Minimising medically unwarranted computed tomography scans

2012 ◽  
Vol 41 (3-4) ◽  
pp. 161-169 ◽  
Author(s):  
D.J. Brenner
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Decision Rules ◽  
Clinical Decision ◽  
Ct Scans ◽  
Slowing Down ◽  
Powerful Approach ◽  
Computed Tomography Scans ◽  
Risk Balance ◽  
Major Factors

As computed tomography (CT) is such a superb diagnostic tool and individual CT risks are small, whenever a CT scan is clinically warranted, the CT benefit/risk balance is by far in the patient's favour. However, if a CT scan is not clinically warranted, this balance shifts dramatically. It is likely that at least 25% of CT scans fall into this latter category, in that they could either be replaced with alternative imaging modalities or could be avoided entirely. Use of clinical decision rules for CT usage represents a powerful approach for slowing down the increase in CT usage, because they have the potential to overcome some of the major factors that result in some CT scans being undertaken when they may not be clinically helpful.

scholarly journals Is This Contrast? Is This Blood? An Agreement Study on Post-thrombectomy Computed Tomography Scans

2020 ◽  
Vol 11 ◽  
Author(s):  
Ronda Lun ◽  
Gregory B. Walker ◽  
Adrien Guenego ◽  
Mohammed Kassab ◽  
Eduardo Portela ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Hemorrhagic Transformation ◽  
Ct Scans ◽  
Computed Tomography Scans ◽  
Kappa Value ◽  
Level Of Training ◽  
Global Agreement ◽  
Contrast Ct ◽  
Agreement Study

Background: Hemorrhagic transformation after acute ischemic stroke is a dreaded and severe complication of thrombolysis and thrombectomy. However, its detection on post-thrombectomy conventional non-contrast computed tomography (CT) scan can be complicated by the frequent (and sometimes concomitant) presence of contrast, resulting in changes in management.Aims: Our objective was to assess the inter- and intra-rater reliability for the detection of blood and/or contrast on day-1 post-thrombectomy CT scans.Methods: A total of 18 raters across 3 different specialties independently examined 30 post-thrombectomy CT scans selected from the Aspiration vs. STEnt-Retriever (ASTER) trial. They were asked to judge the presence of blood and contrast. Thirty days later, the same 18 raters again independently judged the 30 scans, in randomized order. Agreement was measured with Fleiss' and Cohen's K statistics.Results: Overall agreement on blood and/ or contrast presence was only fair, k = 0.291 (95% CI = 0.273–0.309). There were 0 scans with consensus among the 18 readers on the presence of blood and/or contrast. However, intra-rater global agreement across all 18 physicians was relatively high, with a median kappa value of 0.675. This intra-rater consistency was seen across all specialties, regardless of level of training.Conclusion: Physician judgment for the presence of blood and/or contrast on day-1 post-thrombectomy non-contrast CT scan shows limited inter-observer reliability. Advanced imaging modalities may then be warranted for challenging clinical cases.

scholarly journals Utility of Computed Tomography Scans in Predicting Need for Surgery in Nasal Injuries

2013 ◽  
Vol 6 (4) ◽  
pp. 221-223 ◽  
Author(s):  
Benjamin E. Peterson ◽  
Timothy D. Doerr
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Bone Fracture ◽  
Gold Standard ◽  
Nasal Bone ◽  
Plain Film ◽  
Ct Scans ◽  
Nasal Injury ◽  
Computed Tomography Scans ◽  
Nasal Trauma

In many centers, computed tomography (CT) scan is preferred over plain film radiographs in the setting of acute nasal injury because CT scan is thought to be more sensitive in predicting nasal bone fracture. However, the usefulness of CT scans in predicting the need for surgery in acute nasal injury has not been well-studied. We conducted a retrospective review of 232 patients with known nasal bone fracture and found very similar rates of surgery in patients with a diagnosis of nasal fracture by CT scan as by nasal radiographs (41 and 37%, respectively). This suggests that experienced clinical examination remains the gold standard for determining the need for surgery in isolated nasal trauma, regardless of CT findings.

