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Lee K, Lee S, Kwak JS, Park H, Oh H, Koh JC. Development and Validation of an Artificial Intelligence Model for Detecting Rib Fractures on Chest Radiographs. J Clin Med 2024; 13:3850. [PMID: 38999416 PMCID: PMC11242496 DOI: 10.3390/jcm13133850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Chest radiography is the standard method for detecting rib fractures. Our study aims to develop an artificial intelligence (AI) model that, with only a relatively small amount of training data, can identify rib fractures on chest radiographs and accurately mark their precise locations, thereby achieving a diagnostic accuracy comparable to that of medical professionals. Methods: For this retrospective study, we developed an AI model using 540 chest radiographs (270 normal and 270 with rib fractures) labeled for use with Detectron2 which incorporates a faster region-based convolutional neural network (R-CNN) enhanced with a feature pyramid network (FPN). The model's ability to classify radiographs and detect rib fractures was assessed. Furthermore, we compared the model's performance to that of 12 physicians, including six board-certified anesthesiologists and six residents, through an observer performance test. Results: Regarding the radiographic classification performance of the AI model, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were 0.87, 0.83, and 0.89, respectively. In terms of rib fracture detection performance, the sensitivity, false-positive rate, and free-response receiver operating characteristic (JAFROC) figure of merit (FOM) were 0.62, 0.3, and 0.76, respectively. The AI model showed no statistically significant difference in the observer performance test compared to 11 of 12 and 10 of 12 physicians, respectively. Conclusions: We developed an AI model trained on a limited dataset that demonstrated a rib fracture classification and detection performance comparable to that of an experienced physician.
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Affiliation(s)
- Kaehong Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea; (K.L.); (S.L.); (J.S.K.); (H.P.)
| | - Sunhee Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea; (K.L.); (S.L.); (J.S.K.); (H.P.)
| | - Ji Soo Kwak
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea; (K.L.); (S.L.); (J.S.K.); (H.P.)
| | - Heechan Park
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea; (K.L.); (S.L.); (J.S.K.); (H.P.)
| | - Hoonji Oh
- Department of Biostatistics, College of Medicine, Korea University, Seoul 02841, Republic of Korea;
| | - Jae Chul Koh
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul 02841, Republic of Korea; (K.L.); (S.L.); (J.S.K.); (H.P.)
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Bandinelli F, Benucci M, Mallia I, Mauro I, Pecani N, Li Gobbi F, Manfredi M, Guiducci S, Lari B, Grossi V, Infantino M, Giannasi G. Do Ultrasound Lung Abnormalities Correlate to Biomarkers and Male Gender in Rheumatoid Arthritis Patients? A Monocentric Cross-Sectional Study. J Clin Med 2024; 13:3534. [PMID: 38930065 PMCID: PMC11204435 DOI: 10.3390/jcm13123534] [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: 04/17/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Lung ultrasound (LUS) is a tool of growing interest in Rheumatoid Arthritis (RA) oligo- symptomatic ILD to avoid. Objective: We aimed to evaluate (i) the prevalence of pleural (PLUS) and parenchymal (PAUS) abnormalities in LUS in the RA population and their possible correlation to biomarkers; (ii) the predictivity of gender, smoking habits, previous infections (past COVID-19 tuberculosis), and treatments; (iii) the differences in LUS between sexes. Methods: We collected the data of 155 (15 early and 140 late) RA patients with mild respiratory symptoms, evaluating PLUS and PAUS, in fourteen lung areas and also summing the scores (LUS-T). Results: Only 13/155 (8.4%) were completely negative; LUS correlated to age (all parameters p 0.0001), rheumatoid factor IgM (PLUS p 0.0006, PAUS p 0.02, LUS-T p 0.001) and ACPA (p 0.001, 0.006, 0.001, respectively), and PLUS also correlated to IL6 (p 0.02). The male gender was predictive of all LUS evaluations (p 0.001, 0.05, 0.001, respectively), which were higher than in women (p 0.001, 0.01, 0.001, respectively). Other potential risk factors were independent, except biological treatments, which showed a low predictivity to PLUS (p < 0.05). Conclusions: We can conclude that LUS is a useful technique in RA low respiratory symptoms and correlates with age, the most important RA biomarkers, and male sex.
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Affiliation(s)
- Francesca Bandinelli
- Rheumatology Department, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy; (M.B.)
| | - Maurizio Benucci
- Rheumatology Department, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy; (M.B.)
| | - Ilenia Mallia
- Rheumatology Division, Department of Experimental and Clinical Medicine, University of Florence, 50141 Florence, Italy
| | - Ilaria Mauro
- Rheumatology Division, Department of Experimental and Clinical Medicine, University of Florence, 50141 Florence, Italy
| | - Nikita Pecani
- Rheumatology Division, Department of Experimental and Clinical Medicine, University of Florence, 50141 Florence, Italy
| | - Francesca Li Gobbi
- Rheumatology Department, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy; (M.B.)
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy; (M.M.); (V.G.); (M.I.)
| | - Serena Guiducci
- Rheumatology Division, Department of Experimental and Clinical Medicine, University of Florence, 50141 Florence, Italy
| | - Barbara Lari
- Immunology and Allergology Laboratory Unit, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy; (M.M.); (V.G.); (M.I.)
| | - Valentina Grossi
- Immunology and Allergology Laboratory Unit, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy; (M.M.); (V.G.); (M.I.)
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy; (M.M.); (V.G.); (M.I.)
| | - Gianfranco Giannasi
- Emergency Department, San Giovanni di Dio Hospital, Usl Tuscany Center, 50143 Florence, Italy;
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Doss AX, Howarth TP, Ng L, Doss SA, Heraganahally SS. Significance and prognostication of mediastinal lymph node enlargement on chest computed tomography among adult Indigenous Australians. J Med Imaging Radiat Oncol 2023; 67:726-733. [PMID: 37549958 DOI: 10.1111/1754-9485.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION There is a lack of data on chest computed tomography (CT) findings on mediastinal lymph node enlargement (MLE), including normal size threshold of less than 10 or 15 mm for MLE among Indigenous Australians. In this study, we assessed the significance and the applicability of the current guidelines for the threshold for abnormal MLE among adult Indigenous Australians. METHODS Patients who underwent chest CT between 2012 and 2020 among those referred to undergo lung function test (spirometry) were assessed for the presence of MLE which were classified as Group A (no measurable nodes), Group B (<10 mm), Group C (≥10 to 14.99 mm) and Group D (≥15 mm). RESULTS Of the total 67 patients identified to have MLE, 49 patients had at least two CT scans available for assessment over a median follow-up period of 101.3 weeks (IQR: 62.4, 235.6) and were included in the analysis. Evidence of chronic lung disease was common, with a significant proportion demonstrating either COPD or bronchiectasis and a high proportion with smoking history (93%). During the first CT scan, 34/49 (69%) had >10 mm nodes, of which 12/34 (35%) reduced in size, 22/34 (65%) remained stable, and 3/34 (9%) had malignancy on follow-up. CONCLUSION Despite most patients demonstrating the presence of significant MLE with varying size and in most >10 mm, the majority remain stable or benign in nature and only a minor proportion showed evidence of lung malignancy. Further prospective studies are needed in the characterisation of MLE among Indigenous patients.
