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Welarathna S, Velautham S, Sarasanandarajah S. Towards the establishment of national diagnostic reference levels for abdomen, KUB, and lumbar spine x-ray examinations in Sri Lanka: a multi-centric study. J Radiol Prot 2024; 44:021506. [PMID: 38537259 DOI: 10.1088/1361-6498/ad3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Diagnostic reference levels (DRLs) and achievable doses (ADs) provide guidance to optimise radiation doses for patients undergoing medical imaging procedures. This multi-centre study aimed to compare institutional DRLs (IDRLs) across hospitals, propose ADs and multi-centric DRLs (MCDRLs) for four common x-ray examinations in Sri Lanka, and assess the potential for dose reduction. A prospective cross-sectional study of 894 adult patients referred for abdomen anteroposterior (AP), kidney-ureter-bladder (KUB) AP, lumbar spine AP, and lumbar spine lateral (LAT) x-ray examinations was conducted. Patient demographic information (age, sex, weight, BMI) and exposure parameters (tube voltage, tube current-exposure time product) were collected. Patient dose indicators were measured in terms of kerma-area product (PKA) using a PKAmeter. IDRLs, ADs, and MCDRLs were calculated following the International Commission on Radiological Protection guidelines, with ADs and MCDRLs defined as the 50th and 75th percentiles of the median PKAdistributions, respectively. IDRL ranges varied considerably across hospitals: 1.42-2.42 Gy cm2for abdomen AP, 1.51-2.86 Gy cm2for KUB AP, 0.83-1.65 Gy cm2for lumbar spine AP, and 1.76-4.10 Gy cm2for lumbar spine LAT. The proposed ADs were 1.82 Gy cm2(abdomen AP), 2.03 Gy cm2(KUB AP), 1.27 Gy cm2(lumbar spine AP), and 2.21 Gy cm2(lumbar spine LAT). MCDRLs were 2.24 Gy cm2(abdomen AP), 2.40 Gy cm2(KUB AP), 1.43 Gy cm2(lumbar spine AP), and 2.38 Gy cm2(lumbar spine LAT). Substantial intra- and inter-hospital variations in PKAwere observed for all four examinations. Although ADs and MCDRLs in Sri Lanka were comparable to those in the existing literature, the identified intra- and inter-hospital variations underscore the need for dose reduction without compromising diagnostic information. Hospitals with high IDRLs are recommended to review and optimise their practices. These MCDRLs serve as preliminary national DRLs, guiding dose optimisation efforts by medical professionals and policymakers.
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Affiliation(s)
- Sachith Welarathna
- Department of Physics, University of Peradeniya, Peradeniya 20400, Sri Lanka
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Sivakumar Velautham
- Department of Physics, University of Peradeniya, Peradeniya 20400, Sri Lanka
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Takashima Y, Suda T, Soga S. Inguinal hernia detected using radiography. Clin Case Rep 2021; 9:e05165. [PMID: 34917376 PMCID: PMC8645179 DOI: 10.1002/ccr3.5165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 11/04/2021] [Accepted: 11/19/2021] [Indexed: 11/12/2022] Open
Abstract
There are various clinical presentations of inguinal hernia. Computed tomography is a well-known tool to help diagnose inguinal hernia; however, radiographs are rarely reported to be useful in this aspect. We present a rare case wherein radiographs helped in the diagnosis of inguinal hernia.
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Affiliation(s)
- Yoshito Takashima
- Department of GastroenterologyKanazawa Municipal HospitalKanazawaJapan
| | - Tsuyoshi Suda
- Department of GastroenterologyKanazawa Municipal HospitalKanazawaJapan
| | - Shingo Soga
- Department of SurgeryKanazawa Municipal HospitalKanazawaJapan
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Abstract
It is essential for the colon and rectal surgeon to understand the evaluation and management of patients with both small and large bowel obstructions. Computed tomography is usually the most appropriate and accurate diagnostic imaging modality for most suspected bowel obstructions. Additional commonly used imaging modalities include plain radiographs and contrast imaging/fluoroscopy, while less commonly utilized imaging modalities include ultrasonography and magnetic resonance imaging. Regardless of the imaging modality used, interpretation of imaging should involve a systematic, methodological approach to ensure diagnostic accuracy.
