Ultra-low-dose CT-guided lung biopsy in clinic: radiation dose, accuracy, image quality, and complication rate

2020 ◽  
pp. 028418512091762
Author(s):  
Ting Liang ◽  
Yonghao Du ◽  
Chenguang Guo ◽  
Yuan Wang ◽  
Jin Shang ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Complication Rate ◽  
Lung Biopsy ◽  
Ct Guided ◽  
Significant Difference ◽  
Group A ◽  
Mode Group ◽  
Dose Accuracy ◽  
Group B

Background Computed tomography (CT)-guided percutaneous lung biopsy is usually performed by helical scanning. However, there are no studies on radiation dose, diagnostic accuracy, image quality, and complications based on axial scan mode. Purpose To determine radiation dose, accuracy, image quality, and complication rate following an ultra-low-dose (ULD) protocol for CT-guided lung biopsy in clinic. Material and Methods A total of 105 patients were enrolled to receive CT-guided lung biopsy. The use of an ULD protocol (axial scan) for CT-guided biopsy was initiated. Patients were randomly assigned to axial mode (Group A) and conventional helical mode (Group B) CT groups. 64-slice CT was performed for CT-guided pulmonary biopsy with an 18-G coaxial cutting biopsy needle. The radiation dose, accuracy, image quality, and complication rate were measured. Results Ninety-seven patients were selected for the final phase of the study. There was no significant difference between the two groups for pulmonary nodule characteristics ( P > 0.05). The mean effective dose in group A (0.077 ± 0.010 mSv) was significantly reduced relative to group B (0.653 ± 0.177 mSv, P < 0.001). There was no significant difference in accuracy, image quality, and complication rate ( P > 0.050) between the two modes. Conclusion An ULD protocol for CT-guided lung nodule biopsy yields a reduction in the radiation dose without significant change in the accuracy, image quality, and complication rate relative to the conventional helical mode scan.

First experiences of a low-dose protocol for CT-guided musculoskeletal biopsies combining different radiation dose reduction techniques

2019 ◽  
Vol 61 (1) ◽  
pp. 28-36
Author(s):  
Zlatan Alagic ◽  
Haris Alagic ◽  
Robert Bujila ◽  
Subhash Srivastava ◽  
Saif Jasim ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Success Rate ◽  
Low Dose ◽  
Quality Parameters ◽  
Ct Guided ◽  
Protocol Group ◽  
Group A ◽  
The Mean ◽  
Group B

Background The use of computed tomography (CT) for image guidance during biopsies is a powerful approach. The method is, however, often associated with a significant level of radiation exposure to the patient and operator. Purpose To investigate if a low-dose protocol for CT-guided musculoskeletal (MSK) biopsies, including a combination of different radiation dose (RD) techniques, is feasible in a clinical setting. Material and Methods Fifty-seven patients underwent CT-guided fine-needle aspiration cytology (FNAC) utilizing the low-dose protocol (group A). A similar number of patients underwent CT-guided FNAC using the reference protocol (group B). Between-group comparisons comprised radiation dose, success rate, image quality parameters, and workflow. Results In group A, the mean total dose-length product (DLP) was 41.2 ± 2.9 mGy*cm, which was statistically significantly lower than of group B (257.4 ± 22.0 mGy*cm), corresponding to a mean dose reduction of 84% ( P<0.001). The mean CTDIvol for the control scans were 1.88 ± 0.09 mGy and 13.16 ± 0.40 mGy for groups A and B, respectively ( P < 0.001). The success rate in group A was 91.2% and 87.9% in group B ( P = 0.56). No negative effect on image-quality parameters, time of FNAC, and number of control scans were found. Conclusion We successfully developed a low-dose protocol for CT-guided MSK biopsies that maintains diagnostic accuracy and image quality at a fraction of the RD compared to the reference biopsy protocol at our clinic.

