CT Exams Research Articles

Blunt splenic injury: Assessment of follow-up CT utility using quantitative volumetry.

Purpose:Trials of non-operative management (NOM) have become the standard of care for blunt splenic injury (BSI) in hemodynamically stable patients. However, there is a lack of consensus regarding the utility of follow-up CT exams and relevant CT features. The purpose of this study is to determine imaging predictors of splenectomy on follow-up CT using quantitative volumetric measurements.Methods:Adult patients who underwent a trial of non-operative management (NOM) with follow-up CT performed for BSI between 2017 and 2019 were included (n = 51). Six patients (12% of cohort) underwent splenectomy; 45 underwent successful splenic salvage. Voxelwise measurements of splenic laceration, hemoperitoneum, and subcapsular hematoma were derived from portal venous phase images of admission and follow-up scans using 3D slicer. Presence/absence of pseudoaneurysm on admission and follow-up CT was assessed using arterial phase images. Multivariable logistic regression was used to determine independent predictors of decision to perform splenectomy.Results:Factors significantly associated with splenectomy in bivariate analysis incorporated in multivariate logistic regression included final hemoperitoneum volume (p = 0.003), final subcapsular hematoma volume (p = 0.001), change in subcapsular hematoma volume between scans (p = 0.09) and new/persistent pseudoaneurysm (p = 0.003). Independent predictors of splenectomy in the logistic regression were final hemoperitoneum volume (unit OR = 1.43 for each 100 mL change; 95% CI: 0.99–2.06) and new/persistent pseudoaneurysm (OR = 160.3; 95% CI: 0.91–28315.3). The AUC of the model incorporating both variables was significantly higher than AAST grading (0.91 vs. 0.59, p = 0.025). Mean combined effective dose for admission and follow up CT scans was 37.4 mSv.Conclusion:Follow-up CT provides clinically valuable information regarding the decision to perform splenectomy in BSI patients managed non-operatively. Hemoperitoneum volume and new or persistent pseudoaneurysm at follow-up are independent predictors of splenectomy.

Differences in pulmonary nodular consolidation and pulmonary cavity among drug-sensitive, rifampicin-resistant and multi-drug resistant tuberculosis patients: a computerized tomography study with history length matched cases.

BackgroundThere have been concerns that literature described radiological feature differences between drug-sensitive pulmonary tuberculosis (DS-PTB) and multidrug-resistant (MDR)-PTB were confounded by that MDR-PTB cases tend to have a longer history. Using history length matched DS-PTB and MDR-PTB cases from a well-defined urban region in Dalian, we retrospectively analysed the CT feature differences of these paired cases with a focus on pulmonary nodular (PN) consolidation and pulmonary cavity (PC).MethodsThere were 33 consecutive MDR-PTB cases [inclusive of rifampicin-resistant (RR) cases, 27 males and 6 females, mean age: 49.2 years], with 19 cases had a history of <1 month and 8 and 6 cases had a history of 1–6 and >6 months respectively. To pair the MDR-PTB cases with history length, matched 33 cases of DS-PTB patients (21 males and 12 females, mean age: 56.5 years) were included. All patients were new PTB without HIV infection. The first CT exams prior to treatment were analysed.ResultsCompared with DS cases, MDR cases had a much higher prevalence of PN (75.76% vs. 45.45%) and a higher number of PN per positive case for PN (6.2 vs.1.53). For the cases >1 month history, MDR-PTB had a higher number of PC per positive case than that of DS-PTB cases (7.18 vs. 2.36). To differentiate DS-PTB from MDR-PTB, receiver operating characteristic (ROC) analysis showed a cutoff PN number of ≥3 had 48.5% sensitivity and 93.9% specificity, and a cutoff PC number of ≥4 had 39.4% sensitivity and 84.9% specificity. The lung field distribution of all lesions tended to be wider for MDR-PTB cases. MDR-PTB cases appeared to be associated with a faster progression in the absence of treatment.ConclusionsMDR-TB is likely intrinsically more invasive than DS-TB. Multiple PN and Multiple PC are promising signs for the suspicion of MDR-PTB on chest imaging.

