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CT Angiography of the Head-and-Neck Vessels Acquired with Low Tube Voltage, Low Iodine, and Iterative Image Reconstruction: Clinical Evaluation of Radiation Dose and Image Quality  [PDF]
Wei-lan Zhang, Min Li, Bo Zhang, Hai-yang Geng, Yin-qiang Liang, Ke Xu, Song-bai Li
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081486
Abstract: Objectives We aimed to assess the effectiveness and feasibility of head-and-neck Computed Tomography Angiography (CTA) with low tube voltage and low concentration contrast media combined with iterative reconstruction algorithm. Methods 92 patients were randomly divided into group A and B: patients in group A received a conventional scan with 120 kVp and contrast media of 320 mgI/ml. Patients in group B, 80 kVp and contrast media of 270 mgI/ml were used along with iterative reconstruction algorithm techniques. Image quality, radiation dose and the effectively consumed iodine amount between two groups were analyzed and compared. Results Image quality of CTA of head-and-neck vessels obtained from patients in group B was significantly improved quantitatively and qualitatively. In addition, CT attenuation values in group B were also significantly higher than that in group A (p<0.001). Furthermore, compared with the protocol whereby 120 kVp and 320 mgI/dl were administrated, the mean radiation dose and consumed iodine amount in protocol B were also reduced by 50% and 15.6%, respectively (p<0.001). Conclusions With the help of iterative reconstruction algorithm techniques, the head-and-neck CTA with diagnostic quality can be adequately acquired with low tube voltage and low concentration contrast media. This method could be potentially extended to include any part of the body to reduce the risks related to ionizing radiation.
Comparison of Fentanyl with Sufentanil for Chest Tube Removal
M Golmohammadi,SH Sane
Iranian Cardiovascular Research Journal , 2008,
Abstract: Background: After cardiac surgery, the chest tubes cause pain and their removal is painful and unpleasant forpatients. The aim of this research was to study and compare the analgesic effect of fentanyl and sufentanil on painrelief during chest tube removal in post-cardiac surgical patients.Patients and Methods: A total of 80 patients scheduled for elective cardiac surgery, were recruited in prospective,randomized and double-blind study. Patients received 1.5μg/kg fentanyl or 0.15μg/kg sufentanyl, intravenously10 minutes before removal of chest tube. Pain intensity was assessed by measuring visual analogscale (VAS) pain score, 10 minutes before, during, and 5 and10 minutes after removing chest tubes. Level ofsedation, heart rate, arterial blood pressure, and oxygenation saturation were recorded at each stage by a blindedobserver.Results: Mean pain intensity scores 10 minutes before removal of chest tube in fentanyl, and sufentanil groupswere 29.5±12.1 and 31±11.2 respectively. Pain scores during chest tube removal were 38.5±11.6 in fentanylgroup and 44.7±12.8 in sufentanil group (P =0.02). In addition, pain scores during chest tube removal were significantly(P value=0.02) more reduced in fentanyl (17.21±7.5) than in sufentanil group (21.51±11.2). Sedationscores remained low in two groups. None of the patients showed any adverse side effects of opioids. No differenceswere seen in the heart rate or arterial blood pressure, but oxygenation saturation was significantly greaterin sufentanil group than in fentanyl group.Conclusion: Both fentanyl and sufentanil provide adequate analgesia for chest tube removal without increasinguntoward side effects.
