Common Computed Tomography Research Articles

Chest computed tomography in COVID-19 pneumonia: a retrospective study of 155 patients at a university hospital in Rio de Janeiro, Brazil.

ObjectiveTo define diagnostic criteria for coronavirus disease 2019 (COVID-19) on computed tomography (CT); to study the correlation between CT and polymerase chain reaction (PCR) testing for infection with severe acute respiratory syndrome coronavirus 2; and to determine whether the extent of parenchymal involvement and the need for mechanical ventilation are associated with the CT findings and clinical characteristics of patients with COVID-19.Materials and MethodsThis was a retrospective study of 155 patients with COVID-19 treated between March and May 2020. We attempted to determine whether the CT findings correlated with age and clinical variables, as well as whether the need for mechanical ventilation correlated with the extent of the pulmonary involvement.ResultsOn average, the patients with COVID-19 were older than were those without (mean age, 54.8 years vs. 45.5 years; p = 0.031). The most common CT finding (seen in 88.6%) was ground-glass opacity, which correlated significantly with a diagnosis of COVID-19 (p = 0.0001). The CT findings that correlated most strongly with the need for mechanical ventilation were parenchymal bands (p = 0.013), bronchial ectasia (p = 0.046), and peribronchovascular consolidations (p = 0.012). The presence of one or more comorbidities correlated significantly with more extensive parenchymal involvement (p = 0.023). For the diagnosis of COVID-19, CT had a sensitivity of 84.3%, a specificity of 36.7%, and an accuracy of 73.5% (p = 0.012 vs. PCR).ConclusionThe patterns of CT findings are useful for the diagnosis of COVID-19 and the evaluation of disease severity criteria. The presence of any comorbidity is associated with greater severity of COVID-19.

Clinical Profile and CT-Chest Patterns of 56 Patients with Covid-19 Pneumonia

Since the COVID-19 pandemic was announced, the concern of radiologists and physicians regarding its diagnosis has been profoundly raised. The primary reference for confirming COVID-19 pneumonia relies on reverse transcriptase-polymerase chain reaction (RT-PCR) testing, where the subject of availability, false negative-rates, practice dependency, and time-consumption, made computed tomography (CT) more superior in Covid-19 pneumonia diagnosis, which was the situation in Al-Baida-city\Libya. The first local case in Al-Baida-city was reported on 30 July 2020, followed by a dramatic surge in the number of cases, which necessitated the recognition of main clinical features and CT-patterns of COVID-19 to facilitate rapid diagnosis. The aim of study: Describe the clinical features and the CT-chest patterns of COVID-19 pneumonia among the studied population. A descriptive case series study was conducted in the central hospital of Al-Baida city /Libya from 11 August to 21 September 2020, which involved 56 patients (31 females and 25 males). Patients’ ages ranged from 28-88 years (62.79± 11.3). Non-contrast CT-chest was performed on all patients. The main patients’ complaints were fever 94.6%, dyspnea 89.3%, and cough 85.7%. The most common CT pattern among the studied cases was ground-glass opacities found in 100% of patients, followed by vascular thickening 88%, consolidative lesion 71.4%, crazy-paving pattern 57%, vacuolar sign 57.1%, architecture distortion 40%, halo sign 34%, reverse halo sign 34.5%, and traction-bronchiectasis 16% of the studied cases. Finally, recognition of CT-chest patterns of Covid-19 pneumonia plays a significant role in early detection, and therefore isolation and management of the disease. The findings of this study can be used as a baseline for further research in the future.

