Scanner thoracique ultra-basse dose : la mort de la radiographie thoracique ?

Ludes, Claire; Schaal, Marysa; Labani, Aïssam; Jeung, Mi-Young; Roy, Catherine; Ohana, Mickaël

doi:10.1016/j.lpm.2015.12.003

Cited by 22 publications

(12 citation statements)

References 24 publications

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“…However, the significant radiation exposure associated with CT represents a limiting factor for its use in the perioperative setting. Indeed, ionizing radiation exposure during CT is up to 300 times the dose of a standard chest X-ray (Ludes et al, 2016). Magnetic resonance imaging (MRI), a radiation-free technique, is potential alternative to CT for atelectasis measurement (Ball et al, 2018; Kuethe et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Validation of MRI for Volumetric Quantification of Atelectasis in the Perioperative Period: An Experimental Study in Swine

et al. 2019

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Background: Impairment of pulmonary aeration is a frequent postoperative complication that is associated with adverse outcome. Diagnosis and quantification of impaired pulmonary aeration by CT scan is limited due to concern for exposure to ionizing radiation. Magnetic resonance imaging (MRI) represents a potential radiation-free alternative for this use. We undertook an experimental study to validate the use of MRI to quantify pulmonary aeration impairment. Methods: Ten large white pigs were studied before intubation, after intubation, 2 h after non-protective mechanical ventilation and after intra-tracheal negative pressure suction to induce atelectasis. A lung CT scan immediately followed by a lung MRI were performed at all four time points. On the 40 CT images lung volumes corresponding to non-aerated, poorly aerated, normally aerated, and overinflated voxels were measured based on their radiodensity. Similarly, on the 40 MRI images lung volumes corresponding to non-aerated and aerated voxels were measured based on their signal intensity. The correlation between non-aerated lung by MRI vs., CT scans, and with PaO 2 /FiO 2 measured at each of the four time points was assessed with the Pearson’ correlation coefficient, bias and limits of agreement. Results: Pearson correlation coefficient, bias and limits of agreements between the CT non-aerated lung volumes and MRI abnormal lung volumes were 0.88, -16 ml, and (-108, 77), respectively. Pearson correlation coefficient between PaO 2 /FiO 2 and abnormal lung volumes measured with MRI was -0.60. Conclusion: In a preclinical swine model, quantitative measurements of pulmonary atelectasis by MRI-imaging are well correlated with the gold standard, i.e., densitometric scan CT measurements.

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Section: Introductionmentioning

confidence: 99%

Validation of MRI for Volumetric Quantification of Atelectasis in the Perioperative Period: An Experimental Study in Swine

et al. 2019

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“…For the acquisition settings of the ULD CT, we have chosen to decrease the tube current to 10 mA and to maintain a high voltage of 135 kV. We have decided to foster a “higher kV / low mA” technique rather than a "low kV / higher mA” such as 80 kV / 40 mA in order to reduce streak artifacts, improve image quality in the upper and lower areas of the lung and reduce the dose delivered to the superficial structures (skin, thyroid, breast), while being more robust to the image deterioration in obese patient [13]. …”

Section: Discussionmentioning

confidence: 99%

“…Thanks to technological development, and particularly since the implementation of iterative reconstruction techniques, it is possible to acquire a chest CT of diagnostic quality at a radiation dose as low as that of a chest x-ray from a front and lateral view: this is the ULD technique [8–13]. If several recent works dealing with the detection of pulmonary nodules by a ULD chest CT have already shown promising results [8, 14, 15], ULD’s diagnostic performance in detecting asbestos-related diseases is not yet clear, as only one study [16] has recently assessed it on 27 exposed workers in a screening setting.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting

