Computed Tomography Imaging Procedures Research Articles

Magnetic resonance imaging, computed tomography, and gross anatomy of forelimb joints in New Zealand rabbit (Oryctolagus cuniculus L.).

The present study aimed to define the anatomical structures by comparing the transversal computed tomography (CT) and magnetic resonance (MR) images of the forelimb joints of the rabbits with the cross-sectional plastinated images. A total of 14 (seven females, seven males) one-year-old adult New Zealand rabbits were used in the study. After the CT and MR imaging procedures were completed, the forelimbs were removed from the body. The forelimbs were plastinated using the silicone plastination method and sectioned transversal. Cross-sectional plastinates were evaluated and correlated anatomically with conjugate CT and MR images. Joint and surrounding anatomical structures were defined in sections. Cross-sectional plastinated samples were highly correlated with CT and MR images in terms of bone and soft tissue, respectively. It is thought that the anatomical and radiological data obtained from the forelimb joints of rabbits will provide a basis for scientists who are involved in both experimental surgical interventions and clinical anatomy education.

Radiation exposure estimation in pediatric patients during computed tomography imaging procedures

Computed tomography (CT) procedures are the largest source of medical radiation exposure in children and adults. Numerous children undergo high-radiation-dose examinations due to the increasing utilization of CT in children and the wide range of radiation doses. It is therefore necessary to protect pediatric patients, because of their higher sensitivity to ionizing radiation. This study aimed to establish a multicenter cohort of pediatric patients who received CT scans and predict the radiation-related cancer risk. Ninety-five patients who underwent various CT scans [brain 64 (67.4%), chest 14 (14.7%), abdomen 17 (17.9%)] were referred to one of three hospitals. All patients were examined using one of three identical multi-detector CT machines (Toshiba Aquilion 64) according to standard departmental imaging protocols. The average effective doses per scan for brain, chest, and abdominal procedures were 49.7, 34, and 40 mSv, respectively. Dose-reduction measures might significantly decrease the number of radiation-induced malignancies in children.

Decreased Hospital Length of Stay for ICH and PE after Adoption of an Artificial Intelligence-Augmented Radiological Worklist Triage System

The purpose of the study was to determine whether there was a difference in the length of stay (LOS) for inpatients diagnosed with intracranial hemorrhage (ICH) or pulmonary embolism (PE) prior to and following implementation of an (AI) triage software. A retrospective review was performed for patients that underwent CT imaging procedures related to ICH and PE from April 2016 to October 2019. All patient encounters that included noncontrast head computed tomography (CT) or CT chest angiogram (CTCA) procedures, identified by the DICOM study descriptions, from April 2016 to April 2019 were included for ICH and PE, respectively. All patients that were diagnosed with ICH or PE were identified using ICD9 and ICD10 codes. Three separate control groups were defined as follows: (i) all remaining patients that underwent the designated imaging studies, (ii) patients diagnosed with hip fractures, and (iii) all hospital wide encounters, during the study period. Pre-AI and post-AI time periods were defined around the deployment dates of the ICH and PE modules, respectively. The reduction in LOS was 1.30 days (95% C.I. 0.1–2.5), resulting in an observed percentage decrease of 11.9% (p value = 0.032), for ICH and 2.07 days (95% C.I. 0.1–4.0), resulting in an observed percentage decrease of 26.3% (p value = 0.034), for PE when comparing the pre-AI and post-AI time periods. Reductions in LOS were observed in the ICH pre-AI and post-AI time period group for patients that were not diagnosed with ICH, but that underwent related imaging, 0.46 days (95% C.I. 0.1–0.8) resulting in an observed percentage decrease of 5% (p value = 0.018), and inpatients that were diagnosed with hip fractures, 0.60 days (95% C.I. 0.1–1.2) resulting in an observed percentage decrease of 8.3% (p value = 0.004). No other significant decrease in length of stay was observed in any of the other patient groups. The introduction of computer-aided triage and prioritization software into the radiological workflow was associated with a significant decrease in length of stay for patients diagnosed with ICH and PE.

