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Moglioni M, Carra P, Arezzini S, Belcari N, Bersani D, Berti A, Bisogni MG, Calderisi M, Ceppa I, Cerello P, Ciocca M, Ferrero V, Fiorina E, Kraan AC, Mazzoni E, Morrocchi M, Pennazio F, Retico A, Rosso V, Sbolgi F, Vitolo V, Sportelli G. Synthetic CT imaging for PET monitoring in proton therapy: a simulation study. Phys Med Biol 2024; 69:065011. [PMID: 38373343 DOI: 10.1088/1361-6560/ad2a99] [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: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 02/21/2024]
Abstract
Objective.This study addresses a fundamental limitation of in-beam positron emission tomography (IB-PET) in proton therapy: the lack of direct anatomical representation in the images it produces. We aim to overcome this shortcoming by pioneering the application of deep learning techniques to create synthetic control CT images (sCT) from combining IB-PET and planning CT scan data.Approach.We conducted simulations involving six patients who underwent irradiation with proton beams. Leveraging the architecture of a visual transformer (ViT) neural network, we developed a model to generate sCT images of these patients using the planning CT scans and the inter-fractional simulated PET activity maps during irradiation. To evaluate the model's performance, a comparison was conducted between the sCT images produced by the ViT model and the authentic control CT images-serving as the benchmark.Main results.The structural similarity index was computed at a mean value across all patients of 0.91, while the mean absolute error measured 22 Hounsfield Units (HU). Root mean squared error and peak signal-to-noise ratio values were 56 HU and 30 dB, respectively. The Dice similarity coefficient exhibited a value of 0.98. These values are comparable to or exceed those found in the literature. More than 70% of the synthetic morphological changes were found to be geometrically compatible with the ones reported in the real control CT scan.Significance.Our study presents an innovative approach to surface the hidden anatomical information of IB-PET in proton therapy. Our ViT-based model successfully generates sCT images from inter-fractional PET data and planning CT scans. Our model's performance stands on par with existing models relying on input from cone beam CT or magnetic resonance imaging, which contain more anatomical information than activity maps.
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Affiliation(s)
- Martina Moglioni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Pietro Carra
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Silvia Arezzini
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Nicola Belcari
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Davide Bersani
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - Andrea Berti
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Maria Giuseppina Bisogni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | | | | | - Piergiorgio Cerello
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | - Mario Ciocca
- Centro Nazionale di Adroterapia Oncologica, I-27100 Pavia, Italy
| | - Veronica Ferrero
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | - Elisa Fiorina
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | | | - Enrico Mazzoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - Matteo Morrocchi
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | - Francesco Pennazio
- Istituto Nazionale di Fisica Nucleare, Sezione di Torino, I-10125 Torino, Italy
| | - Alessandra Retico
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
| | - Valeria Rosso
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
| | | | - Viviana Vitolo
- Centro Nazionale di Adroterapia Oncologica, I-27100 Pavia, Italy
| | - Giancarlo Sportelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, I-56127 Pisa, Italy
- Dipartimento di Fisica, Università di Pisa, I-56127 Pisa, Italy
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Fischerova D, Frühauf F, Burgetova A, Haldorsen IS, Gatti E, Cibula D. The Role of Imaging in Cervical Cancer Staging: ESGO/ESTRO/ESP Guidelines (Update 2023). Cancers (Basel) 2024; 16:775. [PMID: 38398166 PMCID: PMC10886638 DOI: 10.3390/cancers16040775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
Following the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) joint guidelines (2018) for the management of patients with cervical cancer, treatment decisions should be guided by modern imaging techniques. After five years (2023), an update of the ESGO-ESTRO-ESP recommendations was performed, further confirming this statement. Transvaginal/transrectal ultrasound (TRS/TVS) or pelvic magnetic resonance (MRI) enables tumor delineation and precise assessment of its local extent, including the evaluation of the depth of infiltration in the bladder- or rectal wall. Additionally, both techniques have very high specificity to confirm the presence of metastatic pelvic lymph nodes but fail to exclude them due to insufficient sensitivity to detect small-volume metastases, as in any other currently available imaging modality. In early-stage disease (T1a to T2a1, except T1b3) with negative lymph nodes on TVS/TRS or MRI, surgicopathological staging should be performed. In all other situations, contrast-enhanced computed tomography (CECT) or 18F-fluorodeoxyglucose positron emission tomography combined with CT (PET-CT) is recommended to assess extrapelvic spread. This paper aims to review the evidence supporting the implementation of diagnostic imaging with a focus on ultrasound at primary diagnostic workup of cervical cancer.
