Computed Tomography Examinations Research Articles

Deep learning-based AI model for sinusitis diagnosis

Problem statement While CT (Computed Tomography) is commonly used, its diagnostic accuracy for chronic sinusitis remains uncertain. Moreover, the high cost of CT examinations limits its use as a routine diagnostic method. There is an urgent need to develop an AI-assisted diagnostic model for sinusitis. Objective The primary aim of this study is to develop an AI-assisted diagnostic model for sinusitis that can improve diagnostic accuracy and accessibility compared to traditional CT methods. Methodology This study utilized a retrospective approach, focusing on patients diagnosed with chronic sinusitis via CT and normal patients admitted to the People's Hospital between January 2018 and January 2019. A total of 5000 sinus CT images were collected. All cases underwent T (targeted) coronal plain scans in the hospital's CT room, ensuring complete CT images. In constructing the chronic sinusitis classification model based on deep learning, 5000 CT images of soft tissue windows and sinuses were gathered. This included 1000 CT images for each of the four groups diagnosed with sphenoid sinusitis, frontal sinusitis, ethmoid sinusitis, and maxillary sinusitis, along with 1000 images from normal cases (250 images per group). The sigmoid function replaced the softmax function, and the binary cross-entropy function was used to assess the model's predictive accuracy. Results The model achieved an accuracy of 85.8%, outperforming doctors with low (71.7%), medium (78.4%), and senior (73.4%) qualifications. The model demonstrated high accuracy, superior feature extraction, and resolution capabilities.

Evaluating the impact of dose monitoring software alerts on radiation dose reduction in computed tomography: A systematic review.

Radiation Dose Monitoring Software (DMS) tools have been developed to monitor doses and alert computed tomography (CT) users of high radiation exposure. However, the causal factors for alerts and the impact of DMS in dose optimisation are poorly understood. This review aims to identify high-dose CT examinations triggering alerts and their determinants, and to assess if the alerts from DMS help to reduce CT dose levels. To identify relevant articles published to December 2023, an electronic search of Medline, Scopus, CINAHL, Embase, and the Web of Science was undertaken. Reference lists of published articles were also assessed to identify further articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was employed to evaluate articles for relevance. Articles were included if they used the DMS tool to detect high-dose events that issued alerts in CT and were published in English. The search resulted in 83 articles, of which, nine were included after a thorough screening process. High dose alerts most often occurred in CT chest, CT head/brain, CT Chest/abdomen/pelvis, and CT abdomen/pelvis with alert percentages ranging from 1.45% to 10.21%, 1.54% to 4.18%, 4.48% to 6.60%, and 4.47% respectively. Alerts were mainly triggered by overweight patients, scan repetition, miscentering of the patients, extra CT study added, orthopaedic hardware in the scanning area and scanning beyond the desire anatomy. Most of the studies reviewed show that DMS tools played a role in reducing the number of high-dose events that trigger alerts. DMS tools are valuable in automatically identifying high-dose CT protocols, enabling quick investigation and dose optimisation. The high-dose events occurred due to patient and technical factors, which can be mitigated through proper monitoring and investment in both technological resources and staff training.

CompositIA: an open-source automated quantification tool for body composition scores from thoraco-abdominal CT scans

