Journal of Clinical Imaging Science最新文献

Objectives: Computed tomography (CT) of the wrist may be challenged, due to patients' inability to extend the arm for a "Superman pose" resulting in increased radiation dose due to scatter. Alternative positions and less dose administering modalities such as 3D Cone-beam CT (CBCT) and single-shot CT could be considered. This phantom study aimed to estimate scatter radiation dose in different phantom positions using helical and single-shot CT and 3D CBCT.

Material and methods: Wireless electronic dosimeters attached to the head and chest of an anthropomorphic phantom in various clinically relevant positions were used to measure scatter radiation. In helical CT, the following positions were used: Superman pose, semi-superman pose, wrist on the abdomen, and single-shot CT with the patient sitting in front of and behind the gantry. In 3D CBCT, the phantom was in a supine position with the arm extended laterally.

Results: Helical CT using the Superman pose resulted in a total scattered radiation dose of 64.8 µGy. The highest total dose (269.7 µGy) was obtained with the wrist positioned on the abdomen while the lowest total dose was achieved in single-shot CT with the phantom sitting behind the gantry with the forearm placed inside the gantry (3.2 µGy). The total dose in 3D CBCT was 171.1 µGy.

Conclusion: The commonly used semi-superman and wrist-on-abdomen positions in CT administer the highest scattered doses and should be avoided when either single-shot CT or 3D CBCT is available. Radiographers should carefully consider alternatives when a patient referred for wrist CT cannot comply with the Superman position.

Objectives: This study aimed to compare the safety and efficacy of balloon and non-balloon (or dilator) gastrostomy devices in radiologically inserted gastrostomy (RIG) for patients with neurological disease.

Material and methods: A retrospective analysis of 152 patients was conducted at a tertiary care hospital from July 2017 to September 2020. 104 and 48 patients were included in the balloon and non-balloon groups, respectively. The frequency of complications per specific neurological indication as well as the breakdown of the different complications pertaining to each indication was recorded for analysis. The recovery time, fluoroscopy time, contrast volume, peak radiation, and pain management dosages for each procedure were all reviewed to evaluate for statistical differences between the balloon and non-balloon groups. An adjusted model odds ratio (OR) was conducted to evaluate how each of the variables (type of gastrostomy tube, body mass index [BMI], age, and gender) affected the frequency of complications within our cohort.

Results: This study included 152 patients, with an average age of 65.17 years (interquartile range [IQR] = 12.66) and an average BMI of 26.97 (IQR = 7.19). The majority of patients were male (71.1%). The most common indication for the procedure was stroke (24.3%), followed by post-intubation dysphagia (16.4%) and intracranial hemorrhage (11.8%). Amyotrophic lateral sclerosis (ALS) and altered mental status had a similar prevalence at 9.9%. The overall complication rate was 33.8%, overall mortality rate 3.3%, 30-day mortality rate of 2.6%, and no other major complications according to CIRSE criteria. Notably, patients with neurodegenerative disorders exhibited comparable rates of minor complications: 33.3% in ALS (5/15 patients), 50% in myasthenia gravis (1/2 patients), and 100% in muscular dystrophy (1/1 patient). The study compared two groups: the balloon group (104 patients) and the dilator group (48 patients). The balloon group received significantly lower preoperative sedation in the form of fentanyl (Avg = 4.46 min vs. 6.54 min, P = 0.287). The balloon group had shorter fluoroscopy time, lower radiation exposure dose, and shorter operating time compared to the dilator group, though not statistically significant. In the logistic regression model, there was no statistical difference in complication rates between the dilator and balloon groups. BMI, age, and gender did not significantly affect minor complication rates.

Conclusion: RIG tube insertions may serve as a valuable, alternative approach in providing enteral support in patients with neurological disease.