Kanser Hastalarında COVID-19 Bilgisayarlı Tomografi, Klinik ve Laboratuvar Bulgularının Değerlendirilmesi

Aim: The aim of this study was to evaluate the computed tomography (CT), clinical and laboratory findings of coronavirus disease 2019 (COVID-19) in cancer patients and to compare the findings between polymerase chain reaction (PCR) positive and negative patients.
 Material and Methods: Twenty-three cancer patients with positive PCR tests and 22 diagnosed as COVID-19 with clinical and radiological findings were included in the study. CT images of the patients were evaluated simultaneously by two radiologists. Presence of comorbid diseases, symptoms and laboratory values were evaluated.
 Results: The most common CT involvement pattern was peripheral with 88.9% (n=40). Bilateral lung involvement rate was 57.8% (n=26). The most common finding was ground glass opacities (n=38, 84.5%). 35.6% (n=16) of these were accompanied by consolidation. Multifocal involvement was present in 62.2% (n=28) of the cases. The most frequently involved lobes were lower lobes. Other relatively common findings were septal thickening, subpleural streaking, and air bronchogram. The median neutrophil, lymphocyte, D-dimer, procalcitonin, C-reactive protein and lactate dehydrogenase values of the patients were 2000 mm3, 1200 mm3, 1990 ng/mL, 30.7 mcg/L 15.8 mg/dl, 161 IU/L, respectively.
 Conclusion: Multifocal and bilateral involvement, and ground glass opacities were the most common findings. However, higher rates of septal thickening, which is generally less common, suggest that the findings may be more severe in cancer patients. Most of the inflammatory markers were higher in PCR negative cases. Studies with more patients in multiple centers will provide better comparison of the findings in cancer patients with the general population.

Clinical and Imaging Features of Novel Coronavirus Pneumonia in the Elderly Compared with Young and Middle-Aged Individuals

Background: A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were reported worldwide, but there are few reports on age-related computed tomography (CT) signs and clinical characteristics of COVID-19 patients. Objectives: We aimed to analyze the CT imaging characteristics and clinical features of elderly patients with novel COVID-19 and compare them with young COVID-19 patients, in order to provide imaging basis for clinical diagnosis. Patients and Methods: The clinical and chest CT imaging data of elderly patients (≥ 60 years) and young patients (age of 20 - 60 years) with positive novel coronavirus nucleic acid admitted to our hospital from January 28, 2020 to February 16, 2020 were retrospectively analyzed, and the differences in clinical and imaging characteristics between the two groups were compared. Results: One hundred eighty three COVID-19 patients (96 elderly: mean age, 72.76 ± 5.65; 87 young: mean age, 42.69 ± 12.44) with positive novel coronavirus nucleic acid were retrospectively enrolled. The clinical symptoms of fever (79%), cough (64%) and weakness (59%) in elderly patients were higher than those of young patients (P < 0.01). Asymptomatic young patients (15%) were more common than the elderly (2%) (P < 0.01). Twenty-four patients (13%) had lesions that involved both the periphery and the center of the lung, while the lesions were located in the periphery of the lung in 159 patients (87%). Ground-glass opacification in young patients (71%) was significantly higher than that of the elderly (26%) (P < 0.001). Compared with the young group (37%), the proportion of extensive involvement of lung lobes was higher in the elderly group (72%) (P < 0.001). Conclusion: Elderly and young patients with corona virus disease had some common CT and clinical features, but elderly patients may have relatively severe CT findings, and these differences may be related to the severity and prognosis of COVID-19 pneumonia.

EVALUATION OF IRRADIATION DOSES DELIVERED TO PATIENTS IN COMPUTED TOMOGRAPHY EXAMINATIONS IN 10 RADIOLOGY DEPARTMENTS IN DOUALA-CAMEROON.

Computed tomography (CT) scan is currently the most irradiating radio diagnostic procedure for the patients. The effective dose delivered by a CT-scan exploration corresponds to 1-20years of natural irradiation of an individual. Hence, there is need to evaluate this medical exposure, in order to provide indicators and propose guidelines for its daily practice. The purpose of this work was to assess patient exposure levels due to CT-scan exams and propose a local diagnostic reference levels for the most common CT examinations performed in the radiology units of Douala/Cameroon. Data from 1775 CT scans, amongst which 10 different types of common CT examinations on adults and children, were collected, of which 1378 were adult CT scans and 397 were pediatric CT scans. The dose-length product (DLP) values in the adult population for head, abdomen-pelvic and lumber spine CT scans were high as compared to the Institute for Radiological Protection and Nuclear Safety recommendations and previous local DRL with an increase of 36, 15 and 23%, respectively. A general decrease of the DLP for CT-scans examinations in the pediatric population was observed.