Significant Rise in Cancer Risk Due to the Aggravate Dosage of Medical Radiology: A Research Study within the Last Two Decades

Aim: In recent times, the amount of CT scans conducted has increased rapidly in both the United States and the United Kingdom, raising concerns around the long-term repercussions of such exposure, mainly in rapports of cancer training. Methods and Results: Data from the United States and the United Kingdom show that CT utilization has increased 20-fold and 12-fold, correspondingly, during the last three decades, having per capita CT utilization in the United Kingdom being almost five times that of the US. Almost all of the collaborative daily dosage from diagnostic radiology in both nations did come from high-dose like CT, interventional radiology, also barium enemas; for both those processes, pertinent organ doses remain in variety for them remains today direct reliable epidemiological indication of an extra danger of tumor, without the requirement to extrapolate dangers from higher doses. Though with high-dose radiological operations, the danger to separate cases remains negligible, therefore an advantage of balancing is often in favor of the individuals. Problems emerge when CT exams are utilized without a demonstrated clinical basis, whenever alternate techniques having equivalent effectiveness may be employed, or when CT scans are performed needlessly. Conclusion: It is anticipated that those circumstances version in up to one-third of altogether CT scans in the United States. Another difficulty is the growing usage of CT scans by way of the tests method in symptomless individuals; at the current occasion, the advantage balance for slight generally recommended CT showing modalities has not been determined. keywords: CT scans, US, UK, Radiology interventions.

CT Evaluation of Swallowed Foreign Bodies Located in the Gastrointestinal System.

Background and objectiveCT imaging is important in detecting the location and the structure of swallowed foreign bodies and assessing their complications, due to its features such as the ability to show the detailed anatomical structure and enable multiplanar examination. In this study, we aimed to analyze the CT findings of swallowed foreign bodies located in the gastrointestinal tract and compare them with the data in the existing literature.Materials and methodsWe conducted a retrospective archive study to achieve our goals. Patients who presented to our radiology department with the preliminary diagnosis of foreign body ingestion, abdominal pain, or acute abdomen and were found to have a foreign body in the gastrointestinal tract on CT between April 2018 and April 2021, especially those in whom the presence of a foreign body was confirmed by endoscopy or surgery, were included in our study. The patients were evaluated in terms of age, gender, foreign body type, foreign body localization, and complications.ResultsA total of 31 patients (15 males and 16 females) were included in the study. The patients’ age ranged from 1 to 67 years, and the mean age was 28.5 ±5.4 years. The most common foreign bodies found were metallic toy parts (n=11, 35%), and most of the foreign bodies were located in the ileum (n=9, 29%) of the patients. Complications were observed in nine patients (29%). In patients with complications, the most common finding was perforation (n=3, 38%).ConclusionWhen a CT exam is performed on patients with abdominal pain, the gastrointestinal tract should be carefully evaluated to determine if a foreign body is involved and to analyze the complications caused by the foreign body.

Positive oral contrast material for CT evaluation of non-traumatic abdominal pain in the ED: prospective assessment of diagnostic confidence and throughput metrics.

Evaluate the impact of positive oral contrast material (POCM) for non-traumatic abdominal pain on diagnostic confidence, diagnostic rate, and ED throughput. ED oral contrast guidelines were changed to limit use of POCM. A total of 2,690 abdominopelvic CT exams performed for non-traumatic abdominal pain were prospectively evaluated for diagnostic confidence (5-point scale at 20% increments; 5 = 80-100% confidence) during a 24-month period. Impact on ED metrics including time from CT order to exam, preliminary read, ED length of stay (LOS), and repeat CT scan within 7days was assessed. A subset of cases (n = 729) was evaluated for diagnostic rate. Data were collected at 2 time points, 6 and 24months following the change. A total of 38 reviewers were participated (28 trainees, 10 staff). 1238 exams (46%) were done with POCM, 1452 (54%) were performed without POCM. For examinations with POCM, 80% of exams received a diagnostic confidence score of 5 (mean, 4.78 ± 0.43; 99% ≥ 4), whereas 60% of exams without POCM received a score of 5 (mean, 4.51 ± 0.70; 92% ≥ 4; p < .001). Trainees scored 1,523 exams (57%, 722 + POCM, 801 -POCM) and showed even lower diagnostic confidence in cases without PCOM compared with faculty (mean, 4.43 ± 0.68 vs. 4.59 ± 0.71; p < 0.001). Diagnostic rate in a randomly selected subset of exams (n = 729) was 54.2% in the POCM group versus 56.1% without POCM (p < 0.655). CT order to exam time decreased by 31min, order to preliminary read decreased by 33min, and ED LOS decreased by 30min (approximately 8% of total LOS) in the group without POCM compared to those with POCM (p < 0.001 for all). 205 patients had a repeat scan within 7days, 74 (36%) had IV contrast only, 131 (64%) had both IV and oral contrast on initial exam. Findings were consistent both over a 6-month evaluation period as well as the full 24-month study period. Limiting use of POCM in the ED for non-traumatic abdominal pain improved ED throughput but impaired diagnostic confidence, particularly in trainees; however, it did not significantly impact diagnostic rates nor proportion of repeat CT exams.