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Affiliation(s)
- Arockia X Doss
- Department of Medical Imaging, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Curtin Medical School, Perth, Western Australia, Australia
| | - Timothy P Howarth
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
| | - Lai Ng
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Shibi A Doss
- Bond Medical Program, Bond University, Gold Coast, Queensland, Australia
| | - Subash Shanthakumar Heraganahally
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Derikvand AM, Bagherzadeh S, MohammadSharifi A, Khoshgard K, AllahMoradi F. Estimation of cancer risks due to chest radiotherapy treatment planning computed tomography (CT) simulations. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2023; 62:269-277. [PMID: 37129707 DOI: 10.1007/s00411-023-01025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/28/2023] [Indexed: 05/03/2023]
Abstract
The objective of our study was to determine organ doses to estimate the lifetime attributable risk (LAR) of cancer incidence related to chest tomography simulations for Radiotherapy Treatment Planning (RTTP) using patient-specific information. Patient data were used to calculate organ doses and effective dose. The effective dose (E) was calculated by two methods. First, to calculate effective dose in a standard phantom, the collected dosimetric parameters were used with the ImPACT CT Patient Dosimetry Calculator and E was calculated by applying related correction factors. Second, using the scanner-derived Dose Length Product, LARs were computed using the US National Academy of Sciences (BEIR VII) model for age- and sex-specific risks at each exposure. DLP, CTDIvol, and scan length were 507 ± 143 mGy.cm, 11 ± 4 mGy, and 47 ± 7 cm, respectively. The effective dose was 10 ± 3 mSv using ImPACT patient dosimetry calculator software and 9 ± 2 mSv using the scanner-derived Dose Length Product. The LAR of cancer incidence for all cancers, all solid cancers and leukemia were 65 ± 29, 62 ± 27, 7 ± 2 cases per 100,000 individuals, respectively. Radiation exposure from the usage of CT for radiotherapy treatment planning (RTTP) causes non-negligible increases in lifetime attributable risk. The results of this study can be used as a guide by physicians to implement strategies based on the As Low As Reasonably Achievable (ALARA) principle that lead to a reduction dose without sacrificing diagnostic information.
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Affiliation(s)
- Afsaneh Mir Derikvand
- Department of Medical Physics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeed Bagherzadeh
- Department of Medical Physics, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Ali MohammadSharifi
- Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Karim Khoshgard
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fariba AllahMoradi
- Department of Medical Physics, Kermanshah University of Medical Sciences (KUMS), Building No. 1Shahid Beheshti Boulevard, Kermanshah, 6715847141, Iran.
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Guan S, Tustison N, Qing K, Shim YM, Mugler J, Altes T, Albon D, Froh D, Mehrad B, Patrie J, Ropp A, Miller B, Nehrbas J, Mata J. 3D Single-Breath Chemical Shift Imaging Hyperpolarized Xe-129 MRI of Healthy, CF, IPF, and COPD Subjects. Tomography 2022; 8:2574-2587. [PMID: 36287814 PMCID: PMC9607398 DOI: 10.3390/tomography8050215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
3D Single-breath Chemical Shift Imaging (3D-SBCSI) is a hybrid MR-spectroscopic imaging modality that uses hyperpolarized xenon-129 gas (Xe-129) to differentiate lung diseases by probing functional characteristics. This study tests the efficacy of 3D-SBCSI in differentiating physiology among pulmonary diseases. A total of 45 subjects-16 healthy, 11 idiopathic pulmonary fibrosis (IPF), 13 cystic fibrosis (CF), and 5 chronic obstructive pulmonary disease (COPD)-were given 1/3 forced vital capacity (FVC) of hyperpolarized Xe-129, inhaled for a ~7 s MRI acquisition. Proton, Xe-129 ventilation, and 3D-SBCSI images were acquired with separate breath-holds using a radiofrequency chest coil tuned to Xe-129. The Xe-129 spectrum was analyzed in each lung voxel for ratios of spectroscopic peaks, chemical shifts, and T2* relaxation. CF and COPD subjects had significantly more ventilation defects than IPF and healthy subjects, which correlated with FEV1 predicted (R = -0.74). FEV1 predicted correlated well with RBC/Gas ratio (R = 0.67). COPD and IPF had significantly higher Tissue/RBC ratios than other subjects, longer RBC T2* relaxation times, and greater RBC chemical shifts. CF subjects had more ventilation defects than healthy subjects, elevated Tissue/RBC ratio, shorter Tissue T2* relaxation, and greater RBC chemical shift. 3D-SBCSI may be helpful in the detection and characterization of pulmonary disease, following treatment efficacy, and predicting disease outcomes.
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Affiliation(s)
- Steven Guan
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Nick Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Kun Qing
- Department of Radiation Oncology, City of Hope, Duarte, CA 91010, USA
| | - Yun Michael Shim
- Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - John Mugler
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Talissa Altes
- Department of Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Dana Albon
- Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Deborah Froh
- Department of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Borna Mehrad
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - James Patrie
- Department of Public Health, University of Virginia, Charlottesville, VA 22903, USA
| | - Alan Ropp
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Braden Miller
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Jill Nehrbas
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
| | - Jaime Mata
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA
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The influence of contrast enhancement and experience of observers on the assessment of mediastinal lymph nodes in sarcoidosis patients. Pol J Radiol 2022; 87:e392-e396. [PMID: 35979152 PMCID: PMC9373862 DOI: 10.5114/pjr.2022.118303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to assess the influence of contrast enhancement (CE) and experience of observers on the assessment of chest lymph nodes in patients with sarcoidosis. Material and methods A retrospective analysis of chest lymph nodes on computed tomography (CT) examinations, including CE and non-contrast-enhanced (non-CE) phase, was performed on 40 patients with proven diagnosis of sarcoidosis. Phases were separated, anonymized, and randomized. The assessment was performed by 5 observers: 2 general radiologists, 2 residents, and a senior chest CT expert. Results There were no significant differences between radiologists and residents, apart from the determination of the 4R node short diameter on CE images. Agreement between the reference observer and both residents and specialists was equally high, without any significant difference in the assessment all chest nodes and hilar nodes, and between non-CE and CE images. There was a significant difference between all observers in the determination of the largest 4R node short diameter on non-CE images, but not on CE images. The number of affected node levels was found to be significantly higher when evaluated on CE images than on non-CE images. Compared to CE images, non-CE computed tomography has sensitivity of 0.94-1.00 and specificity of 0.98-1.00, depending on the observer. Conclusions The application of contrast medium has a limited impact on the quality of assessment of the chest lymph nodes in patients with sarcoidosis, regardless of the experience of the observer.