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Affiliation(s)
- David W Nelms
- Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
| | - Brian R Kann
- Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
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Solberg LI, Wang Y, Whitebird R, Lopez-Solano N, Smith-Bindman R. Organizational Factors and Quality Improvement Strategies Associated With Lower Radiation Dose From CT Examinations. J Am Coll Radiol 2020; 17:951-959. [PMID: 32192955 DOI: 10.1016/j.jacr.2020.01.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to identify organizational factors and quality improvement strategies associated with lower radiation doses from abdominal CT. METHODS Cross-sectional survey was administered to radiology leaders, along with simultaneous measurement of CT radiation dose among 19 health care organizations with 100 imaging centers throughout the United States, Europe, and Japan, using a common dose management software system. After adjusting for patient age, gender, and size, quality improvement strategies were tested for association with mean abdominal CT radiation dose and the odds of a high-dose examination. RESULTS Completed surveys were received from 90 imaging centers (90%), and 182,415 abdominal CT scans were collected during the study period. Radiation doses varied considerably across organizations and centers. Univariate analyses identified eight strategies and systems that were significantly associated with lower average doses or lower frequency of high doses for abdominal CT examinations: tracking patient safety measures, assessing the impact of CT changes, identifying areas for improvement, setting specific goals, organizing improvement teams, tailoring decisions to sites, testing process changes before full implementation, and standardizing workflow. These processes were associated with an 18% to 37% reduction in high-dose examinations (P < .001-.03). In multivariate analysis, having a tracking system for patient safety measures, supportive radiology leaders, and obtaining clear images were associated with a 47% reduction in high-dose examinations. CONCLUSIONS This documentation of the relation between quality improvement strategies and radiation exposure from CT examinations has identified important information for others interested in reducing the radiation exposure of their patients.
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Affiliation(s)
| | - Yifei Wang
- University of California, San Francisco, San Francisco, California
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Zvizdic Z, Sefic Pasic I, Dzananovic A, Rustempasic N, Milisic E, Jonuzi A, Vranic S. Bowel Dilatation on Initial Plane Abdominal Radiography May Help to Assess the Severity of Necrotizing Enterocolitis in Preterm Infants. Children (Basel) 2020; 7:E9. [PMID: 31979405 PMCID: PMC7072700 DOI: 10.3390/children7020009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is the most common life-threatening gastrointestinal emergency associated with prematurity. Timely diagnosis and adequate treatment are crucial to reduce the morbidity and mortality of the affected infants. The aim of this study was to evaluate the diagnostic yield of bowel dilatation on plane abdominal radiography (AR) in the early diagnosis and NEC severity in preterm infants. METHODS We retrospectively reviewed initial ARs of 50 preterm infants with NEC ≥ stage II admitted to the neonatal intensive care unit (NICU) in a tertiary-care hospital. The largest bowel loops diameters (AD), the latero-lateral diameters of the peduncle of the first lumbar vertebra (L1), and the distance of the upper edge of the first lumbar vertebra and the lower edge of the second one, including the disc space (L1-L2), were measured. All anteroposterior ARs were done in a supine projection on the day of onset of the initial symptoms of NEC. RESULTS Preterm infants with surgical NEC showed a statistically significant increase in the AD/L1 ratio (p < 0.001) and AD/L1-L2 ratio (p < 0.001) compared with preterm infants with medical NEC. We found no significant association between the site of the most distended bowel loop and the severity of NEC (p > 0.05). CONCLUSION Bowel loop distension on initial AR may serve as an additional diagnostic tool in the early diagnosis and severity of stages II/III NEC. Further prospective clinical studies should validate the results from this study.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina; (Z.Z.); (E.M.); (A.J.)
| | - Irmina Sefic Pasic
- Department of Radiology, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina; (I.S.P.); (A.D.)
| | - Amra Dzananovic
- Department of Radiology, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina; (I.S.P.); (A.D.)
| | - Nedzad Rustempasic
- Clinic of Cardiovascular Surgery, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina; (Z.Z.); (E.M.); (A.J.)