Complications of tube thoracostomy for chest trauma
D Maritz, L Wallis, T Hardcastle
South African Medical Journal , 2009,
Abstract: Objective. To determine the insertional and positional complications encountered by the placement of intercostal chest drains (ICDs) for trauma and whether further training is warranted in operators inserting intercostal chest drains outside level 1 trauma unit settings. Methods. Over a period of 3 months, all patients with or without an ICD in situ in the front room trauma bay of Tygerberg Hospital were included in the study. Patients admitted directly via the trauma resuscitation unit were excluded. No long-term infective complications were included. A self-reporting system recorded complications, and additional data were obtained by searching the department's records and monthly statistics. Results. A total of 3 989 patients with trauma injuries were seen in the front room trauma bay during the study period; 273 (6.8%) patients with an ICD in situ or requiring an ICD were assessed in the trauma unit and admitted to the chest drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of the ICD; 22 (92%) of these had been referred with an ICD in situ. An overall complication rate of 9.5% was seen. Insertional complications numbered 7 (27%), with 19 (73%) positional complications. The most common errors were insertion at the incorrect anatomical site, and extrathoracic and too shallow placement (side portal of the drain lying outside the chest cavity). Conclusion. Operators at the referral hospitals have received insufficient training in the technique for insertion of ICDs for chest trauma and would benefit from more structured instruction and closer supervision of ICD insertion. South African Medical Journal Vol. 99 (2) 2009: pp. 114-117
256层iCT第4代混合迭代重建技术在胸部低剂量扫描中的应用评价
Evaluation of the application of hybrid iterative reconstruction method (iDOSE4) to low-dose chest scan with 256 slices computed tomography
 [PDF]

王博成,薛杨,苏潇,梅云婷,吴利忠,赵江民
WANG Bo-cheng
, XUE yang, SU xiao, MEI Yun-ting, WU Li-zhong, ZHAO Jiang-ming

- , 2016, DOI: 10.3969/j.issn.1674-8115.2016.05.017
Abstract: 目的 比较低剂量iCT、常规剂量iCT及64排常规剂量CT胸部扫描图像质量,探讨第4代混合迭代重建(iDOSE4)技术在低剂量扫描中的应用价值。方法 收集排除胸部病变的150名男性健康体检者的胸部螺旋CT扫描图像资料,分为256层iDOSE4低剂量组(iDOSE4低剂量组,n=50)、256层iDOSE4常规剂量组(iDOSE4常规剂量组,n=50)、64排常规剂量组(n=50),对CT图像质量(肺纹理、纵隔大血管轮廓、支气管形态、腋窝淋巴结)进行评分和比较分析。结果 在iDOSE4低剂量组与常规剂量组,2组间肺纹理、纵隔大血管轮廓、支气管形态等评分的差异无统计学意义(P=0.633,P=0.814,P=0.543),iDOSE4低剂量组腋窝淋巴结评分和4项总分低于常规剂量组(P=0.000,P=0.000);在iDOSE4低剂量组与64排常规剂量组,2组间肺纹理、纵隔大血管轮廓、支气管形态评分的差异无统计学意义(P=0.466, P=0.820, P=0.377),iDOSE4低剂量组腋窝淋巴结评分和4项总分低于64排常规剂量组(P=0.000,P=0.000);iDOSE4常规剂量组与64排常规剂量组的CT图像质量无明显差异。各组辐射剂量值(CTDIvol)从高到低依此为64排常规剂量组(13.6 mGy)、iDOSE4常规剂量组(9.7mGy)和iDOSE4低剂量组(3.4 mGy)。结论 256层iCT的iDOSE4胸部低剂量扫描技术能获取可靠的图像质量,仅腋窝淋巴结显示能力略低于常规剂量,但能够显著减少辐射剂量。
: Objective To compare the quality of chest images scanned by iCT with low radiation dose and with regular radiation dose and by CT with regular radiation dose, and explore the application value of iDOSE4 in low radiation dose scan. Methods Chest spiral CT scan images of 150 healthy males without chest disorders were enrolled and randomly assigned to the 256 slices iDOSE4 low-dose group (iDOSE4 low dose group, n=50), 256 slices iDOSE4 regular dose group (iDOSE4 regular dose group, n=50), and 64 rows regular dose group (n=50). The quality of CT images (lung markings, mediastinum artery outline, bronchial morphology, and axillary lymph nodes) was scored, compared, and analyzed. Results The differences in lung markings, mediastinum artery outline, and bronchial morphology scores between the iDOSE4 low dose group and the iDOSE4 regular dose group were not statistically significant (P=0.633, P=0.814, P=0.543). Axillary lymph nodes score and the total score in the iDOSE4 low dose group were lower as compared with the iDOSE4 regular dose group (P=0.000, P=0.000). The differences in lung markings, mediastinum artery outline, and bronchial morphology scores between the iDOSE4 low dose group and the 64 rows regular dose group were not statistically significant (P=0.466, P=0.820, P=0.377). Axillary lymph nodes score and the total score in the iDOSE4 low dose group were lower as compared with the 64 rows regular dose group (P=0.000, P=0.000). There was no significant difference in the quality of CT images between the iDOSE4 regular dose group and the 64 rows regular dose group. The 64 rows regular dose group had the highest radiation dose (13.6 mGy), followed by the iDOSE4 regular dose group (9.7mGy) and the iDOSE4 low dose group (3.4 mGy). Conclusion The 256 slices low-dose chest CT scan with iDOSE4 method can obtain images with reliable quality and can significantly reduce the radiation dose
Chilaiditi′s sign possibly associated with malposition of chest tube placement  [cached]
Gulati M,Wafula J,Aggarwal S
Journal of Postgraduate Medicine , 2008,
Abstract: Although diaphragmatic paralysis is a rare recognized complication of chest tube malposition, Chilaiditi′s sign occurring as a result of this complication has never been reported in literature to the best of our knowledge. We describe one such case, which had an interesting clinical sequence of events and radiographic findings and suggest that the medial end of the chest tube should be positioned at least 2 cm from the mediastinum on the frontal chest radiograph to avoid these complications.