Ultra-high-resolution imaging of the shoulder and pelvis using photon-counting-detector CT: a feasibility study in patients.

To evaluate ultra-high-resolution (UHR) imaging of large joints using an investigational photon-counting detector (PCD) CT. Patients undergoing clinical shoulder or pelvis energy-integrating-detector (EID) CT exam were scanned using the UHR mode of the PCD-CT system. Axial EID-CT images (1-mm sections) and PCD-CT images (0.6-mm sections) were reconstructed using Br62/Br64 and Br76 kernels, respectively. Two musculoskeletal radiologists rated visualization of anatomic structures using a 5-point Likert scale. Wilcoxon rank-sum test was used for statistical analysis of reader scores, and paired t-test was used for comparing bone CT numbers and image noise from PCD-CT and EID-CT. Thirty-two patients (17 shoulders and 15 pelvis) were prospectively recruited for this feasibility study. Mean age for shoulder exams was 67.3 ± 15.5 years (11 females) and 47.2 ± 15.8 years (11 females) for pelvis exams. The mean volume CT dose index was lower on PCD-CT compared to that on EID-CT (shoulders: 18 mGy vs. 34 mGy, pelvis: 11.6 mGy vs. 16.7 mGy). PCD-CT was rated significantly better than EID-CT (p < 0.001) for anatomic-structure visualization. Trabecular delineation in shoulders (mean score = 4.24 ± 0.73) and femoroacetabular joint visualization in the pelvis (mean score = 3.67 ± 1.03) received the highest scores. PCD-CT demonstrated significant increase in bone CT number (p < 0.001) relative to EID-CT; no significant difference in image noise was found between PCD-CT and EID-CT. The evaluated PCD-CT system provided improved visualization of osseous structures in the shoulders and pelvises at a 31-47% lower radiation dose compared to EID-CT. • A full field-of-view PCD-CT with 0.151 mm × 0.176 mm detector pixel size (isocenter) facilitates bilateral, high-resolution imaging of shoulders and pelvis. • The evaluated investigational PCD-CT system was rated superior by two musculoskeletal radiologists for anatomic structure visualization in shoulders and pelvises despite a 31-47% lower radiation dose compared to EID-CT. • PCD-CT demonstrated significantly higher bone CT number compared to EID-CT, while no significant difference in image noise was observed between PCD-CT and EID-CTdespite a 31-47% dose reduction on PCD-CT.

Association of sonographic grading of fatty liver disease with liver function tests and CT hounsfield

Fatty Liver Disease (FLD) is described as the accumulation of triglycerides within cytoplasmic vesicles of hepatocytes exceeding 5 percent of total liver weight. It is generally of two types: Alcoholic or Non-alcoholic FLD (NAFLD). It has a tendency to progress and cause steatohepatitis, brosis, cryptogenic cirrhosis, hepatocellular carcinoma, chronic liver disease, metabolic syndrome, polycystic ovarian syndrome and adenocarcinomas. Objective: To nd association of Sonographic Grading of Fatty Liver Disease with Liver Function Tests and CT Hounseld units. The evaluation of the signicance of Ultrasound and LFTs over Computed Tomography is the aim of this study for the diagnosis of Fatty Liver Disease. Method: patients were undergone CT exams, Ultrasound exams and LFT tests for this this study (mean age: Their hepatic Hounseld units were obtained, Ultrasonographic grades were specied and LFTs were recorded. Results: The sonographic grading of fatty liver is significant/ not, taking HU value as standard. Conclusion: It is concluded that Ultrasound is effective in diagnosing this disease in all grades of FattyLiver Disease along with Liver Function Tests.

