, Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof. Soedarto SH, Semarang 50275, Central Java, Indonesia
| | - Winda Kusuma Dewi
- MSc, Department of Physics, Faculty of Sciences and Mathematics, Diponegoro University, Jl. Prof. Soedarto SH, Semarang 50275, Central Java, Indonesia
| | - Masdi Masdi
- BSc, Department of Radiology, Prof. Margono Hospital, Purwokerto, Indonesia
| | - Freddy Haryanto
- PhD, Department of Physics, Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung Jl. Ganesha 10 Bandung 40132, Indonesia
| | - Toshioh Fujibuchi
- PhD, Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Geoff Dougherty
- PhD, Department of Applied Physics and Medical Imaging, California State University Channel Islands, Camarillo, CA 93012, USA
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21
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Rivera-López R, García-López C, Sánchez-Moreno JM, Rivera-López RA, Almansa-López J, Rivera-Fernández R, Molina-Navarro E, Jiménez-Fernández M, Ortiz-Pérez S, Ramírez-Hernández JA. High Incidence of Cataracts in the Follow-Up of Patients Undergoing Percutaneous Coronary Intervention for Chronic Coronary Total Occlusion. J Clin Med 2021; 10:jcm10215002. [PMID: 34768525 PMCID: PMC8584919 DOI: 10.3390/jcm10215002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Development of cataracts is a well-known adverse effect of ionizing radiation, but little information is available on their incidence in patients after other medical procedures, such as cardiac catheterizations. The study objective was to determine the incidence of cataracts in a cohort of patients undergoing percutaneous coronary intervention (PCI) for chronic coronary total occlusion (CTO) and its association with radiation dose. The study analyzed the incidence of cataracts during the follow-up of 126 patients who underwent chronic total coronary PCI, using Cox regression to identify predictive factors of cataract development. The study included 126 patients, 86.9% male, with a mean age of 60.5 years (range, 55.0-68.0 years). Twenty-three (18.2% n = 23) developed cataracts during a mean follow-up of 49.5 months (range 37.3-64.5 months). A higher incidence was observed in patients who received more than 5 Gy (29.0% vs. 14.7%, Hazard ratio (HR = 2.84 [1.19-6.77]). Multivariate analysis revealed a relationship between cataract development during the follow-up and a receipt of radiation dose >5 Gy (HR = 2.60, 95% confidence interval [CI 1.03-6.61]; p = 0.03), presence or history of predisposing eye disease (HR = 4.42, CI:1.57-12.40), diabetes (HR = 3.33 [1.22-9.24]), and older age, as in >57 (HR, 6.40 [1.81-22.61]). An elevated incidence of cataracts was observed in patients after PCI for CTO. The onset of cataracts is related to the radiation dose during catheterization, which is a potentially avoidable effect of which operators should be aware.
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Affiliation(s)
- Ricardo Rivera-López
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
| | - Celia García-López
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- Correspondence: ; Tel.: +34-958020009
| | - José M. Sánchez-Moreno
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | | | - Julio Almansa-López
- Radiophysics Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | | | - Eduardo Molina-Navarro
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Miriam Jiménez-Fernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
| | - Santiago Ortiz-Pérez
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Department of Ophtalmology, University Hospital Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
- University of Granada (UGR), 18016 Granada, Spain;
| | - José A. Ramírez-Hernández
- Cardiology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (R.R.-L.); (J.M.S.-M.); (E.M.-N.); (M.J.-F.); (J.A.R.-H.)
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain;
- Medicine Department, University of Granada (UGR), 18016 Granada, Spain
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22
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ALADA Dose Optimization in the Computed Tomography of the Temporal Bone: The Diagnostic Potential of Different Low-Dose CT Protocols. Diagnostics (Basel) 2021; 11:diagnostics11101894. [PMID: 34679601 PMCID: PMC8534882 DOI: 10.3390/diagnostics11101894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Repeated computed tomography (CT) is essential for diagnosis, surgical planning and follow-up in patients with middle and inner ear pathology. Dose reduction to “as low as diagnostically acceptable” (ALADA) is preferable but challenging. We aimed to compare the diagnostic quality of images of subtle temporal bone structures produced with low doses (LD) and reference protocols (RP). Methods: Two formalin-fixed human cadaver heads were scanned using a 64-slice CT scanner and cone-beam CT (CBCT). The protocols were: RP (120 kV, 250 mA, CTDIvol 83.72 mGy), LD1 (100 kV, 80 mA, CTDIvol 26.79 mGy), LD2 (100 kV, 35 mA, CTDIvol 7.66 mGy), LD3 (80 kV, 40 mA, CTDIvol 4.82 mGy), and CBCT standard protocol. Temporal bone structures were assessed using a 5-point scale. Results: A median score of ≥2 was achieved with protocols such as the tendons of m. tensor tympani (RP/LD1/LD2/CBCT) and m. stapedius (CBCT), the incudostapedial joint (RP/LD1/CBCT), the incudomalleolar joint (RP/LD1/LD2/CBCT), the stapes feet (RP/LD1/CBCT), the stapes head (RP/LD1/LD2/CBCT), the tympanic membrane (RP/LD1/LD2/CBCT), the lamina spiralis ossea (none), the chorda tympani (RP/LD1/CBCT), and the modiolus (RP/LD1/LD2/CBCT). Adaptive statistical iterative reconstructions did not show advantages over the filtered back projection. Conclusions: LD protocols using a CTDIvol of 7.66 mGy may be sufficient for the identification of temporal bone structures.
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Alwasiah R, Jawhari A, Orri RA, Khafaji M, Al Bahiti S. MEASUREMENT OF RADIATION DOSE TO THE EYE LENS IN NON-ENHANCED CT SCANS OF THE BRAIN. RADIATION PROTECTION DOSIMETRY 2021; 195:56-60. [PMID: 34337658 DOI: 10.1093/rpd/ncab118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Radiation can have undesirable effects on the eye, including a gradual loss of vision. Unnecessary radiation can reach the eye lens during non-enhanced computed tomography (CT) scans of the brain. The International Commission on Radiological Protection states the threshold for acute and chronic eye lens exposure is 500 mGy and the equivalent dose limit for the eye lens for public exposure is 15 mSv per year. Therefore, we measured the direct radiation dose to the eye lens during head CT scans using NanoDots in 216 adults. The mean absorbed dose to both eyes was 33.62 mGy (standard deviation ±12.442). The averages for the other variables were: tube current-time product: 260 mAs; dose-length product: 708 mGy cm and CT dose index: 35.5 mGy. Our findings encourage further study of radiation exposure and modifications in CT imaging protocols.
