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Goo HW. Contrast-Enhanced CT Protocol for the Fontan Pathway: Comparison Between 1- and 3-Minute Scan Delays. Pediatr Cardiol 2022; 43:1104-1113. [PMID: 35107628 DOI: 10.1007/s00246-022-02830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
Optimal enhancement of the Fontan pathway is crucial for the accurate CT evaluation. Current guidelines for contrast-enhanced CT protocols are rather inconsistent in scan delays and injection methods. This single-center, retrospective study was performed to compare objective measures of contrast enhancement between 1- and 3-min scan delays (41 and 36 patients, respectively) to determine a better contrast-enhanced CT protocols for evaluating the Fontan pathway. In both groups, a biphasic injection protocol, in which 50% diluted contrast agent (the amount of iodinated contrast agent: 2.0 mL/kg; the amount of saline: 2.0 mL/kg) was injected at the injection rate of 0.5‒2.5 mL/s for 50 s followed by a saline flush at the same injection rate (0.5‒2.5 mL/s), was used. The degree and heterogeneity of cardiovascular enhancement, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were quantitatively evaluated. The mean densities of all cardiovascular structures were significantly higher in the 1-min delay protocol than in the 3-min delay protocols (p < 0.001). Heterogeneous enhancement (normalized standard deviation > 0.70) in the Fontan pathway was significantly more frequent in the 1-min delay protocol (p < 0.001). No significant differences were found in image noise (p > 0.141) and the frequency showing suboptimal noise (p = 1.000) between the two protocols. SNR and CNR were significantly lower in the 3-min delay protocol (p < 0.001). Compared with the 1-min delay protocol, the 3-min delay protocol achieved more homogeneous enhancement in the Fontan pathway on CT but showed lower contrast enhancement, SNR, and, CNR, indicating the need for further improvement.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Goo HW. Diagnostic imaging for absent pulmonary valve syndrome: an update with an emphasis on cardiothoracic computed tomography. Pediatr Radiol 2022; 52:1167-1174. [PMID: 35039934 DOI: 10.1007/s00247-021-05254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/11/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
Absent pulmonary valve syndrome is a rare congenital heart disease characterized by partial or complete absence of pulmonary valve cusps which commonly presents with respiratory difficulty during infancy. Because central airway compression by dilated central pulmonary arteries is a key pathology of this syndrome responsible for clinical presentation, severity, and outcome, cardiothoracic computed tomography (CT) is currently regarded as the imaging modality of choice before and after treatment. In addition, tracheobronchomalacia frequently responsible for persistent respiratory problems can be accurately evaluated with conventional two-dimensional cine CT or four-dimensional CT. In this pictorial review, various diagnostic imaging methods used to evaluate absent pulmonary valve syndrome are comprehensively illustrated with an emphasis on a recently spotlighted role of cardiothoracic CT.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Saengsin K, Pickard SS, Prakash A. Utility of cardiac CT in infants with congenital heart disease: Diagnostic performance and impact on management. J Cardiovasc Comput Tomogr 2021; 16:345-349. [PMID: 34949532 DOI: 10.1016/j.jcct.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/24/2021] [Accepted: 12/13/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Advances in cardiac CT (CCT) scanner technology allow imaging without anesthesia, and with low radiation dose, making it an attractive technique in infants with congenital heart disease. However, the utility of CCT using a dual-source scanner with respect to diagnostic performance and impact on management has not been systematically studied in this population. METHODS Retrospective review of infants who underwent CCT to determine the utility of CCT with respect to the following: answering the primary diagnostic question, providing new diagnostic information, prompting a change in management, and concordance with catheterization or surgical inspection. RESULTS A total of 156 infants underwent 172 scans at a median age of 64 days, (IQR 4-188) from Jan 2016-Dec 2019. The most frequent diagnostic question was related to the pulmonary arteries (43%), followed by the aortic arch (30%), pulmonary veins (26%), coronary arteries (17%), patent ductus arteriosus (10%) and others (9%). A high-pitch spiral scan was frequently used (90%). The median effective radiation dose was low (0.66 mSv) and general anesthesia was used infrequently (23%). CCT answered the primary diagnostic question in 168/172 (98%) and added to the diagnostic information already available by echocardiography in 161/172 (96%) scans. CCT led to a change in management following 78/172 (53%) scans and had an impact on management following 167/172 (97%) scans. On follow-up, after 107/172 (62%) scans, subjects underwent cardiac surgery, and after 55/172 (32%) scans, they had cardiac catheterization. CCT findings were concordant with catheterization and/or surgical inspection in 156/159 (98%) scans. CONCLUSIONS In infants with complex congenital heart disease, CCT was accurate, answered the diagnostic questions in nearly all cases, and frequently added diagnostic information that impacted management. Radiation exposure was low, and anesthesia was needed infrequently.