Abstract No. 144 Automated IVC filter detection from abdominopelvic CT exams using deep learning

IVC filters (IVCF) continue to be placed with regularity, estimated at over 30,000 per year in the USA. IVCF retrieval remains below 25% despite growing awareness of potential complications. “Loss to follow-up” is a common reason they may not be retrieved, especially when patients transition to new healthcare providers. This project aims to develop an automated, deep learning-based, approach to detect IVCF from abdominopelvic CTs performed for any reason. Once detected, this algorithm can automatically notify providers to evaluate the ongoing need for filtration.

Cut-off point of CT-assessed epicardial adipose tissue volume for predicting worse clinical burden of SARS-CoV-2 pneumonia.

ObjectiveTo identify a cut-off value of epicardial adipose tissue (EAT) volume quantified by CT associated with a worse clinical outcome in patients with SARS-CoV-2 pneumonia.Materials and methodsIn this retrospective study, sixty patients with a diagnosis of laboratory-confirmed COVID-19 pneumonia and a chest CT exam on admission were enrolled. Based on a total severity score (range 0–20), patients were divided into two groups: ordinary group (total severity score < 7) and severe/critical group (total severity score > 7). Clinical results and EAT volume were compared between the two groups.ResultsThe severe/critical patients, compared to the ordinary ones, were older (66.83 ± 11.72 vs 58.57 ± 16.86 years; p = 0.031), had higher body mass index (27.77 ± 2.11 vs 25.07 ± 2.80 kg/m2; p < 0.001) and higher prevalence of comorbidities. EAT volume was higher in severe/critical group, compared with the ordinary group (151.40 ± 66.22 cm3 vs 92.35 ± 44.46 cm3, p < 0.001). In severe/critical group, 19 (73%) patients were admitted in intensive care unit (ICU), compared with 6 (20%) patients in the ordinary group (p < 0.001). The area under the ROC curve (AUC) is equal to 0.781 (p < 0.001) (95% CI: 0.662–0.900). The cut-off found, in correspondence with the highest value of the Youden Index, is 97 cm3: the sensitivity is equal to 83.3%, while the specificity is equal to 70% for predicting a worse outcome. The risk (odds ratio) of belonging to the severe/critical group in this population due to EAT ≥ 97 cm3 is 11.667 (95% CI: 3.384–40.220; p < 0.001).ConclusionAn EAT volume of 97 cm3 has good sensitivity and specificity to predict a greater extent of pulmonary involvement and therefore a worse clinical outcome in patients with SARS-CoV-2 pneumonia.

P335 AORTIC VALVE INFECTIVE ENDOCARDITIS COMPLICATED BY SUPERIOR MESENTERIC ARTERY ACUTE TROMBOSIS

Abstract The infective endocarditis (IE) has a significant impact on mortality rate in the first year after diagnosis, despite the improvements in early diagnosis and therapy. Embolic complications cause worsening of patient’s prognosis and they occur in the 20–50% of cases, with a risk of new embolic events after the initiation of antibiotic therapy rated between 6 and 12%. Echocardiographic characterization of vegetation has an important role in the definition of the embolization risk, it is documented that vegetation with dimension more than 10 mm are at higher risk. Several characteristic of the patient (diabetes, previous embolization, atrial fibrillation) determine the increase of the embolization risk, as well as the initiation of antibiotic therapy. We describe the case of a 64 y.o. man with chronic coronary syndrome (previous PCI) and previous Bentall–De Bono intervention for ascending aorta aneurysm. Patient was under anticoagulant therapy with DOAC due to atrial fibrillation. He was admitted to the emergency department for intermittent fever during the last three months, dyspnea and fatigue. Blood test showed neutrophilic leukocytosis and increased value of inflammatory markers. Transthoracic echography revealed an hyperechoic image on the ventricular side of the aortic prosthesis. The diagnosis of infective endocarditis was confirmed with transesophageal echocardiography, and empiric antibiotic therapy was initiated. Cardiac surgeon suggested follow up and new evaluation after three weeks of therapy. Clinical course was complicated by acute abdomen. The CT exam revealed dilation of a distal tract of superior mesenteric artery (maximum axial diameter was 10 mm) associated with distal thrombosis extended for 6 mm. The transthoracic echocardiogram showed absence of the vegetation on aortic prosthesis previous documented. Therapy with intravenous infusion of unfractionated heparin was administrated for three weeks, but the control TC showed persistence of the thrombotic occlusion of superior mesenteric artery so the case was discussed with Vascular Surgery team. They decided to treat patient with embolization and aneurysmectomy surgery (cultures were negative). This clinical case demonstrates that embolic complication of infective endocarditis, even on proper antbiotic therapy and close monitorization, are unpredictable and can cause the worsening of patient’s clinical course.