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Affiliation(s)
- Reem Alwasiah
- Department of Radiology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | | | - Rafal Al Orri
- Faculty of Medicine, King Abdulaziz University Jeddah, Saudi Arabia
| | - Mawya Khafaji
- Department of Radiology, King Abdulaziz University Hospital Jeddah, Saudi Arabia
| | - Sarah Al Bahiti
- Department of Radiology, King Abdulaziz University Hospital Jeddah, Saudi Arabia
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24
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Significance of Brain Imaging for Staging in Patients With Clinical Stage T1-2 N0 Non-Small-Cell Lung Cancer on Positron Emission Tomography/Computed Tomography. Clin Lung Cancer 2021; 22:562-569. [PMID: 34253472 DOI: 10.1016/j.cllc.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Routine positron emission tomography/computed tomography (PET/CT) has been recommended even for clinical stage I non-small-cell lung cancer (NSCLC). In spite of the progress in the screening procedure, and revisions to TNM classification, there is no evidence to support brain imaging screening of patients assessed with the current staging protocol including PET/CT. MATERIALS AND METHODS We retrospectively investigated the frequency of extrathoracic metastasis in 466 consecutive patients with clinical stage T1-2 N0 NSCLC with the complete staging assessment comprised of thin-section CT, PET/CT, and brain contrast-enhanced magnetic resonance imaging between 2008 and 2016. All patients were reclassified according to the eighth edition of the tumor, node, and metastasis (TNM) classification. RESULTS Among all patients, 70% of the tumors were pure solid and 30% had part-solid ground-glass opacity on thin-section CT, and 388 (83%) and 78 (17%) were classified into clinical stages T1 and T2, respectively. Eight patients (1.7%) had extrathoracic metastasis, including 3 (0.6%) with brain metastasis, and all showed pure-solid tumors. The frequency of extrathoracic and brain metastasis was 1.0% and 0.5% in 388 T1 patients, and 5.0% and 3.0% in 78 T2 patients. Although brain metastases were detected in 2 of 7 patients (29%) with PET/CT detectable extrathoracic metastases and 1 of 459 patients (0.2%) without PET/CT detectable extrathoracic metastasis, there were no neurologically asymptomatic brain metastases in patients with early-stage NSCLC confirmed by PET/CT. CONCLUSION Routine screening of brain imaging is unnecessary in patients with early-stage NSCLC, assessed with the current staging protocol including PET/CT.
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Riederer I, Fingerle AA, Zimmer C, Noël PB, Makowski MR, Pfeiffer D. Potential of dual-layer spectral CT for the differentiation between hemorrhage and iodinated contrast medium in the brain after endovascular treatment of ischemic stroke patients. Clin Imaging 2021; 79:158-164. [PMID: 33962188 DOI: 10.1016/j.clinimag.2021.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/01/2021] [Accepted: 04/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND One possible complication after mechanical thrombectomy is hemorrhage. In conventional CT it is often difficult to differ between extravasation of iodinated contrast medium and blood. This differentiation, however, is essential for treatments with anticoagulants and antiplatelets. PURPOSE To evaluate dual-layer spectral Computed Tomography (DLSCT) for the differentiation between intracranial hemorrhage and iodinated contrast medium in ischemic stroke patients after mechanical thrombectomy. MATERIALS AND METHODS First, in vitro experiments were performed. Then, head CT images of 47 patients after mechanical thrombectomy were analyzed. Virtual non-contrast (VNC) images and iodine density maps (IDM) were calculated and evaluated. Region of interests (ROIs) analyses were performed. Sensitivity and specificity as well as ROC curves were calculated. RESULTS IDM and VNC images enabled clear differentiation between blood and iodine and reliable quantification of different iodine concentrations in vitro. A total of 23 hyperdense areas were detected in 13 patients, classified as hemorrhage (n = 7), iodinated contrast medium (n = 4) and a mixture of both (n = 12). Sensitivity and specificity for the detection of blood was 100%. CONCLUSION DLSCT enables differentiation between intracranial hemorrhage and iodinated contrast medium in patients after mechanical thrombectomy and might improve diagnostic imaging in post-interventional stroke patients.
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Affiliation(s)
- Isabelle Riederer
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, One Silverstein, Philadelphia, PA 19104, USA
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
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26
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Attenuation correction using deep learning for brain perfusion SPECT images. Ann Nucl Med 2021; 35:589-599. [PMID: 33751364 DOI: 10.1007/s12149-021-01600-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/15/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Non-uniform attenuation correction using computed tomography (CT) improves the image quality and quantification of single-photon emission computed tomography (SPECT). However, it is not widely used because it requires a SPECT/CT scanner. This study constructs a convolutional neural network (CNN) to generate attenuation-corrected SPECT images directly from non-attenuation-corrected SPECT images. METHODS We constructed an auto-encoder (AE) using a CNN to correct the attenuation in brain perfusion SPECT images. SPECT image datasets of 270 (44,528 slices including augmentation), 60 (5002 slices), and 30 (2558 slices) cases were used for training, validation, and testing, respectively. The acquired projection data were reconstructed in three patterns: uniform attenuation correction using Chang's method (Chang-AC), non-uniform attenuation correction using CT (CT-AC), and no attenuation correction (No-AC). The AE learned an end-to-end mapping between the No-AC and CT-AC images. The No-AC images in the test dataset were loaded into the trained AE, which generated images simulating the CT-AC images as output. The generated SPECT images were employed as attenuation-corrected images using the AE (AE-AC). The accuracy of the AE-AC images was evaluated in terms of the peak signal-to-noise ratio (PSNR) and the structural similarity metric (SSIM). The intensities of the AE-AC and CT-AC images were compared by voxel-by-voxel and region-by-region analysis. RESULTS The PSNRs of the AE-AC and Chang-AC images, compared using CT-AC images, were 62.2, and 57.9, and their SSIM values were 0.9995 and 0.9985, respectively. The AE-AC and CT-AC images were visually and statistically in good agreement. CONCLUSIONS The proposed AE-AC method yields highly accurate attenuation-corrected brain perfusion SPECT images.