Assessment of the practice of pediatrics procedural sedation and analgesia for magnetic resonance imaging and computed tomography scan at a teaching hospital, Ethiopia, 2020: A clinical audit

BackgroundThe main goals of paediatric sedation/general anesthesia vary according to the specific imaging procedure, but generally includes anxiety relief, pain control and control of excessive movement. The quality of magnetic resonance imaging (MRI) and computed tomography (CT) depends largely on immobility of the patient during the procedure, which is often difficult to achieve without sedation in children. Sedation is the depression of the central nervous system and reflexes by the administration of drugs. Brain imaging is routinely used to identify stroke, hemorrhage, and structural abnormalities. All patients undergoing procedural sedation and those receiving general anesthesia should be evaluated equally. AimThe study aimed to perform a clinical audit of sedation and analgesia practices for magnetic resonance imaging and computed tomography compared against the guidelines/standards to determine if practice meets the standards and identify areas of non-compliance at a teaching Referral Hospital in Ethiopia. MethodsThis clinical audit was conducted from January 1 to May 30/2020 for 5 months at a teaching Referral Hospital in Ethiopia. All children below the age of 6 years underwent MRI and CT imaging procedures under sedation during a study period were included. Data were collected through direct observation using checklists of standards by a trained data collector. Descriptive statistics were presented with tables, graphs of sums and percentages of items using SPSS version 20. ResultsA total of 40 children underwent MRI and CT imaging were observed at the Hospital imaging sites. Among the 20 standards, 6 of them had 100% compliance rate, 3 of the standards had 0% complaince rate and 11 of the standards had the compliance rate of between 0 and 100%. Conclusions and recommendationsIn general, even though the practice guidelines of procedural sedation for MRI and CT recommend to practice procedures based on the standards, this study showed there were a number of standards that had <100% compliance rate. Therefore, it is recommended that staff should adopt standards or locally prepared protocols for their day-to-day practice.

Evaluation of Impact of Factors Affecting CT Radiation Dose for Optimizing Patient Dose Levels

The dose metrics and factors influencing radiation exposure for patients undergoing head, chest, and abdominal computed tomography (CT) scans were investigated for optimization of patient dose levels. The local diagnostic reference levels (DRLs) of adult CT scans performed in our hospital were established based on 28,147 consecutive examinations, including 5510 head scans, 9091 chest scans, and 13,526 abdominal scans. Among the six CT scanners used in our hospital, four of them are 64-slice multi-detector CT units (MDCT64), and the other two have detector slices higher than 64 (MDCTH). Multivariate analysis was conducted to evaluate the effects of body size, kVp, mAs, and pitch on volume CT dose index (CTDIvol). The local DRLs expressed in terms of the 75th percentile of CTDIvol for the head, chest, and abdominal scans performed on MDCT64 were 59.32, 9.24, and 10.64 mGy, respectively. The corresponding results for MDCTH were 57.90, 7.67, and 9.86 mGy. In regard to multivariate analysis, CTDIvol showed various dependence on the predictors investigated in this study. All regression relationships have coefficient of determination (R2) larger than 0.75, indicating a good fit to the data. Overall, the research results obtained through our workflow could facilitate the modification of CT imaging procedures once the local DRLs are unusually high compared to the national DRLs.

The radiology workforce's response to the COVID-19 pandemic in the Middle East, North Africa and India

