ACR White Paper–Based Comprehensive Dose Reduction Initiative Is Associated With a Reversal of the Upward Trend in Radiation Dose for Chest CT

Rawat, Udit; Cohen, Stuart L.; Levsky, Jeffrey M.; Haramati, Linda B.

doi:10.1016/j.jacr.2015.07.022

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…However, radiation exposure and motion artifacts are major issues in uncooperative, young patients undergoing to repeated CT examinations [11]. To reduce motion artifacts in uncooperative patients (e.g., pediatric patients or patients with dyspnea), fast acquisitions are obtained by lowering the rotation time of the tube-detector system with high pitch and wide collimation values [12].…”

Section: Introductionmentioning

confidence: 99%

Proposal of a low-dose, long-pitch, dual-source chest CT protocol on third-generation dual-source CT using a tin filter for spectral shaping at 100 kVp for CoronaVirus Disease 2019 (COVID-19) patients: a feasibility study

et al. 2020

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Aim To subjectively and objectively evaluate the feasibility and diagnostic reliability of a low-dose, long-pitch dual-source chest CT protocol on third-generation dual-source CT (DSCT) with spectral shaping at 100Sn kVp for COVID-19 patients. Materials and methods Patients with COVID-19 and positive swab-test undergoing to a chest CT on third-generation DSCT were included. The imaging protocol included a dual-energy acquisition (HD-DECT, 90/150Sn kVp) and fast, lowdose, long-pitch CT, dual-source scan at 100Sn kVp (LDCT). Subjective (Likert Scales) and objective (signal-to-noise and contrast-to-noise ratios, SNR and CNR) analyses were performed; radiation dose and acquisition times were recorded. Nonparametric tests were used. Results The median radiation dose was lower for LDCT than HD-DECT (Effective dose, ED: 0.28 mSv vs. 3.28 mSv, p = 0.016). LDCT had median acquisition time of 0.62 s (vs 2.02 s, p = 0.016). SNR and CNR were significantly different in several thoracic structures between HD-DECT and LDCT, with exception of lung parenchyma. Qualitative analysis demonstrated significant reduction in motion artifacts (p = 0.031) with comparable diagnostic reliability between HD-DECT and LDCT. Conclusions Ultra-low-dose, dual-source, fast CT protocol provides highly diagnostic images for COVID-19 with potential for reduction in dose and motion artifacts.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Introductionmentioning

confidence: 99%

Proposal of a low-dose, long-pitch, dual-source chest CT protocol on third-generation dual-source CT using a tin filter for spectral shaping at 100 kVp for CoronaVirus Disease 2019 (COVID-19) patients: a feasibility study

et al. 2020

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“…The good diagnostic performance of the V/Q scan in sickle cell disease patients in our practice confers a radiation reduction advantage and obviates the need for iodinated intravenous contrast. Even with aggressive radiation reduction strategies, the radiation exposure for 64-detector row CTPA scanners we-and many other institutions-currently use is double to triple that of V/Q scans (11)(12)(13). When more advanced CT technologies become widespread, this difference may be mitigated and then a further reassessment of risk-benefit recommendations will be necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Radiation dosimetry data for the present study cohort were not collected. However, institutional dosimetry data for CTPA at our institution, available from 2007 to 2015 (11,12), demonstrated decreased radiation exposure from CTPA from 11 to 5.3 mSv, more recently. The V/Q scan technique was stable during the study period, with an estimated radiation exposure of 2.6 mSv (13).…”

Section: Data Collectionmentioning

confidence: 90%

Imaging for Pulmonary Embolism in Sickle Cell Disease: A 17-Year Experience

et al. 2018

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Sickle cell disease, a complex disorder with known pulmonary complications, has the potential to confound the diagnosis of pulmonary embolism. We hypothesized that when the choice of imaging is guided by chest radiographic results, CT pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scintigraphy have comparable diagnostic performance in sickle cell disease. A retrospective cohort of adults with sickle cell disease who were imaged for suspected pulmonary embolism with either CTPA or V/Q, from 2000 to 2016 at our institution, was established. To reduce radiation exposure, our practice recommends V/Q for stable patients with normal chest radiographs. Results of index pulmonary embolism imaging, 90-d follow-up, and results of chest radiography were recorded. Two hundred forty-five adults with sickle cell disease comprised the cohort. The mean age (±SD) was 33 ± 10.5 y, and 58% (141) were men. Index imaging was V/Q in 62.9% ( = 154) and CTPA in 37.1% ( = 91). Chest radiographs, performed in 96.3% ( = 236), were normal in 72.9% ( = 172). Imaging results for pulmonary embolism were negative in 88.2% ( = 216), positive in 4.1% ( = 10), and indeterminate in 7.8% ( = 19) with no difference between V/Q and CTPA ( = 0.63). Reimaging within 90 d occurred in 9.8% ( = 24), 14.7% (20/136) after initial V/Q, and 5% (4/109) after initial CTPA ( = 0.08). Reimaging revealed a pulmonary embolism diagnosis after negative/indeterminate results in 0.7% (1/149) of V/Qs and 1.2% of (1/86) CTPAs ( = 0.69). Over the 17-y study period, 47% (114/245) underwent repeated imaging, and 11% (27/245) were diagnosed with pulmonary embolism at least once. In sickle cell disease patients with suspected pulmonary embolism, positive imaging rates were low for any given clinical presentation, but 11% of the cohort was diagnosed with pulmonary embolism over the 17-y study period. CTPA and V/Q performed comparably for pulmonary embolism diagnosis when the choice of imaging was guided by results of chest radiography. Hence, V/Q is a reasonable first choice for sickle cell disease patients with normal chest radiographs.