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Overuse of follow-up chest computed tomography in patients with incidentally identified nodules suspicious for lung cancer. J Cancer Res Clin Oncol 2021; 148:1147-1152. [PMID: 34236508 DOI: 10.1007/s00432-021-03692-6] [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: 02/22/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Although professional societies agreed that CT screening inconsistent with recommendation leads to radiation-related cancer and unexpected cost, many patients still undergo unnecessary Chest CT before treatment. The goal of this study was to assess the overuse of Chest CT in different type of patients. METHODS Data on 1853 patients who underwent pulmonary resection from May 2019 to May 2020 were retrospectively analyzed. Data collected include age, sex, follow-up period, density and size of nodules and frequency of undergoing Chest CT. Pearson χ2 test and logistic regression were conducted to compare the receipt of CT screening. RESULTS Among 1853 patients in the study, 689 (37.2%) overused Chest CT during follow-up of the pulmonary nodules. This rate was 16.2% among patients with solid nodules, 57.5% among patients with pure ground glass opacity (pGGO), and 41.4% among patients with mixed ground glass opacity (mGGO) (P < 0.001). 50.7% in the "age ≤ 40" group, 39.8% in the "41 ≤ age ≤ 50" group, 38.7% in the "51 ≤ age ≤ 60" group, 32.3% in the "61 ≤ age ≤ 70" group, 27.8% in the " > 70" group underwent unnecessary CT (P < 0.001). Female got more unnecessary CT than male (40.6% vs 32.8%, P < 0.001). Factors associated with a greater likelihood of overusing Chest CT was the density of nodules [odds ratios (ORs) of 0.53 for mGGO; 0.15 for solid nodule, P < 0.0001, vs patients with pGGO]. CONCLUSION Roughly 37% patients with pulmonary nodules received Chest CT too frequently despite national recommendations against the practice. Closer adherence to clinical guidelines is likely to result in more cost-effective care.
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Chen C, Wang X, Dong J, Nie D, Chen Q, Yang F, Chen W, Hu Q. Temporal lung changes in high-resolution chest computed tomography for coronavirus disease 2019. J Int Med Res 2020; 48:300060520950990. [PMID: 32951493 PMCID: PMC7506184 DOI: 10.1177/0300060520950990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To evaluate temporal lung changes in coronavirus disease 2019 (COVID-19) in high-resolution computed tomography (HRCT) and to determine the appropriate computed tomographic (CT) follow-up time. Methods Eighty-six patients with two or more HRCT scans who were diagnosed with COVID-19 were included. The CT score and major CT findings were evaluated. Results Eighty-two (95.3%) patients had lesions on the initial HRCT scans. Most scans showed bilateral, multifocal lung lesions, with multiple lobes involved and diffuse distribution. For fifty-seven patients with type I (progress compared with the initial CT score), the CT score reached a peak at 12 days and the nadir at 36 days. For twenty-nine patients with type II (no progress compared with the initial CT score), the lowest CT score was reached at 23 days. On the final HRCT scans (>21 days), patients with a reticular pattern were older than those without a reticular pattern. Conclusion The appropriate follow-up time of CT scans is during the second week (approximately 12 days) and the fourth to fifth weeks (approximately 23–36 days) from the onset of illness. These times could help reduce the CT radiation dose and show timely changes in the course of the disease by CT.
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Affiliation(s)
- Chengyang Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Dong
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dianer Nie
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianlan Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Yang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiongjie Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Qin Y, Xu Y, Ma D, Tian Z, Huang C, Zhou X, He J, Liu L, Guo C, Wang G, Zhang J, Wang Y, Liu H. Clinical characteristics of resected solitary ground-glass opacities: Comparison between benign and malignant nodules. Thorac Cancer 2020; 11:2767-2774. [PMID: 32844603 PMCID: PMC7529560 DOI: 10.1111/1759-7714.13575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The management of ground-glass opacities (GGOs) depends mainly on personal experience. In clinical practice, benign GGOs are not rare in resected specimens, for which operations may be avoided. We retrospectively compared the clinical features of resected GGOs to identify differential diagnostic characteristics. METHODS Among 1456 patients with suspected malignant GGOs who underwent surgical resection, 105 patients (35 with benign GGOs and 70 matched controls with malignant GGOs) were included. Clinical characteristics, including demographics and radiologic, surgical and pathologic characteristics, were collected. RESULTS The smoking index (P = 0.044), frequency of coughing (P = 0.026), GGO size (P = 0.003), size change during follow-up (P = 0.011), location (P = 0.022), presence of air bronchogram sign (P = 0.004), distance to the pleura (P = 0.021) and positron emission tomography/computed tomography (PET/CT) appearance (P = 0.003) showed significant differences between the benign and malignant groups. Pathologically, the resected benign GGOs included focal fibrosis (17), inflammation or infection (seven), lymphoproliferative disorder (one), hamartoma (three), inflammatory myofibroblastic tumor (two), hemangioma or vascular malformation (two), endometriosis (two) and pulmonary cyst (one). CONCLUSIONS A higher smoking index, coughing, larger size, similar or increased size during follow-up, location in the upper and middle lobes, air bronchogram sign on CT, lesion margin to pleura distance over 1 cm, and malignant tendency on PET/CT reports were associated with malignant GGOs. Relatively active surgical interventions could be considered for GGOs highly suspected of malignancy.
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Affiliation(s)
- Yingzhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yuan Xu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Dongjie Ma
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Zhenhuan Tian
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiaoyun Zhou
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jia He
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yanqing Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Hongsheng Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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Du S, Gao S, Huang G, Li S, Chong W, Jia Z, Hou G, Wáng YXJ, Zhang L. Chest lesion CT radiological features and quantitative analysis in RT-PCR turned negative and clinical symptoms resolved COVID-19 patients. Quant Imaging Med Surg 2020; 10:1307-1317. [PMID: 32550139 DOI: 10.21037/qims-20-531] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Many studies have described lung lesion computed tomography (CT) features of coronavirus disease 2019 (COVID-19) patients at the early and progressive stages. In this study, we aim to evaluate lung lesion CT radiological features along with quantitative analysis for the COVID-19 patients ready for discharge. Methods From February 10 to March 10, 2020, 125 COVID-19 patients (age: 16-67 years, 63 males) ready for discharge, with two consecutive negative reverse transcription-polymerase chain reaction (RT-PCR) and no clinical symptoms for more than 3 days, were included. The pre-discharge CT was performed on all patients 1-3 days after the second negative RT-PCR test, and the follow-up CTs were performed on 44 patients 2-13 days later. The imaging features and quantitative analysis were evaluated on both the pre-discharge and the follow-up CTs, by both radiologists and an artificial intelligence (AI) software. Results On the pre-discharge CT, the most common CT findings included ground-glass opacity (GGO) (99/125, 79.2%) with bilateral mixed distribution, and fibrosis (56/125, 44.8%) with bilateral subpleural distribution. Enlarged mediastinal lymph nodes were also commonly observed (45/125, 36.0%). AI enabled quantitative analysis showed the right lower lobe was mostly involved, and lesions most commonly had CT value of -570 to -470 HU consistent with GGO. Follow-up CT showed GGO decrease in size and density (40/40, 100%) and fibrosis reduction (17/26, 65.4%). Compared with the pre-discharge CT results, quantitative analysis shows the lung lesion volume regressed significantly at follow-up. Conclusions For COVID-19 patients ready for discharge, GGO and fibrosis are the main CT features and they further regress at follow-up.