BackgroundBody composition scores allow for quantifying the volume and physical properties of specific tissues. However, their manual calculation is time-consuming and prone to human error. This study aims to develop and validate CompositIA, an automated, open-source pipeline for quantifying body composition scores from thoraco-abdominal computed tomography (CT) scans.MethodsA retrospective dataset of 205 contrast-enhanced thoraco-abdominal CT examinations was used for training, while 54 scans from a publicly available dataset were used for independent testing. Two radiology residents performed manual segmentation, identifying the centers of the L1 and L3 vertebrae and segmenting the corresponding axial slices. MultiResUNet was used to identify CT slices intersecting the L1 and L3 vertebrae, and its performance was evaluated using the mean absolute error (MAE). Two U-nets were used to segment the axial slices, with performance evaluated through the volumetric Dice similarity coefficient (vDSC). CompositIA’s performance in quantifying body composition indices was assessed using mean percentage relative error (PRE), regression, and Bland–Altman analyses.ResultsOn the independent dataset, CompositIA achieved a MAE of about 5 mm in detecting slices intersecting the L1 and L3 vertebrae, with a MAE < 10 mm in at least 85% of cases and a vDSC greater than 0.85 in segmenting axial slices. Regression and Bland–Altman analyses demonstrated a strong linear relationship and good agreement between automated and manual scores (p values < 0.001 for all indices), with mean PREs ranging from 5.13% to 15.18%.ConclusionCompositIA facilitated the automated quantification of body composition scores, achieving high precision in independent testing.Relevance statementCompositIA is an automated, open-source pipeline for quantifying body composition indices from CT scans, simplifying clinical assessments, and expanding their applicability.Key PointsManual body composition assessment from CTs is time-consuming and prone to errors.CompositIA was trained on 205 CT scans and tested on 54 scans.CompositIA demonstrated mean percentage relative errors under 15% compared to manual indices.CompositIA simplifies body composition assessment through an artificial intelligence-driven and open-source pipeline.Graphical

Spinal ataxia and computed tomography findings in a Poitou donkey affected with congenital occipitoatlantoaxial malformation

SummaryA 3‐year‐old Poitou donkey was referred for a computed tomography (CT) examination of the cervical spine due to acute deterioration of spinal ataxia. Neurological assessment revealed restricted neck mobility, hypermetria and circumduction of all limbs, indicating a grade 2 out of 5 ataxia. Abnormalities of the neurologic examination were most likely associated with spinal cord disease between C1 and C5. CT examination identified an asymmetric, congenital, occipitoatlantoaxial malformation (OAAM). A static extradural compression of the spinal cord secondary to the malformation was present. This case report represents an inaugural documentation of OAAM in a Poitou donkey.

Long-term retention of the pedicled thymic flap after bronchial stump coverage.

This study aimed to assess the feasibility and retention rates of pedicled thymic flaps to enhance understanding of bronchial stump coverage. A retrospective analysis of 22 consecutive patients who underwent anatomical lung resection followed by bronchial stump coverage with pedicled thymic flaps between January 2017 and December 2022 was conducted. The procedure was performed using a minimally invasive 3-port video-assisted thoracoscopic surgery technique for all patients with no complications related to graft harvest or fixation. Postoperative retention of the engrafted flaps was evaluated in the 16 patients who underwent thin-slice computed tomography (CT) at least once after surgery. The majority of the postoperative CT examinations were performed for surveillance of lung cancer recurrence. The retention rates of pedicled thymic flaps were 100% at 60 days, 87% at 180 days, and 70% at one year post-surgery. Pedicled thymic flaps can be safely harvested using a minimally invasive approach, and the majority of engrafted flaps remain adjacent to the bronchial stump for more than one year. This technique may be a viable option for patients at high risk of a delayed bronchopulmonary fistula.

The Clinical Value of the MAR+ Metal Artifact Reduction Algorithm for Postoperative Assessment of Lumbar Internal Fixation.