Schaal¹,

Séverac

Labani

et al. 2016

PLoS ONE

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ObjectiveTo evaluate the diagnostic performance of Ultra-Low-Dose Chest CT (ULD CT) for the detection of any asbestos-related lesions (primary endpoint) and specific asbestos-related abnormalities, i.e. non-calcified and calcified pleural plaques, diffuse pleural thickening, asbestosis and significant lung nodules (secondary endpoints).Material and Methods55 male patients (55.7±8.1 years old) with occupational asbestos exposure for at least 15 years and where CT screening was indicated were prospectively included. They all underwent a standard unenhanced chest CT (120kV, automated tube current modulation), considered as the reference, and an ULD CT (135kV, 10mA), both with iterative reconstruction.Two chest radiologists independently and blindly read the examinations, following a detailed protocol. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and error rate of ULD CT were calculated using the exact method of Pearson with a confidence interval of 95%.ResultsRadiation dose was 17.9±1.2mGy.cm (0.25mSv) for the ULD-CT versus 288.8 ±151mGy.cm (4mSv); p <2.2e-16.Prevalence of abnormalities was 20%. The ULD CT’s diagnostic performance in joint reading was high for the primary endpoint (sensitivity = 90.9%, specificity = 100%, positive predictive value = 100%, negative predictive value = 97.8%), high for lung nodules, diffuse pleural thickening and calcified pleural plaques (sensitivity, specificity, PPV and NPV = 100%) and fair for asbestosis (sensitivity = 75%, specificity = 100%, PPV = 00%, NPV = 98.1%).Intra-reader accuracy between the ULD CT and the reference CT for the primary endpoint was 98% for the senior and 100% for the junior radiologist. Inter-reader agreement for the primary endpoint was almost perfect (Cohen’s Kappa of 0.81).ConclusionULD CT in the screening of asbestos exposure related diseases has 90.9% sensitivity and 100% specificity, and could therefore be proposed as a first line examination.

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“…Substantial efforts have been made to optimize the dose delivered in chest imaging, particularly through the implementation of iterative reconstruction [ 6 ] and deep learning reconstruction techniques [ 7 ]. It is now possible to achieve a diagnostic chest CT at the radiation dose of a posteroanterior and lateral chest radiograph series [ 8 , 9 ], and this has been proven efficient for various clinical scenarios [ 10 ], such as lung nodule detection and follow-up [ 11 , 12 ], pulmonary infection [ 13 ], CT-guided percutaneous biopsy [ 14 ], lymphangioleiomyomatosis [ 15 ], etc. However, the image quality of these Ultra-Low-Dose (ULD) chest CTs remains dependent on the patient’s morphotype, and prior studies [ 11 , 16 ] seldomly included patients with a Body Mass Index (BMI) greater than 30 kg·m −2 .…”

Section: Introductionmentioning

confidence: 99%

Impact of Morphotype on Image Quality and Diagnostic Performance of Ultra-Low-Dose Chest CT

Ortlieb

Labani

Séverac

et al. 2021

JCM

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Objectives: The image quality of an Ultra-Low-Dose (ULD) chest CT depends on the patient’s morphotype. We hypothesize that there is a threshold beyond which the diagnostic performance of a ULD chest CT is too degraded. This work assesses the influence of morphotype (Body Mass Index BMI, Maximum Transverse Chest Diameter MTCD and gender) on image quality and the diagnostic performance of a ULD chest CT. Methods: A total of 170 patients from three prior prospective monocentric studies were retrospectively included. Renewal of consent was waived by our IRB. All the patients underwent two consecutive unenhanced chest CT acquisitions with a full dose (120 kV, automated tube current modulation) and a ULD (135 kV, fixed tube current at 10 mA). Image noise, subjective image quality and diagnostic performance for nine predefined lung parenchyma lesions were assessed by two independent readers, and correlations with the patient’s morphotype were sought. Results: The mean BMI was 26.6 ± 5.3; 20.6% of patients had a BMI > 30. There was a statistically significant negative correlation of the BMI with the image quality (ρ = −0.32; IC95% = (−0.468; −0.18)). The per-patient diagnostic performance of ULD was sensitivity, 77%; specificity, 99%; PPV, 94% and NPV, 65%. There was no statistically significant influence of the BMI, the MTCD nor the gender on the per-patient and per-lesion diagnostic performance of a ULD chest CT, apart from a significant negative correlation for the detection of emphysema. Conclusions: Despite a negative correlation between the BMI and the image quality of a ULD chest CT, we did not find a correlation between the BMI and the diagnostic performance of the examination, suggesting a possible use of the ULD protocol in obese patients.

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Scanner thoracique ultra-basse dose : la mort de la radiographie thoracique ?

Cited by 22 publications

References 24 publications

Validation of MRI for Volumetric Quantification of Atelectasis in the Perioperative Period: An Experimental Study in Swine

Validation of MRI for Volumetric Quantification of Atelectasis in the Perioperative Period: An Experimental Study in Swine

Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting

Impact of Morphotype on Image Quality and Diagnostic Performance of Ultra-Low-Dose Chest CT

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