Gut wrenching: cases of missed gastrointestinal tumors and their mimics on computed tomography.

Computed tomography (CT) of the abdomen and pelvis is one of the most common imaging studies ordered through the emergency department (ED). Because these studies are ordered for the detection of acute abnormalities and due to the relatively low incidence in patients presenting through the ED, gastrointestinal tumors are commonly missed. Moreover, many CT findings of malignant tumors overlap with benign entities, which can present a diagnostic challenge. This review article will describe the common CT findings of gastric, small bowel, colon, and appendiceal cancer as well as some of the common benign gastrointestinal conditions with similar imaging findings.

LOCAL STUDY OF DIAGNOSTIC REFERENCE LEVELS FOR COMPUTED TOMOGRAPHY EXAMINATIONS OF ADULT PATIENTS IN İZMIR, TURKEY.

This study aims to develop local diagnostic reference levels (DRLs) for the most common computed tomography (CT) examinations carried out around Izmir, Turkey. Five common CT examinations (head, neck, chest, abdomen-pelvis (AP), chest-abdomen-pelvis (CAP)) from four different radiology centres have been included in the study. CT dose index-volume (CTDIvol) and dose length product (DLP) values were recorded for 50 patients per exam in each centre. Third quartiles of CTDIvol and DLP values were determined as DRLs and compared with international findings. 51.3% of the patients were male and 48.7% were female, with a mean age of 57 (between 18 and 93). DRLs for CTDIvol were recorded as 70, 16, 15, 23 and 16 for head, neck, chest, AP and CAP examinations, respectively, while the corresponding DLPs were 1385, 604, 567, 998 and 1180mGy.cm. Results are mostly comparable to the latest international data, except for the head examinations, which were observed to slightly exceed the DRLs established by other countries.

The z-sbDBA, a new concept for a dynamic sheet-based fluence field modulator in x-ray CT.

We present a new concept for dynamic fluence field modulation (FFM) in x-ray computed tomography (CT). The so-called z-aligned sheet-based dynamic beam attenuator (z-sbDBA) is developed to dynamically compensate variations in patient attenuation across the fan beam and the projection angle. The goal is to enhance image quality and to reduce patient radiation dose. The z-sbDBA consists of an array of attenuation sheets aligned along the direction. In neutral position, the array is focused toward the focal spot. Tilting the z-sbDBA defocuses the sheets, thus reducing the transmission for larger fan beam angles. The structure of the z-sbDBA significantly differs from the previous sheet-based dynamic beam attenuator(sbDBA) in two features: (a) The sheets of the z-sbDBA are aligned parallel to the detector rows, and (b)the height of the sheets increases from the center toward larger fan beam angles. We built a motor actuated prototype of the z-sbDBA integrated into a clinical CT scanner. In experiments, we investigated its feasibility for FFM. We compared the z-sbDBA to common CT bowtie filters in terms of the spectral dependency of the transmission and possible image variance distribution in reconstructed phantom images. Additionally, the potential radiation dose saving using z-sbDBA for region-of-interest (ROI) imaging was studied. Our experimental results confirm that the z-sbDBA can realize variable transmission profiles of the radiation fluence by only small tilts. Compared to the sbDBA, the z-sbDBA can mitigate some practical and mechanical issues. In comparison to bowtie filters, the spectral dependency is considerably reduced when using the z-sbDBA. Likewise, more homogeneous image variance distributions can be attained in reconstructed phantom images. The z-sbDBA allows controlling the spatial image variance distribution which makes it suitable for ROI imaging. Our comparison on ROI imaging reveals skin dose reductions of up to 35% at equal ROI image quality by using the z-sbDBA. Our new concept for FFM in x-ray CT, the z-sbDBA, was experimentally validated on a clinical CT scanner. It facilitates dynamic FFM by realizing variable transmission profiles across the fan beam angle on a projection-wise basis. This key feature allows for substantial improvements in image quality, a reduction in patient radiation dose, and additionally provides a technical solution for ROI imaging.