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Affiliation(s)
- Siyao Du
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Si Gao
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Guoliang Huang
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Shu Li
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Wei Chong
- Department of Emergency Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Ziyi Jia
- Department of Emergency Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Lina Zhang
- Department of Radiology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
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11
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Eggleton EJ. Simple, fast and affordable triaging pathway for COVID-19. Postgrad Med J 2020; 97:192-195. [PMID: 32439731 DOI: 10.1136/postgradmedj-2020-138029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 has caused a global pandemic. The majority of patients will experience mild disease, but others will develop a severe respiratory infection that requires hospitalisation. This is causing a significant strain on health services. Patients are presenting at emergency departments with symptoms of dyspnoea, dry cough and fever with varying severity. The appropriate triaging of patients will assist in preventing health services becoming overwhelmed during the pandemic. This is assisted through clinical assessment and various imaging and laboratory investigations, including chest X-ray, blood analysis and identification of viral infection with SARS-CoV-2. Here, a succinct triaging pathway that aims to be fast, reliable and affordable is presented. The hope is that such a pathway will assist health services in appropriately combating the pandemic.
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Affiliation(s)
- Elizabeth Jane Eggleton
- Cardiology Department, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK .,Medical School, The University of Newcastle, Newcastle upon Tyne, UK
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12
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Ma H, Hu J, Tian J, Zhou X, Li H, Laws MT, Wesemann LD, Zhu B, Chen W, Ramos R, Xia J, Shao J. A single-center, retrospective study of COVID-19 features in children: a descriptive investigation. BMC Med 2020; 18:123. [PMID: 32370747 PMCID: PMC7200209 DOI: 10.1186/s12916-020-01596-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/16/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Compared to adults, there are relatively few studies on COVID-19 infection in children, and even less focusing on the unique features of COVID-19 in children in terms of laboratory findings, locations of computerized tomography (CT) lesions, and the role of CT in evaluating clinical recovery. The objective of this study is to report the results from patients at Wuhan Children's Hospital, located within the initial center of the outbreak. METHODS Clinical, imaging, and laboratory data of 76 children were collected retrospectively and analyzed with the Fisher exact test and Cox regression statistical methods. RESULTS Among 50 children with a positive COVID-19 real-time reverse-transcriptase polymerase chain reaction (PCR), five had negative PCR results initially but showed positive results in subsequent tests. Eight (16%) patients had lymphopenia, seven (14%) with thrombocytopenia, four (8%) with lymphocytosis, two (4%) with thrombocytosis, ten (20%) with elevated C-reactive protein, four (8%) with hemoglobin above, and six (12%) with below standard reference values. Seven (14%) of the 50 had no radiologic evidence of disease on chest CT. For the 43 patients who had abnormal CT findings, in addition to previously reported patterns of ground-glass opacity (67%), local patchy shadowing (37%), local bilateral patchy shadowing (21%), and lesion location of lower lobes (65%), other CT features include that an overwhelming number of pediatric patients had lesions in the subpleural area (95%) and 22 of the 28 lower lobe lesions were in the posterior segment (78%). Lesions in most of the 15 patients (67%) who received chest CT at discharge were not completely absorbed, and 26% of these pediatric patients had CT lesions that were either unchanged or worse. CONCLUSIONS There were a few differences between COVID-19 children and COVID-19 adults in terms of laboratory findings and CT characteristics. CT is a powerful tool to detect and characterize COVID-19 pneumonia but has little utility in evaluating clinical recovery for children. These results oppose current COVID-19 hospital discharge criteria in China, as one requirement is that pulmonary imaging must show significant lesion absorption prior to discharge. These differences between pediatric and adult cases of COVID-19 may necessitate pediatric-specific discharge criteria.
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Affiliation(s)
- Huijing Ma
- Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No.100 Hongkong Road, Wuhan, 430016, China
| | - Jiani Hu
- Department of Radiology, School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Jie Tian
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, 100191, China
| | - Xi Zhou
- Department of Radiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, 3002 SunGang Xi Road West, Shenzhen, 518035, China
| | - Hui Li
- Medical department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No.100 Hongkong Road, Wuhan, 430016, China
| | - Maxwell Thomas Laws
- Department of Radiology, School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Luke David Wesemann
- Department of Radiology, School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Baiqi Zhu
- Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No.100 Hongkong Road, Wuhan, 430016, China
| | - Wei Chen
- Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
- Pingshan District People's Hospital, Pingshan General Hospital of Southern Medical University, Shenzhen, 518118, Guangdong, China
| | - Rafael Ramos
- Department of Radiology, School of Medicine, Wayne State University, Detroit, MI, 48201, USA
| | - Jun Xia
- Department of Radiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, 3002 SunGang Xi Road West, Shenzhen, 518035, China.
| | - Jianbo Shao
- Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No.100 Hongkong Road, Wuhan, 430016, China.
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13
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Wang YXJ, Liu WH, Yang M, Chen W. The role of CT for Covid-19 patient's management remains poorly defined. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:145. [PMID: 32175437 DOI: 10.21037/atm.2020.02.71] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Yi Xiang J Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Wei-Hong Liu
- Department of Radiology, General hospital of China Resources & Wuhan Iron and Steel Corporation, Wuhan 430080, China
| | - Mo Yang
- Research Centre, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China
| | - Wei Chen
- Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China.,Pingshan District People's Hospital, Pingshan General Hospital of Southern Medical University, Shenzhen 518118, China
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14
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Lin S, Lin M, Lau K. Efficacy of model-based iterative reconstruction in cystic fibrosis assessment using CT. Clin Radiol 2019; 74:569.e19-569.e27. [DOI: 10.1016/j.crad.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/11/2019] [Indexed: 02/03/2023]
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15
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Gunnell ET, Franceschi DK, Inscoe CR, Hartman A, Goralski JL, Ceppe A, Handly B, Sams C, Fordham LA, Lu J, Zhou O, Lee YZ. Initial clinical evaluation of stationary digital chest tomosynthesis in adult patients with cystic fibrosis. Eur Radiol 2019; 29:1665-1673. [PMID: 30255248 PMCID: PMC6896210 DOI: 10.1007/s00330-018-5703-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/19/2018] [Accepted: 07/31/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The imaging evaluation of cystic fibrosis currently relies on chest radiography or computed tomography. Recently, digital chest tomosynthesis has been proposed as an alternative. We have developed a stationary digital chest tomosynthesis (s-DCT) system based on a carbon nanotube (CNT) linear x-ray source array. This system enables tomographic imaging without movement of the x-ray tube and allows for physiological gating. The goal of this study was to evaluate the feasibility of clinical CF imaging with the s-DCT system. MATERIALS AND METHODS CF patients undergoing clinically indicated chest radiography were recruited for the study and imaged on the s-DCT system. Three board-certified radiologists reviewed both the CXR and s-DCT images for image quality relevant to CF. CF disease severity was assessed by Brasfield score on CXR and chest tomosynthesis score on s-DCT. Disease severity measures were also evaluated against subject pulmonary function tests. RESULTS Fourteen patients underwent s-DCT imaging within 72 h of their chest radiograph imaging. Readers scored the visualization of proximal bronchi, small airways and vascular pattern higher on s-DCT than CXR. Correlation between the averaged Brasfield score and averaged tomosynthesis disease severity score for CF was -0.73, p = 0.0033. The CF disease severity score system for tomosynthesis had high correlation with FEV1 (r = -0.685) and FEF 25-75% (r = -0.719) as well as good correlation with FVC (r = -0.582). CONCLUSION We demonstrate the potential of CNT x-ray-based s-DCT for use in the evaluation of cystic fibrosis disease status in the first clinical study of s-DCT. KEY POINTS • Carbon nanotube-based linear array x-ray tomosynthesis systems have the potential to provide diagnostically relevant information for patients with cystic fibrosis without the need for a moving gantry. • Despite the short angular span in this prototype system, lung features such as the proximal bronchi, small airways and pulmonary vasculature have improved visualization on s-DCT compared with CXR. Further improvements are anticipated with longer linear x-ray array tubes. • Evaluation of disease severity in CF patients is possible with s-DCT, yielding improved visualization of important lung features and high correlation with pulmonary function tests at a relatively low dose.