A two step workflow for pulmonary embolism detection using deep learning and feature extraction

ABSTRACT Pulmonary embolism is among the leading causes of death all over the world. In order to achieve a fast diagnosis and response from the medical team, a CT exam is used as a means to detect embolisms. Over the years, different methods of computer-aided diagnosis systems (CADs) were implemented to facilitate the analysis of a CT exam for pulmonary embolism detection, and due to the high amount of data produced in these exams, methods that use deep learning are also growing as of late. This paper proposes a pipeline to detect pulmonary embolisms from a CT exam. It uses a U-net network to detect embolisms candidates and classifies them between false positives and true positives using machine learning algorithms. The method achieved a dice score of 0.81 and an IoU of 0.79.

Transvaginal US vs. CT in non-pregnant premenopausal women presenting to the ED: clinical impact of the second examination when both are performed.

ObjectiveTo determine the clinical impact of the second examination when both CT and TVUS are obtained in the same ED visit for acute pelvic/lower abdominal symptoms in non-pregnant premenopausal women.Methods200 consecutive non-pregnant premenopausal women (mean age, 31.8 years; range, 18–49 years) who underwent both ED-based TVUS and abdominopelvic CT evaluation for acute symptoms over a 12 month period were included; 107 women had TVUS first, followed by CT; 93 women had CT first. All relevant clinical, radiologic, and pathologic findings were reviewed to establish a final diagnosis. Any additional clinical impact provided by the second imaging test was assessed by two experienced abdominal radiologists.ResultsInitial TVUS was interpreted as normal (n = 63) or mentioned incidental findings (n = 11) in 69% (74/107); subsequent CT established a non-gynecologic GI/GU etiology in 25 (34%). For 37% (34/93) of CT exams interpreted as normal, TVUS added no new information. In 32 cases (34%), TVUS further excluded ovarian torsion/adnexal pathology when initial CT was indeterminate/equivocal. Overall, CT following TVUS provided a key new or alternative diagnosis in 26% (28/107), whereas TVUS after CT provided a relevant new/alternative diagnosis in only 1/93 cases (p < 0.001). In nine cases (8%), CT confirmed a positive US diagnosis but detected relevant additional diagnostic information.ConclusionCT following negative TVUS frequently identified a non-gynecologic cause of acute pelvic or lower abdominal symptoms in non-pregnant premenopausal women, whereas the main benefit of TVUS after CT was more confident exclusion of ovarian torsion. Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s00261-022-03504-6.

Volume-based tomography for the diagnosis of incipient silicosis in former gold miners

ObjectiveTo evaluate silicosis diagnosed through CT, with integration of clinical-occupational data, in silica-exposed workers presenting chest X-rays within International Labor Organization (ILO) category 0.MethodsCross-sectional study with 339 former gold miners,...

Improving coronary artery imaging in single source CT with cardiac motion correction using attention and spatial transformer based neural networks.