Computed Tomography (CT) Imaging Features of Patients with COVID-19: Systematic Review and Meta-Analysis.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious disease, and its first outbreak was reported in Wuhan, China. A coronavirus disease (COVID-19) causes severe respiratory distress (ARDS). Due to the primary involvement of the respiratory system, chest CT is strongly recommended in suspected COVID-19 cases, for both initial evaluation and follow-up. Objective The aim of this review was to systematically analyze the existing literature on CT imaging features of patients with COVID-19 pneumonia. Methods A systematic search was conducted on PubMed, Embase, Cochrane Library, Open Access Journals (OAJ), and Google Scholar databases until April 15, 2020. All articles with a report of CT findings in COVID-19 patients published in English from the onset of COVID-19 outbreak to April 20, 2020, were included in the study. Result From a total of 5041 COVID-19-infected patients, about 98% (4940/5041) had abnormalities in chest CT, while about 2% have normal chest CT findings. Among COVID-19 patients with abnormal chest CT findings, 80% (3952/4940) had bilateral lung involvement. Ground-glass opacity (GGO) and mixed GGO with consolidation were observed in 2482 (65%) and 768 (18%) patients, respectively. Consolidations were detected in 1259 (22%) patients with COVID-19 pneumonia. CT images also showed interlobular septal thickening in about 691 (27%) patients. Conclusion Frequent involvement of bilateral lung infections, ground-glass opacities, consolidation, crazy paving pattern, air bronchogram signs, and intralobular septal thickening were common CT imaging features of patients with COVID-19 pneumonia.

Maternal and neonatal outcomes in pregnant women with COVID-19: a systemic review

Objective: To fully understand the maternal and neonatal outcomes in pregnant women with COVID-19 and explore the evidence of intrauterine vertical transmission of 2019-nCoV by analyzing clinical and laboratory information in peer-reviewed publications on COVID-19 in pregnant women Methods: PubMed, Embase, China National Knowledge Infrastructure, China Academic Journals, and Wanfang Databases were searched to retrieve articles on COVID-19 in pregnancy published from December 1, 2019, to April 9, 2020 In addition, the World Health Organization COVID-19 Database and the reference lists in each included article were also searched All included cases were positive for 2019-nCoV nucleic acid with maternal and neonatal outcomes regardless of delivery or not Clinical manifestations, perinatal and neonatal outcomes were analyzed systematically Results: This study reviewed 29 publications involving 146 pregnant women who tested positive for 2019-nCoV nucleic acid and their 116 newborns (including two twins) Five cases of severe COVID-19 and three cases of unidentified type that were admitted to ICU for treatment were severe symptoms, accounting for 5 5% (8/146) of all cases Totally, 69 9% (102/146) of the women underwent cesarean section and 8 2% (12/146) gave birth vaginally Thirty (20 5%) women continued their pregnancies One case (0 7%, 1/146) terminated the pregnancy at 26 weeks of gestation due to bidirectional affective disorder and one (0 7%, 1/146) received artificial abortion at 6 weeks of gestation Fever (58 2%, 85/146) and cough (32 9%, 48/146) were the most common symptoms However, 15 8% (23/146) of the pregnant women were asymptomatic on admission and symptoms appeared or became worse after delivery in 20 5% (30/146) Lymphocytopenia (49 6%, 56/113) and elevated C-reactive protein (58 4%, 66/113) were the main laboratory findings The most common computed tomography (CT) finding was bilateral multiple patchy ground-glass opacity in lungs (79 7%, 94/118) The outcomes of 92 2% (107/116) of the newborns were good, and the rest 7 8% (9/116) showed different abnormalities of varying degrees Among the nine newborns, six showed different degrees of dyspnea, cyanosis and vomiting including one died of multiple organ failure and disseminated intravascular coagulation;one tested positive for viral nucleic acid 36 hours after birth;one was stillbirth due to unknown reason, but intrauterine vertical transmission was excluded;one neonatal death in a critically ill mother undergoing cesarean delivery Conclusions: Pregnant women are less likely to progress to severe COVID-19 and mostly have a good outcome Despite reports of adverse neonatal outcomes, evidence of intrauterine vertical transmission of 2019-nCoV remains insufficient Copyright © 2020 by the Chinese Medical Association