IntroductionThis study aimed to investigate the response of the radiology workforce to the impact of the coronavirus disease 2019 (COVID-19) pandemic on professional practice in India and eight other Middle Eastern and North African countries. It further investigated the levels of fear and anxiety among this workforce during the pandemic. MethodsA quantitative cross-sectional study was conducted using an online survey from 22 May-2 June 2020 among radiology workers employed during the COVID-19 pandemic. The survey collected information related to the following themes: (1) demographic characteristics, (2) the impact of COVID-19 on radiology practice, and (3) fear and (4) anxiety emanating from the global pandemic. ResultsWe received 903 responses. Fifty-eight percent had completed training on infection control required for handling COVID-19 patients. A large proportion (79.5%) of the respondents strongly agreed or agreed that personal protective equipment (PPE) was adequately available at work during the pandemic. The respondents reported experiences of work-related stress (42.9%), high COVID-19 fear score (83.3%) and anxiety (10%) during the study period. ConclusionThere was a perceived workload increase in general x-ray and Computed Tomography imaging procedures because they were the key modalities for the initial and follow-up investigations of COVID-19. However, there was adequate availability of PPE during the study period. Most radiology workers were afraid of being infected with the virus. Fear was predominant among workers younger than 30 years of age and also in temporary staff. Anxiety occurred completely independent of gender, age, experience, country, place of work, and work status. Implications for practiceIt is important to provide training and regular mental health support and evaluations for healthcare professionals, including radiology workers, during similar future pandemics.

Imaging of psoriatic arthritis and aspects of radiographic progression

Psoriatic arthritis (PsA) is a heterogeneous multifactorial disease with musculoskeletal involvement, which can be manifested as monoarthritis, oligoarthritis or polyarthritis and in some patients can also affect the axial skeleton. The most frequent indications of inflammation are bone marrow edema and enthesitis. The early and differential diagnosis of PsA is a clinical challenge, particularly as a differential diagnosis from other inflammatory or degenerative diseases of joints. Inflammatory joint and tendon alterations in the region of the extremities and the spine can be visualized with high sensitivity by the use of magnetic resonance imaging (MRI), musculoskeletal sonography (US) and fluorescence optical imaging (FOI). The use of MRI has a prognostic value with respect to the further radiographic course of the disease, particularly in the initial stages of the disease. Structural damage can be specifically and also partially demonstrated 3‑dimensionally in peripheral joints and the spine by the use of computed tomography (CT) and conventional X‑ray imaging. High-resolution peripheral quantitative CT (HR-pQCT) in particular, can visualize pathophysiological processes and the morphological consequences even in early stages of the disease. The values of conventional X‑ray diagnostics, CT, MRI, musculoskeletal US and alternative imaging procedures are presented with respect to the diagnostics and prognosis of the progression of patients with PsA.

Use of Public Data to Target Variation in Providers' Use of CT and MR Imaging among Medicare Beneficiaries.

To examine geographic variation in providers' use of diagnostic imaging to identify potential targets for quality improvement initiatives after adjusting for imaging referral across hospital referral regions (HRRs). Using two Centers for Medicare and Medicaid Services datasets, the authors included all claims for beneficiaries enrolled in the Medicare fee-for-service program. Diagnostic imaging procedures were selected on the basis of common procedure coding system codes, excluding interventional procedures. The authors assessed providers' use of imaging for each HRR after creating an imaging referral index (IRI) to adjust for imaging referral rates across HRRs. Relative risk statistics were used to assess geographic variation. The authors calculated two imaging measures for computed tomography (CT) and magnetic resonance (MR) imaging: IRI-adjusted utilization intensity (number of examinations per 1000 beneficiaries) and total payments (in dollars, after deducting deductibles and coinsurances) in each HRR. High-impact regions were defined as those in the highest deciles for both imaging intensity and payment. For 34 million Medicare beneficiaries, 124 million unique diagnostic imaging services (totaling $5.6 billion) were performed in 2012. The average adjusted CT utilization intensity ranged from 330.4 studies per 1000 beneficiaries in the lowest decile to 684.0 in the highest decile (relative risk, 2.1); adjusted MR imaging utilization intensity varied from 105.7 studies per 1000 beneficiaries to 256.3 (relative risk, 2.4). The most common CT and MR imaging procedures were head CT and lumbar spine MR imaging. With use of public data, the authors identified a wide variation in imaging use across the United States. Potential targets for future imaging quality improvement initiatives include head CT and lumbar spine MR imaging.