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Little MP, Azizova TV, Hamada N. Low- and moderate-dose non-cancer effects of ionizing radiation in directly exposed individuals, especially circulatory and ocular diseases: a review of the epidemiology. Int J Radiat Biol 2021; 97:782-803. [PMID: 33471563 PMCID: PMC10656152 DOI: 10.1080/09553002.2021.1876955] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/24/2020] [Accepted: 01/09/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE There are well-known correlations between high and moderate doses (>0.5 Gy) of ionizing radiation exposure and circulatory system damage, also between radiation and posterior subcapsular cataract. At lower dose correlations with circulatory disease are emerging in the Japanese atomic bomb survivors and in some occupationally exposed groups, and are still to some extent controversial. Heterogeneity in excess relative risks per unit dose in epidemiological studies at low (<0.1 Gy) and at low-moderate (>0.1 Gy, <0.5 Gy) doses may result from confounding and other types of bias, and effect modification by established risk factors. There is also accumulating evidence of excess cataract risks at lower dose and low dose rate in various cohorts. Other ocular endpoints, specifically glaucoma and macular degeneration have been little studied. In this paper, we review recent epidemiological findings, and also discuss some of the underlying radiobiology of these conditions. We briefly review some other types of mainly neurological nonmalignant disease in relation to radiation exposure. CONCLUSIONS We document statistically significant excess risk of the major types of circulatory disease, specifically ischemic heart disease and stroke, in moderate- or low-dose exposed groups, with some not altogether consistent evidence suggesting dose-response non-linearity, particularly for stroke. However, the patterns of risk reported are not straightforward. We also document evidence of excess risks at lower doses/dose-rates of posterior subcapsular and cortical cataract in the Chernobyl liquidators, US Radiologic Technologists and Russian Mayak nuclear workers, with fundamentally linear dose-response. Nuclear cataracts are less radiogenic. For other ocular endpoints, specifically glaucoma and macular degeneration there is very little evidence of effects at low doses; radiation-associated glaucoma has been documented only for doses >5 Gy, and so has the characteristics of a tissue reaction. There is some evidence of neurological detriment following low-moderate dose (∼0.1-0.2 Gy) radiation exposure in utero or in early childhood.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Tamara V Azizova
- Clinical Department, Southern Urals Biophysics Institute, Ozyorsk, Ozyorsk Chelyabinsk Region, Russia
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Komae, Tokyo, Japan
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Ainsbury EA, Dalke C, Hamada N, Benadjaoud MA, Chumak V, Ginjaume M, Kok JL, Mancuso M, Sabatier L, Struelens L, Thariat J, Jourdain JR. Radiation-induced lens opacities: Epidemiological, clinical and experimental evidence, methodological issues, research gaps and strategy. ENVIRONMENT INTERNATIONAL 2021; 146:106213. [PMID: 33276315 DOI: 10.1016/j.envint.2020.106213] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/11/2020] [Accepted: 08/25/2020] [Indexed: 06/12/2023]
Abstract
In 2011, the International Commission on Radiological Protection (ICRP) recommended reducing the occupational equivalent dose limit for the lens of the eye from 150 mSv/year to 20 mSv/year, averaged over five years, with no single year exceeding 50 mSv. With this recommendation, several important assumptions were made, such as lack of dose rate effect, classification of cataracts as a tissue reaction with a dose threshold at 0.5 Gy, and progression of minor opacities into vision-impairing cataracts. However, although new dose thresholds and occupational dose limits have been set for radiation-induced cataract, ICRP clearly states that the recommendations are chiefly based on epidemiological evidence because there are a very small number of studies that provide explicit biological and mechanistic evidence at doses under 2 Gy. Since the release of the 2011 ICRP statement, the Multidisciplinary European Low Dose Initiative (MELODI) supported in April 2019 a scientific workshop that aimed to review epidemiological, clinical and biological evidence for radiation-induced cataracts. The purpose of this article is to present and discuss recent related epidemiological and clinical studies, ophthalmic examination techniques, biological and mechanistic knowledge, and to identify research gaps, towards the implementation of a research strategy for future studies on radiation-induced lens opacities. The authors recommend particularly to study the effect of ionizing radiation on the lens in the context of the wider, systemic effects, including in the retina, brain and other organs, and as such cataract is recommended to be studied as part of larger scale programs focused on multiple radiation health effects.
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Affiliation(s)
- Elizabeth A Ainsbury
- Public Health England (PHE) Centre for Radiation, Chemical and Environmental Hazards, Oxon, United Kingdom.
| | - Claudia Dalke
- Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Germany.
| | - Nobuyuki Hamada
- Radiation Safety Research Center, Nuclear Technology Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), Tokyo, Japan.
| | - Mohamed Amine Benadjaoud
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP 17, 31 avenue de la division Leclerc, Fontenay-aux-Roses, France.
| | - Vadim Chumak
- National Research Centre for Radiation Medicine, Ukraine.
| | | | - Judith L Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Mariateresa Mancuso
- Laboratory of Biomedical Technologies, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, (ENEA), Rome, Italy.
| | - Laure Sabatier
- Commissariat à l'Energie Atomique et aux Energies Alternatives, Saclay, France.
| | | | - Juliette Thariat
- Laboratoire de physique corpusculaire IN2P3/ENSICAEN -UMR6534 - Unicaen - Normandie University, France
| | - Jean-René Jourdain
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), BP 17, 31 avenue de la division Leclerc, Fontenay-aux-Roses, France.
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Omer H, Alameen S, Mahmoud WE, Sulieman A, Nasir O, Abolaban F. Eye lens and thyroid gland radiation exposure for patients undergoing brain computed tomography examination. Saudi J Biol Sci 2021; 28:342-346. [PMID: 33424315 PMCID: PMC7783653 DOI: 10.1016/j.sjbs.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
This study aims to estimate the effective radiation dose and organ dose from head CT procedures. It was conducted in three main private hospitals in Khartoum State-Sudan, using Toshiba machines with 64 slices. The total number of patients included in this study was 142 patients (82 males and 60 females). The effective dose and organ dose were calculated by CT Expo software. The effective dose slightly varied among patients according to gender and age. The effective dose for female patients (5.99 mSv) was higher than that for male patients (5.84 mSv), and the pediatric dose (5.46 mSv) was lower than the adults' dose (5.94 mSv). The dose for eye lens was found lower for male patients (89.117 mSv) than the dose for female patients (94.62) mSv). According to patients' age: the dose received by the lens of the eye was much lower in pediatric (79.93 mSv) than the adults (92.41 mSv). The dose for thyroid in female patients (33.52 mSv) was higher than the male patients (28 mSv). The pediatric dose (28.34 mSv) was lower than the adults' dose (30.64 mSv). Departmental imaging protocol and lack of training among hospital staff are expected to be responsible for these variations. Therefore, this study recommends that the CT technologists be trained on suitable strategies to achieve dose optimization. Moreover, patients' doses must be monitored regularly.