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Affiliation(s)
- Elias Taylor Gunnell
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Dora K Franceschi
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Christina R Inscoe
- Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Allison Hartman
- Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jennifer L Goralski
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Division of Pediatric Pulmonology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Agathe Ceppe
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Brian Handly
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Cassandra Sams
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lynn Ansley Fordham
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jianping Lu
- Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Otto Zhou
- Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Yueh Z Lee
- Department of Physics and Astronomy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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16
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Showalter K, Hoffmann A, Rouleau G, Aaby D, Lee J, Richardson C, Dematte J, Agrawal R, Chang RW, Hinchcliff M. Performance of Forced Vital Capacity and Lung Diffusion Cutpoints for Associated Radiographic Interstitial Lung Disease in Systemic Sclerosis. J Rheumatol 2018; 45:1572-1576. [PMID: 30275265 DOI: 10.3899/jrheum.171362] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Forced vital capacity (FVC) and DLCO are used for screening of systemic sclerosis-associated interstitial lung disease (SSc-ILD). The study purpose was to determine the sensitivity, specificity, and negative predictive value (NPV) (proportion of true negative screening tests) of FVC and DLCO thresholds for SSc-ILD on chest high-resolution computed tomography (HRCT) scans. METHODS Patients fulfilling American College of Rheumatology 2013 SSc criteria with a chest HRCT scan and pulmonary function tests (PFT) were studied. A thoracic radiologist quantified radiographic ILD. Optimal FVC and DLCO % predicted thresholds for ILD were identified using receiver-operating characteristic curves. The FVC and DLCO combinations with greatest sensitivity and specificity were also determined. Subanalysis was performed in patients with positive Scl-70 autoantibodies. RESULTS The study included 265 patients. Of 188 (71%) with radiographic ILD, 59 (31%) had "normal" FVC (≥ 80% predicted), and 65 out of 151 (43%) had "normal" DLCO (≥ 60% predicted). FVC < 80% (sensitivity 0.69, specificity 0.73), and DLCO < 62% (sensitivity 0.60, specificity 0.70) were optimal thresholds for radiographic SSc-ILD. All FVC and DLCO threshold combinations evaluated had NPV < 0.70. The NPV for radiographic ILD for FVC < 80% was lower in patients with positive Scl-70 autoantibody (NPV = 0.05) compared to negative Scl-70 autoantibody (NPV = 0.57). CONCLUSION Radiographic ILD is prevalent in SSc despite "normal" PFT. No % predicted FVC or DLCO threshold combinations yielded high NPV for SSc-ILD screening. "Normal" FVC and DLCO in patients with SSc, especially those with positive Scl-70 autoantibodies, should not obviate consideration of HRCT for ILD evaluation.
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Affiliation(s)
- Kimberly Showalter
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Aileen Hoffmann
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Gerald Rouleau
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - David Aaby
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Jungwha Lee
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Carrie Richardson
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Jane Dematte
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Rishi Agrawal
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Rowland W Chang
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Monique Hinchcliff
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. .,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine.
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Gharbi S, Labidi S, Mars M, Chelli M, Meftah S, Ladeb MF. Assessment of organ dose and image quality in head and chest CT examinations: a phantom study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2018; 38:807-818. [PMID: 29869615 DOI: 10.1088/1361-6498/aac336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this study is to assess dose for radiosensitive organs and image quality in head and chest computed tomography (CT) examinations. Our focus was in the brain, eye lens and lung organs using two protocols; one protocol with fixed mAs and filtered back projection (FBP) and another with tube current modulation (TCM) and sinogram affirmed iterative reconstruction (SAFIRE). Measurements were performed on a 128-slice CT scanner by placing thermoluminescent dosimeters (TLDs) in an anthropomorphic adult phantom. Results were compared to a CT-Expo software. Objective image quality was assessed in terms of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). SPSS software was used for data analyses. Results showed that, using TCM, doses were reduced by 22.84%-25.06% for brain, by 21.82%-23.48% for eye lens and by 54%-53.22% for lung with TLD and CT-Expo respectively. The increased SNR and CNR values achieved for scans performed with TCM combined with iterative reconstruction techniques were 38.68%-58.81% and 38.91%-43.60% respectively. We conclude that, using TCM, a significant mean organ dose reduction is achieved for brain, eye lens and lung organs. Then, combined with iterative reconstruction, image quality was well maintained in terms of SNR and CNR. Thus it is highly recommended in clinical practice optimization in head and chest CT examinations.
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Affiliation(s)
- S Gharbi
- Université Tunis EL Manar, Institut Supérieur des Technologies Médicales de Tunis, Laboratoire de recherche de Biophysique et de Technologies Médicales, 9, Avenue du Docteur Z. Essafi, Tunis 1006, Tunisia
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Ittyachen AM, Vijayan A, Isac M. The forgotten view: Chest X-ray - Lateral view. Respir Med Case Rep 2017; 22:257-259. [PMID: 29021952 PMCID: PMC5633363 DOI: 10.1016/j.rmcr.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022] Open
Abstract
With CT (computed tomography) chest gaining more importance as a diagnostic tool, chest X-ray especially the lateral view is taken less commonly nowadays. Besides CT chest is also proven to be superior to chest X-ray in patients with major blunt trauma. We are presenting a 68-year old male who was partially treated from outside for a left sided pneumonia. He came to our hospital because of persisting chest pain. Chest X-ray, frontal view (postero-anterior) was almost normal except for a mild opacity in the left lower zone. CT scan of the chest revealed a fluid collection posteriorly enclosed within enhancing pleura. Chest X-ray, left lateral view showed a corresponding posterior pleural based opacity. We are presenting this case to highlight the importance of the lateral view of the chest X-ray. In selected cases there is still a role for the lateral view. With the three dimensional visualization provided by the CT, the lateral view of the chest may be easier to understand. Consequent to the initial diagnosis by CT further follow up can be done with the chest X-ray. In a limited way this mitigates unnecessary expenditure and more importantly prevents the patient from exposure to harmful radiation in the form of repeated CT.