Image optimization and reduction of radiation dose in CT of the paranasal sinuses

Introduction: Due to use of ionization radiation in the computed tomography (CT), optimal parameters should be used to reduce the risk of incidence of secondary cancers in patients who are constantly exposed to x-rays. To reduce the dose delivered to patients in each scan, CT technologists can change the image acquisition parameters. However, this reduces image quality. The present study aimed to optimize and reduce radiation dose in a CT of the paranasal sinuses while minimizing deterioration of image quality. Methods: In this study patients were divided in two groups: Group A was scanned axially and coronally using default parameters, while Group B was scanned axially and coronally using new parameters. Common CT dose descriptors including weighted computed tomography dose index (CTDIw), volumetric CTDI (CTDIvol), dose length product (DLP), effective dose (ED) and image noise were measured for each group. The patients’ organ doses were estimated using the ImPACT CT patient Dosimetry Calculator. The tube voltage, tube current, pitch, rotation time, and other parameters were then reduced and optimized. After reconstruction and analysis, all of the images were of good diagnostic quality in both groups Results: Using the new parameters, good agreement was found between the direct and reconstructed images. The CT parameters were reduced by the following proportions: kVp—16.6%, mA—75%, rotation time—20%, and mAs—80%. However, these reductions did not obscure any anatomical landmarks. These parameters reduced the CTDIw, CTDIvol and DLP by 88.2%, 91.3%, and 91.3% respectively. Conclusion: The results suggest that the use of a Bone algorithm reduces the total amount of radiation used during CT of the sinuses. We recommend using these parameters in children, in the evaluation of facial trauma, and in emergency CT of the paranasal sinuses.

Cost Effectiveness of Mobile versus Fixed Computed Tomography and Magnetic Resonance Imaging: A Systematic Review

Mobile technologies are widely used in healthcare. The purpose of this study was to compare the effectiveness and cost-effectiveness of fixed computed tomography (CT) and magnetic resonance imaging (MRI) with the mobile ones. In this systematic review, PubMed, Cochrane Library, Scopus and CRD database were searched from 1995 to 2015. The data on safety and effectiveness of technologies were extracted from included studies. Because the review showed no significant differences in the performance of mobile CT and MRI compared to the fixed ones, then a cost minimization approach was used to explore the cost-effectiveness of three scenarios. Twenty two articles were included in the review that showed no statistically significant differences in the performance of mobile MRI and CT scan compared to the fixed ones. The cost minimization approach showed that the third scenario based on purchasing a common mobile MRI and CT scan; and using it by two or more hospitals that are in rational distance from each other is associated with the lowest costs, so it is the most cost-effectiveness strategy. The performance of Mobile CT and mobile MRI is comparable to the fixed ones; and using a combined mobile CT and MRI by two or three hospitals is the most cost-effective approach.

Direct and indirect CT imaging features of esophago-airway fistula in adults.

