scholarly journals Evaluation of spirometry gated CT scan to measure lung volumes in emphysema patients

2021 ◽  
pp. 00492-2021
Author(s):  
Jens T Bakker ◽  
Karin Klooster ◽  
Jan Bouwman ◽  
Gert Jan Pelgrim ◽  
Rozemarijn Vliegenthart ◽  
...  
Keyword(s):  
Ct Scan ◽  
Pearson Correlation ◽  
Ct Scanning ◽  
Breath Hold ◽  
Strongly Correlated ◽  
Body Plethysmography ◽  
Lung Volumes ◽  
Copd Patients ◽  
The Mean ◽  
Correlation Factors

IntroductionIn emphysema patients, being evaluated for bronchoscopic lung volume reduction (BLVR), accurate measurement of lung volumes is important. Total Lung Capacity (TLC) and Residual Volume (RV) are commonly measured by body-plethysmography, but can also be derived from chest computed tomography (CT). Spirometry-gated CT scanning potentially improves the agreement of CT and body-plethysmography.ObjectiveTo compare lung volumes derived from spirometry-gated CT and “breath-hold-coached” CT to the reference standard: body-plethysmography.MethodsIn this single centre retrospective cohort study, emphysema patients, evaluated for BLVR, underwent body-plethysmography, inspiration (TLC) and expiration (RV) CT-scan with spirometer guidance (“gated group”) or with breath-hold-coaching (“non-gated group”). Quantitative analysis was used to calculate lung volumes from the CT.ResultsWe included 200 patients (age 62±8 years, FEV1 29.2±8.7%, TLC 7.50±1.46 L, RV 4.54±1.07 L). The mean CT-derived TLC was 280(±340)ml lower compared to body-plethysmography in the gated group (n=100), and 590(±430)ml lower for the non-gated group (n=100) (both p<0.001). The mean CT-derived RV was 300(±470)ml higher in the gated group and 700(±720)ml higher in the non-gated group (both p<0.001). Pearson correlation factors were 0.947 for TLC gated, 0.917 for TLC non-gated, 0.823 for RV gated, 0.693 for RV non-gated, 0.539 for %RV/TLC gated and 0.204 for %RV/TLC non-gated. The differences between the gated and non-gated CT results for TLC and RV were significant for all measurements (p<0.001).ConclusionIn severe COPD patients with emphysema, CT-derived lung volumes are strongly correlated to body-plethysmography lung volumes, and especially for RV, more accurate when using spirometry-gating.

Abstract W P187: Utilization of Emergency Medical Services to Transfer Acute Stroke Patients Directly to Scanning Reduces the Length of Time to Scan Result

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Scott Dunbar ◽  
Theresa Hoffecker ◽  
Avery Schwenk
Keyword(s):  
Acute Stroke ◽  
Ct Scan ◽  
Emergency Medical Services ◽  
Ct Scanning ◽  
Medical Services ◽  
Time Of Arrival ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Number Of Patients ◽  
The Mean

Background: Rapid assessment and treatment of acute stroke patients including computerized tomography (CT) scanning to determine the need for tissue plasminogen activator (tPA) has been shown to be vital to positive patient outcomes. As part of an ongoing effort to reduce door-to-needle time for such patients, the door-to-CT result time was identified as an area that could be reduced by collaborative effort between Emergency Medical Services (EMS) and Emergency Department (ED) staff. We hypothesized that implementing an EMS protocol for direct-to-CT scanning as part of a collaborative stroke alert protocol would reduce overall door-to-CT result time. Methods: Local EMS and ED implemented criteria to alert the ED of acute stroke patients being transported to their facility. This alert included an estimated time of arrival and was sent to radiology, neurology, registration and pharmacy. Upon arrival, the patient was met by ED personnel while still on the EMS gurney. If the ED physician concurred with the field impression of acute stroke, the patient was taken directly to CT scanning by EMS. Data on time of door-to-CT result were collected from 7/9/12 to 7/8/13 and divided into those patients who received a stroke alert from EMS (n=41), and those who did not (n=81). All data are expressed as mean ± standard error. Results: The time for door-to-CT result was reduced (p<0.0001) for patients who received a stroke alert from EMS [16.5 ± 1.2 vs 31.6 ± 1.5 minutes, alert vs no alert, respectively]. Similarly, in the subset of patients who received tPA after the CT scan, the mean time door-to-CT scan results was reduced (p<0.005) in those patients who received a stroke alert from EMS (14.3 ± 1.1 vs 36.4 ± 7.3 minutes, alert vs no alert, respectively). Conclusions: Implementation of a stroke alert including a direct-to-CT protocol by EMS significantly reduced the mean door-to-CT result time in acute stroke patients. Expanding this protocol to include other area EMS services and hospitals could potentially result in a greater number of patients benefiting from these reduced times.