With the widespread use of lumbar pedicle screws for internal fixation, the morphology of the screws and the surrounding tissues should be evaluated. The metal artifact reduction (MAR) technique can reduce the artifacts caused by pedicle screws, improve the quality of computed tomography (CT) images after pedicle fixation, and provide more imaging information to the clinic. To explore whether the MAR+ method, a projection-based algorithm for correcting metal artifacts through multiple iterative operations, can reduce metal artifacts and have an impact on the structure of the surrounding metal. A total of 57 patients who underwent lumbar spine CT examination after lumbar internal fixation from January to December 2023 in our hospital were retrospectively enrolled. The CT images were reconstructed using MAR+ and non-MAR+ techniques and were subdivided into MAR+ and non-MAR+ groups. The CT number (in Hounsfield units) and the SD noise values of the spinal canal, vertebral body, psoas major muscle, and adjacent fat were measured in the 2 groups of CT images, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The subjective score was evaluated by two diagnostic radiologists using a double-blind method for image quality evaluation of the MAR+ group and the non-MAR+ group, and the image quality was classified on a 5-point scale. The rank-sum test was utilized to compare the subjective and objective scores of the 2 groups. The SD values of the spinal canal (Z=-4.12, P<0.01), vertebral body (Z=-3.81, P<0.01), and psoas major muscle (Z=-3.87, P<0.01) in the MAR+ group were significantly lower than those in the non-MAR+ group (P<0.05). However, the SD values of the adjacent fat (Z=-2.03, P=0.42) in the MAR+ group, although smaller than those in the non-MAR+ group, were not statistically significant. The CNR values of vertebral canal (Z=-2.67, P=0.008) and fat (Z=-2.60, P=0.009) were higher in the MAR+ group than in the non-MAR+ group, whereas the CNR values of the vertebral body (Z=-6.74, P<0.01) in the MAR+ group were smaller than those in the non-MAR+ group, and the difference of all of them was statistically significant (P<0.05). Furthermore, for both CT and SNR values, the MAR group's values were all less than those of the non-MAR group and were statistically significant (P<0.05). The subjective scores of the measurement points were all higher in the MAR+ group than in the non-MAR+ group. The MAR+ technique has a noise reduction effect on different tissues and artifacts are significantly reduced. Although the artifacts caused by metal screws were not completely eliminated, the MAR+ technique was able to reduce the interference of artifacts in the diagnosis of CT images, thus improving their diagnostic quality.

A Forgotten Rare Cause of Unilateral Basal Ganglia Calcinosis Due to Venous Angioma and Complicating Acute Stroke Management: A Case Report

Background: Unilateral basal ganglia calcinosis (BGC) is a rare radiological finding that can be diagnosed on computed tomography (CT) and magnetic resonance imaging (MRI) but often presents challenges for clinicians and radiologists in determining its underlying cause. So far, only a few potential causes that could explain unilateral BGC have been described in the literature. Case Report: A 54-year-old Caucasian male was admitted to a tertiary university hospital due to the sudden onset of speech impairment and right-sided weakness. The patient had no significant medical history prior to this event. Non-enhanced computed tomography (NECT) of the brain revealed no evidence of acute ischemia; CT angiography (CTA) showed acute left middle cerebral artery (MCA) M2 segment occlusion. CT perfusion (CTP) maps revealed an extensive penumbra-like lesion, which is potentially reversible upon achieving successful recanalization. However, a primary neoplastic tumor with calcifications in the basal ganglia was initially interpreted as the potential cause; therefore, acute stroke treatment with intravenous thrombolysis was contraindicated. A follow-up CT examination at 24 h revealed an ischemic lesion localized to the left insula, predominantly involving the left parietal lobe and the superior gyrus of the left temporal lobe. Subsequent gadolinium-enhanced brain MRI revealed small blood vessels draining into the subependymal periventricular veins on the left basal ganglia. Digital subtraction angiography was conducted, confirming the diagnosis of venous angioma. Conclusions: Unilateral BGC caused by venous angioma is a rare entity with unclear pathophysiological mechanisms and heterogeneous clinical presentation. It may mimic conditions such as intracerebral hemorrhage or hemorrhagic brain tumors, complicating acute stroke management, as demonstrated in this case. Surrounding tissue calcification may provide a valuable radiological clue in diagnosing venous angiomas DVAs and vascular malformations.

A case of sepsis complicated by multiple organ dysfunction syndrome with CT appearance of subarachnoid hemorrhage.

A 39-year-old male patient was admitted to hospital with abdominal distension, unconsciousness, and anuria. Head computed tomography (CT) scan showed subarachnoid hemorrhage and diffuse cerebral edema. The high-density area of contrast accumulation region in the high-density CT plaque was 38 HU, and the preliminary diagnosis was SAH, incomplete intestinal obstruction, and sepsis caused by acute cerebrovascular disease. After admission, the patient had sudden upturned eyes, limb convulsions, serum procalcitonin level exceeding 100ng/mL, low blood pressure and septic shock. Imipenem was given for intensive anti-infection therapy. After treatment, the procalcitonin levels showed a slow decline, renal function returned to normal, intra-abdominal pressure dropped to normal, urine volume gradually increased, but platelets still showed a downward trend. The lumbar puncture showed colorless and clear cerebrospinal fluid, and the biochemical and routine results of cerebrospinal fluid were normal. SAH and intracranial infection were excluded, and it was considered that the head CT scan showed pseudo subarachnoid hemorrhage. On the 4th day of admission, laparoscopic exploratory laparotomy+appendectomy+abdominal drainage under general anesthesia were performed. During the operation, purulent gangrene was observed in the appendix, abscess and moss were observed on the surface of the intestine, and a large amount of pus was found in the abdominal cavity. Rhabdomyolysis syndrome appeared after surgery. After continuous renal replacement therapy, the indicators gradually returned to normal level. The patient was conscious, and the head CT examination was normal. The patient was discharged from the hospital on the 10th day after surgery, and no special discomfort and abdominal pain and distension occurred during the 3-month follow-up.