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Affiliation(s)
- Daniela Fischerova
- Gynecologic Oncology Centre, Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic; (F.F.); (D.C.)
| | - Filip Frühauf
- Gynecologic Oncology Centre, Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic; (F.F.); (D.C.)
| | - Andrea Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic;
| | - Ingfrid S. Haldorsen
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, N-5021 Bergen, Norway;
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Elena Gatti
- Department of Biomedical Science for Health, University of Milan, 20133 Milan, Italy;
| | - David Cibula
- Gynecologic Oncology Centre, Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 121 08 Prague, Czech Republic; (F.F.); (D.C.)
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Suter B, Anthis AHC, Zehnder A, Mergen V, Rosendorf J, Gerken LRH, Schlegel AA, Korcakova E, Liska V, Herrmann IK. Surgical Sealant with Integrated Shape-Morphing Dual Modality Ultrasound and Computed Tomography Sensors for Gastric Leak Detection. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2301207. [PMID: 37276437 PMCID: PMC10427398 DOI: 10.1002/advs.202301207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/26/2023] [Indexed: 06/07/2023]
Abstract
Postoperative anastomotic leaks are the most feared complications after gastric surgery. For diagnostics clinicians mostly rely on clinical symptoms such as fever and tachycardia, often developing as a result of an already fully developed, i.e., symptomatic, surgical leak. A gastric fluid responsive, dual modality, electronic-free, leak sensor system integrable into surgical adhesive suture support materials is introduced. Leak sensors contain high atomic number carbonates embedded in a polyacrylamide matrix, that upon exposure to gastric fluid convert into gaseous carbon dioxide (CO2 ). CO2 bubbles remain entrapped in the hydrogel matrix, leading to a distinctly increased echogenic contrast detectable by a low-cost and portable ultrasound transducer, while the dissolution of the carbonate species and the resulting diffusion of the cation produces a markedly reduced contrast in computed tomography imaging. The sensing elements can be patterned into a variety of characteristic shapes and can be combined with nonreactive tantalum oxide reference elements, allowing the design of shape-morphing sensing elements visible to the naked eye as well as artificial intelligence-assisted automated detection. In summary, shape-morphing dual modality sensors for the early and robust detection of postoperative complications at deep tissue sites, opening new routes for postoperative patient surveillance using existing hospital infrastructure is reported.
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Affiliation(s)
- Benjamin Suter
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Alexandre H. C. Anthis
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Anna‐Katharina Zehnder
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
| | - Victor Mergen
- Diagnostic and Interventional RadiologyUniversity Hospital ZurichUniversity of ZurichRämistrasse 100Zürich8091Switzerland
| | - Jachym Rosendorf
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Lukas R. H. Gerken
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Andrea A. Schlegel
- Department of Surgery and TransplantationSwiss HPB CentreUniversity Hospital ZurichRämistrasse 100Zurich8091Switzerland
- Fondazione IRCCS Ca' GrandaOspedale Maggiore PoliclinicoCentre of Preclinical ResearchMilan20122Italy
- Transplantation Center, Digestive Disease and Surgery Institute and Department of Immunity and Inflammation, Lerner Research InstituteCleveland Clinic9620 Carnegie AveClevelandOH44106United States
| | - Eva Korcakova
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
- Department of Imaging MethodsFaculty of Medicine in Pilsen, Charles UniversityAlej Svobody 80Pilsen30460Czech Republic
| | - Vaclav Liska
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Inge K. Herrmann
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