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Affiliation(s)
- Hiba Omer
- Department of Basic Sciences, Deanship of Preparatory Year and Supporting Studies, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 34212, Saudi Arabia
| | - Suhaib Alameen
- Sudan University of Science and Technology College of Medical Radiologic Science, P.O. Box 1908, Khartoum, Sudan
| | - Waleed E. Mahmoud
- Sudan University of Science and Technology College of Medical Radiologic Science, P.O. Box 1908, Khartoum, Sudan
| | - Abdelmoneim Sulieman
- Prince Sattam Bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, PO Box 422, Alkharj 11942, Saudi Arabia
| | - Omaima Nasir
- Department of Biology, Turabah University College, Taif University, P.O.Box 11099, Taif 21944, Saudi Arabia
| | - Fouad Abolaban
- Nuclear Engineering Department, Faculty of Engineering, King Abdulaziz University, P.O. Box 80204 Jeddah 21589 Saudi Arabia
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Thurley P, Bowker R, Bhatti I, Skelly R, Law R, Salaman R, Young B, Fogarty A. Development and evaluation of a brief educational cartoon on trainee clinicians' awareness of risks of ionising-radiation exposure: a feasibility pre-post intervention study of a novel educational tool to promote patient safety. BMJ Open Qual 2020; 9:bmjoq-2019-000900. [PMID: 33246934 PMCID: PMC7703407 DOI: 10.1136/bmjoq-2019-000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background Over recent decades, CT scans have become routinely available and are used in both acute medical and outpatient environments. However, there is a small increase in the risk of adverse consequences, including an increase in the risk of both malignancy and cataracts. Clinicians are often unaware of these facts, and this represents a challenge for medical educators in England, where almost 5 million CT scans are done annually. New whiteboard methodologies permit development of innovative educational tools that are efficient and scalable in communicating simple educational messages that promote patient safety. Methods A short educational whiteboard cartoon was developed to explore the prior observation that adolescents under the care of paediatricians had a much lower risk of receiving a CT scan than those under the care of clinicians who care for adults. This explored the risks after receiving a CT scan and strategies that can be used to avoid them. The educational cartoon was piloted on new doctors who were attending induction training at a busy teaching hospital. Results The main output was the educational whiteboard cartoon itself. Before the new medical trainees’ induction, 56% (25/45) had received no formal training in radiation awareness, and this decreased to 26% (6/23) after the exposure to the educational cartoon (p=0.02). At baseline, 60% (27/45) of respondents considered that young females were at highest risk from exposure to ionising radiation, and this increased to 87% (20/23) after exposure to the educational cartoon (p=0.06). Conclusions This proof-of-concept feasibility study demonstrates that whiteboard cartoons provide a novel and feasible approach to efficiently promote patient safety issues, where a short succinct message is often appropriate.
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Affiliation(s)
- Pete Thurley
- Department of Radiology, Royal Derby Hospital, Derby, UK
| | - Richard Bowker
- Department of Peadiatrics, Royal Derby Hospital, Derby, UK
| | - Imran Bhatti
- Department of Surgery, Royal Derby Hospital, Derby, UK
| | - Rob Skelly
- Department of Geriatrics, Royal Derby Hospital, Derby, UK
| | | | | | - Ben Young
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Andrew Fogarty
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Automated Segmentation of the Craniofacial Skeleton With "Black Bone" Magnetic Resonance Imaging. J Craniofac Surg 2020; 31:1015-1017. [PMID: 32503096 DOI: 10.1097/scs.0000000000006552] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Three-dimensional (3D) imaging of the craniofacial skeleton is integral in managing a wide range of bony pathologies. The authors have previously demonstrated the potential of "Black Bone" MRI (BB) as a non-ionizing alternative to CT. However, even in experienced hands 3D rendering of BB datasets can be challenging and time consuming. The objectives of this study were to develop and test a semi- and fully-automated segmentation algorithm for the craniofacial skeleton.Previously acquired adult volunteer (n = 15) BB datasets of the head were utilized. Imaging was initially 3D rendered with our conventional manual technique. An algorithm to remove the outer soft-tissue envelope was developed and 3D rendering completed with the processed datasets (semi-automated). Finally, a fully automated 3D-rendering method was developed and applied to the datasets. All 3D rendering was completed with Fovia High Definition Volume Rendering (Fovia Inc, Palo Alto, CA). Analysis was undertaken of the 3D visual results and the time taken for data processing and interactive manipulation.The mean time for manual segmentation was 12.8 minutes, 3.1 minutes for the semi-automated algorithm, and 0 minutes for the fully automated algorithm. Further fine adjustment was undertaken to enhance the automated segmentation results, taking a mean time of 1.4 minutes.Automated segmentation demonstrates considerable potential, offering significant time saving in the production of 3D BB imaging in adult volunteers. the authors continue to undertake further development of our segmentation algorithms to permit adaption to the pediatric population in whom non-ionizing imaging confers the most potential benefit.
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Dubucs X, Balen F, Schmidt E, Houles M, Charpentier S, Houze-Cerfon CH, Lauque D. Cutaneous impact location: a new tool to predict intracranial lesion among the elderly with mild traumatic brain injury? Scand J Trauma Resusc Emerg Med 2020; 28:87. [PMID: 32867809 PMCID: PMC7460762 DOI: 10.1186/s13049-020-00781-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/27/2020] [Indexed: 11/22/2022] Open
Abstract
Background Mild traumatic brain injury is the leading cause of arrivals to emergency department due to trauma in the 65-year-old population and over. Recent studies conducted in ED suggested a low intracranial lesion prevalence. The objectives of this study were to assess the prevalence and risk factors of intracranial lesion in older patients admitted to emergency department for mild traumatic brain injury by reporting in the emergency department the precise anamnesis of injury and clinical findings. Methods Patients of 65 years old and over admitted in emergency department were prospectively included in this monocentric study. The primary outcome was the prevalence of intracranial lesion threw neuroimaging. Results Between January and June 2019, 365 patients were included and 66.8% were women. Mean age was 86.5 years old (SD = 8.5). Ground-level fall was the most common cause of mild traumatic brain injury and occurred in 335 patients (91.8%). Overall, 26 out of 365 (7.2%) patients had an intracranial lesion. Compared with cutaneous frontal impact (medium risk group), the relative risk of intracranial lesion was 2.54 (95% CI 1.20 to 5.42) for patients with temporoparietal or occipital impact (high risk group) and 0.12 (95% CI 0.01 to 0.93) for patients with facial impact or no cutaneous impact (low risk group). There was not statistical increase in risk of intracranial injury with patients receiving antiplatelets (RR = 1.43; 95% CI 0.68 to 2.99) or anticoagulants (RR = 0.98; 95% CI 0.45 to 2.14). Conclusion Among patients of 65 years old and over, the prevalence of intracranial lesion after a mild traumatic brain injury was similar to the younger adult population. The cutaneous impact location on clinical examination at the emergency department may identify older patients with low, medium and high risk for intracranial lesion.