P0303 Evaluation of the Terminal Ileum on Computed Tomography of Patients with Non-Traumatic Acute Abdominal Pain in the Emergency Department

Abstract Background Crohn’s Disease (CD) may be overlooked in patients presenting to the emergency department with acute abdominal pain. We aimed to determine the frequency of CD and increased terminal ileum wall thickness on abdominal computed tomography (CT) in patients presenting to the emergency department with non-traumatic acute abdominal pain. Methods A cross-sectional observational study was conducted among patients who had presented to the emergency department with non-traumatic acute abdominal pain and underwent CT between September 2023 and September 2024. Before CT, patients with known diseases such as CD, vasculitis, tuberculosis, and lymphoma were excluded from the study. A colonoscopy was performed on patients with terminal ileum wall thickness on CT examination. Results A total of 1014 patients were admitted to the emergency department with non-traumatic acute abdominal pain, 10 (1%) of whom were determined to increase terminal ileum wall thickness. The median age was 41.2, and 7 (70%) patients were female. Median terminal ileum wall thickness was measured as 6.04 mm. 9 (90%) had limited terminal ileum, 6 (60%) had a length of wall thickness more than &amp;gt; 5cm, 7 (70%) had stenosis and 5 (50%) had pre-stenotic dilatation on CT. Colonoscopy revealed aphthous ulcers in the terminal ileum in 6 patients, longitudinal deep ulcers in 2 patients, and 2 patients with intact terminal ileum mucosa. 3 (0.3%) of the patients with terminal ileum wall thickness were diagnosed CD after colonoscopic examination. One patient had ileocolonic involvement with stricturing behavior, while the other two had isolated ileal involvement with inflammatory behavior. 2 patients were managed with medical treatment and the other patient with ileal resection. The remaining 5 patients with terminal ileal aphthous ulcers had a history of antibiotic, nonsteroidal anti-inflammatory drug use, or gastroenteritis within the last 3 months. Conclusion In this study, CD was detected in 3 (0.3%) patients who has previously undiagnosed, presented non-traumatic acute abdominal pain with terminal ileum wall thickness on CT. Terminal ileitis is a rare reason in patients presenting acute abdominal pain. However, CD should be kept in mind among differential diagnosis.

P0360 Bowel Ultrasonography and Computed Tomography tell the same story using different languages in analizing Crohn’s disease lesions

Abstract Background Inflammatory bowel diseases (IBD) are chronic diseases that require multiple endoscopic and imaging assessments, being diseases that not only involve a multitude of medical resources but patient compliance too. Bowel ultrasonography (BUS) and computed tomography (CT) have similar sensitivities (89.7% and 84.3%) and specificities (95.6% and 95.1%) in assessing IBD patients.Current guidelines recommend BUS altogether with other cross-sectional imaging methods to diagnose, monitor IBD patients and also for detecting complications and post-surgery recurrence Methods 36 Crohn’s disease patients with established endoscopic and histologic diagnosis were included in the study. Patients with moderate and severe disease were prospectively evaluated using two cross-sectional imaging methods (CT and BUS) by two different examiners. Patients with superimposed infection or with surgical history were excluded. The BUS examination was performed using 5-12 MHz micro-convex transducer with no special preparation before, while CT examination was performed using both intra-venous and oral contrasts. Both examiners were blinded to each other’s data. Different bowel wall characteristics were noted using the two methods. A subjective overall assessment of the obtained images was noted according to each examiner. Results A moderate correlation was observed between the measurements of bowel wall thickness using BUS and CT (Spearman’s equation, r= 0.504, p&amp;lt;0.01). Regarding bowel wall stratification, no corrrelation was observed using the two methods. Regarding the comb sign, there was no BUS surrogate for the CT observation. Doppler signal correlated well with the presence of bowel wall stratification observed using CT ( K= 0,36, p p&amp;lt;0.006). A very good agreement was noticed regarding mesenteric fat densification using the two imaging techniques ( k=0,55, p p&amp;lt;0.00006). A low but significantly statistic inter-observer agreement was obtained when lymph nodes were searched ( k=0.28, p p&amp;lt;0.03). When comparing the overall assessment of the examinators, we obtained a good inter-rater agreement (k=0.58, p&amp;lt;0.001) between the two cross-sectional techniques. Conclusion Several BUS and CT observations do not overlap even though the general aspect is similar. This happens when analizing bowel wall stratification that should be understood and applied in clinical pactice differently. The good inter-rater agreement between the two methods prooves that both investigations are useful and should be used according to availability.