Diagnostic Accuracy of Magnetic Resonance Imaging and Computed Tomography Scan in Young Athletes With Spondylolysis

2019 ◽  
Vol 58 (6) ◽  
pp. 671-676
Author(s):  
Amy M. West ◽  
Pierre A. d’Hemecourt ◽  
Olivia J. Bono ◽  
Lyle J. Micheli ◽  
Dai Sugimoto
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Ct Scan ◽  
False Negative ◽  
False Negative Rate ◽  
Ct Scans ◽  
Resonance Imaging ◽  
Young Athletes ◽  
Negative Rate

The objective of this study was to determine diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) scans in young athletes diagnosed with spondylolysis. A cross-sectional study was used. Twenty-two young athletes (14.7 ± 1.5 years) were diagnosed as spondylolysis based on a single-photon emission CT. Following the diagnosis, participants underwent MRI and CT scan imaging tests on the same day. The sensitivity and false-negative rate of the MRI and CT scans were analyzed. MRI test confirmed 13 (+) and 9 (−) results while CT test showed 17 (+) and 5 (−) results. The sensitivity and false-negative rate of MRI were, respectively, 59.1% (95% confidence interval [CI] = 36.7% to 78.5%) and 40.9% (95% CI = 21.5% to 63.3%). Furthermore, the sensitivity and false-negative rate of CT scan were 77.3% (95% CI = 54.2% to 91.3%) and 22.7% (95% CI = 0.09% to 45.8%). Our results indicated that CT scan is a more accurate imaging modality to diagnose spondylolysis compared with MRI in young athletes.

scholarly journals The Effect of Contrast-enhanced Computed Tomography (CT) Scans on the Calculated Dose of Radiotherapy in a Thorax Phantom

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Athar Ehtiati ◽  
Payman Hejazi ◽  
Mohsen Bakhshandeh ◽  
Ali Jabbary Arfaee ◽  
Eftekhar Rajab Bolookat ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Contrast Media ◽  
Ct Scan ◽  
Treatment Planning ◽  
Tumor Volume ◽  
Ct Scans ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Background: Despite the benefits of contrast-enhanced computed tomography (CT) scans in better tumor volume delineation, it can affect the accuracy of dose calculation in radiation therapy. This study examined this effect on a thorax phantom. Objectives: The influence of different variables including the concentrations of the Visipaque contrast media, tumor sizes, and CT scan energies on the dose measurement was examined. Methods: Transparent cylinders containing the contrast media were inserted in the lung area of the phantom and the CT scans were made. Non-enhanced CT scans were also acquired. Treatment planning using 2 opposite fields was performed on the CT scans and the doses were calculated in the treatment planning system. The results of the 2 sets of enhanced and non-enhanced CT scans were compared. Results: The correlation between concentration and the percentage of mean dose of the tumor volume was significant in 2 of the tumor sizes. The differences in the mean doses of the 2 plans were examined and more than 3% increase was observed in higher concentrations of the contrast media. Conclusions: According to this study, the suitable concentration of the contrast media administered and the CT scan energy should be considered. This would help to decrease the discrepancies between the calculated and delivered dose in radiotherapy treatments to a clinically acceptable level. The importance of time delays for CT scans after administration of the contrast media is emphasized.

scholarly journals A Comparison of Intra-Observer and Inter-Observer Reliability of Plain Radiographs, Standard Computed Tomography Scans and Mobile Computed Tomography Scans in the Assessment of Distal Radius Fractures: A Cadaveric Study

2019 ◽  
pp. 53
Author(s):  
Sitthiphong Suwannaphisit ◽  
Saowapar Yoykaew ◽  
Chitchaya Suwanraksa ◽  
Varah Yuenyongviwat ◽  
Porames Suwanno ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Observer Agreement ◽  
Ct Scans ◽  
Radius Fractures ◽  
Plain Radiographs ◽  
Observer Reliability ◽  
Computed Tomography Scans ◽  
Mobile Ct