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Service evaluation of radiographer-led vetting and protocoling of Computed Tomography (CT) scan requests in a Singapore public healthcare institution. Radiography (Lond) 2023; 29:139-144. [PMID: 36370639 DOI: 10.1016/j.radi.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A service improvement project involving the vetting and protocoling of Computed Tomography (CT) scan requests by qualified CT radiographers was initiated in 2018. AIM This study provides a comprehensive evaluation of how a radiographer-led initiative aims to ensure that the CT scan requests received by the Radiology department are clinically appropriate, which in turn will reduce interruptions to the interpretation and reporting of imaging examinations by radiologists, who might otherwise be required to attend to clinically inappropriate and wrongly protocolled CT scan requests. METHOD Outpatient CT scan requests received from July to October 2021 were vetted and protocolled by a qualified CT-trained radiographer for parameters which included the appropriateness of the clinical indication, adequacy of patient preparation for the scan, as well as the suitability of the requested examination protocol pertaining to the need for contrast media, multiple contrast-enhanced imaging phases, and the appropriateness of the scan range. RESULTS Poor patient preparation and insufficient or inaccurate clinical indications were the most common findings during the vetting process (71%). Out of the 64 CT scan requests with protocol errors, 77% were attributed to contrast media type errors. The odds of incorrect CT scan requests increased with the requesting clinician's rank, while there was no such significant correlation with the clinical specialty of the requesting clinician or the CT scan type. CONCLUSION The meticulous vetting of imaging requests helps to ensure that limited imaging hardware resources are allocated to more clinically appropriate cases, correct protocols are applied to requested imaging scans, and that patients undergoing imaging are adequately prepared, thereby enhancing overall patient care. IMPLICATIONS FOR PRACTICE Vetting of imaging requests by radiographers, who are capable to make appropriate clinical decisions related to their enhanced level of practice ensures patient safety and optimisation of Radiology resources.
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Al-Hayek Y, Zheng X, Hayre C, Spuur K. The influence of patient positioning on radiation dose in CT imaging: A narrative review. J Med Imaging Radiat Sci 2022; 53:737-747. [PMID: 36280573 DOI: 10.1016/j.jmir.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Although it is fundamental for optimal scanner operation, it is generally accepted that accurate patient centring cannot always be achieved. This review aimed to examine the reported knowledge of the negative impact of patient positioning on radiation dose and image quality during CT imaging. Furthermore, the study evaluated the current optimisation tools and techniques used to improve patient positioning relative to the gantry iso-center. METHODOLOGY A comprehensive search through the databases PubMed, Ovid, and Google Scholar was performed. Keywords included patient off-centring, patient positioning, localiser radiograph orientation, radiation dose, and automatic patient positioning (including synonyms). The search was limited to full-text articles that were written in English. After initial title and abstract screening, a total of 52 articles were identified to address the aim of the review. No limitations were imposed on the year of publication. RESULTS Vertical off-centring was reported in up to 95% of patients undergoing chest and abdominal CT examinations, showing a significant influence on radiation dose. Depending on the scanner model and vendor, localiser orientation, bowtie filter used, and patient size, radiation dose varied from a decrease of 36% to an increase of 91%. A significant dose reduction was demonstrated when utilising an AP localiser, aligning with the trend for radiographers to off-center patients below the gantry iso-centre. Utilizing a 3D camera for body contour detection allowed for more accurate patient positioning and promoted further dose reduction. CONCLUSION Patient positioning has shown significant effects on radiation dose and image quality in CT. Developing a good understanding of the key factors influencing patient dose (off-centring direction, localiser orientation, patient size and bowtie filter selection) is critical in optimising CT scanning practices. Utilising a 3D camera for body contour detection is strongly recommended to improve patient positioning accuracy, image quality and to minimise patient dose.
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Affiliation(s)
- Yazan Al-Hayek
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia; Department of Medical Imaging, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, 13133, Jordan.
| | - Xiaoming Zheng
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
| | - Christopher Hayre
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, Devon, UK.
| | - Kelly Spuur
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, NSW, 2650, Australia.