scholarly journals Magnetic resonance imaging as an alternative to computed tomography in select patients with traumatic brain injury: a retrospective comparison

2015 ◽  
Vol 15 (5) ◽  
pp. 529-534 ◽  
Author(s):  
Marie Roguski ◽  
Brent Morel ◽  
Megan Sweeney ◽  
Jordan Talan ◽  
Leslie Rideout ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Scan ◽  
Intracranial Hemorrhage ◽  
Skull Fracture ◽  
Ct Scanning ◽  
Skull Fractures ◽  
Radiology Reports ◽  
Subdural Hematomas ◽  
The Mean ◽  
Ct And Mri

OBJECT Traumatic head injury (THI) is a highly prevalent condition in the United States, and concern regarding excess radiation-related cancer mortality has placed focus on limiting the use of CT in the evaluation of pediatric patients with THI. Given the success of rapid-acquisition MRI in the evaluation of ventriculoperitoneal shunt malfunction in pediatric patient populations, this study sought to evaluate the sensitivity of MRI in the setting of acute THI. METHODS Medical records of 574 pediatric admissions for THI to a Level 1 trauma center over a 10-year period were retrospectively reviewed to identify patients who underwent both CT and MRI examinations of the head within a 5-day period. Thirty-five patients were found, and diagnostic images were available for 30 patients. De-identified images were reviewed by a neuroradiologist for presence of any injury, intracranial hemorrhage, diffuse axonal injury (DAI), and skull fracture. Radiology reports were used to calculate interrater reliability scores. Baseline demographics and concordance analysis was performed with Stata version 13. RESULTS The mean age of the 30-patient cohort was 8.5 ± 6.7 years, and 63.3% were male. The mean Injury Severity Score was 13.7 ± 9.2, and the mean Glasgow Coma Scale score was 9 ± 5.7. Radiology reports noted 150 abnormal findings. CT scanning missed findings in 12 patients; the missed findings included DAI (n = 5), subarachnoid hemorrhage (n = 6), small subdural hematomas (n = 6), cerebral contusions (n = 3), and an encephalocele. The CT scan was negative in 3 patients whose subsequent MRI revealed findings. MRI missed findings in 13 patients; missed findings included skull fracture (n = 5), small subdural hematomas (n = 4), cerebral contusions (n = 3), subarachnoid hemorrhage (n = 3), and DAI (n = 1). MRI was negative in 1 patient whose preceding CT scan was read as positive for injury. Although MRI more frequently reported intracranial findings than CT scanning, there was no statistically significant difference between CT and MRI in the detection of any intracranial injury (p = 0.63), DAI (p = 0.22), or intracranial hemorrhage (p = 0.25). CT scanning tended to more frequently identify skull fractures than MRI (p = 0.06). CONCLUSIONS MRI may be as sensitive as CT scanning in the detection of THI, DAI, and intracranial hemorrhage, but missed skull fractures in 5 of 13 patients. MRI may be a useful alternative to CT scanning in select stable patients with mild THI who warrant neuroimaging by clinical decision rules.

Internal Fixation of Osteochondral Lesion of the Talus Involving a Large Bone Fragment

2021 ◽  
Vol 49 (4) ◽  
pp. 1031-1039
Author(s):  
Young Rak Choi ◽  
Bom Soo Kim ◽  
Yu Mi Kim ◽  
Jae Yong Park ◽  
Jae Ho Cho ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Ct Scan ◽  
Correlation Coefficient ◽  
Pearson Correlation ◽  
Osteochondral Lesion ◽  
Pearson Correlation Coefficient ◽  
Skeletally Immature ◽  
Bone Fragment ◽  
The Mean ◽  
Large Bone