Deep learning-based CT radiomics predicts prognosis of unresectable hepatocellular carcinoma treated with TACE-HAIC combined with PD-1 inhibitors and tyrosine kinase inhibitors

ObjectiveTo develop and validate a computed tomography (CT)-based deep learning radiomics model to predict treatment response and progression-free survival (PFS) in patients with unresectable hepatocellular carcinoma (uHCC) treated with transarterial chemoembolization (TACE)-hepatic arterial infusion chemotherapy (HAIC) combined with PD-1 inhibitors and tyrosine kinase inhibitors (TKIs).MethodsThis retrospective study included 172 patients with uHCC who underwent combination therapy of TACE-HAIC with TKIs and PD-1 inhibitors. Among them, 122 were from the Interventional Department of the Harbin Medical University Cancer Hospital, with 92 randomly assigned to the training cohort and 30 cases randomly assigned to the testing cohort. The remaining 50 cases were from the Interventional Department of the Affiliated Fourth Hospital of Harbin Medical University and were used for external validation. All patients underwent liver enhanced CT examination before treatment. Residual convolutional neural network (ResNet) technology was used to extract image features. A predictive model for treatment response of combination therapy and PFS was established based on image features and clinical features. Model effectiveness was evaluated using metrics such as the area under the receiver operating characteristic (ROC) curve (AUC), concordance index (C-index), accuracy, precision, and F1-score.ResultsAll patients had a median follow-up of 25.2 months (95% CI 24.4–26.0), with a median PFS of 14.0 months (95% CI 8.5–19.4) and a median overall survival (OS) of 26.2 months (95% CI 15.9–36.4) achieved. Objective response rate (ORR) and disease control rate (DCR) was 41.0% and 55.7%, respectively. In the treatment response prediction model, the AUC for the training cohort reached 0.96, with an accuracy of 89.5%, precision of 85.6%, and F1-score of 0.896; the AUC for the testing cohort was 0.87, with an accuracy of 80.4%, precision of 74.5%, and F1-score of 0.802. The AUC of the external validation cohort was 0.85, with accuracy of 79.1%, precision of 73.6%, and f1-score of 0.784. In the PFS prediction model, the predicted AUC for 12 months, 18 months, and 24 months-PFS in the training cohort were 0.874, 0.809, 0.801, respectively. The AUC of testing cohort were 0.762, 0.804, 0.792. The AUC of external validation cohort were 0.764, 0.796, 0.773. The C-index of the combination model, radiomics model, and clinical model were 0.75, 0.591, and 0.655, respectively. The calibration curve demonstrated that the combination model was significantly superior to both the radiomics and clinical models.ConclusionsThe study provides a CT-based radiomics model that can predict PFS for patients with uHCC treated with TACE-HAIC combined with PD-1 and TKIs.

Assessment of root resorption on lateral incisors after primary canine extraction treating mesioangular displaced permanent canines: a randomised controlled trial.