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Ugwuanyi DC, Sibeudu TF, Irole CP, Ogolodom MP, Nwagbara CT, Ibekwe AM, Mbaba AN. Evaluation of common findings in brain computerized tomography (CT) scan: A single center study. AIMS Neurosci 2020; 7:311-318. [PMID: 32995488 PMCID: PMC7519969 DOI: 10.3934/neuroscience.2020017] [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] [Received: 05/15/2020] [Accepted: 08/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Computed Tomography (CT) is an invaluable imaging tool in the diagnostic workup of patients presenting with head trauma, stroke, brain tumour and epilepsy. The objective of this study was to document the common intracranial pathologies as revealed by CT in our setting and also determine if the indications for CT scan are justified so that patients are not exposed to radiation unnecessarily. Materials and methods This was a cross-sectional study carried out in Hansa Clinic Enugu, Enugu State, Nigeria. Demographic data and brain CT radiological reports with imaging findings and clinical indications for patients referred to this study centre from January, 2017 to January 2019 were retrieved from the CT reports' archives and reviewed retrospectively. Relevant information such age, gender, radiological CT findings and clinical indications were collected using structured proforma. Results A total of 300 patients' brain CT radiological reports were included in this study. The mean age of the patients was 41.25 ± 16.5 years with majority been within the age group of 31–40 years 92 (30.67%). Out of 300 cases, normal finding was highest 117 (39%) and the least was intracranial physiological calcification, which is 1 (0.33%). Headache is the most common clinical indication, 53 (17.67%) the least was unsteady Gait, which is 3 (1%). The Chi-square test revealed that there was statistically significance relationship between brain CT findings and clinical indications for the investigations (X2 = 285.60, p = 0.002). Conclusion The study showed that more males than females undergo brain CT scan with headache being the most common presenting complaint. The majority of findings of the brain CT scans in this study are normal despite, myriads of complaints necessitating the investigations. The study also revealed significant association between clinical indications and CT findings.
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Affiliation(s)
- Daniel Chimuanya Ugwuanyi
- Department of Medical Radiography and Radiological Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Tochukwu Florence Sibeudu
- Department of Nursing Sciences, Faculty of Health sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | - Chidmma Precious Irole
- Department of Medical Radiography and Radiological Sciences, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
| | | | - Chukwudi Thaddeus Nwagbara
- Cardiology Unit, Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria
| | - Adaobi Maryann Ibekwe
- Department of Nursing Sciences, Faculty of Health sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
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Almujally A, Sulieman A, Calliada F. Patients Radiation Risks from Computed Tomography Lymphography. J Clin Imaging Sci 2020; 10:46. [PMID: 32874751 PMCID: PMC7451181 DOI: 10.25259/jcis_92_2020] [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] [Received: 06/08/2020] [Accepted: 07/10/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: This study aims to first measure patient doses during computed tomography (CT) chest, abdomen, and extremities procedures for evaluation lymphedema, and second to estimate the radiation dose-related risks during the procedures. Material and Methods: Radiation effective doses from CT lymphography procedures quantified using CT machines from different vendors. After the calibration of CT systems, the data collected for a total of 28 CT lymphography procedures. Effective and organ doses extrapolated using national radiological protection software based on Monte Carlo simulation. Results: The mean patient doses for chest and abdomen procedures in term of CTDIvol (mGy) and DLP (mGy.cm) are 10.0 ± 3 and 425 ± 222 and 24 ± 12 and 1118 ± 812 for CT 128 and CT 16 slice, respectively. The mean DLP (mGy.cm) for extremities was 320 ± 140 and 424 ± 212 for CT 128 and CT 16 slice, in that order. Conclusion: Patients’ dose showed significant differences due to variation in the scan length and clinical indication. Organs lay in the primary beam received high radiation doses especially in the chest region which increases the probability of radiation-induced cancer. The current patient’s doses are higher compared to the previous studies.
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Affiliation(s)
- Abdullah Almujally
- Departments of Radiology, Fondazione IRCCS Policlinico S. Matteo, School University of Pavia, Pavia, Italy
| | - Abdelmoneim Sulieman
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Fabrizio Calliada
- Departments of Radiology, Fondazione IRCCS Policlinico S. Matteo, School University of Pavia, Pavia, Italy
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Imai S, Akahane M, Imamura T. Computed Tomography: Return on Investment and Regional Disparity Factor Analysis. Front Public Health 2019; 6:380. [PMID: 30687691 PMCID: PMC6335945 DOI: 10.3389/fpubh.2018.00380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022] Open
Abstract
The number of computed tomography (CT) systems in operation in Japan is approximately 4.3 times higher than that of the OECD average. However, CT systems are expensive, and thus, a heavy financial burden for hospital management. We calculate the annual net profits from CT introduction in Japan for single-slice CT (SSCT), multi-slice CT (MSCT), number of hospital beds, and prefecture. We also analyze the factors that affect CT profitability. First, the annual income per CT in operation is estimated for 2011. Second, the annual costs per CT are calculated as the sum of depreciation, maintenance, and labor costs. Finally, the annual net profits per CT are estimated for SSCT and MSCT, the number of hospital beds, and prefecture. A correlation analysis between the annual net profits, population, and number of physicians per CT equipment is used to determine the determinants of the net CT profits by prefecture. Our results show that, for hospitals with fewer than 100 beds, the annual net CT profits are higher for SSCT than MSCT, and vice versa for hospitals with at least 100 beds. Both SSCT and MSCT increased profits as the number of hospital beds increased. The annual net CT profits per prefecture are USD −12,105 for SSCT and USD 87,233 for MSCT, on average. The annual net profits per prefecture and population per CT show positive correlations with both SSCT and MSCT, as do the annual net profits per prefecture and number of physicians per CT. Thus, choosing high-performance MSCT is advantageous in terms of profitability in facilities with at least 100 beds. Additionally, CT profitability presumably affects the balance between the number of introduced CTs, population per CT, and number of physicians per CT.