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities. Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses. Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure. 

scholarly journals Enlargement of Post-Traumatic Intracerebral Haematoma: Incidence and Time Course

2005 ◽  
Vol 33 (1) ◽  
pp. 119-122 ◽  
Author(s):  
WG Liu ◽  
Y Yao ◽  
JY Zhou ◽  
XF Yang
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Time Course ◽  
Ct Scans ◽  
Intracerebral Haematoma ◽  
Automated Method ◽  
Haematoma Volume ◽  
Traumatic Intracerebral Haematoma ◽  
Radiographic Criterion ◽  
Post Traumatic

We retrospectively assessed the incidence and time course of enlargement in posttraumatic intracerebral haematoma (PTICH). Computed tomography (CT) scans from 165 patients who underwent a scan within 72 h and a repeat scan within 120 h of the onset of trauma were examined. A semi-automated method using region deformation-based segmentation was used to calculate the haematoma volume. The presence of haematoma enlargement was also determined based on a consensus by five observers. Seventy cases (42%) showed enlargement of the haematoma. The frequency of haematoma enlargement decreased as the interval between the onset of trauma and the initial scan increased. The discriminant value of the ratio of the haematoma volume in the second scan to that in the initial scan was ascertained, and the cut-off value for haematoma enlargement was determined to be 1.45. The radiographic criterion for enlargement in PTICH on CT scan was, therefore, defined as a ≥ 1.45 times increase in haematoma volume.

Prospective Study of the Correlation Between Postoperative Computed Tomography Scan and Primary Surgeon Assessment in Patients With Advanced Ovarian, Tubal, and Peritoneal Carcinoma Reported to Have Undergone Primary Surgical Cytoreduction to Residual Disease 1 cm or Less

2007 ◽  
Vol 25 (31) ◽  
pp. 4946-4951 ◽  
Author(s):  
Dennis S. Chi ◽  
Pedro T. Ramirez ◽  
Jerrold B. Teitcher ◽  
Svetlana Mironov ◽  
Debra M. Sarasohn ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Residual Disease ◽  
Advanced Ovarian Cancer ◽  
Ct Scans ◽  
Eligibility Criteria ◽  
Primary Surgery ◽  
The Right ◽  
Analysis Scale ◽  
Tomography Scan

Purpose To compare surgeons' operative assessments of residual disease (RD) to those identified on postoperative computed tomography (CT) scans in patients with advanced ovarian carcinoma reported to have undergone optimal primary cytoreduction. Patients and Methods All patients at one of two institutions, who were scheduled to have primary surgery for presumed advanced ovarian cancer, were asked to consent to a postoperative CT scan if cytoreduction to ≤ 1 cm RD was reported. CT scan findings were graded using a qualitative analysis scale from 1 (normal) to 5 (definitely malignant). Results From January 2001 to September 2006, 285 patients were enrolled. A total of 78 patients met eligibility criteria and had postoperative CT scans. In 41 cases (52%), postoperative scan findings correlated with the surgical report of no RD more than 1 cm, and in seven cases (9%), the CT findings were indeterminate. In 10 cases (13%), more than 1 cm RD was noted by the radiologist as probably malignant, and in 20 cases (26%), definitely malignant. In these 30 cases, the radiologically reported median largest residual mass was 1.9 cm (range, 1.1 to 5.1), with RD more than 1 cm reported most commonly in the right upper quadrant (15 patients [50%]) and central abdomen (nine patients [30%]). Conclusion There was only a 52% correlation between surgeons' assessments and postoperative CT scan evaluations of RD in patients reported to have undergone optimal cytoreduction. Further study is required to determine whether this lack of correlation is due to rapid interval tumor regrowth, RD underestimated by the surgeons, and/or overestimated by the radiologists; and to determine the clinical implications of these discrepancies.