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Affiliation(s)
| | - Sarah S Pickard
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Virtual Noncontrast Images Derived From Contrast-Enhanced Dual-Layer Spectral Abdominal Computed Tomography. J Comput Assist Tomogr 2021; 46:71-77. [DOI: 10.1097/rct.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goo HW, Siripornpitak S, Chen SJ, Lilyasari O, Zhong YM, Latiff HA, Maeda E, Kim YJ, Tsai IC, Seo DM. Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications. Korean J Radiol 2021; 22:1397-1415. [PMID: 33987995 PMCID: PMC8316776 DOI: 10.3348/kjr.2020.1332] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Shyh Jye Chen
- Department of Medical Imaging, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yu Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai, China
| | - Haifa Abdul Latiff
- Pediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taichung, Taiwan
| | - Dong Man Seo
- Department of Cardiothoracic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
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Abstract
Computed tomography angiography (CTA) has become a mainstay for the imaging of vascular diseases, because of high accuracy, availability, and rapid turnaround time. High-quality CTA images can now be routinely obtained with high isotropic spatial resolution and temporal resolution. Advances in CTA have focused on improving the image quality, increasing the acquisition speed, eliminating artifacts, and reducing the doses of radiation and iodinated contrast media. Dual-energy computed tomography provides material composition capabilities that can be used for characterizing lesions, optimizing contrast, decreasing artifact, and reducing radiation dose. Deep learning techniques can be used for classification, segmentation, quantification, and image enhancement.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55904, USA.
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Eichler M, May M, Wiesmueller M, Saake M, Heiss R, Uder M, Wuest W. Single source split filter dual energy: Image quality and liver lesion detection in abdominal CT. Eur J Radiol 2020; 126:108913. [PMID: 32135408 DOI: 10.1016/j.ejrad.2020.108913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/23/2019] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Aim of this study was to evaluate image quality of single source dual energy CT (SSDE-CT) using split filter technique in oncologic abdominal CT. METHOD 51 consecutive patients with newly diagnosed breast carcinoma were prospectively enrolled in this study and underwent a staging examination of the abdomen using SSDE-CT (120 kV, split filter technique, 400 ref. mAs). Inline default images (DI) and post-processed virtual monoenergetic images at 40 keV, 50 keV, 60 keV, 70 keV and 80 keV were reconstructed. Objective image quality was evaluated as contrast to noise ratio (CNR) for liver parenchyma, portal vein, spleen, pancreas, aorta and hypoattenuating liver lesions. Subjective image quality was rated on a 5-point scale. Image quality at different keV settings was analyzed in paired t-tests. RESULTS CNR was highest at 40 keV for vessels (portal vein: 9.0, aorta: 8.8, all p < 0.001) and for upper abdominal organs (spleen: 4.8, all p < 0.001; pancreas: 2.7, all p < 0.01 except p = 0.93 for 50 keV; liver parenchyma: 3.4, all p < 0.01). Highest CNR values for hypoattenuating liver lesions were found at 40 keV (7.7, all p < 0.001). Overall subjective image quality was highest with 80 keV and DI (both 4.8, all p < 0.001). Artifacts were most pronounced at 40 keV. CONCLUSIONS High image quality can be obtained with SSDE-CT of the abdomen. Lowest monoenergetic reconstructions provide the highest image contrast and should be used for vessel evaluation. The best trade-off between artifacts and parenchymal contrast can be obtained with 80 keV images.
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Affiliation(s)
- Mathis Eichler
- Radiological Institute Friedrich-Alexander-University-Erlangen-Nuremberg, Germany.
| | - Matthias May
- Radiological Institute Friedrich-Alexander-University-Erlangen-Nuremberg, Germany.
| | - Marco Wiesmueller
- Radiological Institute Friedrich-Alexander-University-Erlangen-Nuremberg, Germany.
| | - Marc Saake
- Radiological Institute Friedrich-Alexander-University-Erlangen-Nuremberg, Germany.
| | - Rafael Heiss
- Radiological Institute Friedrich-Alexander-University-Erlangen-Nuremberg, Germany.
| | - Michael Uder
- Radiological Institute Friedrich-Alexander-University-Erlangen-Nuremberg, Germany.
| | - Wolfgang Wuest
- Radiological Institute Friedrich-Alexander-University-Erlangen-Nuremberg, Germany.
