Background There is lack of guidance on specific CT protocols for imaging patients with coronavirus disease 2019 (COVID-19) pneumonia. Purpose To assess international variations in CT utilization, protocols, and radiation doses in patients with COVID-19 pneumonia. Materials and Methods In this retrospective data collection study, the International Atomic Energy Agency (IAEA) coordinated a survey between May and July 2020 regarding CT utilization, protocols, and radiation doses from 62 healthcare sites in 34 countries across five continents for CT exams performed in COVID-19 pneumonia. The questionnaire obtained information on local prevalence, method of diagnosis, most frequent imaging, indications for CT, and specific policies on use of CT in COVID-19 pneumonia. Collected data included general information (patient age, weight, clinical indication), CT equipment (CT make and model, year of installation, number of detector rows), scan protocols (body region, scan phases, tube current and potential), and radiation dose descriptors (CT dose index (CTDI vol ) and dose length product (DLP)). Descriptive statistics and generalized estimating equations were performed. Results Data from 782 patients (median age (interquartile range) of 59(15) years) from 54 healthcare sites in 28 countries were evaluated. Less than one-half of the healthcare sites used CT for initial diagnosis of COVID-19 pneumonia and three-fourth used CT for assessing disease severity. CTDI vol varied based on CT vendors (7-11mGy, p<0.001), number of detector-rows (8-9mGy, p<0.001), year of CT installation (7-10mGy, p=0.006), and reconstruction techniques (7-10mGy, p=0.03). Multiphase chest CT exams performed in 20% of sites (11 of 54) were associated with higher DLP compared with single-phase chest CT exams performed in 80% (43 of 54 sites) (p=0.008). Conclusion CT use, scan protocols, and radiation doses in patients with COVID-19 pneumonia showed wide variation across healthcare sites within the same and different countries. Many patients were scanned multiple times and/or with multiphase CT scan protocols. See also the editorial by Lee .

Objectives: (1.1) to evaluate the association between baseline 18F-FDG PET/CT semi-quantitative parameters of the primary lesion with progression free survival (PFS), overall survival (OS) and response to immunotherapy, in advanced non-small cell lung carcinoma (NSCLC) patients eligible for immunotherapy; (1.2) to evaluate the application of radiomics analysis of the primary lesion to identify features predictive of response to immunotherapy; (1.3) to evaluate if tumor burden assessed by 18F-FDG PET/CT (N and M factors) is associated with PFS and OS. Materials and Methods: we retrospectively analyzed clinical records of advanced NCSLC patients (stage IIIb/c or stage IV) candidate to immunotherapy who performed 18F-FDG PET/CT before treatment to stage the disease. Fifty-seven (57) patients were included in the analysis (F:M 17:40; median age = 69 years old). Notably, 38/57 of patients had adenocarcinoma (AC), 10/57 squamous cell carcinoma (SCC) and 9/57 were not otherwise specified (NOS). Overall, 47.4% patients were stage IVA, 42.1% IVB and 8.8% IIIB. Immunotherapy was performed as front-line therapy in 42/57 patients and as second line therapy after chemotherapy platinum-based in 15/57. The median follow up after starting immunotherapy was 10 months (range: 1.5–68.6). Therapy response was assessed by RECIST 1.1 criteria (CT evaluation every 4 cycles of therapy) in 48/57 patients or when not feasible by clinical and laboratory data (fast disease progression or worsening of patient clinical condition in nine patients). Radiomics analysis was performed by applying regions of interest (ROIs) of the primary tumor delineated manually by two operators and semi-automatically applying a threshold at 40% of SUVmax. Results: (1.1) metabolic tumor volume (MTV) (p = 0.028) and total lesion glycolysis (TLG) (p = 0.035) were significantly associated with progressive vs. non-progressive disease status. Patients with higher values of MTV and TLG had higher probability of disease progression, compared to those patients presenting with lower values. SUVmax did not show correlation with PD status, PFS and OS. MTV (p = 0.027) and TLG (p = 0.022) also resulted in being significantly different among PR, SD and PD groups, while SUVmax was confirmed to not be associated with response to therapy (p = 0.427). (1.2) We observed the association of several radiomics features with PD status. Namely, patients with high tumor volume, TLG and heterogeneity expressed by “skewness” and “kurtosis” had a higher probability of failing immunotherapy. (1.3) M status at 18F-FDG PET/CT was significantly associated with PFS (p = 0.002) and OS (p = 0.049). No significant associations were observed for N status. Conclusions: 18F-FDG PET/CT performed before the start of immunotherapy might be an important prognostic tool able to predict the disease progression and response to immunotherapy in patients with advanced NSCLC, since MTV, TLG and radiomics features (volume and heterogeneity) are associated with disease progression.

The aim of the guideline presented in this article is to unify the test parameters for image quality evaluation and radiation output in all types of cone-beam computed tomography (CBCT) systems. The applications of CBCT spread over dental and interventional radiology, guided surgery and radiotherapy. The chosen tests provide the means to objectively evaluate the performance and monitor the constancy of the imaging chain. Experience from all involved associations has been collected to achieve a consensus that is rigorous and helpful for the practice. The guideline recommends to assess image quality in terms of uniformity, geometrical precision, voxel density values (or Hounsfield units where available), noise, low contrast resolution and spatial resolution measurements. These tests usually require the use of a phantom and evaluation software. Radiation output can be determined with a kerma-area product meter attached to the tube case. Alternatively, a solid state dosimeter attached to the flat panel and a simple geometric relationship can be used to calculate the dose to the isocentre. Summary tables including action levels and recommended frequencies for each test, as well as relevant references, are provided. If the radiation output or image quality deviates from expected values, or exceeds documented action levels for a given system, a more in depth system analysis (using conventional tests) and corrective maintenance work may be required.

There is a growing interest in Gafchromic films for patient dosimetry in radiotherapy and in radiology. A new model (XR-QA) with high sensitivity to low dose was tested in this study. The response of the film to different x-ray beam energies (range 28-145 kVp with various filtrations, dose range 0-100 mGy) and to visible light was investigated, together with the after exposure darkening properties. Exposed films were digitized with a commercially available, optical flatbed scanner. A single functional form for dose versus net pixel value variation has been determined for all the obtained calibration curves, with a unique fit parameter different for each of the used x-ray beams. The film response was dependent on beam energy, with higher colour variations for the beams in the range 80-140 kVp. Different sources of uncertainties in dose measurements, governed by the digitalization process, the film response uniformity and the calibration curve fit procedure, have been considered. The overall one-sigma dose measurement uncertainty depended on the beam energy and decreased with increasing absorbed dose. For doses above 10 mGy and beam energies in the range 80-140 kVp the total uncertainty was less than 5%, whereas for the 28 kVp beam the total uncertainty at 10 mGy was about 10%. The post-exposure colour variation was not negligible in the first 24 h after the exposure, with a consequent increase in the calculated dose of about 10%. Results of the analysis of the sensitivity to visible light indicated that a short exposure of this film to ambient and scanner light during the measurements will not have a significant impact on the radiation dosimetry.