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Affiliation(s)
- Shinya Imai
- Faculty of Health Sciences, Butsuryo College of Osaka, Osaka, Japan
| | - Manabu Akahane
- Department of Public Health, Health Management and Policy, y, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, y, Nara, Japan
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Lahham A, ALMasri H. ESTIMATION OF RADIATION DOSES FROM ABDOMINAL COMPUTED TOMOGRAPHY SCANS. RADIATION PROTECTION DOSIMETRY 2018; 182:235-240. [PMID: 29660098 DOI: 10.1093/rpd/ncy054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/19/2018] [Indexed: 06/08/2023]
Abstract
A total of 120 adult female and male patients randomly selected from 10 hospitals in the West Bank and Gaza Strip were investigated for organ and effective doses from abdominal computed tomography scan. The organs considered in this study are liver, stomach and colon. Assessment of radiation doses was performed by using a commercially available Monte Carlo based software VirtualDose™ CT, a product of Virtual Phantoms, Inc. The software utilizes male and female tissue equivalent mathematical phantoms of all ages and sizes from new born up to morbidly obese patients. The corresponding phantom was selected for every patient according to patient's demographic parameters. Patient demographic data, scanning parameters and dose indicators (including patient body mass index (BMI), milliampere-second (mAs), X-ray tube kilovoltage (kVp), computed tomography dose index (CTDIvol), dose length product (DLP), manufacturer, name and type of operated CT scanner) were recorded for every examination. The collected parameters were used to calculate the organ and effective doses for every patient. The highest estimated patient organ doses were 25 mGy for liver, 20 mGy for stomach and 30 mGy for colon for a male patient with BMI of 30 kg/m2 and 90 kg of weight. This patient correspondent effective dose was 9 mSv. The average effective dose for the entire patient population was 5.5 mSv with a range between 2 and 10 mSv. The highest effective dose was found for a female patient with a BMI of 26.6 kg/m2, and 77 kg of weight. This patient correspondent organ doses were 14, 9 and 14 mGy for the liver, stomach and colon, respectively. The average organs doses per patient estimated for patients from all investigated hospitals were 13.1, 7.6 and 13.2 mGy for liver, stomach and colon, respectively. Both effective dose and organ doses increase with BMI and body weight. In general, the estimated radiation doses from abdominal CT examinations in this study are low and comparable with those published in the literature.