Root resorption (RR) of the adjacent maxillary lateral incisors is considered the most common complication of displaced maxillary canines. The aim of this study was to assess the effect of interceptive extraction of the primary canines on the condition of the roots of permanent neighbouring teeth to mesioangular displaced canines (MDC). In addition, this study aimed to investigate the relationship between the position of the unerupted canine and the risk of RR in adjacent lateral incisors. Randomised controlled clinical trial. Eighty-five patients 9-12-year-old with MDC were allocated equally to either an extraction group (EG) or a control group (CG). Of the sample, 33 were males (38.8%), and 52 were females (61.2%). Among this sample, 81 canines (51.9%) were buccally displaced, 34 canines (21.8%) were palatally displaced, and 41 canines (26.3%) were mid-alveolar. All subjects underwent cone-beam computed tomography examination to determine the presence, stage, and level of lateral incisor root resorption (RR). Measurements were performed at T0 and repeated at a 12-month follow-up (T2). Root resorption (RR) was present in 28.2% of lateral incisors at the baseline assessment (T0) and exhibited a significant increase at the 12-month follow-up (T12). This marked increase in resorption severity was evident between T0 and T12 (P = 0007), regardless of group allocation. There was a significant increase in the degree of resorption between T2 and T0, with a mean difference equals to 0.31 (0.73), P < 0.0001. While there was no statistically significant difference in resorption levels between the extraction and control groups at T0 (P = 0.11), RR occurred more frequently with midalveolar (34.1%) and palatal (32.3%) displacements than with buccal displacements (23.5%). Severe resorption was observed more frequently in cases involving palatally displaced canines within both groups, but it did not reach statistical significance. Lateral incisor root resorption (RR) progressed significantly within a 12-month period irrespective of treatment modality. RR occurred more frequently with midalveolar and palatal displacement with a trend towards increased RR severity in cases with palatally displaced canines. Early clinical evaluation and consistent monitoring is essential for early detection and potential intervention in patients with mesioangular canine displacement.

Association between non-alcoholic fatty liver disease and progression of abdominal aortic aneurysm: a multicenter study

BackgroundThe purpose of our study was to investigate the association between non-alcoholic fatty liver disease (NAFLD) and abdominal aortic aneurysms (AAA) progression using non-enhanced computed tomography (CT) and CT angiography (CTA).MethodsPatients with AAA and age- and sex-matched healthy subjects who underwent abdominal CTA and non-enhanced CT examination between January 2015 and January 2023 from four hospitals were retrospectively analyzed. Patients with AAA were divided into progression (growth rate > 10 mL/year) and non-progression groups, as well as those with NAFLD and without NAFLD, based on abdominal CT results. The Kaplan-Meier and Cox regression were used to investigate the association between NAFLD and AAA progression.ResultsA total of 151 patients with AAA (mean age: 69.1 ± 10.5 years old, 133 men) were included, among which 66 patients (43.7%) had NAFLD. During a median of 10.7 months (6.0–76.0 months), 57 patients (37.7%) had AAA progression. The prevalence of NAFLD was significantly higher in the AAA group compared to the control group (43.7% vs. 31.1%, p = 0.024). Multivariable regression analysis revealed that the NAFLD was independently associated with AAA progression (HR, 4.28; 95% CI, 2.20–8.31; p < 0.001). The area under curve of combined NAFLD and AAA maximal diameter was 0.857 for predicting AAA progression.ConclusionsNAFLD on non-enhanced CT is an independent predictor of AAA progression. It can improve the diagnostic efficacy of predicting the progression of abdominal aortic aneurysms.Clinical trial numberNot applicable. This research is a retrospective analysis.

Critical reflection on the indication for computed tomography: an interdisciplinary survey of risk and benefit management in patients with sepsis