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Affiliation(s)
- Xavier Dubucs
- Emergency Department, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.
| | - Frederic Balen
- Emergency Department, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Eric Schmidt
- Department of Neurosurgery, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Mathieu Houles
- Department of Geriatric Medecine, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Department of Geriatric Medecine, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | | | - Dominique Lauque
- Emergency Department, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
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Weinstein O, Yitshak Sade M, Shelef I, Novack V, Abu Tailakh M, Levy J. The association between exposure to radiation and the incidence of cataract. Int Ophthalmol 2020; 41:237-242. [PMID: 32852647 DOI: 10.1007/s10792-020-01572-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the association between exposure to radiation from computed tomography (CT) studies and the incidence of cataract. METHODS In a nested case-control study, all cataract cases and their matched controls were sampled from a retrospective cohort of Israeli residents who underwent CT scans or ultrasonic tests in Soroka Medical Center, Beer-Sheva, Israel, between the years 1996 and 2014. The risk of cataract associated with head, neck or the rest of the body CT was assessed using Poisson survival analysis. RESULTS The nested matched sample included 3841 cataract cases and their age- and sex-matched controls (n = 228,743). CT radiation exposure was more frequent in the cataract group, with 9.7% head CT, 1.2% neck CT and 6.6% other CT, compared to 5%, 0.7% and 3.7% among person-years without cataract (p < 0.001). In a multivariate analysis, a similar increased risk of cataract associated with head (hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.11; 1.38) and other CT (HR: 1.25, 95% CI: 1.10; 1.43) was found. No association with neck CT (HR: 1.07, 95% CI: 0.80; 1.43) was observed. CONCLUSION In our study population, a similar risk of cataract with head, neck or the rest of the body CT was detected.
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Affiliation(s)
- Orly Weinstein
- Ophthalmology Department, Soroka University Medical Center, Beer-Sheva, Israel.,Ministry of Health, Jerusalem, Israel.,Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Maayan Yitshak Sade
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ilan Shelef
- Radiological Institute, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Muhammad Abu Tailakh
- Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jaime Levy
- Department of Ophthalmology, Hadassah Medical Center, P.O. Box 12000, 91120, Jerusalem, Israel.
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Godwin SA, Cherkas DS, Panagos PD, Shih RD, Byyny R, Wolf SJ. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache. Ann Emerg Med 2020; 74:e41-e74. [PMID: 31543134 DOI: 10.1016/j.annemergmed.2019.07.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This clinical policy from the American College of Emergency Physicians addressed key issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In the adult emergency department patient presenting with acute headache, are there risk-stratification strategies that reliably identify the need for emergent neuroimaging? (2) In the adult emergency department patient treated for acute primary headache, are nonopioids preferred to opioid medications? (3) In the adult emergency department patient presenting with acute headache, does a normal noncontrast head computed tomography scan performed within 6 hours of headache onset preclude the need for further diagnostic workup for subarachnoid hemorrhage? (4) In the adult emergency department patient who is still considered to be at risk for subarachnoid hemorrhage after a negative noncontrast head computed tomography, is computed tomography angiography of the head as effective as lumbar puncture to safely rule out subarachnoid hemorrhage? Evidence was graded and recommendations were made based on the strength of the available data.
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Dobson GM, Dalton AK, Nicholson CL, Jenkins AJ, Mitchell PB, Cowie CJA. CT scan exposure in children with ventriculo-peritoneal shunts: single centre experience and review of the literature. Childs Nerv Syst 2020; 36:591-599. [PMID: 31428872 DOI: 10.1007/s00381-019-04345-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/07/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE A computed tomography (CT) scan in childhood is associated with a greater incidence of brain cancer. CT scans are used in patients with ventriculo-peritoneal (VP) shunts in whom shunt dysfunction is suspected. We wanted to assess the CT scan exposure in a cohort of children with VP shunts and attempt to quantify their radiation exposure. METHODS A single-centre retrospective analysis was performed recording CT head scans in children younger than 18 years with VP shunts. Hospital coding data was cross-referenced with electronic records and radiology databases both in our neurosurgery unit and in hospitals referring to it. RESULTS One hundred and fifty-two children with VP shunts were identified. The mean time with shunt in situ was 5.4 years (± 4.61). A mean of 3.33 CT scans (range 0-20) were performed on each child, amounting to 0.65 (± 0.87) CTs per shunt year. Based on 2 msv of radiation per scan, this equates to an average exposure of 1.31 msv per child per shunt year. CONCLUSION Children who have multiple CT head scans for investigation of possible shunt dysfunction are at a greater risk of developing cancer. We discuss the implications of this increased risk and discuss strategies to limit radiation exposure in children with VP shunts.
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Affiliation(s)
- Gareth M Dobson
- Department of Neurosurgery, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, UK
| | - Arthur K Dalton
- Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
| | - Claire L Nicholson
- Department of Neurosurgery, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, UK
| | - Alistair J Jenkins
- Department of Neurosurgery, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, UK
| | - Patrick B Mitchell
- Department of Neurosurgery, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, UK
| | - Christopher J A Cowie
- Department of Neurosurgery, Great North Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, UK.
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Gaudreau K, Thome C, Weaver B, Boreham DR. Cataract Formation and Low-Dose Radiation Exposure from Head Computed Tomography (CT) Scans in Ontario, Canada, 1994–2015. Radiat Res 2020; 193:322-330. [DOI: 10.1667/rr15504.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Katherine Gaudreau
- Northern Ontario School of Medicine, Sudbury, Canada, P3E 2C6 and Thunder Bay, Canada, P7B 5E1
| | - Christopher Thome
- Northern Ontario School of Medicine, Sudbury, Canada, P3E 2C6 and Thunder Bay, Canada, P7B 5E1
| | - Bruce Weaver
- Northern Ontario School of Medicine, Sudbury, Canada, P3E 2C6 and Thunder Bay, Canada, P7B 5E1
| | - Douglas R. Boreham
- Northern Ontario School of Medicine, Sudbury, Canada, P3E 2C6 and Thunder Bay, Canada, P7B 5E1
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Roslee MAAM, Shuaib IL, Napi AFM, Razali MASM, Osman ND. Cumulative organ dose and effective dose in adult population underwent repeated or multiple head CT examination. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ronner E, Reid R, Basonbul RA, Caloway C, Arruda J, Juliano AFY, Cohen MS. Outcomes with non-sedated MRI for infants with sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2019; 127:109662. [PMID: 31479917 DOI: 10.1016/j.ijporl.2019.109662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/17/2019] [Accepted: 08/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Evette Ronner
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Rochelle Reid
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Razan A Basonbul
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Christen Caloway
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Julie Arruda
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Amy Fan-Yee Juliano
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Michael S Cohen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
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Harbron RW, Ainsbury EA, Barnard SGR, Lee C, McHugh K, Berrington de González A, Edyvean S, Pearce MS. Radiation dose to the lens from CT of the head in young people. Clin Radiol 2019; 74:816.e9-816.e17. [PMID: 31375261 DOI: 10.1016/j.crad.2019.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 06/28/2019] [Indexed: 11/28/2022]
Abstract
AIM To determine cumulative scan frequencies and estimate lens dose for paediatric computed tomography (CT) head examinations in the context of potential cataract risk. MATERIALS AND METHODS The cumulative number of head-region CT examinations among a cohort of 410,997 children and young adults who underwent CT in the UK between 1985 and 2014 was calculated. Images from a sample of these head examinations (n=668) were reviewed to determine the level of eye inclusion. Lens dose per scan was estimated using the computer program, NCICT V1.0, for different levels of eye inclusion and exposure settings typical of past and present clinical practice. RESULTS In total 284,878 patients underwent 448,108 head-region CT examinations. The majority of patients (72%) had a single recorded head-region examination. A small subset (∼1%, n=2,494) underwent ≥10 examinations, while 0.1% (n=387) underwent ≥20. The lens was included within the imaged region for 57% of reviewed routine head examinations. In many cases, this appeared to be intentional, i.e. protocol driven. In others, there appeared to have been an attempt to exclude the eyes through gantry angulation. Estimated lens doses were 20-75 mGy (mean: 47 mGy) where the eye was fully included within the examination range and 2-7 mGy (mean: 3.1 mGy) where the lens was fully excluded. Potential cumulative lens doses ranged from ∼3 mGy to ∼4,700 mGy, with 2,335 patients potentially receiving >500 mGy. CONCLUSION The majority of young people will receive cumulative lens doses well below 500 mGy, meaning the risk of cataract induction is likely to be very small.