BackgroundEsophago-airway fistula (EAF) is an abnormal connection between the esophagus and the trachea or a major bronchus. While contrast esophagography remains the primary radiographic tool for the diagnosis of EAF, computed tomography (CT) is often employed in its evaluation. A systematic analysis of CT findings of EAF in adults has not been previously published. The goal of our study is to determine the direct and indirect CT findings of EAF in adults.MethodsWe identified patients with EAF detected on CT at our institution between January 1, 2001 and December 31, 2019, with endoscopic or surgical confirmation. We collected patient clinicopathologic characteristics and assessed CTs for direct and indirect imaging features of EAF in these patients.ResultsTwenty-six patients (median age: 56 years; range, 25–79 years; F=13, 50% and M=13, 50%) with confirmed EAF were identified. Half of the patients had an underlying malignancy. On CT, a direct connection between the esophagus and the airway was identified in most cases (22/26; 85%). Common indirect CT findings of EAF included esophageal wall thickening (21/26, 81%), mediastinal fatty stranding (21/26, 81%), airway wall thickening (20/26, 77%), fluid or debris within the airways (17/26, 65%), and focal or diffuse esophageal dilation with air (17/26, 65%). Mediastinal fluid collections were infrequently seen (4/26, 15%), but findings of aspiration or other pneumonia were common (19/26, 73%).ConclusionsCT plays an essential role in both the primary and secondary evaluation of adult EAF resulting from both malignant and benign etiologies. CT may be the first diagnostic exam to suggest and detect the presence of EAF and may precede clinical suspicion, and it can detect a subset of fistulas not demonstrated on esophagography. There are several direct and indirect imaging findings on CT that can help in the detection of EAF.

CT imaging features of 4121 patients with COVID-19: A meta-analysis.

ObjectiveWe systematically reviewed the computed tomography (CT) imaging features of coronavirus disease 2019 (COVID‐19) to provide reference for clinical practice.MethodsOur article comprehensively searched PubMed, FMRS, EMbase, CNKI, WanFang databases, and VIP databases to collect literatures about the CT imaging features of COVID‐19 from 1 January to 16 March 2020. Three reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies, and then, this meta‐analysis was performed by using Stata12.0 software.ResultsA total of 34 retrospective studies involving a total of 4121 patients with COVID‐19 were included. The results of the meta‐analysis showed that most patients presented bilateral lung involvement (73.8%, 95% confidence interval [CI]: 65.9%‐81.1%) or multilobar involvement (67.3%, 95% CI: 54.8%‐78.7%) and just little patients showed normal CT findings (8.4%). We found that the most common changes in lesion density were ground‐glass opacities (68.1%, 95% CI: 56.9%‐78.2%). Other changes in density included air bronchogram sign (44.7%), crazy‐paving pattern (35.6%), and consolidation (32.0%). Patchy (40.3%), spider web sign (39.5%), cord‐like (36.8%), and nodular (20.5%) were common lesion shapes in patients with COVID‐19. Pleural thickening (27.1%) was found in some patients. Lymphadenopathy (5.4%) and pleural effusion (5.3%) were rare.ConclusionThe lung lesions of patients with COVID‐19 were mostly bilateral lungs or multilobar involved. The most common chest CT findings were patchy and ground‐glass opacities. Some patients had air bronchogram, spider web sign, and cord‐like. Lymphadenopathy and pleural effusion were rare.

Traumatic Brain Injury: Comparison of Computed Tomography Findings in Pediatric and Adult Populations

Abstract Introduction Traumatic brain injury (TBI) is a global health issue, accounting for a significant number of adult and pediatric deaths and morbidity. Computed tomography (CT) is an important diagnostic modality for TBI. The primary goal of this study was to determine if there were any significant radiological differences in CT brain findings between adult and pediatric populations. Materials and Methods Data of individual patients were collected from admission to discharge/death, which included various parameters in terms of demographics, mechanism of injury, and patient outcome which were later analyzed. A total of 1,150 TBI patients were enrolled in the study. Results The most common mode of injury in adults is road traffic accident (RTA) followed by fall from height (FFH), while in pediatrics it is vice versa. Findings of basal cisterns on CT brain were found to be statistically significant in both groups; 65% adults and 71% pediatrics had only one abnormal CT finding. Most common combination CT finding in adults was acute subdural hematoma (ASDH) and basal cistern abnormality, while in pediatrics it was traumatic subarachnoid hemorrhage (SAH) and contusion. Rotterdam score (based on CT brain findings) was significantly lower for pediatric age group compared with adults. It was 2.2 ± 0.85 for adults and 1.99 ± 0.74 for pediatrics, which was statistically significant (p < 0.001). Conclusions The Rotterdam score has immense predictive power for prognostication of mortality status. Pediatric age group has better prognosis in terms of survival as compared with adults, thus justifying the role of Rotterdam CT score for mortality risk stratification in providing clinical care.

