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      High-Pitch CT Pulmonary Angiography in Third Generation Dual-Source CT: Image Quality in an Unselected Patient Population

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          Abstract

          Objectives

          To investigate the feasibility of high-pitch CT pulmonary angiography (CTPA) in 3 rd generation dual-source CT (DSCT) in unselected patients.

          Methods

          Forty-seven patients with suspected pulmonary embolism underwent high-pitch CTPA on a 3 rd generation dual-source CT scanner. CT dose index (CTDI vol) and dose length product (DLP) were obtained. Objective image quality was analyzed by calculating signal-to-noise-ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality on the central, lobar, segmental and subsegmental level was rated by two experienced radiologists.

          Results

          Median CTDI was 8.1 mGy and median DLP was 274 mGy*cm. Median SNR was 32.9 in the central and 31.9 in the segmental pulmonary arteries. CNR was 29.2 in the central and 28.2 in the segmental pulmonary arteries. Median image quality was “excellent” in central and lobar arteries and “good” in subsegmental arteries according to both readers. Segmental arteries varied between “excellent” and “good”. Image quality was non-diagnostic in one case (2%), beginning in the lobar arteries. Thirteen patients (28%) showed minor motion artifacts.

          Conclusions

          In third-generation dual-source CT, high-pitch CTPA is feasible for unselected patients. It yields excellent image quality with minimal motion artifacts. However, compared to standard-pitch cohorts, no distinct decrease in radiation dose was observed.

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          Most cited references21

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          Size-specific dose estimates for adult patients at CT of the torso.

          To determine relationships among patient size, scanner radiation output, and size-specific dose estimates (SSDEs) for adults who underwent computed tomography (CT) of the torso. Informed consent was waived for this institutional review board-approved study of existing data from 545 adult patients (322 men, 223 women) who underwent clinically indicated CT of the torso between April 1, 2007, and May 13, 2007. Automatic exposure control was used to adjust scanner output for each patient according to the measured CT attenuation. The volume CT dose index (CTDI(vol)) was used with measurements of patient size (anterioposterior plus lateral dimensions) and the conversion factors from the American Association of Physicists in Medicine Report 204 to determine SSDE. Linear regression models were used to assess the dependence of CTDI(vol) and SSDE on patient size. Patient sizes ranged from 42 to 84 cm. In this range,CTDI(vol) was significantly correlated with size (slope = 0.34 mGy/cm; 95% confidence interval [CI]: 0.31, 0.37 mGy/cm; R(2) = 0.48; P < .001), but SSDE was independent of size (slope = 0.02 mGy/cm; 95% CI: -0.02, 0.07 mGy/cm; R(2) = 0.003; P = .3). These R(2) values indicated that patient size explained 48% of the observed variability in CTDI(vol) but less than 1% of the observed variability in SSDE. The regression of CTDI(vol) versus patient size demonstrated that, in the 42-84-cm range, CTDI(vol) varied from 12 to 26 mGy. However, use of the evaluated automatic exposure control system to adjust scanner output for patient size resulted in SSDE values that were independent of size. For the evaluated automatic exposure control system,CTDI(vol) (scanner output) increased linearly with patient size; however, patient dose (as indicated by SSDE) was independent of size. © RSNA, 2012.
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            Optimal tube potential for radiation dose reduction in pediatric CT: principles, clinical implementations, and pitfalls.

            In addition to existing strategies for reducing radiation dose in computed tomographic (CT) examinations, such as the use of automatic exposure control, use of the optimal tube potential also may help improve image quality or reduce radiation dose in pediatric CT examinations. The main benefit of the use of a lower tube potential is that it provides improved contrast enhancement, a characteristic that may compensate for the increase in noise that often occurs at lower tube potentials and that may allow radiation dose to be substantially reduced. However, selecting an appropriate tube potential and determining how much to reduce radiation dose depend on the patient's size and the diagnostic task being performed. The power limits of the CT scanner and the desired scanning speed also must be considered. The use of a lower tube potential and the amount by which to reduce radiation dose must be carefully evaluated for each type of examination to achieve an optimal tradeoff between contrast, noise, artifacts, and scanning speed. Copyright © RSNA, 2011.
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              The indeterminate CT pulmonary angiogram: imaging characteristics and patient clinical outcome.

              To retrospectively review imaging characteristics of indeterminate computed tomographic (CT) pulmonary angiograms for pulmonary embolism (PE) and patient outcome. Investigational review board approval was obtained, informed consent was waived, and the study was HIPAA compliant. Retrospective review of 3612 CT pulmonary angiography reports created between July 1, 2001, and July 1, 2003, was performed with a keyword search for "indeterminate," "nondiagnostic," or "inadequate" (thereafter, all defined as "indeterminate") and yielded studies from 237 patients (mean age, 57 years; 117 men, 120 women). Randomly selected diagnostic studies were used to form a control group of 25 subjects (mean age, 64 years; eight men, 17 women). Electronic medical records were reviewed for follow-up imaging (repeat CT pulmonary angiography, conventional pulmonary angiography, ventilation-perfusion scintigraphy, or lower-extremity ultrasonography [US]), use of anticoagulation, placement of inferior vena cava (IVC) filters, clinical outcomes, and comments regarding indeterminate reading of CT angiograms. Studies (in patients and control subjects) were reviewed for PE, contrast attenuation in the main pulmonary artery (MPA), motion artifacts, image noise, and flow artifacts. Findings were compared with two-sample t tests assuming unequal variance. The cause cited for indeterminism was most often motion (74%), followed by poor contrast enhancement (40%). Contrast attenuation in the MPA was 245 HU +/- 80 (standard deviation) in patients and 339 HU +/- 88 in control subjects (P < .001). Only 46% of indeterminate studies met institutional criteria for adequate contrast attenuation in the MPA. Rereview of studies demonstrated five missed PEs. A total of 81 patients (33%) underwent follow-up imaging within 5 days, with one positive pulmonary angiogram and four positive lower-limb US scans. Reread or follow-up images depicted thromboembolic disease in 4.2% of patients. Nineteen patients (8%) with indeterminate final result were treated for thromboembolic disease with either anticoagulation or IVC filters. Reports on 22% of indeterminate studies contained recommendations for follow-up imaging, and those recommendations nonsignificantly increased the rate for those examinations from 13% to 19%. Review of discharge summaries showed 22% of studies are clinically interpreted as negative. The two major causes of indeterminism are motion artifacts and poor contrast enhancement. RSNA, 2005
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 February 2016
                2016
                : 11
                : 2
                Affiliations
                [001]Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
                The University of Chicago, UNITED STATES
                Author notes

                Competing Interests: Dr. Meinel has received speaker's honoraria from b.e.imaging. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: BS KB NK FM. Performed the experiments: BS KB NK FM. Analyzed the data: BS KB NK FM. Contributed reagents/materials/analysis tools: BS KB FM WS. Wrote the paper: BS KB NK FM KT JD WS.

                Article
                PONE-D-15-35307
                10.1371/journal.pone.0146949
                4752234
                26872262
                1ab55aed-e38e-4079-8ac8-2e6bfb035232
                © 2016 Sabel et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 3, Tables: 4, Pages: 11
                Product
                Funding
                The authors have no support or funding to report.
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                Biology and Life Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
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                Medicine and Health Sciences
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