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High-Pitch Computed Tomography Coronary Angiography—A New Dose-Saving Algorithm: Estimation of Radiation Exposure  [PDF]
Dominik Ketelsen,Markus Buchgeister,Andreas Korn,Michael Fenchel,Bernhard Schmidt,Thomas G. Flohr,Christoph Thomas,Christoph Schabel,Ilias Tsiflikas,Roland Syha,Claus D. Claussen,Martin Heuschmid
Radiology Research and Practice , 2012, DOI: 10.1155/2012/724129
Abstract: Purpose. To estimate effective dose and organ equivalent doses of prospective ECG-triggered high-pitch CTCA. Materials and Methods. For dose measurements, an Alderson-Rando phantom equipped with thermoluminescent dosimeters was used. The effective dose was calculated according to ICRP 103. Exposure was performed on a second-generation dual-source scanner (SOMATOM Definition Flash, Siemens Medical Solutions, Germany). The following scan parameters were used: 320?mAs per rotation, 100 and 120?kV, pitch 3.4 for prospectively ECG-triggered high-pitch CTCA, scan range of 13.5?cm, collimation ?mm with z-flying focal spot, gantry rotation time 280?ms, and simulated heart rate of 60 beats per minute. Results. Depending on the applied tube potential, the effective whole-body dose of the cardiac scan ranged from 1.1?mSv to 1.6?mSv and from 1.2 to 1.8?mSv for males and females, respectively. The radiosensitive breast tissue in the range of the primary beam caused an increased female-specific effective dose of % compared to males. Decreasing the tube potential, a significant reduction of the effective dose of 35.8% and 36.0% can be achieved for males and females, respectively ( ). Conclusion. The radiologist and the CT technician should be aware of this new dose-saving strategy to keep the radiation exposure as low as reasonablly achievable. 1. Introduction At present, computed tomography coronary angiography (CTCA) is an important, widely accepted diagnostic tool for the assessment of coronary artery disease. Several studies have shown the potential of different dose-saving strategies to keep the radiation exposure as low as reasonablly achievable. Hausleiter et al. reported in an international multicenter trial (PROTECTION I) a mean effective dose of 12?mSv in CTCA, ranging from 5 to 30?mSv [1]. Radiation exposure can be reduced substantially by currently available strategies, but these possibilities are used infrequently [1]. Since the introduction of a second-generation dual-source scanner system, a new scanning mode with increased table feed is available. Compared to retrospective ECG-gated and prospective ECG-triggered CTCA, this high-pitch, prospective triggered scanning mode has the potential for drastic dose reduction due to a gapless imaging of the heart within one heartbeat with no overlapping data acquisition. The aim of the study was to estimate effective whole-body dose and organ equivalent doses of prospective ECG-triggered high-pitch CTCA. 2. Material and Methods 2.1. Dosimetry The experiments were performed by using an anthropomorphic,
Parapneumonic empyema diagnosed by chest radiograph and computed tomography
Ning Jin,John Paul Brady,David M. Widlus
Journal of Community Hospital Internal Medicine Perspectives , 2013, DOI: 10.3402/jchimp.v3i1.20503
Abstract: Pleural effusion is commonly seen associated with pneumonia. When this progresses to empyema, directed therapy is frequently required. Chest radiographic and computed tomography findings can help distinguish empyema from a transudative pleural effusion.
Comparison of Chest Computed Tomography and Chest X-Ray in the Diagnosis of Rib Fractures in Patients with Blunt Chest Trauma  [cached]
Rasih Yazkan,G?khan Ergene,Cumhur Murat Tulay,Sedat Güne?