Advantages of Application of Whole-Body Low-Dose Computed Tomography in Multiple Myeloma

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Chen J ◽  
◽  
Li M ◽  
Gao Z ◽  
Liu S ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Image Quality ◽  
Radiation Dose ◽  
Ct Scan ◽  
Reconstruction Algorithm ◽  
Objective Evaluation ◽  
Whole Body ◽  
Significant Difference ◽  
Group A ◽  
Group B

Aim: This study was designed to investigate the application of whole-body low-dose computed tomography in the examination of multiple myeloma. Method: 40 patients with multiple myeloma admitted to our hospital were prospectively selected as the study subjects. All patients were pathologically confirmed and/or clinically diagnosed with multiple myeloma. Patients were randomly divided into two groups: Group A (n=20) received whole-body lowdose CT scan with SAFIR iterative reconstruction algorithm; Group B (n=20) underwent whole body conventional dose CT scan combined with conventional reconstruction algorithm. The image quality was scored subjectively, and the objective evaluation indexes (including CT value and noise of neck, chest, abdomen, pelvic cavity and lower extremities, signal-to-noise ratio and image quality index) were measured and recorded, and the radiation dose was recorded. Mann-Whitney U test (to evaluate the subjective score) and t test (to evaluate the objective evaluation index and radiation dose) were used to compare the differences of the above indexes between group A and group B. Result: All the images met the diagnostic requirements. There was no statistical significance in the scores between group A and group B (P>0.05). Significant differences in CT value, noise and SNR of neck, chest, abdomen, pelvis and lower extremities between group A and group B (P<0.05) were identified. For the image quality index (figure of merit, FOM), the FOM of chest, abdomen and pelvis was not statistically significantly changed (P<0.05). The radiation dose of group A decreased by 56.77% (3.06/5.39) compared to group B with a statistically significant difference (P<0.05). The Kappa values of subjective scores of the two groups showed no statistically significant difference (respectively, 0.68 and o.69, P>0.05). Conclusion: Compared to conventional CT examination, whole-body lowdose CT scan combined with SAFIR iterative reconstruction algorithm can effectively reduce noise, reduce X-ray radiation dose, and obtain ideal image quality in multiple myeloma examination, which has a certain application value.

Risk of Damaging Anatomical Structures During Minimally Invasive Hallux Valgus Correction (Bösch Technique): An Anatomical Study

2018 ◽  
Vol 39 (11) ◽  
pp. 1355-1359 ◽  
Author(s):  
Martin Kaipel ◽  
Lukas Reissig ◽  
Lukas Albrecht ◽  
Stefan Quadlbauer ◽  
Joachim Klikovics ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Complication Rate ◽  
Metatarsal Osteotomy ◽  
Anatomical Structures ◽  
Intensive Training ◽  
Increased Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Percutaneous, transverse distal metatarsal osteotomy with K-wire fixation (the Bösch technique) is an established technique for hallux valgus correction. Nevertheless, the risk of damaging the anatomical structures during the operation is unknown. Methods: Forty fresh-frozen anatomical foot specimens with hallux valgus deformity underwent a percutaneous corrective procedure. Specimens of group A (n = 20) were operated by an experienced surgeon while specimens of group B (n = 20) were done by untrained residents. Results: The dorsal cutaneous nerve was injured in 1 of 20 cases in group A and 6 of 20 cases in group B ( P = .037). There was a significant difference in overall complication rate between specimens of group A and group B ( P = .043). Conclusions: The results show an increased risk of perioperative injury of the dorsal cutaneous branch of the deep peroneal nerve as well as a significant effect of the surgeon’s experience on the overall complication rate. Clinical Relevance: Results of this study are highly relevant for all surgeons who perform percutaneous, minimally invasive hallux valgus surgery to avoid damage to the peripheral nerves. In addition, the data suggest an intensive training for surgeons before minimally invasive hallux valgus surgery is performed without supervision.

scholarly journals Evaluation of Low-kVp Low-Volume Iodinated Contrast Protocol for Coronary CT Angiography Using Retrospective ECG Gating

2022 ◽  
Author(s):  
Atul Kapoor ◽  
Goldaa Mahajan ◽  
Aprajita Kapoor
Keyword(s):  
Radiation Dose ◽  
Ct Angiography ◽  
Ecg Gating ◽  
Heart Rates ◽  
Iodinated Contrast ◽  
Significant Difference ◽  
Group A ◽  
Low Volume ◽  
Group B ◽  
Low Kvp