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina; (Z.Z.); (E.M.); (A.J.)
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha PO Box 2713, Qatar
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Abstract
A 46-year-old Chinese woman with a history of cholecystectomy and appendicectomy presented to the emergency department with symptoms of intestinal obstruction. Physical examination revealed central abdominal tenderness but no clinical features of peritonism. Plain radiography of the abdomen revealed a grossly distended large bowel loop with the long axis extending from the right lower abdomen toward the epigastrium, and an intraluminal air-fluid level. These findings were suspicious for an acute caecal volvulus, which was confirmed on subsequent contrast-enhanced computed tomography (CT) of the abdomen and pelvis. CT demonstrated an abnormal positional relationship between the superior mesenteric vein and artery, indicative of an underlying intestinal malrotation. This case highlights the utility of preoperative imaging in establishing the diagnosis of an uncommon cause of bowel obstruction. It also shows the importance of recognising the characteristic imaging features early, so as to ensure appropriate and expedient management, thus reducing patient morbidity arising from complications.
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Affiliation(s)
| | - Tien Jin Tan
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
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Moreno CC, Hemingway J, Johnson AC, Hughes DR, Mittal PK, Duszak R. Changing Abdominal Imaging Utilization Patterns: Perspectives From Medicare Beneficiaries Over Two Decades. J Am Coll Radiol 2016; 13:894-903. [PMID: 27084072 DOI: 10.1016/j.jacr.2016.02.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess changing utilization patterns of abdominal imaging in the Medicare fee-for-service population over the past two decades. METHODS Medicare Physician Supplier Procedure Summary master files from 1994 through 2012 were used to study changes in the frequency and utilization rates (per 1,000 Medicare beneficiaries per year) of abdominal CT, MRI, ultrasound, and radiography. RESULTS In Medicare beneficiaries, the most frequently performed abdominal imaging modality changed from radiography in 1994 (207.4 per 1,000 beneficiaries) to CT in 2012 (169.0 per 1,000). Utilization rates of abdominal MR (1037.5%), CT (197.0%), and ultrasound (38.0%) all increased from 1994-2012 (but declined briefly from 2007 to 2009). A dramatic 20-year utilization rate decline occurred for gastrointestinal fluoroscopic examinations (-91.9% barium enema, -80.0% upper gastrointestinal series) and urologic radiographic examinations (-95.3%). Radiologists were the dominant providers of all modalities, accounting for >90% of CT and MR studies, and >75% of most ultrasound examination types. CONCLUSIONS Medicare utilization of abdominal imaging has markedly changed over the past two decades, with overall dramatic increases in CT and MRI and dramatic decreases in gastrointestinal fluoroscopic and urologic radiographic imaging. Despite these changes, radiologists remain the dominant providers in all abdominal imaging modalities.
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Affiliation(s)
- Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | | | - Aileen C Johnson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Harvey L. Neiman Health Policy Institute, Reston, Virginia
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Laberke PJ, Blum S, Waelti S, Fornaro J, Hausmann R, Alkadhi H, Leschka S. Systematic Evaluation of Radiation Dose Reduction in CT Studies of Body Packers: Accuracy Down to Submillisievert Levels. AJR Am J Roentgenol 2016; 206:740-6. [PMID: 26866340 DOI: 10.2214/AJR.15.15374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to systematically evaluate the accuracy of abdominal CT performed at different radiation dose levels for the detection of body packs in human cadavers, in comparison with the accuracy of abdominal radiography. MATERIALS AND METHODS In this study, differing numbers of body packs (range, 0-20) were placed in the alimentary tract of human cadavers and then underwent imaging with abdominal radiography and with CT performed at different radiation dose levels (ranging from the standard abdominal CT dose to the technical minimum dose). Depiction of body packs on abdominal radiographs and on each CT scan was assessed by two independent blinded radiologists, and the accuracy of detection of body packs was calculated. The radiation dose associated with abdominal radiography was measured, and the effective radiation dose associated with CT was estimated. RESULTS The mean (± SD) effective radiation dose for abdominal radiography was 1.4 ± 0.3 mSv, whereas the mean effective dose of CT ranged from 0.1 to 9.6 mSv. Interobserver agreement for body pack detection was moderate (κ = 0.51) for abdominal radiography and good (κ = 0.72-0.85) for CT. In a per-body pack analysis, abdominal radiography depicted 42% of the body packs with a sensitivity of 71% and a specificity of 100%. When performed at radiation dose levels of 0.6 mSv or greater, CT correctly detected all body packs. In per-person analysis, the sensitivity and specificity of CT for the correct detection of at least one body pack per cadaver was 100% for all radiation dose levels. CONCLUSION CT performed at a dose of 0.6 mSv can be used for the detection of body packs. With a sensitivity and specificity of 100%, CT is superior to abdominal radiography in terms of reliability, associated radiation dose, and accuracy of detection.