Radiation doses during chest examinations using dose modulation techniques in multislice CT scanner  [cached]
Livingstone Roshan,Pradip Joe,Dinakran Paul,Srikanth B
Indian Journal of Radiology and Imaging , 2010,
Abstract: Objective: To evaluate the radiation dose and image quality using a manual protocol and dose modulation techniques in a 6-slice CT scanner. Materials and Methods: Two hundred and twenty-one patients who underwent contrast-enhanced CT of the chest were included in the study. For the manual protocol settings, constant tube potential (kV) and tube current-time product (mAs) of 140 kV and 120 mAs, respectively, were used. The angular and z-axis dose modulation techniques utilized a constant tube potential of 140 kV; mAs values were automatically selected by the machine. Effective doses were calculated using dose-length product (DLP) values and the image quality was assessed using the signal-to-noise (SNR) ratio values. Results: Mean effective doses using manual protocol for patients of weights 40-60 kg, 61-80 kg, and 81 kg and above were 8.58 mSv, 8.54 mSv, and 9.07 mSv, respectively. Mean effective doses using z-axis dose modulation for patients of weights 40-60 kg, 61-80 kg, and 81 kg and above were 4.95 mSv, 6.87 mSv, and 10.24 mSv, respectively. The SNR at the region of the liver for patients of body weight of 40-60 kg was 5.1 H, 6.2 H, and 8.8 H for manual, angular, and z-axis dose modulation, respectively. Conclusion: Dose reduction of up to 15% was achieved using angular dose modulation and of up to 42% using z-axis dose modulation, with acceptable diagnostic image quality compared to the manual protocol.
Dose Efficiency in Dual Source High-Pitch Computed Tomography of the Chest  [PDF]
Boris Bodelle, Thomas Lehnert, Martin Beeres, Thomas Josef Vogl, Boris Schulz
Advances in Computed Tomography (ACT) , 2014, DOI: 10.4236/act.2014.34008
Abstract:

Objectives: Evaluation of radiation efficiency of dual source high-pitch (DSHP) chest CT in comparison to single source technique with special regards to individual patient anatomy. Methods: 150 consecutive patients who underwent chest CT with automated tube current modulation were evaluated retrospectively and divided into three study groups, each with an equal quantity of 50 patients (DSHP vs. single source 128 slices vs. single source 16 slices). By using a dedicated workstation, volumetric analyses of each of the scanned anatomic area were performed and correlated to the individual dose length product (DLP). The calculated result was defined as dose efficiency. Results: DLP was 203 mGycm (DSHP), vs. 269 mGycm (single source) vs. 273 mGycm (16 slice CT). The total patient volume was lowest in the dual source group with 18956.3 cm3 (vs. 22481.2 cm3 vs. 22133.8 cm3). With regards to the DLP, the calculated dose efficiency of dual source CT was better than the 128 slice CT (p = 0.045) and the 16 slice CT (p < 0.01). Conclusions: DSHP CT has considerably better dose efficiency compared to 16 slice CT. Compared to 128 slice single source technique, the high-pitch mode does not cause any dose penalty when performing chest CT.

Volume Threshold for Chest Tube Removal: A Randomized Controlled Trial
Mohammad Ali Hessami,Farid Najafi,Sajad Hatami
Journal of Injury and Violence Research , 2009,
Abstract: Background: Despite importance of chest tube insertion in chest trauma, there is no general agreement on the level of daily volume drainage from chest tube. This study was conducted to compare the effectiveness and safety of chest tube removal at the levels of 150 ml/day and 2oo ml/day. Methods: Eligible patients (138) who needed replacement of chest tube (because of trauma or malignancy) were randomized into two groups; control (removal of chest tube when drainage reached to 150 ml/day) and trial (removal of chest tube at the level of 200 ml/day). All patients received standard care during hospital admission and a follow- up visit after 7days of discharge from hospital. Patients were then compared in terms of major clinical outcomes using chi-squared and t-test. Results: From the total of 138 patients, 70 and 68 patients were randomized to control (G150) and trial (G200) group, respectively. Baseline characteristics were comparable between the two groups. Although the trial group had a shorter mean for length of hospital stay (LOS) (4.1 compared to 4.8, p=0.04), their differences in drainage time did not reach to the level of statistical significance (p=0.1). Analysis of data showed no statistically significant differences between the rate of radiological reaccumulation, thoracentesis and decrease in pulmonary sounds (auscultatory), one week after discharge from hospital. Conclusions: Compared to a daily volume drainage of 150 ml, removal of chest tube when there is 200 ml/day is safe and will even result in a shorter hospital stay. This in turn leads to a lower cost.