Background: Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure. Purpose: To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT). Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively. Results: Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively ( P < .001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively ( P < .001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, P = .008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, r = −0.07, P = 0.72) or the postoperative FFI (Pearson correlation coefficient, r = –0.05, P = .80). Conclusion: Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT.

scholarly journals Estimation of effective dose from CT scanning using dose length product in a Nepalese hospital

2020 ◽  
Vol 6 (1) ◽  
pp. 56-63
Author(s):  
Pooja Shah
Keyword(s):  
Ct Scan ◽  
Effective Dose ◽  
Ct Scanning ◽  
Reference Level ◽  
Radiation Doses ◽  
Reference Levels ◽  
Contrast Imaging ◽  
Dose Length Product ◽  
Effective Doses ◽  
The Mean

Keywords: Effective dose, Dose Length Product, Computed Tomography Dose Indexvolume, Dose Reference Level AbstractAim: The aim of this study was to estimate the effective doses from CT scans using DoseLength Product (DLP) in a Nepalese hospital.Materials and methods: This prospective study was conducted in 150 patients above 18years of age who were referred for CT scan of head, chest and abdomen. The CT scan wasperformed on a 128 slice multi detector scanner. All the subjects who met the inclusioncriteria were included in the study. Following the non-contrast imaging phases of the head,chest and abdomen CTDIvol, DLP, kVp and pitch were recorded for each patient from theconsole display of the scanner. The effective dose was calculated for each examination usingDLP which were graphically analyzed and correlated with the age of the patient.Results: The study showed the mean CTDIvol for head, chest and abdomen to be 53.95±4.83mGy, 5.28±1.17 mGy and 11.15±2.71 mGy respectively along with mean DLP to be923.52±71.11 mGycm, 229.32±48.70 mGycm and 517.02±148.32 mGycm respectively. Usingthese values, the mean effective doses were calculated and found to be 1.93±0.14 mSv,3.20±0.68 mSv and 7.75±2.19 mSv respectively.Conclusion: The calculated effective dose values were lower than in other studies for CTexaminations of chest and abdomen while higher or similar for CT examination of head. Theresults of this survey could motivate other researchers to investigate the radiation doses inother hospitals and help establish national diagnostic reference levels.  

The Concurrent Validity of the Minnesota Child Development Inventory as a Measure of Young Children's Language Development

1989 ◽  
Vol 54 (1) ◽  
pp. 101-105 ◽  
Author(s):  
J. Bruce Tomblin ◽  
Cynthia M. Shonrock ◽  
James C. Hardy
Keyword(s):  
Child Development ◽  
Language Development ◽  
Expressive Language ◽  
Strong Predictor ◽  
Receptive Language ◽  
Strongly Correlated ◽  
Language Measure ◽  
The Mean ◽  
Child Development Inventory ◽  
Mean Length Of Utterance

The extent to which the Minnesota Child Development Inventory (MCDI), could be used to estimate levels of language development in 2-year-old children was examined. Fifty-seven children between 23 and 28 months were given the Sequenced Inventory of Communication Development (SICD), and at the same time a parent completed the MCDI. In addition the mean length of utterance (MLU) was obtained for each child from a spontaneous speech sample. The MCDI Expressive Language scale was found to be a strong predictor of both the SICD Expressive scale and MLU. The MCDI Comprehension-Conceptual scale, presumably a receptive language measure, was moderately correlated with the SICD Receptive scale; however, it was also strongly correlated with the expressive measures. These results demonstrated that the Expressive Language scale of the MCDI was a valid predictor of expressive language for 2-year-old children. The MCDI Comprehension-Conceptual scale appeared to assess both receptive and expressive language, thus complicating its interpretation.

The Y-shaped trabecular bone structure in the odontoid process of the axis: a CT scan study in 54 healthy subjects and biomechanical considerations

2019 ◽  
Vol 30 (5) ◽  
pp. 585-592 ◽  
Author(s):  
Nicola Montemurro ◽  
Paolo Perrini ◽  
Vittoriano Mangini ◽  
Massimo Galli ◽  
Andrea Papini
Keyword(s):  
Ct Scan ◽  
Healthy Subjects ◽  
Bone Structure ◽  
Cone Beam Ct ◽  
Odontoid Process ◽  
Trabecular Structure ◽  
Anatomical Entity ◽  
Significant Difference ◽  
Axial Ct ◽  
The Mean