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Affiliation(s)
- Adnan Lahham
- Center For Radiation Science & Technology, Al-Quds University, East Jerusalem, Palestine
| | - Hussein ALMasri
- Center For Radiation Science & Technology, Al-Quds University, East Jerusalem, Palestine
- Medical Imaging Department, Al-Quds University, East Jerusalem, Palestine
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Quinn B, Dauer Z, Pandit-Taskar N, Schoder H, Dauer LT. Radiation dosimetry of 18F-FDG PET/CT: incorporating exam-specific parameters in dose estimates. BMC Med Imaging 2016; 16:41. [PMID: 27317478 PMCID: PMC4912712 DOI: 10.1186/s12880-016-0143-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022] Open
Abstract
Background Whole body fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the standard of care in oncologic diagnosis and staging, and patient radiation dose must be well understood to balance exam benefits with the risk from radiation exposure. Although reference PET/CT patient doses are available, the potential for widely varying total dose prompts evaluation of clinic-specific patient dose. The aims of this study were to use exam-specific information to characterize the radiation dosimetry of PET/CT exams that used two different CT techniques for adult oncology patients and evaluate the practicality of employing an exam-specific approach to dose estimation. Methods Whole body PET/CT scans from two sets of consecutive adult patients were retrospectively reviewed. One set received a PET scan with a standard registration CT and the other a PET scan with a diagnostic quality CT. PET dose was calculated by modifying the standard reference phantoms in OLINDA/EXM 1.1 with patient-specific organ mass. CT dose was calculated using patient-specific data in ImPACT. International Commission on Radiological Protection publication 103 tissue weighting coefficients were used for effective dose. Results One hundred eighty three adult scans were evaluated (95 men, 88 women). The mean patient-specific effective dose from a mean injected 18F-FDG activity of 450 ± 32 MBq was 9.0 ± 1.6 mSv. For all standard PET/CT patients, mean effective mAs was 39 ± 11 mAs, mean CT effective dose was 5.0 ± 1.0 mSv and mean total effective dose was 14 ± 1.3 mSv. For all diagnostic PET/CT patients, mean effective mAs was 120 ± 51 mAs, mean CT effective dose was 15.4 ± 5.0 mSv and mean total effective dose was 24.4 ± 4.3 mSv. The five organs receiving the highest organ equivalent doses in all exams were bladder, heart, brain, liver and lungs. Conclusions Patient-specific parameters optimize the patient dosimetry utilized in the medical justification of whole body PET/CT referrals and optimization of PET and CT acquisition parameters. Incorporating patient-specific data into dose estimates is a worthwhile effort for characterizing patient dose, and the specific dosimetric information assists in the justification of risk and optimization of PET/CT.
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Affiliation(s)
- Brian Quinn
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Zak Dauer
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Heiko Schoder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Lawrence T Dauer
- Department of Medical Physics, Box 84, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
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Vasco MAA, Souza JTAD, Las Casas EBD, de Castro e Silva ALR, Hecke M. A method for constructing teeth and maxillary bone parametric model from clinical CT scans. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2014. [DOI: 10.1080/21681163.2014.889579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Symonette CJ, Gan BS. Computed tomography-based preoperative vascular imaging in autologous breast reconstruction: A Canadian perspective. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2014; 21:11-4. [PMID: 24431929 DOI: 10.1177/229255031302100107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There appears to be increased use of computed tomography angiography (CTA) in the preoperative planning of autologous perforator flap breast reconstruction. Despite the advantages of providing superior anatomical detail, concerns regarding cost and radiation exposure of this technique remain. In the current study, a paper-based survey was distributed to 44 plastic surgeons with a special interest in breast reconstruction at 19 different centres across Canada to collect their perspectives and practice characteristics with respect to the use of CTA as a preoperative imaging modality in breast reconstruction. The response rate of the survey was 75%. The majority of respondents commonly use perforator flap breast reconstruction and CTA in their breast reconstruction practice. Surgeons identified particular benefits of CTA in patients who had previously undergone abdominal surgery. However, more than one-half of the overall cohort was concerned about radiation exposure associated with CTA. A review of the literature suggests that it may be worthwhile to reduce the unnecessary risks of additional radiation exposure to the breast cancer population. A prospective study may help to better define the group of patients in whom CTA will provide optimal benefits in terms of reducing perioperative microvascular morbidity.