Early chest tube removal after coronary artery bypass graft surgery
Mohsen Mirmohammad-Sadeghi,Ali Etesampour,Mojgan Gharipour,Zeinab Shariat
North American Journal of Medical Sciences , 2009,
Abstract: Background: There is no clear data about the optimum time for chest tube removal after coronary artery bypass surgery. Aim: The aim of this study was to assess the impact of the chest tube removal time following coronary artery bypass grafting surgery on the clinical outcome of the patients. Material and Methods: An analysis of data from 307 patients was performed. The patients were randomized into two groups: in group 1 (N=107) chest tubes were removed within the first 24 hours after surgery, whereas in group 2 (N=200), chest tubes were removed in the second 24 hours after surgery. Demographics, lactate and pH at the beginning, during and after the operation, creatinine, left ventricular ejection fraction, inotropic drugs administration, length of ICU stay, and mortality data were collected. Respiratory rate and pain level was assessed. Results: In these surgeries, the mean± standard deviation for the aortic clamping time was 49.18±17.59 minutes and cardiopulmonary bypass time was 78.39±25.12 minutes. The amount of heparin consumed by the second group was higher (P <0.001) which could be considered as an important factor in increasing the drainage time after the surgery (P =0.047). The pain level evaluated 24 hours post-operation was lower in the first group, and the difference in the pain level between the 2 groups evaluated 30 hours post-operation was significant (P=0.016). The mean time of intensive care unit stay was longer in the second group but it was not statistically significant. Conclusion: Early extracting of chest tubes after coronary artery bypass graft surgery when there is no significant drainage can lead to pain reduction and consuming oxygen is an effective measure after surgery toward healing; it doesn't increase the risk of creation of plural effusion and pericardial effusion.
Management for Pediatric Pleural Empyema in Resource-Poor Country: Is Chest Tube Drainage with Antiseptic Lavage-Irrigation Better than Tube Thoracostomy Alone?  [PDF]
Seydou Togo, Moussa Abdoulaye Ouattara, Ibrahim Sangaré, Jacque Saye, Cheik Amed Sékou Touré, Ibrahim Boubacar Maiga, Dokore Jerome Dakouo, Liang Guo, Sékou Koumaré, Adama Konoba Koita, Zimogo Zié Sanogo, Sadio Yéna
Surgical Science (SS) , 2015, DOI: 10.4236/ss.2015.612077
Abstract: Drainage by chest tube thoracostomy is widely used in treatment of early empyema thoracis in children, but drainage with antiseptic lavage-irrigation is more frequent in our context since the last 20 years. This study was to determine which was more effective in our experience comparing chest tube drainage with catheter antiseptic lavage-irrigation versus drainage by chest tube thoracostomy alone in the management of empyema thoracis in children. Patients and Methods: Demographic, clinical and microbiological data on children with thoracic empyema undergoing drainage by chest tube thoracostomy alone or with antiseptic lavage-irrigation were obtained from 2 thoracic surgical centers from September 2008 to December 2014. It was a retrospective study included 246 children (137 boys and 109 girls) who were managed for empyema thoracis at the author’s different department of surgery. Outcomes analysis with respect to treatment efficacy, hospital duration, chest tube duration, hospital costs, and need for subsequent procedures was analyzed and compared in the 2 groups. Results: Drainage of pus and antiseptic irrigation resulted in resolution of pyrexia with improvement in general condition in 85.82% of patients in group 1 and by tube thoracostomy alone in 73.95% in group 2. There are a significant difference in the length of hospital stay (p = 0.022), duration of chest tubes in situ (p = 0.040), treatment coast (p = 0.015) and outcome of stage 2 empyema disease (p = 0.037) between the 2 groups. Conclusion: it seems that chest tube drainage with antiseptic lavage-irrigation method is associated with a higher efficacy, shorter length of hospital stay, shorter duration of chest tube in situ, less cost and better outcome of stage 2 empyema diseases than a treatment strategy that utilizes chest tube thoracostomy alone.
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