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Friedlander AH, El Saden SM, Hazboun RC, Chang TI, Wong WK, Garrett NR. Detection of carotid artery calcification on the panoramic images of post-menopausal females is significantly associated with severe abdominal aortic calcification: a risk indicator of future adverse vascular events. Dentomaxillofac Radiol 2015; 44:20150094. [PMID: 25945511 DOI: 10.1259/dmfr.20150094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Outcome studies among post-menopausal females with calcified carotid artery plaque (CCAP) on their panoramic images have not been previously undertaken. We sought to compare the extent of abdominal aortic calcification (AAC) on lateral lumbar spine radiographs (LLSRs), among groups of females with (CCAP+) and without (CCAP-) carotid lesions on their panoramic images. "Severe" levels of AAC have previously been validated as a risk indicator of future adverse cardiovascular events. METHODS This cross-sectional case-control study included a "CCAP+ group" consisting of females more than 50 years of age having the carotid lesion diagnosed by their dentists and an atherogenic risk factor (age, body mass index, hypertension, diabetes and dyslipidaemia)-matched "CCAP- group". A physician radiologist, using the Framingham index, evaluated the LLSRs for the magnitude of AAC. Summary statistics for key variables were computed and conditional logistic regression techniques were considered. RESULTS Members of the CCAP+ group were significantly (p=0.038) more likely to demonstrate "severe" levels of AAC on their LLSRs than members of the CCAP group. CONCLUSIONS This is the first published study demonstrating that CCAP on panoramic images of post-menopausal females is significantly associated with "severe" levels of AACs on LLSRs independent of traditional risk factors. Given that these levels of AAC are a validated risk indicator of future myocardial infarction and stroke, dentists must evaluate the panoramic images of post-menopausal females for the presence of CCAP. Patients with carotid atheromas should be referred to their physicians for further evaluation given the systemic implications.
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Affiliation(s)
- A H Friedlander
- 1 Department of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,2 Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - S M El Saden
- 3 Imaging Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,4 Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - R C Hazboun
- 5 Dental Service, Oral and Maxillofacial Surgery Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - T I Chang
- 2 Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA.,5 Dental Service, Oral and Maxillofacial Surgery Division, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - W K Wong
- 6 Department of Biostatistics, School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - N R Garrett
- 7 Dean's Office, School of Dentistry, University of California Los Angeles, CA, USA
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Abstract
Several studies have demonstrated that a diagnosis based solely on a patient’s medical history, physical examination, and laboratory tests is not reliable enough, despite the fact that these aspects are essential parts of the workup of a patient presenting with acute abdominal pain. Traditionally, imaging workup starts with abdominal radiography. However, numerous studies have demonstrated low sensitivity and accuracy for plain abdominal radiography in the evaluation of acute abdominal pain as well as various specific diseases such as perforated viscus, bowel obstruction, ingested foreign body, and ureteral stones. Computed tomography, and in particular computed tomography after negative ultrasonography, provides a better workup than plain abdominal radiography alone. The benefits of computed tomography lie in decision-making for management, planning of a surgical strategy, and possibly even avoidance of negative laparotomies. Based on abundant available evidence, major advances in diagnostic imaging, and changes in the management of certain diseases, we can conclude that there is no place for plain abdominal radiography in the workup of adult patients with acute abdominal pain presenting in the emergency department in current practice.
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Affiliation(s)
- Sarah L Gans
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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