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Sambataro D, Sambataro G, Dal Bosco Y, Campagna D, Polosa R. Is there any role for thoracic ultrasound for interstitial lung disease underlying rheumatologic conditions? Intern Emerg Med 2017; 12:283-285. [PMID: 28260220 DOI: 10.1007/s11739-017-1642-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 02/24/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Domenico Sambataro
- ArtroReuma srl, Outpatient of Rheumatology Accredited with National Health System, Corso San Vito 53, 95030, Mascalucia, CT, Italy.
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
- , Via G. Vitale 1, 95028, Valverde, CT, Italy.
| | - Gianluca Sambataro
- ArtroReuma srl, Outpatient of Rheumatology Accredited with National Health System, Corso San Vito 53, 95030, Mascalucia, CT, Italy
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Ylenia Dal Bosco
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Davide Campagna
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Riccardo Polosa
- Institute of Internal and Emergency Medicine, Teaching Hospital "Policlinico, Vittorio Emanuele" University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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20
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Gao JW, Rizzo S, Ma LH, Qiu XY, Warth A, Seki N, Hasegawa M, Zou JW, Li Q, Femia M, Lv TF, Song Y. Pulmonary ground-glass opacity: computed tomography features, histopathology and molecular pathology. Transl Lung Cancer Res 2017; 6:68-75. [PMID: 28331826 PMCID: PMC5344841 DOI: 10.21037/tlcr.2017.01.02] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/15/2016] [Indexed: 12/20/2022]
Abstract
The incidence of pulmonary ground-glass opacity (GGO) lesions is increasing as a result of the widespread use of multislice spiral computed tomography (CT) and the low-dose CT screening for lung cancer detection. Besides benign lesions, GGOs can be a specific type of lung adenocarcinomas or their preinvasive lesions. Evaluation of pulmonary GGO and investigation of the correlation between CT imaging features and lung adenocarcinoma subtypes or driver genes can be helpful in confirming the diagnosis and in guiding the clinical management. Our review focuses on the pathologic characteristics of GGO detected at CT, involving histopathology and molecular pathology.
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Affiliation(s)
- Jian-Wei Gao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Stefania Rizzo
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Li-Hong Ma
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Xiang-Yu Qiu
- The Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Arne Warth
- The Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Translational Lung Research Centre Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Nobuhiko Seki
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Mizue Hasegawa
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
- Department of Respiratory Medicine, Tokyo Women’s Medical University, Yachiyo Medical Center, Tokyo, Japan
| | - Jia-Wei Zou
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qian Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Marco Femia
- Università degli studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy
| | - Tang-Feng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - written on behalf of the AME Lung Cancer Collaborative Group
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Department of Radiology, European Institute of Oncology, Milan, Italy
- The Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
- Translational Lung Research Centre Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
- Department of Respiratory Medicine, Tokyo Women’s Medical University, Yachiyo Medical Center, Tokyo, Japan
- Università degli studi di Milano, Postgraduation School in Radiodiagnostics, Milan, Italy
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Abstract
Idiopathic interstitial pneumonias are a heterogeneous group of diffuse lung diseases characterized by distinct clinicopathologic entities with the usual interstitial pneumonia (UIP) being the most common. The pattern of UIP can be seen in idiopathic pulmonary fibrosis (IPF) as well as in secondary causes, most commonly in connective tissue diseases. IPF is usually progressive and associated with a very poor prognosis, and newer therapies pose a risk of serious complications; therefore, diagnostic certainty is crucial. This article reviews the radiologic findings in UIP with clinical correlation and histopathologic features along with its significance for prognosis and patients monitoring.
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Affiliation(s)
- Joanna E Kusmirek
- Department of Radiology, Virginia Commonwealth University, 1250 East Marshall Street, Richmond, VA 23298, USA.
| | - Maria Daniela Martin
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin, 600 Highland Avenue, Madison, WI 53792-3252, USA
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Prevalence of negative CT scans in a level one trauma center. Eur J Trauma Emerg Surg 2016; 44:29-33. [PMID: 27866218 DOI: 10.1007/s00068-016-0741-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The rise of computed tomography (CT) use in trauma has become the subject of concern given the harms of CT including radiation, cost, over diagnosis and identification of incidental lesions. We developed a novel metric, the Negative CT Score, (∑CT-) which quantifies how often CT imaging identifies important injuries. Our objective was to describe the pattern of CT utilization in trauma at an urban academic level one trauma center using this novel metric. METHODS This was a retrospective study of intermediate level trauma patients who received CT imaging over a 1-year study period at an urban level one trauma center. We applied the Negative CT Score, (∑CT-) to quantify the results of CT imaging. ∑CT- is computed by subtracting the number of non-extremity body regions (maximum four: head, neck, chest, abdomen) with an important positive CT finding (defined by a priori criteria) from the total number of non-extremity body regions scanned. RESULTS Of the 552 cases reviewed during the study period, 410 (74.3%) were male and the mean age was 40.3 years [SD ± 21.2]. Four hundred eighty-six patients (88.0%) suffered blunt trauma; 66 (12.0%) suffered penetrating trauma. The average injury severity score for admitted patients was seven. Four hundred ninety-five cases had at least one CT performed. The average number of regions per patient that received CT imaging was 2.36 (SD ± 1.3), and the average ∑CT- was 2.10 (SD ± 1.2). Three hundred and sixty-seven (74.3%) patients had no important findings on CT imaging. CONCLUSIONS In a consecutive series of 552 intermediate trauma patients at our urban trauma center, 2.36 body regions were scanned per patient; of these, 2.10 regions revealed no important CT findings. We hope that these results and the Negative CT Score can be used to identify trends, variations in practice, and outliers within and across departments so that CT utilization can be optimized.
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Irodi A, Leena RV, Prabhu SM, Gibikote S. Role of Computed Tomography in Pediatric Chest Conditions. Indian J Pediatr 2016; 83:675-90. [PMID: 26916888 DOI: 10.1007/s12098-015-1955-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 11/04/2015] [Indexed: 12/15/2022]
Abstract
CT is the preferred cross-sectional imaging modality for detailed evaluation of anatomy and pathology of the lung and tracheobronchial tree, and plays a complimentary role in the evaluation of certain chest wall, mediastinal, and cardiac abnormalities. The article provides an overview of indications and different types of CT chest, findings in common clinical conditions, and briefly touches upon the role of each team member in optimizing and thus reducing radiation dose.