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Affiliation(s)
- Caitlin Jane Symonette
- Schulich School of Medicine and Dentistry, Western University, London, Ontario ; Department of Surgery, Division of Plastic Surgery, Western University, London, Ontario
| | - Bing Siang Gan
- Schulich School of Medicine and Dentistry, Western University, London, Ontario ; Department of Surgery, Division of Plastic Surgery, Western University, London, Ontario ; Department of Medical Biophysics, Western University, London, Ontario
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13
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Yoganandan N, Pintar FA, Lew SM, Rao RD. Geometrical properties of the human child cervical spine with a focus on the C1 vertebra. TRAFFIC INJURY PREVENTION 2014; 15:287-293. [PMID: 24372501 DOI: 10.1080/15389588.2013.811719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Child dummies and injury criteria used in automotive crashworthiness environments are based on scaling from the adult and/or between children of different ages. Cartilage-to-bone ossification, spinal canal and joint developments of the spine, and strength attainments do not grow linearly from birth to maturity. Though this is known to medical professionals, age-based quantitative analyses are needed to accurately model the pediatric spine. The objective of this study was to quantify longitudinal growths of various regions of the first cervical vertebrae, responsible for transmitting the axial load from the base of the skull through the condyles to the neck/torso. METHODS Computed tomography (CT) images of 54 children from one day to 18 years of age were retrospectively used to determine the following geometrical properties: bilateral neurocentral synchondroses widths, the width of posterior synchondrosis, outer and inner anteroposterior and transverse diameters, spinal canal area, and depths of the anterior and posterior arches of the C1 vertebra. Both axial and sagittal CT images were used in the analysis. Sagittal images were used to quantify data for the anterior and posterior arches and axial images were used for all described cross-sectional parameters. RESULTS Geometrical properties were extracted and reported for the various parameters at 6 months; one year; 18 months; and 3, 6, and 10 years of age corresponding to the dummy family ages routinely used in motor vehicle crashworthiness research and other applications. The outer transverse diameter ranged from 4.97 to 7.08 cm; outer and inner antero-posterior diameters ranged from 2.99 to 4.18 and 2.19 to 3.03 mm; and spinal canal area ranged from 4.34 to 6.68 mm(2). Other data are given in the body of the article. The growths of the first cervical vertebra quantified in terms of the above variables occurred nonlinearly with age and the degree of nonlinearity depended on the type of the geometrical parameter. Growths did not match with the simple scaling ratios based on the adult spine, used in different studies reported in the current literature. CONCLUSIONS These early nonlinear and nonuniform age- and local geometry-specific variations should be considered in human finite element models for an accurate transfer of the external load from the atlas to the subaxial spine and to improve their fidelity and biomechanical capabilities.
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Affiliation(s)
- Narayan Yoganandan
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
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Ma S, Kong B, Liu B, Liu X. Biological effects of low-dose radiation from computed tomography scanning. Int J Radiat Biol 2013; 89:326-33. [PMID: 23216318 DOI: 10.3109/09553002.2013.756595] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE With the widespread use of computed tomography (CT), the risks of low-dose radiation from CT have been increasingly highlighted. This study aims to illustrate the CT-induced biological effects and analyze the potential beneficial or harmful outcomes so as to provide radiologists with reasonable advice on CT usage. MATERIALS AND METHODS The related literature was analyzed according to the topics of stochastic effect, hereditary effect, deterministic effect, accumulative injuries, hormesis and adaptive response; population epidemiology data were also analyzed. RESULTS CT accounts for 9% of X-ray examinations and approximately 40-67% of medical-related radiation, the dose is within the range of low-dose radiation (LDR). Two opposite viewpoints exist nowadays regarding the biological effects of CT scanning: They are either harmful or harmless. Approximately 0.6% and 1.5% of the cumulative cancer risk could be attributed to diagnostic X-rays in the UK and Germany, respectively. The probability of CT scans induced-cancer is about 0.7% and CT angiography's risk is around 0.13%. It is estimated that approximately 29,000 cancers could be related to CT scans in the USA every year. Meanwhile, another investigation of 25,104 patients who underwent 45,632 CT scans in 4 years showed that the majority of CT-induced cancers were accidents rather than certainties of frequent CT scans. CONCLUSION Although the LDR effects of CT are still controversial, the current problems include the high frequency-use and abuse of CT scans, the increase of radiation dose and accumulative dose in high-accuracy CT, and the poor understanding of carcinogenic risks. The underlying biological basis needs further exploring and the ratio of risks and benefits should be considered.
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Affiliation(s)
- Shumei Ma
- Key Laboratory of Radiobiology (Ministry of Health), School of Public Health, Jilin University, Changchun, China
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15
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Superko HR, Roberts R, Agatston A, Frohwein S, Reingold JS, White TJ, Sninsky JJ, Margolis B, Momary KM, Garrett BC, King SB. Genetic testing for early detection of individuals at risk of coronary heart disease and monitoring response to therapy: challenges and promises. Curr Atheroscler Rep 2011; 13:396-404. [PMID: 21830102 PMCID: PMC3165136 DOI: 10.1007/s11883-011-0198-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coronary heart disease (CHD) often presents suddenly with little warning. Traditional risk factors are inadequate to identify the asymptomatic high-risk individuals. Early identification of patients with subclinical coronary artery disease using noninvasive imaging modalities would allow the early adoption of aggressive preventative interventions. Currently, it is impractical to screen the entire population with noninvasive coronary imaging tools. The use of relatively simple and inexpensive genetic markers of increased CHD risk can identify a population subgroup in which benefit of atherosclerotic imaging modalities would be increased despite nominal cost and radiation exposure. Additionally, genetic markers are fixed and need only be measured once in a patient's lifetime, can help guide therapy selection, and may be of utility in family counseling.