Motion artifact is a major challenge in cardiac CT which hampers accurate delineation of key anatomic (e.g. coronary lumen) and pathological features (e.g. stenosis). Conventional motion correction techniques are limited on patients with high / irregular heart rate, due to simplified modeling of CT systems and cardiac motion. Emerging deep learning based cardiac motion correction techniques have demonstrated the potential of further quality improvement. Yet, many methods require CT projection data or advanced motion simulation tools that are not readily available. We aim to develop an image-domain motion-correction method, using convolutional neural network (CNN) integrated with customized attention and spatial transformer techniques. Forty cardiac CT exams acquired from a clinical dual-source CT system were retrospectively collected to generate training (n=26) and testing (n=14) sets. Dual-source data uniquely allow image reconstruction with different temporal resolutions from the same patient scan. Slow temporal resolution (140ms; equivalent to single-source CT (SSCT) half scan) and fast temporal resolution (75ms; dual source) images were reconstructed to generate paired samples of motion-corrupted and reference images. The combinations of 2 training-inference strategies and 3 CNNs were evaluated: strategy #1 - whole-heart images in training / inference; strategy #2 - vessel patches in training / inference; CNN #1 - attention only; CNN #2 - spatial-transformer (STN) only; CNN #3 - attention & STN synergy. Testing data showed that CNN #3 with strategy #2 provided relatively better performance: improving vessel delineation, increasing structural similarity index from 0.85 to 0.91, and reducing mean CT number error of lumen by 71.0%. Our method could improve the image quality in cardiac exams with SSCT.

A 25-reader performance study for hepatic metastasis detection: lessons from unsupervised learning.

There is substantial variability in the performance of radiologist readers. We hypothesized that certain readers may have idiosyncratic weaknesses towards certain types of lesions, and unsupervised learning techniques might identify these patterns. After IRB approval, 25 radiologist readers (9 abdominal subspecialists and 16 non-specialists or trainees) read 40 portal phase liver CT exams, marking all metastases and providing a confidence rating on a scale of 1 to 100. We formed a matrix of reader confidence ratings, with rows corresponding to readers, and columns corresponding to metastases, and each matrix entry providing the confidence rating that a reader gave to the metastasis, with zero confidence used for lesions that were not marked. A clustergram was used to permute the rows and columns of this matrix to group similar readers and metastases together. This clustergram was manually interpreted. We found a cluster of lesions with atypical presentation that were missed by several readers, including subspecialists, and a separate cluster of small, subtle lesions where subspecialists were more confident of their diagnosis than trainees. These and other observations from unsupervised learning could inform targeted training and education of future radiologists.

103P Effectiveness of artificial intelligence in retrospective COVID-19 lung CT analysis for lung cancer detection

In the context of the Covid-19 pandemic, due to the dramatically increased volume of CT exams and COVID-19 pneumonia signs as a background there is a the risk of missing nodules. The goal of our project was to evaluate the effectiveness of using automated image processing with AI in chest COVID CT scans analysis for pulmonary nodes detection.

COMPUTED TOMOGRAPHY FEATURES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE ASSOCIATED WITH LUNG CANCER

Relevance: Chronic obstructive pulmonary disease (COPD) associated with lung can-cer is common in smoking patients. Computed&#x0D; tomography (CT) is vital in detecting lung cancer, assessing regional lung parenchymal destruction, and airway remodeling in COPD.&#x0D; The study aimed to determine the CT features of COPD associated with lung cancer.&#x0D; Methods: This retrospective study included chest CT exams of 56 patients over the age of 40 with a smoking history of 10 years and&#x0D; more and with suspected COPD. 46.43% of patients had CT signs of lung cancer associated with COPD.&#x0D; Results: Barrel-shaped chest (19.23%), saber-sheath trachea(7.69%), and bronchiecta-sis (15.38%) were less common in patients with&#x0D; lung cancer. 96.15% were diagnosed with paraseptal and centrilobular emphysema, bullae – 73.33%. Bronchial narrowing of the lumen&#x0D; and wall thickening were identified for all lobar bronchus, segmen-tal bronchus, and subsegmental bronchus.&#x0D; Conclusion: Paraseptal and centrilobular emphysema and bullae in the upper lobes of the lungs were predominant CT features in&#x0D; patients with COPD associated with lung cancer. Lumen narrowing and wall thickening of lobar bronchus, segmental bronchus, and subsegmental bronchus were also revealed.

Cranioplasty after Two Giant Intraosseous Angiolipomas of the Cranium: Case Report and Literature Review.