ObjectivesTo survey physicians’ views on the risks and benefits of computed tomography (CT) in the management of septic patients and indications for and contraindications to contrast media use in searching for septic foci.MethodsA web-based questionnaire was administered to physicians at a large European university medical center in January 2022. A total of 371 questionnaires met the inclusion criteria and were analyzed with physicians’ work experience, workplace, and medical specialty as independent variables. Chi-square tests were used for exploratory analysis.ResultsWhile physicians with all levels of work experience were included, the largest group (35.0%, n = 130/371) had 3–7 years of experience. Most physicians agreed that the benefits of CT outweigh its potential adverse effects in septic patients (90.5%, n = 336/371). Responders saw the strongest indication for contrast media administration in septic patients for (1) CT examinations of the abdomen (92.7%, n = 333/359) and (2) combined CT examinations of the chest, abdomen, and pelvis (94.1%, n = 337/358). While radiologists were most likely to consider manifest hyperthyroidism an absolute contraindication to contrast media administration (43.8%, n = 14/32), most other groups of physicians opted for appropriate preparation before contrast media administration in this subset of septic patients.ConclusionIn this survey, most participating physicians considered CT an essential diagnostic modality to detect an infectious focus in septic patients. Whereas the risk of ionizing radiation was regarded as justifiable by most physicians, different specialties varied in their assessment of the risks of contrast media administration.Key PointsPhysicians recognize CT as a relevant imaging modality in the diagnostic management of patients with sepsis.There is an interdisciplinary consensus that the use of ionizing radiation is justified in septic patients.There is disagreement about indications for and contraindications to contrast media administration among physicians from different medical specialties.Graphical

Outcome of follow-up computed tomography of suspected occult scaphoid fracture after normal radiography.

To evaluate the rate of missed scaphoid fractures on follow-up computed tomography (CT) for suspected occult scaphoid fracture after normal radiography with residual radial-sided wrist pain. In a retrospective analysis, wrist CT during a five-year period was analyzed. The CT examinations and radiological reports were re-evaluated. Available clinical findings and radiologic follow-up performed during a period of a minimum of three years served as outcome reference. In total, 178 examinations had been performed on 174 patients for suspect scaphoid fracture, 67 men and 107 women, showing 15 and 6 scaphoid fractures, respectively; a statistically significant sex difference (p = 0.0024). In 157 examinations, no scaphoid fracture was detected on CT, instead 29 other wrist or carpal bone fractures were found. On follow-up, no missed scaphoid fractures were found. Before CT, 124 of the 157 patients had been treated with a cast. After CT, 35 patients continued with cast treatment for a median of 14days. CT appears to be a reliable method for evaluating suspect scaphoid fracture as part of a diagnosis-treatment regimen including pain immobilization with a plaster cast.

Clinical application and prognostic value of computed tomography examination in foals diagnosed with osteomyelitis: Forty-four cases.

Computed tomography (CT) is increasingly recognized as superior to conventional imaging methods for diagnosing osteomyelitis in foals. However, comprehensive studies in this area are limited. This study aims to report on clinical cases of osteomyelitis in foals, establishing a relationship between CT findings and survival outcomes. Additionally, it compares CT imaging with conventional methods such as radiography and ultrasound. We hypothesized that CT variables would more accurately predict survival than other clinical factors and provide more detailed information about osteomyelitis lesions. This retrospective study included foals presenting at a single equine referral hospital between July 2019 and December 2022. Inclusion criteria were: (1) foals less than 9 months of age, (2) presumptive clinical diagnosis of osteomyelitis, and (3) CT examination for further evaluation. Forty-four foals met the criteria; 29 (66%) survived to discharge, and 23 (55%) had long-term survival. Key variables associated with survival included joint collapse (P=.011, OR, 0.054, 95% CI, 0.006-0.506) and lesions in multiple locations (P=.015, OR, 0.19, 95% CI, 0.05-0.7). In 93% of cases, CT examination modified the diagnosis, revealing improved lesion localization (72%), lesion size (76%), or detecting additional lesions (45%). Common lesions involved the axial and proximal appendicular skeletons, with 8 foals (18%) having only axial skeleton involvement and 5 (11%) presenting with both axial and appendicular lesions. Coxofemoral joint involvement was diagnosed in 12 foals (27%), while pelvic lesions were found in 8 (18%). These findings underscore the critical role of CT in identifying and localizing complex lesions, ultimately improving prognostic assessments.