Journal of Academic Emergency Medicine , 2012,
Abstract: Objective: The purpose of this study was to compare computed tomography and chest X-ray in the diagnosis of rib fractures in patients with blunt chest trauma.Materials and Methods: A total of 83 patients with blunt chest trauma who were treated in three hospitals between May 2010 and June 2011 and who had received both chest computed tomography scan and chest X-ray as part of their initial assessment were included in the study. Results: The number of rib fractures was 2.15±2.12 on chest X-ray, however, on chest computed tomography the number was 3.75±2.35. There was a significant difference between the chest X-ray and the computed tomography (p<0.001). Conclusion: Chest computed tomography is the best and a significantly more sensitive radiological method than chest X-ray in the detection of rib fracture, and it should be routinely used in the initial assessment of chest trauma. However, chest X-ray can be a suitable method in follow-up period.
Evaluation of the application of hybrid iterative reconstruction method (iDOSE4) to low-dose chest scan with 256 slices computed tomography

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
Is There a Role for Chest Computed Tomography in Patients with Primary Spontaneous Pneumothorax?  [PDF]
Iskander Al-Githmi
Surgical Science (SS) , 2017, DOI: 10.4236/ss.2017.810047
Abstract: Background: Primary spontaneous pneumothorax is a relatively common condition in young adults. Although blebs and bullae are frequently found in patients with primary spontaneous pneumothorax, they are very rarely the actual cause of the pneumothorax. Objective: To assess our experience with chest computed tomography evaluation in patients with recurrent spontaneous pneumothorax as compared to their histopathology findings. Study Design: A prospective study analysis. Materials and Methods: From January 2013 to December 2016, 38 consecutive patients with unilateral recurrent spontaneous pneumothorax underwent video-assisted thoracic surgery. Their chest computed tomography scans were reviewed and compared with their histopathology findings. Results: Thirty-six adult patients with unilateral recurrent spontaneous pneumothorax were included; their mean age was 33.9 years, and they all received video-assisted thoracic surgery and mechanical pleurodesis. Blebs or bullae were present in the chest computed tomography scans of fourteen patients (39%); of those fourteen patients, five (35.7%) had emphysematous changes in histopathology. Seventeen out of the thirty-six (47%) had no blebs or bullae in their chest computed tomography scans; of those seventeen patients, ten (59%) had emphysema like changes and seven (41%) had blebs in their histopathology studies. The remaining five patients (14%) had normal chest computed tomography scans. Conclusions: We conclude that preoperative chest computed tomography is not beneficial in every patient with recurrence of primary spontaneous pneumothorax.
Imaging Findings in Chest Computed Tomography: Initial Experience in a Developing Country  [PDF]
Adenike T. Adeniji-Sofoluwe, Ademola J. Adekanmi, Richard Efidi
Open Journal of Clinical Diagnostics (OJCD) , 2017, DOI: 10.4236/ojcd.2017.74012
Abstract: Background:?High resolution chest computed tomography (HRCT) is an established imaging modality that accurately assesses disease processes that are non-specific on conventional chest radiography. Chest Computed Tomography (CT) has proven invaluable in the evaluation of various diseases of the chest providing precise diagnosis that have great impact on the course of management. In this study, our aim is to evaluate the spectrum of radiological findings in all patients that had chest CTs at a tertiary health Institution in a developing Country. Method: This is a 6-year retrospective study of all patients that had Chest CT from 2009 till 2015. All patient data were retrieved and their Chest CT images reviewed and radiological findings and diagnosis documented. Results: Age range of patients was 1 - 84 years with a mean of 52.36 ± 22.9 years. Ten patients were children (12%). There were more males 53 (63.1%) than females 31 (36.9%) in the study. Referral for imaging was predominantly from internal medicine 33 (47.1%) and Surgery 27 (38.6%) departments. Most of the patients, 53 (63.1%) did not have previous chest radiographs. Consolidative changes were the most common parenchymal finding (77.4%). Few mediastinal masses were found in the study population. CT angiography constituted only 10.7% of all chest CTs done in adults. Conclusion: Few chest CT evaluations are performed compared to CTs of other parts of the body done in the same period. Chest CT is generally under-utilized even in a tertiary institution. There is a need to educate chest physicians on the role and advantages of CT use for the management of their patients.