Angiolipomas are rare, benign tumors resulting from the proliferation of adipose tissue and blood vessels, most frequently encountered subcutaneously at the upper limbs and trunk level. Due to their rarity, few cases of intraosseous angiolipomas are presented in the literature. The paper reports a 50-year-old female case with intracranial hypertension syndrome, frontal and parietal headache, nausea, and vomiting symptoms increasing in intensity. A CT exam revealed two hypodense expansive intraosseous formations/lesions. The first one was located in the projection of the frontal bone and the second one was placed on the left parietal bone. After further investigations, a two-stage procedure was considered. A frontal craniotomy with excision of the intraosseous tumor was performed in the first stage. In the second stage, a left parietal craniotomy was done with excision of the intraosseous tumor combined with a cranioplasty procedure. The patient had a favorable postoperative evolution with no symptoms or neurological deficits. This is among the few reported cases of intraosseous angiolipoma located at the cranium level and the first case report of two intraosseous angiolipomas situated on the same site. The medical recommendation was a complete surgical excision of the lesion followed by cranioplasty.

ASSOCIATION OF SONOGRAPHIC GRADING OF FATTY LIVER DISEASE WITH LIVER FUNCTION TESTS AND CT HOUNSFIELD

Fatty Liver Disease is described as the accumulation of triglycerides within cytoplasmic vesicles of hepatocytes exceeding 5 percent of total liver weight. It is generally of two types: Alcoholic or Non-alcoholic fatty liver disease. It has a tendency to progress and cause steatohepatitis, fibrosis, cryptogenic cirrhosis, hepatocellular carcinoma, chronic liver disease, metabolic syndrome, polycystic ovarian syndrome and adenocarcinomas. It is associated with obesity, diabetes mellitus, high triglycerides and low HDL levels.The Objective of this study is to find association of Sonographic Grading of Fatty Liver Disease with Liver function tests and CT Hounsfield units. The evaluation of the significance of Ultrasound and LFTs over Computed Tomography is the aim of this study for the diagnosis of Fatty Liver Disease. Material and Method:104 patients were undergone CT exams, Ultrasound exams and LFT tests for this this study (mean age: 38 years). Their hepatic (right lobe and left lobe) and Splenic Hounsfield units were obtained, Ultrasonographic grades were specified and LFTs were recorded. Crosstabulations, multiple comparisons and ANOVA was done separately on the results obtained. Results:In a cross-tabulation between Lobes of Liver, Hounsfield Units and Fatty Liver Grades through ultrasonography, a significant association is seen.The means of total bilirubin in three groups of Fatty Liver (Grade I, Grade II, Grade III) are statistically insignificant. The means of ALT, AST and Alkaline Phosphatase in three groups of Fatty Liver (Grade I, Grade II, Grade III) are statistically significant. Conclusion:It is concluded that Ultrasound is effective in diagnosing this disease in all grades of FattyLiver Disease along with Liver Function Tests.

Impact of a radiological protection campaign in emergency paediatric radiology: a multicentric observational study in Brazil

PurposeTo evaluate the impact of a paediatric radiological protection campaign, implemented in the emergency units of a healthcare provider network in Brazil. This campaign aimed to promote awareness among emergency department physicians, regarding justification of paediatric X-ray referrals for paranasal sinus, chest and CT exams, as a strategy to reduce exposure to ionising radiation.MethodFrequency analysis of common paediatric imaging referrals from 19 emergency departments was performed for a 3-year period (2015–2018) to coincide with before, during and after the implementation of the radiation protection campaign. The campaign was multifaceted and involved dissemination of educational materials and imaging referral guidelines along with quarterly meetings with participating centres' leaderships. Additionally, patient dose cards were distributed to patients/carers. The Chi-Square test was used to examine the association between the type of examination and the patient's age group. Exact-Fisher test was performed to check for an association between participant engagement and the existence of the radiation protection committee.ResultsReferrals reduced by 25% following the campaign with no reports of misdiagnosis. Many referrals in the youngest age groups. In 15 units, a radiological protection committee was created to raise awareness and to create a multi professional team to communicate the risks and benefits of radiological procedure in children.ConclusionThe campaign resulted in a substantial reduction in radiological referrals while promoting a radiation protection culture. Simple education initiatives can contribute to savings in both finances and radiation doses, particularly important in radiosensitive cohorts.