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Affiliation(s)
- R W Harbron
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK.
| | - E A Ainsbury
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - S G R Barnard
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - C Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - K McHugh
- Radiology Department, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - A Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Edyvean
- Public Health England, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, UK
| | - M S Pearce
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne NE1 4LP, UK; NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, UK
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40
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Poon R, Badawy MK. Radiation dose and risk to the lens of the eye during CT examinations of the brain. J Med Imaging Radiat Oncol 2019; 63:786-794. [DOI: 10.1111/1754-9485.12950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Rebekah Poon
- Department of Medical Imaging and Radiation Sciences School of Primary and Allied Health Care Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
| | - Mohamed K Badawy
- Department of Medical Imaging and Radiation Sciences School of Primary and Allied Health Care Faculty of Medicine, Nursing and Health Sciences Monash University Clayton Victoria Australia
- Monash Imaging Monash Health Clayton Victoria Australia
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Abstract
Exposure of the lenses to direct ionizing radiation during computed tomography (CT) examinations predisposes patients to cataract formation and should be avoided when possible. Avoiding such exposure requires positioning and other maneuvers by technologists that can be challenging. Continuous feedback has been shown to sustain quality improvement and can remind and encourage technologists to comply with these methods. Previously, for use cases such as this, cumbersome manual techniques were required for such feedback. Modern deep learning methods utilizing convolutional neural networks (CNNs) can be used to develop models that can detect lenses in CT examinations. These models can then be used to facilitate automatic and continuous feedback to sustain technologist performance for this task, thus contributing to higher quality patient care. This continuous evaluation for quality purposes also surfaces other operational or process-based challenges that can be addressed. Given high-performance characteristics, these models could also be used for other tasks such as population health research.
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Torabi AA, Afshari M, Esmaeili R, Moosazadeh M. Crude and standardized prevalences of cataract and related factors in the elderly people in Northern Iran. Ther Adv Ophthalmol 2019; 11:2515841419835339. [PMID: 30911734 PMCID: PMC6425536 DOI: 10.1177/2515841419835339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/08/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study aims to estimate the crude and standardized prevalences of cataract and its related factors among old people in northern parts of Iran. Methods: This cross-sectional study was carried out among 397 people aged 60 and older in northern Iran. Required information about treated and nontreated cataract was collected using a standard checklist. The World Standard Population was applied for direct standardization. Results: The standardized prevalence (95% confidence interval) of cataract among men, women, and all people were 27.5% (21.2–33.8), 30.9% (24.5–37.4), and 29.1% (24.6–33.6), respectively. Based on multivariate logistic regression models, age over 75 years (OR = 3.03, 95% CI: 1.21–7.59), living alone (OR = 4.89, 95% CI: 1.86‒12.86), diabetes mellitus (odds ratio = 19.10, 95% confidence interval: 8.13–44.89), rheumatoid arthritis (OR = 7.76, 95% CI: 2.32–25.99), history of infectious diseases (OR = 4.02, 95% CI: 1.35‒11.98), hypertension (OR = 3.19, 95% CI: 1.59–6.42), history of ophthalmic surgery (OR = 2.83, 95% CI: 1.29–6.16), history of sedative drug use (OR = 2.71, 95% CI: 1.35–5.47), history of vitamin supplementation use (OR = 0.21, 95% CI: 0.08–0.55), and familial history of cataract (OR = 2.81, 95% confidence interval: 1.38–5.72) increased the odds of cataract. Our multiple logistic regression model explained 53% of the variation in developing cataract. Conclusion: Our study showed that the prevalence of cataract in the study population was relatively high. We also found that aging, living alone, diabetes mellitus, rheumatoid arthritis, hypertension, infectious diseases, ophthalmic surgery, sedative drugs and familial history of cataract were the risk factors of cataract and vitamin supplementations were its protective factors.