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Affiliation(s)
- H. Robert Superko
- Celera Corporation, 1401 Harbor Bay Parkway, Alameda, CA 94502 USA
- Saint Joseph’s Hospital of Atlanta, 665 Peachtree Dunwoody Road, N.E., Atlanta, GA 30342 USA
- College of Pharmacy and Health Sciences, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341-4415 USA
- Cholesterol, Genetics, and Heart Disease Institute, 40 Bear Paw, Portola Valley, CA 94028 USA
| | - Robert Roberts
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada
| | - Arthur Agatston
- South Beach Preventive Cardiology, 1691 Michigan Ave, #500, Miami Beach, FL 33139 USA
| | - Stephen Frohwein
- Saint Joseph’s Hospital of Atlanta, 665 Peachtree Dunwoody Road, N.E., Atlanta, GA 30342 USA
| | - Jason S. Reingold
- Saint Joseph’s Hospital of Atlanta, 665 Peachtree Dunwoody Road, N.E., Atlanta, GA 30342 USA
| | - Thomas J. White
- Celera Corporation, 1401 Harbor Bay Parkway, Alameda, CA 94502 USA
| | - John J. Sninsky
- Celera Corporation, 1401 Harbor Bay Parkway, Alameda, CA 94502 USA
| | - Basil Margolis
- Saint Joseph’s Hospital of Atlanta, 665 Peachtree Dunwoody Road, N.E., Atlanta, GA 30342 USA
| | - Kathryn M. Momary
- Saint Joseph’s Hospital of Atlanta, 665 Peachtree Dunwoody Road, N.E., Atlanta, GA 30342 USA
- College of Pharmacy and Health Sciences, Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341-4415 USA
| | - Brenda C. Garrett
- Cholesterol, Genetics, and Heart Disease Institute, 40 Bear Paw, Portola Valley, CA 94028 USA
| | - Spencer B. King
- Saint Joseph’s Hospital of Atlanta, 665 Peachtree Dunwoody Road, N.E., Atlanta, GA 30342 USA
- Emory University, Atlanta, GA USA
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Yoganandan N, Pintar FA, Lew SM. Quantitative analyses of pediatric cervical spine ossification patterns using computed tomography. ANNALS OF ADVANCES IN AUTOMOTIVE MEDICINE. ASSOCIATION FOR THE ADVANCEMENT OF AUTOMOTIVE MEDICINE. ANNUAL SCIENTIFIC CONFERENCE 2011; 55:159-168. [PMID: 22105393 PMCID: PMC3256844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The objective of the present study was to quantify ossification processes of the human pediatric cervical spine. Computed tomography images were obtained from a high resolution scanner according to clinical protocols. Bone window images were used to identify the presence of the primary synchondroses of the atlas, axis, and C3 vertebrae in 101 children. Principles of logistic regression were used to determine probability distributions as a function of subject age for each synchondrosis for each vertebra. The mean and 95% upper and 95% lower confidence intervals are given for each dataset delineating probability curves. Posterior ossifications preceded bilateral anterior closures of the synchondroses in all vertebrae. However, ossifications occurred at different ages. Logistic regression results for closures of different synchondrosis indicated p-values of <0.001 for the atlas, ranging from 0.002 to <0.001 for the axis, and 0.021 to 0.005 for the C3 vertebra. Fifty percent probability of three, two, and one synchondroses occurred at 2.53, 6.97, and 7.57 years of age for the atlas; 3.59, 4.74, and 5.7 years of age for the axis; and 1.28, 2.22, and 3.17 years of age for the third cervical vertebrae, respectively. Ossifications occurring at different ages indicate non-uniform maturations of bone growth/strength. They provide an anatomical rationale to reexamine dummies, scaling processes, and injury metrics for improved understanding of pediatric neck injuries.
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Affiliation(s)
- Narayan Yoganandan
- CORRESPONDING AUTHOR: Narayan Yoganandan, PhD, Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA;
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