OBJECTIVEOdontoid process fractures are very common in both young and geriatric patients. The axial trabecular architecture of the dens appears to be crucial for physiological and biomechanical function of the C1–2 joint. The aim of this study is to demonstrate the presence of a Y-shaped trabecular structure of the dens on axial CT and to describe its anatomical and biomechanical implications.METHODSFifty-four C2 odontoid processes in healthy subjects were prospectively examined for the presence of a Y-shaped trabecular structure at the odontocentral synchondrosis level with a dental cone beam CT scan. Length, width, and axial area of the odontoid process were measured in all subjects. In addition, measurements of the one-third right anterior area of the Y-shaped structure were taken.RESULTSThe Y-shaped trabecular structure was found in 79.6% of cases. Length and width of the odontoid process were 13.5 ± 0.6 mm and 11.2 ± 0.9 mm, respectively. The mean area of the odontoid process at the odontocentral synchondrosis was 93.5 ± 4.3 mm2, whereas the mean one-third right anterior area of the odontoid process at the same level was 29.3 ± 2.5 mm2. The mean area of the odontoid process and its length and width were similar in men and women (p > 0.05). No significant difference was found in the mean area of the odontoid process in people older than 65 years (94 ± 4.2 mm2) compared to people younger than 65 years (93.3 ± 4.4 mm2; p > 0.05).CONCLUSIONSThe authors identified a new anatomical entity, named the Y-shaped trabecular structure of the odontoid process, on axial CT scans. This structure appears to be the result of bone transformation induced by the elevated dynamic loading at the C1–2 level. The presence of the Y-shaped structure provides new insights into biomechanical responses of C2 under physiological loading and traumatic conditions.

scholarly journals Towards Understanding Variability in Droughts in Response to Extreme Climate Conditions over the Different Agro-Ecological Zones of Pakistan

2021 ◽  
Vol 13 (12) ◽  
pp. 6910
Author(s):  
Adil Dilawar ◽  
Baozhang Chen ◽  
Arfan Arshad ◽  
Lifeng Guo ◽  
Muhammad Irfan Ehsan ◽  
...  
Keyword(s):  
Pearson Correlation ◽  
Principal Component ◽  
Mitigation Strategies ◽  
Precipitation Extremes ◽  
Climate Mitigation ◽  
Mean Annual Temperature ◽  
Climate Extreme ◽  
Ecological Zones ◽  
The Mean ◽  
Agro Ecological Zones

Here, we provided a comprehensive analysis of long-term drought and climate extreme patterns in the agro ecological zones (AEZs) of Pakistan during 1980–2019. Drought trends were investigated using the standardized precipitation evapotranspiration index (SPEI) at various timescales (SPEI-1, SPEI-3, SPEI-6, and SPEI-12). The results showed that droughts (seasonal and annual) were more persistent and severe in the southern, southwestern, southeastern, and central parts of the region. Drought exacerbated with slopes of −0.02, −0.07, −0.08, −0.01, and −0.02 per year. Drought prevailed in all AEZs in the spring season. The majority of AEZs in Pakistan’s southern, middle, and southwestern regions had experienced substantial warming. The mean annual temperature minimum (Tmin) increased faster than the mean annual temperature maximum (Tmax) in all zones. Precipitation decreased in the southern, northern, central, and southwestern parts of the region. Principal component analysis (PCA) revealed a robust increase in temperature extremes with a variance of 76% and a decrease in precipitation extremes with a variance of 91% in the region. Temperature and precipitation extremes indices had a strong Pearson correlation with drought events. Higher temperatures resulted in extreme drought (dry conditions), while higher precipitation levels resulted in wetting conditions (no drought) in different AEZs. In most AEZs, drought occurrences were more responsive to precipitation. The current findings are helpful for climate mitigation strategies and specific zonal efforts are needed to alleviate the environmental and societal impacts of drought.

scholarly journals Characteristics and outcomes in acute patients receiving mechanical ventilation in a Coronary Care Unit (CCU)

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Rivadeneira Ruiz ◽  
DF Arroyo Monino ◽  
T Seoane Garcia ◽  
MP Ruiz Garcia ◽  
JC Garcia Rubira
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Coronary Care Unit ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Funding Sources ◽  
Copd Patients ◽  
The Mean ◽  
Coronary Care