Chest Computed Tomography of Elderly Subjects at University Hospital Campus Lomé  [PDF]
Pihou Gbande, Lantam Sonhaye, Massaga Dagbé, Dagouaba Ouoba, Lama Kegdigoma Agoda-Koussema, Komlanvi Victor Adjenou
Open Journal of Radiology (OJRad) , 2018, DOI: 10.4236/ojrad.2018.84027
Abstract: Background: Radiology in elderly as pediatric radiology poses a number of problems. The normal radiological appearance of the elderly patient’s chest is very varied and the changes are ubiquitous. Purpose: To describe the computed tomography profile of the elderly subject’s chest. Materials and Methods: Descriptive prospective study from January 1st to June 30th, 2018 carried out at the University Campus Hospital of Lomé. Results: We recorded 64 chest CT scans. The average age of the patients was 71.3. Internists (n = 21, 32.8%) and general practitioner (n = 16, 25%) were the major applicants for these tests. In most cases, thoracic CT examinations were requested as part of an extension assessment (n = 21, 32.8%), dyspnea and pneumonitis in 18.8% of cases each. All thoracic CT examinations were performed with contrast injection. CT with the TAP protocol was the most observed, accounted for more than half of the exams (56%). The main pathological lesions observed were diffuse parenchymal lesions (39.5%), pleurisy (11.1%) and PAH (11.1%). Conclusion: Computed tomography occupies an important place in the care of the elderly but the actors involved in their care must be trained to take optimal care.
Noninvasive Demonstration of Dual Coronary Artery Fistulas to Main Pulmonary Artery with 64-Slice Multidetector-Computed Tomography: A Case Report  [PDF]
Yoshiki Noda,Ryo Matsutera,Yoshinori Yasuoka,Haruhiko Abe,Hidenori Adachi,Susumu Hattori,Ryo Araki,Takahiro Imanaka,Motohiro Kosugi,Tatsuya Sasaki
Cardiology Research and Practice , 2010, DOI: 10.4061/2010/861068
Abstract: Coronary artery fistulas, including coronary pulmonary fistulas, are usually discovered accidently among the adult population when undergoing invasive coronary angiographies. We report here a 58-year-old woman with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery, demonstrating noninvasively with multidetector-computed tomography (MDCT) and transthoracic echocardiography (TTE). 1. Introduction Coronary artery fistulas are rare anomalies of coronary arteries detected in around 0.1% to 0.2% of the adult population and usually discovered accidently when undergoing invasive coronary angiographies (ICA) [1, 2]. In addition, dual or multiple coronary fistulas are reported to be quite rare [3, 4]. The definite diagnoses of these patients were made only by ICA in the past. However, it has been reported that coronary artery fistulas can be detected by various kinds of noninvasive cardiac imaging, such as multidetector computed tomography (MDCT) and transthoracic echocardiography (TTE) in recent years [5, 6]. We report here an adult patient with dual fistulas originating from the left anterior descending coronary artery and right coronary sinus to the main pulmonary artery demonstrated noninvasively with MDCT and TTE. 2. Case A 58-year-old woman with no history of cardiac disease was introduced to our hospital with atypical chest pain at rest and before sleeping at night for a month. Her risk factors for coronary artery disease were obesity and dyslipidemia, and she was administered with statin by a local clinic. On clinical examination, she had no murmur, and both chest X-ray and resting electrocardiogram were normal. We performed TTE and 64-slice MDCT (Aquilion 64, Toshiba Medical Systems, Japan) since treadmill exercise test indicated positive finding for myocardial ischemia. TTE revealed continuous flow into the main pulmonary artery which had peak flow in the diastolic phase. MDCT was performed with a retrospective ECG-gated protocol and with a collimation of ?mm, detector pitch of 11.2, gantry rotation time of 350?ms, tube current of 400?mA, and tube voltage of 120?kV. She received 2?mg propranolol hydrochloride and sublingual nitroglycerin before scanning, and 59?mL of contrast medium (370?mg iodine/mL) was used for MDCT angiography. Axial images demonstrated the leakage of contrast medium into the main pulmonary artery from the aberrant artery originating from coronary arteries (Figure 1), and we could not detect any other leakages of contrast medium in the pulmonary artery.