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“…Major clinical and paraclinical features of patients with 2019-nCoV Induced Pneumonia (NCIP) include fever and/or respiratory illness, lymphopenia, and radiologic abnormality [6][7][8]. Computed Tomography (CT) is capable of accurately assessing the condition of the lungs' parenchyma and is available in many medical centers worldwide [9]. Chest CT scan is relatively sensitive for detecting the initial evidence of COVID-19 pneumonia, which crucially helps to increase the effectiveness of early-onset therapy.…”

Section: Introductionmentioning

confidence: 99%

Predicting mortality rate in ICU admitted COVID-19 patients implementing visual semi-quantitative CT severity scoring system

Azadbakh¹,

Akbari²

2021

J Clin Images Med Case Rep

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Objectives: The aim of this study was to identify the clinical and laboratory features and CT scan (CT intensity score and pleural effusion) associated with COVID-19 pneumonia to evaluate the relationship between CT scan findings and mortality by comparing deceased patients with normal patients. Methods: In this retrospective case-control study, 290 ICU admitted patients with RT-PCR confirmed COVID-19 pneumonia were investigated. Totally, 150 deceased patients (with confirmed COVID-19 related death) were extracted from the COVID-19 registry of the affiliated university hospital belonging to mentioned period of time (in-hospital mortality subgroup, case), and 150 patients who survived the admission course were randomly selected from the same data set (surviving subgroup, control). Available electronic records for each patient were enlisted, including laboratory and clinical information, and their on-admission Computed Tomography (CT) images were reviewed. Mortality-related risk factors were compared between case and control subgroups. Results: The mean age of deceased patients (68.20 ± 16.07) was significantly higher than that of the surviving patients (54.72 ± 19.50) (p<0.001). Diabetes, hypertension, and Chronic Kidney Disease (CKD) were significantly related with higher mortality rates (62.2%, 58.7%, and 80.4% mortality in diabetic, hypertensive, and CKD patients versus 41.7%, 42.1%, and 35.9% in non-diabetics, normotensives, and patients without CKD). Additionally, the mean on-admission air-room SPO2 level in deceased patients (90%) was significantly lower than that of the survivors (93%) (p = 0.001). Lymphocyte count, Neutrophil to Lymphocyte Ratio (NLR), Erythrocyte Sedimentation Rate (ESR), CReactive Protein (CRP), Lactate Dehydrogenase (LDH), Fasting Blood Sugar (BS), Blood Urea Nitrogen (BUN), and Creatinine (Cr), mean CT Severity Score (CT-ss), and O2 supportive therapy requirement were significantly higher in the mortality subgroup (p<0.05). Pleural effusion showed no significant correlation with short-term mortality. CTss of >11, in isolation or in combination with above-mentioned prognosticators, was 64% or 81.4% sensitive, and 60% or of 78.6% specific, to predict mortality. Conclusions: Factors such as advanced age, underlying diseases such as diabetes, hypertension, and CKD, decreased air-room SPO2 , and increased lymphocyte count, higher NLR, ESR, CRP, LDH, BS, BUN, and Cr level, as well as higher CT-ss and O2 supportive therapy, are all significantly correlated with higher mortality in ICU-admitted COVID-19 patients. Keywords: COVID-19; CT scan; CT Severity score; ICU; pneumonia.

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ACR White Paper–Based Comprehensive Dose Reduction Initiative Is Associated With a Reversal of the Upward Trend in Radiation Dose for Chest CT

Cited by 11 publications

References 23 publications

Proposal of a low-dose, long-pitch, dual-source chest CT protocol on third-generation dual-source CT using a tin filter for spectral shaping at 100 kVp for CoronaVirus Disease 2019 (COVID-19) patients: a feasibility study

Proposal of a low-dose, long-pitch, dual-source chest CT protocol on third-generation dual-source CT using a tin filter for spectral shaping at 100 kVp for CoronaVirus Disease 2019 (COVID-19) patients: a feasibility study

Imaging for Pulmonary Embolism in Sickle Cell Disease: A 17-Year Experience

Predicting mortality rate in ICU admitted COVID-19 patients implementing visual semi-quantitative CT severity scoring system

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