Abstract Objective The aim of this study was to evaluate the use of low peak kilovoltage (kVp) low-volume iodinated contrast protocol for performing coronary computed tomography (CT) angiography (CCTA) in patients using retrospective electrocardiogram (ECG) gating. Materials and Methods Hundred prospective patients undergoing CCTA were studied in two groups, A and B, using 70 kilovoltage (kV) and 120 kV protocols with half and standard intravenous volumes of injected iodinated contrast, respectively. All patients had heart rates less than 100 beats/min and body mass index (BMI) less than 31 kg/m2. Both the groups were evaluated for signal-to-noise (S/N) and contrast-to-noise (C/N) ratios along with radiation dose delivered in millisievert (mSv), and for image quality (IQ), on per patient and per segment basis. Results Patients with group A showed statistically reduced radiation dose of 1.86 mSv compared with 6.86 mSv in group B patients. Marked reduction in image noise with statistically improved S/N and C/N ratios in all coronary vessels was seen in group A. S/N ratios in group A were 20.25, 18.68, 19.04, 17.41, and 18.69 for aorta, left main, left anterior descending, right coronary, and left circumflex arteries while they were 13.34, 11.12, 10.96, 9.74, and 8.67 in group B patients. C/N ratios were also higher in all vessels in group A patients, that is, 19.48, 19.48, 19.04, 19.48, and 17.68, compared with group B patients, who had 12.43, 10.03, 9.23, 9.57, and 8.23 ratios (p < 0.0001). No significant difference in IQ per patient and per vessel was seen between both the groups. Discussion Retrospective ECG-gated low-kVp low-volume iodinated contrast protocol provides good diagnostic quality angiograms in patients with BMI up to 31 kg/m2 and with heart rates of less than 100 beats/min with three times reduced radiation dose. The reduced volume of contrast reduces the cost as well as the chance of contrast-induced nephropathy.

Effect of different contrast administration protocols on contrast enhancement and image quality in CT scan

2019 ◽  
Author(s):  
Noor Ruhaya Ibrahim ◽  
Noor Khairiah A. Karim ◽  
Ibrahim Lutfi Shuaib ◽  
Noor Diyana Osman ◽  
Salwah Hashim ◽  
...  
Keyword(s):  
Image Quality ◽  
Contrast Enhancement ◽  
Hounsfield Unit ◽  
Fixed Time ◽  
Qualitative Assessment ◽  
Contrast Administration ◽  
Contrast Volume ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Objective The aim of this study is to compare the effect of different contrast administration protocols practiced in Advanced Medical and Dental Institute, Universiti Sains Malaysia (Group A) and Hospital Pulau Pinang, Malaysia (Group B), on contrast enhancement and image quality in computed tomography scan. The two protocols were fixed time delay (FTD) with fixed volume (FV), and automatic bolus tracking (ABT) with weight based volume (WBV) contrast administration. Quantification of contrast enhancement’s magnitude in four different anatomical structures was measured in Hounsfield Unit (HU) and based on 5-point scale (1=poor, 5=excellent), the images were rated qualitatively.Results Mean enhancement values of all structures in Group B was higher compared to Group A (p = < 0.001). Mean of quality rating between the two groups was statistically not significant (p = 0.185). There was a weak correlation between HU values and administered contrast volume (r = 0.152). It can be concluded that FTD with FV protocol is non inferior to ABT with WBV protocol as it yielded higher degree of contrast enhancement. There was no significant difference between the two protocols in term of qualitative assessment although ABT with WBV protocol had higher mean grading in image quality.

Image quality and radiation dose of CT venography with double dose reduction using model based iterative reconstruction: comparison with conventional CT venography using filtered back projection

2017 ◽  
Vol 59 (5) ◽  
pp. 546-552 ◽  
Author(s):  
Yeo-Jin Jeong ◽  
Ki Seok Choo ◽  
Kyung Jin Nam ◽  
Ji Won Lee ◽  
Jin You Kim ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Iterative Reconstruction ◽  
Radiation Doses ◽  
Back Projection ◽  
Filtered Back Projection ◽  
Ct Venography ◽  
Group A ◽  
Vascular Enhancement ◽  
Group B

Background Computed tomography venography (CTV) at low kVp using model-based iterative reconstruction (MBIR) can enhance vascular enhancement with noise reduction. Purpose To evaluate image qualities and radiation doses of CTV at 80 kVp using MBIR and a small iodine contrast media (CM) dose and to compare these with those of CTV performed using a conventional protocol. Material and Methods Sixty-five patients (mean age = 58.1 ± 7.2 years) that underwent CTV for the evaluation of deep vein thrombosis (DVT) and varicose veins were enrolled in this study. Patients were divided into two groups: Group A (35 patients, 80 kVp, MBIR, automatic tube current modulation, CM = 270 mg/mL, 100 mL) and Group B (30 patients, 100 kVp, filtered back projection [FBP], 120 fixed mA, CM = 370 mg/mL, 120 mL). Objective and subjective image qualities of inferior vena cava (IVC), femoral vein (FV), and popliteal vein (PV) were assessed and radiation doses were recorded. Results Mean vascular enhancement in group A was significantly lower than in group B ( P < 0.01). Noise in group A was significantly lower than in group B except for PV and contrast-to-noise ratio were not significantly different in the two groups ( P > 0.05). In addition, radiation dose in group A was significantly lower than in group B ( P < 0.001). Subjective image quality comparison revealed group A was statistically inferior to group B except for subjective image noise. Conclusion CTV at 80 kVp using MBIR with small iodine contrast dose provided acceptable image quality at a lower radiation dose than conventional CTV using FBP.