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Affiliation(s)
- Ali Asghar Torabi
- Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Ravanbakhsh Esmaeili
- Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Chen Q, Ma R, Gan L, Ren H, Yuan Y. Value of ultrasound biomicroscopy in assessment of small masses at medial canthal region. Graefes Arch Clin Exp Ophthalmol 2019; 257:827-834. [PMID: 30671657 DOI: 10.1007/s00417-019-04252-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/06/2019] [Accepted: 01/11/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Conventional imaging techniques are not sensitive enough to reveal detailed structures of lacrimal drainage system (LDS) and its surrounding tissue (ST). Our study aimed to explore utility of ultrasound biomicroscopy (UBM) in assessment of small masses at the medial canthal region and compare performance of UBM with conventional imaging techniques. METHODS We prospectively recruited cases with small mass (long axis < 1 cm) at the medial canthal region (upper LDS-located area) from June 2017 to October 2018. UBM ± color Doppler flow imaging (CDFI) and conventional imaging techniques (computed tomography, magnetic resonance imaging, and dacryocystography) were conducted by four independent practitioners. Results were analyzed against gold standards with Cohen's kappa test in three aspects including LDS patency, mass location, and presumptive diagnosis. Corresponding gold standards were syringe and dacryocystography, intraoperative findings, and pathological/empirical diagnosis. RESULTS Seventy-two cases were recruited, including 20 cases of LDS lesions and 52 cases of ST lesions. Female (odds ratio 7.14) and age ≥ 37 (odds ratio 9.80) were risk factors for LDS lesion, and age range of 15-25 (odds ratio 9.17) was a risk factor for inflammatory ST lesion. In terms of LDS patency, UBM results were reliable for the detection of pre-saccal obstruction (kappa = 0.920), but were not reliable for intra-saccal and post-saccal obstruction (kappa = 0.106). In terms of mass location, the UBM (kappa = 0.766) performed better than conventional techniques (except for dacryocystography) to sort out ST lesions, with sensitivity of 93.8% and specificity of 83.3%. In terms of diagnosis, the UBM (kappa = 0.882) outweighed conventional techniques (except for magnetic resonance imaging) to distinguish cysts from nodules, with sensitivity of 93.8% and specificity of 94.4%. Notably, the UBM + CDFI achieved better performance than the UBM when screen out inflammatory lesions (kappa = 0.926 vs kappa = 0.689) and LDS-adjacent lesions (kappa = 0.815 vs kappa = 0.673), resulting in sensitivity of 91.7% and specificity of 100% for both testing items. If deep lesions (at the lacrimal sac-harbored area) were excluded, UBM reliability to detect inflammatory lesions (kappa = 0.915) and LDS-adjacent lesions (kappa = 0.770) improved, achieving sensitivity of 90.0% and 88.9%, and specificity of 100.0% and 92.7%, respectively. CONCLUSIONS The UBM is a valuable tool to assess superficial masses at the medial canthal region regarding pre-saccal obstruction, mass location, and presumptive diagnosis. TRIAL REGISTRATION This work was registered on Chinese Clinical Trial Registry website with registration number ChiCTR1800018956 .
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Affiliation(s)
- Qian Chen
- Department of Ophthalmology, Fudan Eye and ENT Hospital, 83 Fen Yang Road, Xuhui District, Shanghai, 200031, China
| | - Ruiqi Ma
- Department of Ophthalmology, Fudan Eye and ENT Hospital, 83 Fen Yang Road, Xuhui District, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Lu Gan
- Department of Ophthalmology, Fudan Eye and ENT Hospital, 83 Fen Yang Road, Xuhui District, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Hui Ren
- Department of Ophthalmology, Fudan Eye and ENT Hospital, 83 Fen Yang Road, Xuhui District, Shanghai, 200031, China
| | - Yifei Yuan
- Department of Ophthalmology, Fudan Eye and ENT Hospital, 83 Fen Yang Road, Xuhui District, Shanghai, 200031, China.
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Rodrigues dos Santos M, Silva LB, Silva A, Rocha NP. DICOM Metadata Analysis for Population Studies. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2019. [DOI: 10.4018/ijehmc.2019010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article reports an experimental study to determine how to use the stored Digital Imaging and Communication in Medicine (DICOM) metadata to perform population studies. As a case study, it was considered three types of medical imaging studies (i.e. routine head computed tomography, thorax computed radiography and thorax digital radiography) stored in the picture archiving and communication systems (PACS) of three healthcare institutions. The final sample consisted of DICOM metadata belonging to 1370360 images, corresponding to 109160 medical imaging studies performed on 72716 patients. The study followed a methodological approach that allows the identification of the number of patients with performed studies by age group and gender, as well as the average number of studies by patient, age group and gender in each one of the three healthcare institutions. The results show the relevance of the aggregation and analyses of DICOM metadata stored in heterogeneous PACS facilities.
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Affiliation(s)
| | | | - Augusto Silva
- Department of Electronics, Telecommunications and Informatics, IEETA, University of Aveiro, Aveiro, Portugal
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Kimple AJ, McClurg SW, Huang BY, Sreenath SB, McClintock BW, Tomoum M, Lin FC, Ebert CS, Senior BA. Image quality and dose reduction in sinus computed tomography using iterative reconstruction: a cadaver study. RHINOLOGY ONLINE 2018; 1:45-49. [PMID: 30556057 DOI: 10.4193/rhinol/18.015] [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] [Indexed: 11/08/2022] Open
Abstract
Background Concerns about radiation dose in computed tomography (CT) imaging have renewed interest in iterative reconstruction (IR), a technique which has the potential to produce images with less noise at lower radiation doses than traditional filtered back projection (FBP). This study aimed to assess whether application of IR could provide comparable quality sinus CT images to FBP at lower kilovolt (kV) and milliamp (mA) settings, and to establish optimal scan settings for sinus imaging. Methodology/Principal 30 sinus CT scans were performed on 5 cadaver heads at two kV setting and three mA settings. Each scan was reconstructed using FBP and 3 IR settings, yielding a total of 120 images series. Each image set was blinded and randomly reviewed by 3 rhinologists and 2 neuroradiologists. Using a 5-point Likert scale, 16 anatomical landmarks, were graded with respect to image quality. Data were assessed with respect to dose and IR settings using statistical analysis. Results Higher kV and mAs settings produced significantly higher quality images for structure identification across all 16 landmarks; however, the suitability for surgery did not increase in a linear fashion and plateaued by a total radiation dose of 0.1201 mSv. IR algorithm did not provide a benefit in the overall score of scans at a fixed kV and mAs. Conclusions Identification of structures in sinus CT imaging significantly correlate with the kV and mA and overall dose of radiation; however, IR did not provide additional benefit in the image quality.