Abstract Funding Acknowledgements Type of funding sources: None. Objectives Mechanical ventilation is the short-term technical support most widely used and cardiac arrest its main indication in a Coronary Care Unit (CCU). However, the knowledge about the specific moment and ventilator mode of onset to avoid the acute lung injury is still equivocal. Our objective is to determine the survival rate and the prognostic factors in patients supported by mechanical ventilation. Methods We conducted a retrospective cohort study of adult patients admitted to the CCU between January 2018 and November 2020 that received mechanical ventilation during the hospital stay. Results We collected 94 patients, 28% females with a median age of 68 ± 11,9. 43% were diabetics and almost one quarter of them had some degree of chronic obstructive pulmonary disease (COPD). Ischemic cardiopathy (33%) and heart failure (31%) were frequent pathologies as well as renal injury (29% patients a filtration rate below 45 mL/min/1,73m2). The reason for initiating mechanical ventilation was cardiac arrest in the half of the patients. Volume-controlled ventilation (73%) was the initial setting mode in most cases. The support with vasoactive drugs were highly necessary in these patients (Infection rate of 48%). In the subgroup analysis, we realized that the number of reintubations and the necessity of non-invasive ventilation were higher in the COPD group (p = 0,01), as well as tracheostomy (p = 0,03). COPD patients also needed higher maintaining PEEP, though this was not statistically significant. The mean length of stay in the intensive care unit of our cohort was 11 days (range: 1-78 days; median: 8 days) and the mean length of mechanical ventilation 6 days (range: 1-64 days; median: 3 days). The in-hospital mortality was 41,4%. Conclusions Cardiac arrest is the most common reason of mechanical ventilation support. Our study showed that COPD patients presented more complications during the weaning and the period after extubation. In-hospital mortality remains high in intubated patients.

scholarly journals Decreased exercise capacity in young athletes using self-adapted mouthguards

2021 ◽  
Author(s):  
Johannes Lässing ◽  
Roberto Falz ◽  
Antina Schulze ◽  
Christoph Pökel ◽  
Maximilian Vondran ◽  
...  
Keyword(s):  
Blood Lactate ◽  
Maximum Load ◽  
Body Plethysmography ◽  
Con A ◽  
Young Athletes ◽  
Exercise Tests ◽  
Mean Values ◽  
The Mean ◽  
Preventive Effects ◽  
Randomized Crossover Study

Abstract Purpose There is evidence of both the preventive effects and poor acceptance of mouthguards. There are various effects on performance depending on the type of mouthguard model. Hemodynamic responses to wearing a mouthguard have not been described. The aim of this study was to investigate the effects of self-adapted mouthguards with breathing channels (SAMGvent). Methods In this randomized crossover study, 17 healthy, active subjects (age 25.12 ± 2.19 years) underwent body plethysmography and performed two incremental exertion tests wearing a (SAMGvent) and not wearing (CON) a mouthguard. Blood lactate, spirometrics, and thoracic impedance were measured during these maximum exercise tests. Results The mean values using a SAMGvent revealed significantly greater airway resistance compared to CON (0.53 ± 0.16 kPa·L−1 vs. 0.35 ± 0.10 kPa·L−1, respectively; p = < 0.01). At maximum load, ventilation with SAMGvent was less than CON (118.4 ± 28.17 L min−1 vs. 128.2 ± 32.16 L min−1, respectively; p = < 0.01). At submaximal loads, blood lactate responses with SAMGvent were higher than CON (8.68 ± 2.20 mmol·L−1 vs. 7.89 ± 1.65 mmol·L−1, respectively; p < 0.01). Maximum performance with a SAMGvent was 265.9 ± 59.9 W, and without a mouthguard was 272.9 ± 60.8 W (p < 0.01). Maximum stroke volume was higher using a SAMGvent than without using a mouthguard (138.4 ± 29.9 mL vs. 130.2 ± 21.2 mL, respectively; p < 0.01). Conclusion Use of a self-adapted mouthguard led to increased metabolic effort and a significant reduction in ventilation parameters. Unchanged oxygen uptake may be the result of cardiopulmonary compensation and increased breathing efforts, which slightly affects performance. These results and the obvious preventive effects of mouthguards support their use in sports.

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