Imperial Needs, Imperial Methods: Chimú Ceramic Manufacturing Process Through CT Scan Analysis of Stirrup-Spout Bottles

2016 ◽  
Vol 27 (2) ◽  
pp. 238-256
Author(s):  
Valentine Wauters
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Manufacturing Process ◽  
Ceramic Production ◽  
Ct Scans ◽  
Manufacturing Processes ◽  
Ceramic Assemblage ◽  
Ceramic Manufacturing ◽  
Industrial Level ◽  
Ct Scan Analysis

The stirrup-spout bottle is one of the most representative forms in the Chimú (A.D. 900-1470) ceramic repertoire. I discuss the ceramic assemblage of this coastal culture and describes more precisely the various manufacturing processes of the stirrup-spout bottle. Although molds used to produce these complex vessels are known today, only little information has been published on the various stages involved in their manufacture. My purpose is to contribute to this research using medical imaging computed tomography (CT) scans of intact stirrup-spout vessels. Based on my findings, I propose that changes in the construction of these vessels correlated with a transition in ceramic production to a semi-industrial level during the time of the Chimú Empire.

scholarly journals Prediction of Extrathyroidal Extension Using Ultrasonography and Computed Tomography

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Doh Young Lee ◽  
Tack-Kyun Kwon ◽  
Myung-Whun Sung ◽  
Kwang Hyun Kim ◽  
J. Hun Hah
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Extrathyroidal Extension ◽  
Ct Scans ◽  
Imaging Features ◽  
Predictive Values ◽  
Preoperative Prediction ◽  
Ct Findings ◽  
Sensitivity Specificity ◽  
Thyroid Capsule

Objectives. The aim of the present study was to evaluate the value of high-resolution ultrasound (US) and computed tomography (CT) scan for preoperative prediction of the extrathyroidal extension (ETE).Methods. We analyzed the medical records of 377 patients with papillary thyroid carcinoma (PTC) with preoperative US and CT scan to calculate the sensitivity, specificity, and positive and negative predictive values of characteristics imaging features (such as contact and disruption of thyroid capsule) for the presence of ETE in postoperative pathologic examination. We also evaluated the diagnostic power for several combinations of US and CT findings.Results. ETE was present in 174 (46.2%) based on pathologic reports. The frequency of ETE was greater in the patients with greater degrees of tumor contact and disruption of capsule, as revealed by both US and CT scans (positive predictive value of 72.2% and 81.8%, resp.). Considering positive predictive values and AUC of US and CT categories, separately or combined, a combination of US and CT findings was most accurate for predicting ETE (83.0%, 0.744).Conclusions. This study suggests that ETE can be predicted most accurately by a combination of categories based on the findings of US and CT scans.

Can a CT be Omitted in Pediatric Minor Head Trauma?

2017 ◽  
Vol 16 (01) ◽  
pp. 001-007
Author(s):  
Maria Sinzig ◽  
Eveline Achatz ◽  
Günter Fasching ◽  
Christoph Arneitz
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Head Trauma ◽  
Neurological Status ◽  
Ct Scans ◽  
Minor Head Trauma ◽  
Pediatric Ct ◽  
Ct Protocol ◽  
In Infants And Children

AbstractThis study aimed to evaluate the need for radiation exposure in pediatric minor head trauma. Symptomatic patients after minor head trauma were observed for at least 24 hours in a 13-month period. A computed tomography (CT) scan was performed on children with a depressed neurological status. Two hundred fourteen patients with a mean age of 9.3 years were included. An intracranial hemorrhage (ICH) was diagnosed in three (1.4%) patients. The overall CT rate was 10.7%. The study concluded that neuro-observation without initial CT scans is safe in infants and children following minor head trauma. Special pediatric CT protocol can limit radiation exposure.

Sign in / Sign up

Export Citation Format

Share Document