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Affiliation(s)
- Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, USA
| | - Stanley W McClurg
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, USA
| | - Benjamin Y Huang
- Department of Radiology, University of North Carolina at Chapel Hill, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, USA
| | | | - Mohamed Tomoum
- Department of Otolaryngology-Head and Neck Surgery, Tanta University, Tanta, Egypt
| | - Feng-Chang Lin
- Carolina Translational and Clinical Science Institute, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, USA.,Department of Neurosurgery, University of North Carolina at Chapel Hill, USA
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Sadigh G, Kadom N, Karthik P, Sengupta D, Strauss KJ, Frush D, Applegate KE. Noncontrast Head CT in Children: National Variation in Radiation Dose Indices in the United States. AJNR Am J Neuroradiol 2018; 39:1400-1405. [PMID: 29976832 DOI: 10.3174/ajnr.a5719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiologists should manage the radiation dose for pediatric patients to maintain reasonable diagnostic confidence. We assessed the variation in estimated radiation dose indices for pediatric noncontrast head CT in the United States. MATERIALS AND METHODS Radiation dose indices for single-phase noncontrast head CT examinations in patients 18 years of age and younger were retrospectively reviewed between July 2011 and June 2016 using the American College of Radiology CT Dose Index Registry. We used the reported volume CT dose index stratified by patient demographics and imaging facility characteristics. RESULTS The registry included 295,296 single-phase pediatric noncontrast head CT studies from 1571 facilities (56% in male patients and 53% in children older than 10 years of age). The median volume CT dose index was 33 mGy (interquartile range = 22-47 mGy). The volume CT dose index increased as age increased. The volume CT dose index was lower in children's hospitals (median, 26 mGy) versus academic hospitals (median, 32 mGy) and community hospitals (median, 40 mGy). There was a lower volume CT dose index in level I and II trauma centers (median, 27 and 32 mGy, respectively) versus nontrauma centers (median, 40 mGy) and facilities in metropolitan locations (median, 30 mGy) versus those in suburban and rural locations (median, 41 mGy). CONCLUSIONS Considerable variation in the radiation dose index for pediatric head CT exists. Median dose indices and practice variations at pediatric facilities were both lower compared with other practice settings. Decreasing dose variability through proper management of CT parameters in pediatric populations using benchmarks generated by data from registries can potentially decrease population exposure to ionizing radiation.
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Affiliation(s)
- G Sadigh
- From the Department of Radiology and Imaging Sciences (G.S., N.K.,), Emory University School of Medicine, Atlanta, Georgia
| | - N Kadom
- From the Department of Radiology and Imaging Sciences (G.S., N.K.,), Emory University School of Medicine, Atlanta, Georgia
| | - P Karthik
- American College of Radiology (P.K., D.S.), Reston, Virginia
| | - D Sengupta
- American College of Radiology (P.K., D.S.), Reston, Virginia
| | - K J Strauss
- Department of Radiology (K.J.S.), University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - D Frush
- Department of Radiology (D.F.), Duke University Medical Center, Durham, North Carolina
| | - K E Applegate
- Department of Radiology (K.E.A.), University of Kentucky, Lexington, Kentucky
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Lee HJ, Kim J, Kim KW, Lee SK, Yoon JS. Feasibility of a low-dose orbital CT protocol with a knowledge-based iterative model reconstruction algorithm for evaluating Graves' orbitopathy. Clin Imaging 2018; 51:327-331. [PMID: 29960265 DOI: 10.1016/j.clinimag.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/17/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the clinical feasibility of low-dose orbital CT with a knowledge-based iterative model reconstruction (IMR) algorithm for evaluating Graves' orbitopathy. METHODS Low-dose orbital CT was performed with a CTDIvol of 4.4 mGy. In 12 patients for whom prior or subsequent non-low-dose orbital CT data obtained within 12 months were available, background noise, SNR, and CNR were compared for images generated using filtered back projection (FBP), hybrid iterative reconstruction (iDose4), and IMR and non-low-dose CT images. Comparison of clinically relevant measurements for Graves' orbitopathy, such as rectus muscle thickness and retrobulbar fat area, was performed in a subset of 6 patients who underwent CT for causes other than Graves' orbitopathy, by using the Wilcoxon signed-rank test. RESULTS The lens dose estimated from skin dosimetry on a phantom was 4.13 mGy, which was on average 59.34% lower than that of the non-low-dose protocols. Image quality in terms of background noise, SNR, and CNR was the best for IMR, followed by non-low-dose CT, iDose4, and FBP, in descending order. A comparison of clinically relevant measurements revealed no significant difference in the retrobulbar fat area and the inferior and medial rectus muscle thicknesses between the low-dose and non-low-dose CT images. CONCLUSIONS Low-dose CT with IMR may be performed without significantly affecting the measurement of prognostic parameters for Graves' orbitopathy while lowering the lens dose and image noise.
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Affiliation(s)
- Ho-Joon Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinna Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Ki Wook Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Koo Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Radiation dose reduction in perfusion CT imaging of the brain using a 256-slice CT: 80 mAs versus 160 mAs. Clin Imaging 2018; 50:188-193. [DOI: 10.1016/j.clinimag.2018.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/12/2018] [Accepted: 03/29/2018] [Indexed: 11/21/2022]
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Cataract risk of neuro-interventional procedures: a nationwide population-based matched-cohort study. Clin Radiol 2018; 73:836.e17-836.e22. [PMID: 29945717 DOI: 10.1016/j.crad.2018.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/04/2018] [Indexed: 10/28/2022]
Abstract
AIM To demonstrate the risk of cataract associated with radiation exposure from neuro-interventional procedures. MATERIALS AND METHODS This was a nationwide population-based, matched-cohort study. The exposed group (group E) comprised patients diagnosed with an aneurysm, cerebrovascular system anomaly, or subarachnoid haemorrhage who underwent a neuro-interventional procedure, such as brain digital subtraction angiography or endovascular embolisation. The comparison group (group C) included subjects who were never exposed to radiation from neuro-interventional procedures and were propensity score-matched by the date of enrolment, age, sex, and associated comorbidities. Multiple Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of cataract risk due to radiation exposure while adjusting for potential confounding factors. RESULTS There were 838 patients and 3,352 matched subjects in groups E and C, respectively. The incidence of cataracts was significantly greater among subjects in group E (adjusted HR [aHR] = 1.88; 95% confidence interval [CI] = 1.08-3.26), especially those aged >40 years (aHR = 2.14; 95% CI = 1.16-3.94). The number of computed tomography examinations was positively correlated, but not statistically significant, with an increased risk of cataract occurrence. CONCLUSIONS Neuro-interventional procedures might be significantly associated with an increased risk of cataract occurrence.
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Lukoff J, Olmos J. Minimizing Medical Radiation Exposure by Incorporating a New Radiation "Vital Sign" into the Electronic Medical Record: Quality of Care and Patient Safety. Perm J 2018; 21:17-007. [PMID: 29035181 DOI: 10.7812/tpp/17-007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There is a clearly perceived and imminent need to decrease unnecessary and detrimental exposure to medical ionizing radiation. We propose a new radiation "vital sign" that incorporates cumulative radiation exposure to create a risk score on the basis of an individualized assessment of potential harm from additional exposure to medical radiation. We propose to then tie the risk score to real-time, evidence-based, clinical decision support for procedures that use ionizing radiation. Additionally, we offer recommendations that minimize unnecessary or low-yield uses. Preference is given to approaches and modalities that use less or no ionizing radiation and that are medically appropriate, acceptable to, and safer for patients.
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Affiliation(s)
- Jonathan Lukoff
- Retired Pediatrician and Informatician from the Southern California Permanente Medical Group and The Permanente Federation in CA.
| | - Jaime Olmos
- Retired Nuclear Engineer from the San Onofre Nuclear Generating Station in Pendleton, CA.
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