The Value of Low-dose Prospective Dual-energy Computed Tomography with Iodine Mapping in the Diagnosis of Gastric Cancer

2020 ◽  
Vol 16 (4) ◽  
pp. 433-437
Author(s):  
Lifeng Wang ◽  
Xingxing Jin ◽  
Zhenguo Qiao ◽  
Bin Xu ◽  
Jiaqing Shen
Keyword(s):  
Gastric Cancer ◽  
Computed Tomography ◽  
Image Quality ◽  
Radiation Dose ◽  
Low Dose ◽  
Preoperative Staging ◽  
Control Group ◽  
Imaging Quality ◽  
Group A ◽  
Group B

Objectives: This study investigated the radiation dose and value of prospective dualenergy computed tomography (DECT) in the diagnosis of gastric cancer. Methods: Sixty patients scheduled for computed tomography (CT) for preoperative staging were divided into two groups. Thirty patients (Group A) underwent a single contrast-enhanced abdominal CT acquisition using a dual-source mode (100 kV/140 kV). Weighted average images of the two-kilovolt acquisitions and iodine maps were created. The remaining 30 patients underwent a standard CT scan (Group B). Two observers performed a blinded read of the images for gastric lesions, evaluating the image quality and recording effective dose. Results: During the blinded read, observers found 90% (27/30) of the cancers in both groups. The mean imaging quality scores were 2.1±0.9 for Group A, and 2.3±1.1 for Group B. The effective mean doses were 6.59±0.59 mSv and 25.86±0.44 mSv for Groups A and B, respectively. Compared with the control group (B), the imaging quality in the low-dose group decreased a little, but the radiation dose substantially decreased by 74.6%. Conclusion: The new DECT technique is valuable for examining gastric cancer patients. The dualkV scan mode can substantially reduce radiation dose while preserving good diagnostic image quality.

Single-needle Celiac Plexus Block 

1997 ◽  
Vol 87 (6) ◽  
pp. 1301-1308 ◽  
Author(s):  
Marcello De Cicco ◽  
Mira Matovic ◽  
Luca Balestreri ◽  
Augusto Fracasso ◽  
Sandro Morassut ◽  
...  
Keyword(s):  
Pain Relief ◽  
Celiac Artery ◽  
Celiac Plexus ◽  
Celiac Plexus Block ◽  
Ct Guided ◽  
Needle Position ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Plexus Block

Background The "single-needle" celiac plexus block is becoming a popular technique. Despite different approaches and methods used to place the needle, the success of the block depends on adequate spread of the injectate in the celiac area. In the present retrospective study, the influence of needle tip position in relation to the celiac artery on injectate spread was evaluated. Methods Among 138 cancer patients subjected, via an anterior approach, to computed tomography (CT)-guided single-needle neurolytic celiac plexus block, a radiologist, blinded to the aim of the study, retrospectively selected 53 cases with normal anatomy of the celiac area as judged by CT. The decision was based on images obtained before the block. Patients were then classified into either group A (29 patients), in whom the needle tip was caudad to the celiac artery, and group B (24 patients), in whom it was cephalad. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: upper right and left and lower right and left, as related to the celiac artery. Patient assessments by visual analog scale were reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was judged as long-lasting. The patterns of contrast spread in relation to the needle position and pain relief according to the number of quadrants with contrast were analyzed. Results The percentage of cases with four quadrants with contrast was higher when the needle tip was cephalad (58%, group B) than when it was caudad (14%, group A) to the celiac artery (P &lt; 0.01). The percentage of patients with four and three quadrants with contrast was also higher in group B at 79% than in group A at 38% (P &lt; 0.01). A significant difference in long-lasting pain relief was observed between patients with four quadrants with contrast (18 of 18, 100%; 95% confidence interval [CI], 81-100%) and patients with three quadrants with contrast (5 of 12, 42%; 95% CI, 15-72%) (P &lt; 0.01). No patients showing two or one quadrant with contrast had long-lasting pain relief. Conclusions These findings suggest that, when the celiac area is free from anatomic distortions, and the single-needle neurolytic celiac plexus block technique is used, the needle tip should be positioned cephalad to the celiac artery to achieve a wider neurolytic spread. It also appears that only a complete (four quadrants) neurolytic spread in the celiac area can guarantee long-lasting analgesia.