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Affiliation(s)
- Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - R V Leena
- Department of Radiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | - Shailesh M Prabhu
- Department of Radiology, SSM Superspeciality Hospital, Hassan, Karnataka, India
| | - Sridhar Gibikote
- Department of Radiology, Christian Medical College, Vellore, 632004, Tamil Nadu, India.
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Franklin D, Swift L, Flavel A. ‘Virtual anthropology’ and radiographic imaging in the Forensic Medical Sciences. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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25
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Zarb F, McEntee MF, Rainford L. A multi-phased study of optimisation methodologies and radiation dose savings for head CT examinations. RADIATION PROTECTION DOSIMETRY 2015; 163:480-490. [PMID: 25009189 DOI: 10.1093/rpd/ncu227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The impact of optimisation methods on dose reductions for head computerised tomography was undertaken in three phases for two manufacturer models. Phase 1: a Catphan(®)600 was employed to evaluate protocols where the impact of parameter manipulation on dose and image quality was gauged by psychophysical measurements of contrast and spatial resolution in terms of contrast discs and line pairs. mA, kV and pitch were systematically altered until the optimisation threshold was identified. Phantom studies provide dose comparisons during optimisation but lack anatomical detail. Phase 2: optimised protocols were tested on a porcine model permitting further dose reductions over phantom findings providing anatomical structures for image quality evaluation using relative visual grading analysis of anatomical criteria. Phase 3: patient images using pre- and post-optimised protocols were clinically audited using visual grading characteristic analysis and ordinal regression analysis providing a robust analysis of image quality data prior to clinical implementation.
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Affiliation(s)
- Francis Zarb
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Mark F McEntee
- Discipline of Medical Radiation Sciences and Brain and Mind Research Institute, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Louise Rainford
- School of Medicine and Medical Science, Health Science Centre, University College Dublin, Belfield Dublin 4, Ireland
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What is the minimal radiation dose that can be used for detecting pleural effusion? AJR Am J Roentgenol 2014; 203:118-22. [PMID: 24951204 DOI: 10.2214/ajr.13.11842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to assess the effect of radiation dose reduction on the detection of pleural effusions, thickening, and calcifications. MATERIALS AND METHODS Forty-five human cadavers (mean age at death, 60 ± 17 [SD] years; male-female ratio, 29:16; mean body mass index, 29 ± 5.7 [SD] kg/m(2)) were scanned at seven different dose levels (CT Dose Index volume [CTDIvol] = 20, 12, 10, 6, 4, 2, and 0.8 mGy) on a 128-MDCT unit (Definition FLASH). Images were reconstructed at a 3-mm slice thickness and 2-mm increment with filtered back projection (FBP) technique. Two chest radiologists independently reviewed all image series for the detection of pleural effusion, pleural calcification, and adjacent parenchymal opacification from atelectasis or consolidation. Objective image noise was measured at each dose level on the pleural effusion using ImageJ software. Data analysis was performed with the Student t test and kappa test. RESULTS Pleural effusions were seen in 39 of 45 cadavers on image series acquired at 2-20 mGy. Only 14 of 39 pleural effusions were identified at 0.8 mGy. Pleural effusions were not detected in 25 of 39 cadavers at 0.8 mGy because of photon starvation and increased image noise. Patient size was significantly larger in subjects with undetected pleural effusion than in those with detectable pleural effusion at 0.8 mGy (p < 0.01). Pleural calcifications and thickening (seen at 2-10 mGy images in three of three cadavers) were not identified on 0.8-mGy FBP images. On the other hand, adjacent parenchymal opacification could be assessed at all dose levels. The mean CT numbers of the pleural effusion were significantly lower on 0.8-mGy images than on images obtained at all other dose levels (-21 ± 55 [SD] vs 17.6 ± 19 HU, respectively) (p < 0.001). CONCLUSION Pleural effusions, thickening, and calcifications can be seen on FBP images reconstructed at a CTDIvol as low as 2 mGy (32-cm body phantom). CT at 0.8 mGy may provide suboptimal information on very small pleural effusions, pleural thickening, and calcifications.
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Image quality and radiation dose of 128-slice dual-source CT venography using low kilovoltage combined with high-pitch scanning and automatic tube current modulation. Int J Cardiovasc Imaging 2013; 29 Suppl 1:47-51. [PMID: 23748369 DOI: 10.1007/s10554-013-0252-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
To compare vascular enhancement, image quality, and radiation dose of 128-slice dual-source CT venography (CTV) between an imaging setting of 120 kVp with low pitch, and a setting of 100 kVp combined with high pitch and automatic tube current modulation. A total of 100 patients with suspected deep vein thrombosis and varicose veins were divided into two groups: Group 1 [50 patients, 120 kVp, low pitch (0.6), and fixed 120 mA) and Group 2 (50 patients, 100 kVp, high pitch (3.0), and automatic tube current modulation]. Two radiologists, who were blinded to the image protocol, assessed vascular enhancement and image noise in the inferior vena cava (IVC), femoral vein, and popliteal vein. They also assigned an image quality score independently using a 5-point visual scale. Effective dose was estimated using the dose-length product (DLP). Group demographics, radiation dose, vascular enhancement, image noise, and image quality in the two groups were analyzed. Mean vascular enhancement of the IVC, femoral vein, and popliteal vein was significantly higher in group 2 than in group 1, and images in group 2 had significantly higher image noise. However, there were no significant differences in subjective image quality score of the IVC, femoral vein, and popliteal vein. The mean DLP in group 2 (402.10 ± 94.29 mGy cm) was significantly lower than that in group 1 (973.36 ± 63.20 mGy cm) (P < 0.001). Lower extremity CTV using 100 kVp, high pitch (3.0), and automatic tube current modulation improved vascular enhancement with acceptable image quality and low radiation dose.
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Ay MR, Mehranian A, Maleki A, Ghadiri H, Ghafarian P, Zaidi H. Experimental assessment of the influence of beam hardening filters on image quality and patient dose in volumetric 64-slice X-ray CT scanners. Phys Med 2013; 29:249-60. [DOI: 10.1016/j.ejmp.2012.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 02/08/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022] Open
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Adams JM, Bilaniuk JW, Difazio LT, Siegel BK, Durling-Grover R, Mccarthy D, Grob P, Bobbin MD, Skerker RS, NÉMeth ZH. Standard Computed Tomography of the Chest, Abdomen, and Pelvis Is Sensitive and Cost-Effective for the Detection of Fractures of the Shoulder Girdle. Am Surg 2011. [DOI: 10.1177/000313481107700931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Computed tomography of the chest, abdomen, and pelvis (CTCAP) has become the mainstay of diagnosis in stable blunt trauma patients. The purpose of this study was to investigate whether standard CTCAP has adequate sensitivity to identify fractures of the scapula, clavicle, and humeral head to replace routine radiographs of the shoulder. A retrospective chart review was carried out from January 1, 2004, to December 31, 2007, at Morristown Memorial Hospital. Inclusion criteria were all shoulder fracture patients in our trauma registry who underwent both a CTCAP and plain radiographs of the injured shoulder. Data were collected for patient age, sex, Injury Severity Score, mechanism of injury, and fracture location. Sensitivity was calculated for each diagnostic modality as well as hospital costs and radiation dose of plain radiographs. A total of 374 charts were reviewed and 98 patients were included in the study with a total of 117 fractures. The sensitivity of trauma CTCAP for scapula fractures was 100 per cent, clavicle fractures 98 per cent, and humeral head fractures 100 per cent. The sensitivity of the shoulder series for scapula fractures was 60 per cent, clavicle fractures 85 per cent, and humeral head fractures 100 per cent. The plain radiographs added $298 in hospital charges and 0.191 mSv of radiation per patient. CTCAP is a sensitive tool for identifying fractures in the shoulder girdle. Therefore, CTCAP can replace the routine radiographs of the shoulder resulting in less total radiation exposure of the trauma patients. This also would lead to lower healthcare cost and better diagnostic workflow.