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Choe YH. Characteristics of Recent Articles Published in the Korean Journal of Radiology Based on the Citation Frequency. Korean J Radiol 2020; 21:1284. [PMID: 33236548 PMCID: PMC7689137 DOI: 10.3348/kjr.2020.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- HVSI Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hong SH, Goo HW, Maeda E, Choo KS, Tsai IC. User-Friendly Vendor-Specific Guideline for Pediatric Cardiothoracic Computed Tomography Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 1. Imaging Techniques. Korean J Radiol 2019; 20:190-204. [PMID: 30672159 PMCID: PMC6342752 DOI: 10.3348/kjr.2018.0571] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/30/2018] [Indexed: 12/13/2022] Open
Abstract
Optimal performance of pediatric cardiothoracic computed tomography (CT) is technically challenging and may need different approaches for different types of CT scanners. To meet the technical demands and improve clinical standards, a practical, user-friendly, and vendor-specific guideline for pediatric cardiothoracic CT needs to be developed for children with congenital heart disease (CHD). In this article, we have attempted to describe such guideline based on the consensus of experts in the Asian Society of Cardiovascular Imaging CHD Study Group. This first part describes the imaging techniques of pediatric cardiothoracic CT, and it includes recommendations for patient preparation, scan techniques, radiation dose, intravenous injection protocol, post-processing, and vendor-specific protocols.
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Affiliation(s)
- Sun Hwa Hong
- Department of Radiology, Mediplex Sejong Hospital, Incheon, Korea
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taiwan
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Oh J, Shin WJ, Jeong D, Yun TJ, Park CS, Choi ES, Choi JM, Gwak M, Song IK. Low Muscle Mass as a Prognostic Factor for Early Postoperative Outcomes in Pediatric Patients Undergoing the Fontan Operation: A Retrospective Cohort Study. J Clin Med 2019; 8:jcm8081257. [PMID: 31430973 PMCID: PMC6723208 DOI: 10.3390/jcm8081257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/16/2023] Open
Abstract
The impact of low muscle mass on pediatric cardiac patients remains unclear. We investigated the impact of low muscle mass on early postoperative outcomes in patients undergoing the Fontan operation. The electronic medical records of 74 patients (aged <18 years) who underwent the Fontan operation were retrospectively reviewed. The cross-sectional areas of the erector spinae and pectoralis muscles were measured using preoperative chest computed tomography (CT), normalized to the body surface area, and combined to obtain the total skeletal muscle index (TSMI). Low muscle mass was defined as a TSMI value lower than the median TSMI for the second quintile. The incidence of major postoperative complications was higher in patients with low muscle mass than in those with high muscle mass (48% (15/31) versus 14% (6/43); P = 0.003). Multivariable analyses revealed that a higher TSMI was associated with a lower likelihood of an increased duration of intensive care unit (>5 days) and hospital stay (>14 days) (odds ratio (OR) 0.86; 95% confidence interval (CI) 0.77–0.96; P = 0.006 and OR 0.92; 95% CI 0.85–0.99; P = 0.035 per 1 cm2/m2 increase in TSMI) and incidence of major postoperative complications (OR 0.90; 95% CI 0.82–0.99; P = 0.039 per 1 cm2/m2 increase in TSMI). Preoperative low muscle mass was associated with poor early postoperative outcomes in pediatric patients undergoing the Fontan operation.
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Affiliation(s)
- Jimi Oh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Won-Jung Shin
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - DaUn Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Tae-Jin Yun
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Chun Soo Park
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Eun Seok Choi
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Jae Moon Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Mijeung Gwak
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - In-Kyung Song
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
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Trends in radiation dose and image quality for pediatric patients with a multidetector CT and a third-generation dual-source dual-energy CT. Radiol Med 2019; 124:745-752. [PMID: 31004322 DOI: 10.1007/s11547-019-01037-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023]
Abstract
AIM To provide an overview on dose reduction and image quality after the installation of a third-generation dual-source CT (dsCT) in a Pediatric Radiology Department. MATERIALS AND METHODS We included pediatric patients (< 20 years old) undergoing CT for oncological staging (neck, chest and abdomen) or low-dose chest CT for lung diseases. Each of these two groups were further divided in two age groups (≤ or > 10 years old) including patients scanned in the same period of two consecutive years, in 2017 with a 16-row LightSpeed CT (GE Healthcare) or in 2018 with a Somatom Force dsCT (Siemens Healthineers). Technical parameters such as kVp, mAs, slice thickness, exposure times and dose indicators were retrieved and compared. Image quality was evaluated in consensus by two radiologists on a five-point semiquantitative scale. Nonparametric tests were used. RESULTS In oncological patients, significantly lower kVp and tube current with better image quality were achieved with the dsCT. Radiation dose (total DLP) was 5-6 times lower with dsCT, thanks also to virtual non-contrast images. In low-dose chest CT, the frequent use of tin filter required higher tube current; a total DLP 3 times lower was achieved with dsCT in patients ≤ 10 years old. The image quality was better with the dsCT in low-dose chest CT protocols. CONCLUSION The third-generation dsCT provides high-quality images with reduced motion artifacts at lower dose.
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Choe YH. A Glimpse on Trends and Characteristics of Recent Articles Published in the Korean Journal of Radiology. Korean J Radiol 2019; 20:1555-1561. [PMID: 31854145 PMCID: PMC6923209 DOI: 10.3348/kjr.2019.0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yeon Hyeon Choe
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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