Diagnostic accuracy and complication rate of CT-guided fine needle aspiration biopsy of lung lesions: A study based on the experience of the cytopathologist

2010 ◽  
Vol 51 (5) ◽  
pp. 527-533 ◽  
Author(s):  
Adriano Massimiliano Priola ◽  
Sandro Massimo Priola ◽  
Aldo Cataldi ◽  
Marisa Di Franco ◽  
Francesco Pazè ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fine Needle Aspiration ◽  
Complication Rate ◽  
Fine Needle Aspiration Biopsy ◽  
Needle Aspiration ◽  
Ct Guided ◽  
Lung Lesions ◽  
Fine Needle ◽  
Group A ◽  
Group B

Background: CT-guided transthoracic needle biopsy is a well-established technique for the diagnosis of focal lung lesions. Fine needle aspiration biopsy (FNAB) requires the presence of a cytopathologist on-site to assess the adequacy of samples. For this reason FNAB is less and less used, and core biopsy is the first-line procedure when an experienced cytopathologist is not immediately available. Purpose: To evaluate the accuracy and complication rate of CT-guided FNAB of lung lesions according to the experience of the cytopathologist on-site. Material and Methods: A total of 321 consecutive biopsies were considered. Immediate cytological assessment was performed by an experienced cytopathologist for the first 165 procedures (group A) and by two training pathologists for the remaining 156 biopsies (group B). At the time of FNAB the pathologist assigned a semiquantitative score (0–3) to each specimen to assess its diagnostic quality. All variables between the two groups were analyzed by chi-square and Student's t test. A P value <0.05 was considered statistically significant. Results: For all procedures, overall diagnostic accuracy was 80% for cytology alone, with no statistical difference between the two groups for diagnostic accuracy and sample score assigned. In all, 75% of the cytological samples (75% group A, 74% group B) obtained a higher score with a specific diagnosis of histotype. A post biopsy pneumothorax was detected in 27% of biopsies (25% group A, 28% group B). Thirteen patients (4.0%) required chest tube insertion for treatment. For all cases, the pneumothorax rate was significantly affected by the number of samples obtained ( P=0.02), but not by the pleural punctures ( P=0.15). There was no statistically significant difference between the two groups concerning the number of needle passes and complication rate ( P>0.05). Conclusion: The efficacy and safety of CT-guided FNAB is not significantly affected by the training level of the cytopathologist on-site. Moreover, the number of specimens obtained for each procedure is a risk factor for pneumothorax.

scholarly journals Intradiverticular Ampulla of Vater: Personal Experience at ERCP

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Girolamo Geraci ◽  
Giuseppe Modica ◽  
Carmelo Sciumè ◽  
Antonio Sciuto
Keyword(s):  
Complication Rate ◽  
Personal Experience ◽  
Ampulla Of Vater ◽  
Stone Disease ◽  
Technical Success ◽  
Endoscopic Retrograde ◽  
Successful Cannulation ◽  
Significant Difference ◽  
Group A ◽  
Group B

Introduction. Conflicting results have been reported about the true impact of intradiverticula ampulla (IA) on the technical success and complication rate of endoscopic retrograde cholangiopancreatography (ERCP). Patients. A total of 500 patients who underwent ERCP were divided into two groups according to the presence (group A, 81 patients) or absence (group B, 419 patients) of IA. Success rate, difficulty at cannulation, findings at ERCP, and procedure-related complications were retrospectively reviewed. Results. Successful cannulation was achieved in 100% of group A patients compared to 98% of group B patients (P = ns). There was a significant difference in the type of cannulation that was routinary in group B (), while requiring guidewire in group A (). Cholangitis (), microstones (), dilated common bile duct without stones (), stone recurrence (), and transient postprocedure hyperamylasemia () were more frequently observed in group A. There was no significant difference in complication rate between both groups. Conclusions. The finding of an IA at ERCP should not be considered a predictor for failed cannulation. IA is associated with post-ERCP transient hyperamylasemia and is a risk factor for biliary stone disease and its recurrence.

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