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Affiliation(s)
- John M. Adams
- Departments of Surgery, Morristown Medical Center, Morristown, New Jersey
| | | | - Louis T. Difazio
- Departments of Surgery, Morristown Medical Center, Morristown, New Jersey
| | - Brian K. Siegel
- Departments of Surgery, Morristown Medical Center, Morristown, New Jersey
| | | | - Denise Mccarthy
- Departments of Radiology, Morristown Medical Center, Morristown, New Jersey
| | - Patricio Grob
- Atlantic Orthopedic Associates, Morristown Medical Center, Morristown, New Jersey
| | - Mark D. Bobbin
- Departments of Radiology, Morristown Medical Center, Morristown, New Jersey
| | - Robert S. Skerker
- Atlantic Rehabilitation Institute, Atlantic Health, Morristown, New Jersey
| | - ZoltÁN H. NÉMeth
- Departments of Surgery, Morristown Medical Center, Morristown, New Jersey
- Department of Surgery, UMDNJ–New Jersey Medical School, Newark, New Jersey
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Zarb F, Rainford L, McEntee MF. Developing optimized CT scan protocols: Phantom measurements of image quality. Radiography (Lond) 2011. [DOI: 10.1016/j.radi.2010.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Arrangoiz R, Opreanu RC, Mosher BD, Morrison CA, Stevens P, Kepros JP. Reduction of Radiation Dose in Pediatric Brain CT is not Associated with Missed Injuries or Delayed Diagnosis. Am Surg 2010. [DOI: 10.1177/000313481007601128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increased accuracy of CTs in the identification of traumatic injuries compared with physical examination or conventional radiography is well documented. Our goal was to identify the most effective strategy for decreasing radiation exposure while retaining the benefits of computerized imaging. Based on a literature review and our trauma registry, the mortality risk of untreated injuries was compared with that of patients who received treatment of injuries diagnosed by CT. Because automated exposure control of tube current is not routinely used with brain CT, this region was identified as the initial focus for a dose-saving algorithm. CT settings were adjusted for children studies and the new settings were implemented into four protocols based on age. Images were compared and reviewed by radiologists for the ability to identify traumatic injuries. Effective dose (ED) was estimated using Monte Carlo simulations. The lifetime incidence and mortality for thyroid cancer and leukemia were assessed. In-hospital mortality of unidentified injury in trauma patients is 8.0%. Forty dose-saving CTs were performed and no injuries were missed. The ED decreased by 5.2-, 4.5-, 2.62-, and 2.5-fold in each group. Decreasing the ED is achievable, theoretically decreases the cancer risk and does not increase the missed injury rate.
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Affiliation(s)
- Rodrigo Arrangoiz
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
| | - Razvan C. Opreanu
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
| | | | - Chet A. Morrison
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
- Sparrow Health System, East Lansing, Michigan
| | | | - John P. Kepros
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, Michigan
- Sparrow Health System, East Lansing, Michigan
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O'Connor OJ, Vandeleur M, McGarrigle AM, Moore N, McWilliams SR, McSweeney SE, O'Neill M, Ni Chroinin M, Maher MM. Development of low-dose protocols for thin-section CT assessment of cystic fibrosis in pediatric patients. Radiology 2010; 257:820-9. [PMID: 20876388 DOI: 10.1148/radiol.10100278] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To develop low-dose thin-section computed tomographic (CT) protocols for assessment of cystic fibrosis (CF) in pediatric patients and determine the clinical usefulness thereof compared with chest radiography. MATERIALS AND METHODS After institutional review board approval and informed consent from patients or guardians were obtained, 14 patients with CF and 11 patients without CF (16 male, nine female; mean age, 12.6 years ± 5.4 [standard deviation]; range, 3.5-25 years) who underwent imaging for clinical reasons underwent low-dose thin-section CT. Sections 1 mm thick (protocol A) were used in 10 patients, and sections 0.5 mm thick (protocol B) were used in 15 patients at six levels at 120 kVp and 30-50 mA. Image quality and diagnostic acceptability were scored qualitatively and quantitatively by two radiologists who also quantified disease severity at thin-section CT and chest radiography. Effective doses were calculated by using a CT dosimetry calculator. RESULTS Low-dose thin-section CT was performed with mean effective doses of 0.19 mSv ± 0.03 for protocol A and 0.14 mSv ± 0.04 for protocol B (P < .005). Diagnostic acceptability and depiction of bronchovascular structures at lung window settings were graded as almost excellent for both protocols, but protocol B was inferior to protocol A for mediastinal assessment (P < .02). Patients with CF had moderate lung disease with a mean Bhalla score of 9.2 ± 5.3 (range, 0-19), compared with that of patients without CF (1.1 ± 1.4; P < .001). There was excellent correlation between thin-section CT and chest radiography (r = 0.88-0.92; P < .001). CONCLUSION Low-dose thin-section CT can be performed at lower effective doses than can standard CT, approaching those of chest radiography. Low-dose thin-section CT could be appropriate for evaluating bronchiectasis in pediatric patients, yielding appropriate information about lung parenchyma and bronchovascular structures.
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Affiliation(s)
- Owen J O'Connor
- Department of Radiology, University College Cork and Cork University Hospital, Wilton, Cork 1111, Ireland
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Hammad AMM, Regal MA. Is Routine Spiral CT-Chest Justified in Evaluation of the Major Blunt Trauma Patients? Eur J Trauma Emerg Surg 2008; 35:31-4. [DOI: 10.1007/s00068-008-8025-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 06/11/2008] [Indexed: 11/27/2022]
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Abstract
OBJECTIVE This article aims to summarize the available data on reducing radiation dose exposure in routine chest CT protocols. First, the general aspects of radiation dose in CT and radiation risk are discussed, followed by the effect of changing parameters on image quality. Finally, the results of previous radiation dose reduction studies are reviewed, and important information contributing to radiation dose reduction will be shared. CONCLUSION A variety of methods and techniques for radiation dose reduction should be used to ensure that radiation exposure is kept as low as is reasonably achievable.
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