A novel analytic procedure for accurate patient surface dose measurement during computed tomography examination: systematic uncertainty correction related to incident X-ray direction

A novel analytic procedure for accurate patient surface dose measurement during computed tomography examination: systematic uncertainty correction related to incident X-ray direction

The scope of practice for diagnostic radiographers in Singapore: A preliminary survey

IntroductionThere has been an increased demand for medical imaging procedures through the years. This demand requires the diagnostic radiographers in the workforce to be equipped with adequate training and understanding of their roles. The aims of this research are to distill and further describe the current scope of practice as established by the Allied Health Professional Council and map the diffusion of tasks, roles and responsibilities within Singapore’s radiography imaging modalities. MethodsA structured questionnaire was distributed to all diagnostic radiographers in Singapore through emails sent out by the Singapore Society of Radiographers. Information collected included respondents' duties in their respective imaging modalities, the professional tracks they specialised in, and their demographical information. Quantitative data analysis was conducted using SPSS and Fisher’s Exact test of independence was used to determine correlations between variables. ResultsA total of 120 questionnaire responses were obtained and after exclusion, 99 responses were analysed. It was observed that there was a significant positive correlation in radiography experience and performing specialised Computed Tomography examinations (p = 0.005). Additionally, higher radiographer designation was shown to be correlated with the ability to perform more specialised Ultrasound examinations (p < 0.001). The study demonstrated a diverse range of tasks by radiographers which was determined by education, disparity in experience, institutional practice and training provided. ConclusionThis preliminary study on Singapore diagnostic radiographers provided valuable insight and mapping of their activities in several imaging modalities, allowing for future development of a scope of practice document for Singapore. Implication for practiceThe tasks undertaken by the diagnostic radiographers were integral to imaging service delivery and play a significant role in the advancement of radiography to further enhance the quality of patient care.

Artefacts due to putrefactive gas production - an overview.

Autolytic and putrefactive processes can cause considerable alterations to soft tissues and internal organs that may complicate forensic assessments. An overview was undertaken of the range of taphonomonic changes and processes that may result from postmortem putrefactive gas accumulation. The most commonly encountered phenomenon was purging of putrefactive fluids from the nose and mouth that was on occasion confused with bleeding from antemortem trauma. Much less common was putrefactive 'rigor mortis' where the limbs extend due to the accumulation of soft tissue and subcutaneous gas. This may sometimes be associated with alteration of the position of a body suggesting that it had been deliberately moved. Distension and stretching of the skin and subcutaneous tissues may cause recently sutured surgical incisions to dehisce, raising the possibility of inflicted incised wounds. Raised intra-abdominal pressures may cause diaphragmatic herniation of small intestine and has been associated with so-called 'coffin birth' where a fetus is expelled from the uterus after death due to pressure on the fundus. Gas accumulation on postmortem computed tomography examination may be confused with air embolism or the effects of trauma. All of these changes are the result of anaerobic bacterial action generating gases such as methane, carbon dioxide and hydrogen sulphide resulting in pressure gradients.

Comparison of Lung-RADS Version 2022 and British Thoracic Society Guidelines in Classifying Solid Pulmonary Nodules Detected at Lung Cancer Screening CT.

Lung cancer screening is critical for early detection and management, particularly through the use of computed tomography (CT). This study aims to compare the Lung Imaging Reporting and Data System (Lung-RADS) Version 2022 with the British Thoracic Society (BTS) guidelines in classifying solid pulmonary nodules detected at lung cancer screening CT examinations. This retrospective study included 224 patients who underwent lung cancer screening CT between 2016 and 2022 and had a reported solid pulmonary nodule. A fellowship-trained thoracic radiologist reviewed the CT images, characterizing nodules by size, location, margins, attenuation, calcification, growth at follow-up, and final pathologic diagnosis if malignant. The sensitivity and specificity of Lung-RADS Version 2022 in detecting malignant nodules were compared with those of the BTS guidelines using the McNemar test. Of the 224 patients, 198 (88%) had nodules deemed benign, while 26 (12%) had malignant nodules. The Lung-RADS Version 2022 resulted in higher specificity than the BTS guidelines (85% vs. 65%, p < 0.001), without sacrificing sensitivity (92% for both). Nodules larger than 8 mm, spiculated margins, upper lobe location, and interval growth were associated with higher malignancy risk (p < 0.01). Compared with the BTS guidelines, Lung-RADS Version 2022 reduces the number of false-positive screening CT examinations while maintaining high sensitivity for detecting malignant solid pulmonary nodules.