Computed Tomography-based Diagnosis of Post-laparoscopic Sleeve Gastrectomy Gastric Leak.

Objective:Gastric leak post-laparoscopic sleeve gastrectomy may appear as a variety of computed tomography (CT) findings. We aimed to review the various CT findings sensitivity and specificity in confirmed cases of gastric leak.Materials and Methods:A retrospective review was performed for all patients who underwent sleeve gastrectomy, CT, and endoscopy for suspected leak between 2011 and 2018. All patients with positive CT findings for gastric leak were included in the study.Results:A total of 152 consecutive patients underwent CT for suspected post-sleeve gastrectomy gastric leak. Out of 152 patients, 88 had positive CT findings for gastric leak and underwent endoscopy. The CT findings sensitivity and specificity of perigastric collection without oral contrast leak were 61% and 88.8%, oral contrast leak were 28% and 100%, and gas leak were 10% and 77.7%, respectively.Conclusions:Perigastric fluid collection without contrast leak and with variable wall enhancement and gas content is the most common CT findings of post-sleeve gastrectomy gastric leak. Among various CT findings, it exhibits good diagnostic accuracy with 61% sensitivity and 88.8% specificity.

Study of risk factors, clinical spectrum, and outcome for head injury in pediatric age group in Western India.

Aim:To study various risk factors which leads to head injury, severity of head injury and to compare survival as predicted by the Revised Trauma Score (RTS) and Pediatric Trauma Score (PTS) in pediatric patients admitted in a tertiary care hospital.Methods:300 consecutive pediatric patients below 12 years of age with head injury admitted in our institute were analysed as per a set proforma. Data pertaining to patient's demographic details, mode of injury, computed tomography (CT) findings, type of management, severity of head injury, and outcome were recorded. The results were tabulated and analyzed. RTS and PTS scores were calculated to predict the survival of an individual patient.Results:The most commonly affected age group was 1–5 years. Boys outnumbered girls in the incidence. Fall was the most common injury, with road traffic accident being the most common cause of mortality. Skull fracture was the most common CT scan finding. Most of the patients presented with mild head injury (Glasgow Coma Scale 13–15), and they improved with conservative management only. RTS and PTS scores were calculated and were equally effective in predicting the outcome for a particular patient.Conclusion:Head injury occurs more commonly in 1–5 years' age group due to fall from unprotected roof tops. The overall prognosis in majority of the cases is excellent. However, road traffic accident shows the highest mortality and hence, we propose to include mode of injury as a variable for designing future predictive outcome models.

Influenza H1N1 virus-associated pneumonia often resembles rapidly progressive interstitial lung disease seen in collagen vascular diseases and COVID-19 pneumonia; CT-pathologic correlation in 24 patients

PurposeTo describe computed tomography (CT) findings of influenza H1N1 virus-associated pneumonia (IH1N1VAP), and to correlate CT findings to pathological ones. MethodsThe study included 24 patients with IH1N1VAP. Two observers independently evaluated the presence, distribution, and extent of CT findings. CT features were divided into either classical form (C-form) or non-classical form (NC-form). C-form included: A.) broncho-bronchiolitis and bronchopneumonia type, whereas NC-forms included: B.) diffuse peribronchovascular type, simulating subacute rheumatoid arthritis-associated (RA) interstitial lung disease (ILD) and C.) lower peripheral and/or peribronchovascular type, resembling dermatomyositis-associated ILD and COVID-19 pneumonia. In 10 cases with IH1N1VAP where lung biopsy was performed, CT and pathology findings were correlated. ResultsThe most common CT findings were ground-glass opacities (24/24, 100 %) and airspace consolidation (23/24, 96 %). C-form was found in 11 (46 %) patients while NC-form in 13 (54 %). Types A, B, and C were seen in 11(46 %), 4 (17 %), and 9 (38 %) patients, respectively. The lung biopsy revealed organizing pneumonia in all patients and 6 patients (60 %) showed incorporated type organizing pneumonia that was common histological findings of rapidly progressive ILD. ConclusionIn almost half of patients of IH1N1VAP, CT images show NC-form pneumonia pattern resembling either acute or subacute RA or dermatomyositis-associated ILD and COVID-19 pneumonia.