Pulmonary Emphysema in Cystic Fibrosis Detected by Densitometry on Chest Multidetector Computed Tomography  [PDF]
Mark O. Wielpütz, Oliver Weinheimer, Monika Eichinger, Matthias Wiebel, Jürgen Biederer, Hans-Ulrich Kauczor, Claus P. Heu?el, Marcus A. Mall, Michael Puderbach
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0073142
Abstract: Background Histopathological studies on lung specimens from patients with cystic fibrosis (CF) and recent results from a mouse model indicate that emphysema may contribute to CF lung disease. However, little is known about the relevance of emphysema in patients with CF. In the present study, we used computationally generated density masks based on multidetector computed tomography (MDCT) of the chest for non-invasive characterization and quantification of emphysema in CF. Methods Volumetric MDCT scans were acquired in parallel to pulmonary function testing in 41 patients with CF (median age 20.1 years; range 7-66 years) and 21 non-CF controls (median age 30.4 years; range 4-68 years), and subjected to dedicated software. The lung was segmented, low attenuation volumes below a threshold of -950 Hounsfield units were assigned to emphysema volume (EV), and the emphysema index was computed (EI). Results were correlated with forced expiratory volume in 1 s percent predicted (FEV1%), residual volume (RV), and RV/total lung capacity (RV/TLC). Results We show that EV was increased in CF (457±530 ml) compared to non-CF controls (78±90 ml) (P<0.01). EI was also increased in CF (7.7±7.5%) compared to the control group (1.2±1.4%) (P<0.05). EI correlated inversely with FEV1% (rs=-0.66), and directly with RV (rs=0.69) and RV/TLC (rs=0.47) in patients with CF (P<0.007), but not in non-CF controls. Emphysema in CF was detected from early adolescence (~13 years) and increased with age (rs=0.67, P<0.001). Conclusions Our results indicate that early onset emphysema detected by densitometry on chest MDCT is a characteristic pathology that contributes to airflow limitation and may serve as a novel endpoint for monitoring lung disease in CF.
Use of Chest Computed Tomography in Stable Patients with Blunt Thoracic Trauma: Clinical and Forensic Perspective  [PDF]
Makbule Ergin,Ismail Ergin,Koray Dural,Ali Yeginsu
Journal of Clinical and Analytical Medicine , 2011, DOI: 10.4328
Abstract: Aim: The aim of this study was to investigate the medical and forensic importance of thorax computed tomography in stable patients with blunt chest trauma. Material and Methods: Fifty patients with blunt chest injury were retrospectively evaluated with chest radiography and thorax computed tomography in the first 24 hours after trauma. Patient demographics, thoracic lesions, management options, and forensic assessment were rewieved. Results: The most common lesion of the study was rib fracture. Thorax computed tomography was significantly superior to chest radiography in detecting thoracic lesions. Sixty eight (33%) occult lesions were detected. Forty six (18%) of these were life threatening that not detected with plain chest radiography. Associated injuries were present in 33 (66%) patients. Pelvic and extremity fractures were the most common injury. Thorax computed tomography was significantly superior to chest radiography in detecting pneumothorax , hemothorax and lung contusion. Eightyone life threatening lesions were detected and 50 (61%; pneumothorax 13, hemothorax 24, lung contusion 9,and pneumomediastinum 4) of these lesions could not be detected with plain chest radiography. The clinical management [in 15 patients (30%)], and the forensic assesment was changed [in 14 (28%)] patients were changed. Conclusion:We concluded that using Computed Tomography of the thorax in thoracic travmas prive meticulous assesment in management of patients and forens icissues.
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