Trends in Computed Tomography Utilization Rates

Computed tomography (CT) use has increased dramatically over the past 2 decades, leading to increased radiation exposure at the population level. We assessed trends in CT use in a primary care (PC) population from 2000 to 2010. Trends in CT use from 2000 to 2010 were assessed in an integrated, multi-specialty group practice. Administrative data were used to identify patients associated with a specific primary care provider and all CT imaging procedures. Utilization rates per 1000 patients and CT rates by type and medical specialty were calculated. Of 179,032 PC patients, 55,683 (31%) underwent CT. Mean age (SD) was 31.0 (23.6) years; 53% were female patients. In 2000, 178.5 CT scans per 1000 PC patients were performed, increasing to 195.9 in 2010 (10% absolute increase, P = 0.01). Although utilization rates across the 10-year period remained stable, emergency department (ED) CT examinations rose from 41.1 per 1000 in 2000 to 74.4 per 1000 in 2010 (81% absolute increase, P < 0.01). CT abdomen accounted for more than 50% of all CTs performed, followed by CT other (19%; included scans of the spine, extremities, neck and sinuses), CT chest (16%), and CT head (14%). Top diagnostic CT categories among those undergoing CT were abdominal pain, lower respiratory disease, and headache. Although utilization rates across the 10-year period remained stable, CT use in the ED substantially increased. CT abdomen and CT chest were the two most common studies performed and are potential targets for interventions to improve the appropriateness of CT use.

Safety of Computed Tomography in Patients With Cardiac Rhythm Management Devices: Assessment of the U.S. Food and Drug Administration Advisory in Clinical Practice

To assess the safety of computed tomography (CT) imaging in patients with cardiac rhythm management (CRM) devices, which was subject to an advisory from the U.S. Food and Drug Administration (FDA) in 2008. The FDA warned about potential interference of CT imaging with CRM devices and made recommendations for clinical practice despite only limited evidence. All 516 CT scans that involved direct radiation exposure of CRM devices (332 defibrillators, 184 pacemakers) at 2 large-volume centers between July 2000 and May 2010 were included. The primary outcome was a composite endpoint of death, bradycardia or tachycardia requiring termination of the scan or an immediate intervention, unplanned hospital admission, reprogramming of the device, inappropriate defibrillator shocks, or device replacement/revision thought to be due to CT imaging. Significant changes in device parameters were sought as a secondary outcome (control group 4:1 ratio). The main finding was that none of the CTs were associated with the primary outcome. With serial device interrogations, there were no differences in changes in battery voltage or lead parameters between devices exposed to radiation and their controls. Potentially significant changes in device parameters were observed in a small group of devices (both the CT group and control group), but no definitive link to CT was confirmed, and there were no associated clinical consequences. The findings suggest that the presence of CRM devices should not delay or result in cancellation of clinically indicated CT imaging procedures, and provide evidence that would be helpful when the FDA advisory is re-evaluated.

Comparison between positron emission tomography using 2-[fluorine-18]fluoro-2-deoxy-D-glucose, conventional imaging and computed tomography for staging of breast cancer

BackgroundThe presence, extent and localization of distant metastases are key prognostic factors in breast cancer patients and play a central role in therapeutic decision making. The aim of this study was to compare the diagnostic performance of positron emission tomography using 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG–PET) with that of computed tomography (CT) and conventional imaging including chest radiography, abdominal ultrasound and bone scintigraphy. Patients and methodsA total of 119 consecutive patients with newly diagnosed locally advanced disease (n = 69) or previous history of breast cancer (n = 50) who had clinical suspicion of metastatic disease underwent FDG–PET, CT and conventional imaging procedures. Imaging results were retrospectively compared with histopathology and clinical follow-up which served as a reference standard. ResultsFDG–PET detected distant metastases with a sensitivity of 87% and a specificity of 83%. In contrast, the sensitivity and specificity of combined conventional imaging procedures were 43% and 98%, respectively. CT revealed a sensitivity of 83% and a specificity of 85%. ConclusionsIn breast cancer, FDG–PET is superior to conventional imaging procedures for detection of distant metastases. Although FDG–PET and CT provided similar diagnostic accuracy, the information was often found to be complementary. With increasing availability of FDG–PET/CT, prospective studies are needed to determine whether it could potentially replace the array of conventional imaging procedures used today.