Pediatric coronavirus disease 2019 (COVID-19): An insight from west of Iran.

OBJECTIVE:To study the clinical, laboratory, and radiological characteristics of the pediatric patients infected with the new emerging 2019 coronavirus virus (SARS-CoV-2) in Hamadan and Sanandaj, west of Iran.METHODS:A descriptive study was conducted in Hamadan and Kurdistan province between March 1 to April 15, 2020. Medical records of the children diagnosed as probable or confirmed cases of COVID-19 disease were extracted and analyzed in this study. We followed the WHO Guideline for the case definition of the patients.RESULTS:Thirty patients admitted to the wards specified for COVID-19 diseases. Nineteen (63%) patients categorized as confirmed by Real-Time Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) and 11 (37%) patients as probable according to Computed Tomography (CT) findings of the chest. Sixteen (53.3%) cases were female, the youngest patient was one day old, and the oldest patient was 15 years old. 11 (36.7%) cases had a definite history of close contact. The most common symptoms were fever, cough, and dyspnea, and the most common sign was tachypnea. None of our patients presented with a runny nose. Lymphopenia and marked elevation of the C-reactive Protein observed in four (13.3%) and 12 (40%) cases, respectively. There were 10 (33.3%) cases with normal chest X-rays. Ground-Glass Opacities (GGOs) were the most common CT findings (19, 73.1%). All but one of the patients discharged without sequala. An 11-yrs-old girl expired with a fulminant pneumonia.CONCLUSION:COVID-19 is not uncommon in children and could have different presentations. Concomitant use of RT-PCR and chest CT scans in symptomatic cases recommended as a modality of choice to diagnose the disease. Routine laboratory tests, like many other viral infections, may not show significant or specific changes. The superimposed bacterial infection seems not the determinant of clinical outcomes as most patients had a negative evaluation by specific laboratory tests for bacterial infections; got improved dramatically with a short or no antibiotic therapy.

OPTIMIZATION OF RADIATION DOSE IN CT IMAGING: ESTABLISHING THE INSTITUTIONAL DIAGNOSTIC REFERENCE LEVELS AND PATIENT DOSE AUDITING.

The aim of this study was to propose local diagnostic reference levels (LDRLs) for the most common computed tomography (CT) examinations (including contrast and non-contrast scan phase) performed at Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia (USM), Malaysia. A retrospective CT dose survey of 1488 subjects from January 2015 until December 2018 was performed at AMDI USM, Malaysia. The proposed DRLs were established at 50th and 75th percentile of dose distribution for all dose metrics (CT dose index [CTDI]; CTDIvol, CTDIw and dose-length product). The proposed LDRLs were compared with national DRLs and other established DRLs. The 10 most common CT examinations at AMDI were thorax-abdomen-pelvis (TAP) CT (46%), followed by pelvis CT (17%), abdomen-pelvis CT (10%), brain/head CT (9%) and other CT protocols. The local DRLs were established using the third quartile values of dose distribution and were categorized based on CT region protocols. Most of the proposed DRLs were exceeded the national DRLs (63%) and other international DRLs (67%). From the dose auditing, almost half of the recent dose data (for year 2018) exceeded the proposed local DRLs and the unusual dose were observed in TAP, brain/head and pelvis CT examinations. The unusual higher dose could be due to higher mAs settings, higher number of scan phase for contrast study and higher pitch factor. The local DRLs should be established for dose optimization and reduction of the occurrence of excessive radiation exposure to the patients. The establishment of the Ads and LDRLs should also consider all the factors that affect the variation in DRLs such as CT technology, scanning protocols and population characteristics. The local dose distribution should always be revised for improvement of the current local practice.