Young adults presenting with non-traumatic hip pain may suffer from acetabular retroversion (AR). The previous studies have suggested that patient positioning during the radiographic procedure, that is, pelvic tilt and/or rotation may alter the appearance of the acetabulum. The purpose of this systematic review was to explore and collate existing literature on the correlation between pelvic positioning in weight-bearing anterior-posterior radiographs and the radiographic signs of AR, namely, the ischial spine sign (ISS) the cross-over sign (COS) and posterior wall sign (PWS). The preferred reporting items for systematic reviews and meta-analysis guidelines were followed. MEDLINE, EMBASE, PubMed, The Cochrane Library, and CINAHL were searched. The search string included the following keywords: Pelvic, tilt, rotation, positioning, inclination, incidence, AR, ISS, COS, PWS, and acetabular version. Two authors independently screened the studies identified in the search, extracted data, and critically assessed included studies for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. In total, 2289 publications were screened. Fifteen articles were found eligible for full-text screening, and four articles met the inclusion criteria. Although the studies varied methodologically, all reported that pelvic positioning impacted radiographic signs of AR investigated. One study suggested that more than 9° of pelvic inclination would result in positive COS. No other benchmark values on the degree of pelvic tilt and rotation that would compromise the diagnosis of AR, that is, the detection of ISS, COS, and PWS were reported. At present, literature reporting on the correlation between patient positioning and AR is sparse. Four studies met the inclusion criteria, and they all reported a link between pelvic positioning and the radiographic appearance of AR.

Radiological expertise requires tremendous time, effort, and training. While there has been a myriad of studies focusing on radiological expertise and error, the precise underlying neural mechanism still remains largely unexplored. In this article, we review potential neural mechanisms, namely, the fusiform face area, working memory, and predictive coding and propose experiments to test the predictive coding framework.

Pulmonary alveolar microlithiasis (PAM) is a rare chronic lung disease characterized by calcium and phosphate deposition in the alveolar lumen throughout the parenchyma of both lungs, with predominance in the middle and lower lung fields. It is caused by mutations in the recessive gene, SLC34A2, on the autosomal chromosome. In this article, we characterize four cases of PAM and analyze the loss of diagnostic vigilance in two of them. Patients came to medical facilities with clinical manifestations such as cough, shortness of breath, chest pain, and fatigue. The initial diagnosis was unclear in two cases because the X-ray film's quality was not good enough and the medical staff had little experience in clinical and chest X-ray interpretations for PAM. The definitive diagnosis was based on a combination of high-resolution computed tomography (CT) and bronchoalveolar lavage fluid testing. In addition, chest X-ray and high-resolution CT enable the assessment of the stage, progression, and severity of the disease. There is currently no specific treatment for PAM other than lung transplantation.

Small-cell cancer is an uncommon histological subtype of neuroendocrine carcinoma. It frequently has a poor prognosis because of distant metastasis. It is diagnosed using histopathological and immunohistochemical tests. We report the case of a 29-year-old female with small-cell cancer in the perihilar bile duct who presented with bleeding esophageal varices. This case report aims to improve physicians' understanding of small-cell cancer, thereby helping to reduce the frequency of missed clinical diagnoses.

Objectives: Given emerging data suggesting that uncertainty in the relative biologic effectiveness at the distal end of the Bragg peak results in increased mucosal injury in patients with oropharynx cancer receiving adjuvant proton therapy, we evaluated the results of post-treatment positron emission tomography-computed tomography (PET/CT) in patients with p16-positive oropharynx cancer (p16+OPC) treated with definitive intensity-modulated proton therapy (IMPT).

Material and methods: A retrospective cohort study of patients with p16+OPC treated with definitive IMPT between 2016 and 2022 was performed at a single institution. Patients with PET/CT scans within 6 months following completion of IMPT were included in the study. Positive post-treatment scans were defined by a maximum standard uptake values (SUVmax) >4.0 or a <65% reduction in SUVmax in either the primary tumor or lymph node. The Fisher's exact test was used to evaluate factors associated with positive post-treatment PET/ CT values.

Results: Sixty-two patients were included for analysis. Median follow-up was 21 months (range: 3-71 months) with a median time to post-treatment PET/CT of 3 months (range: 2-6 months). Median post-treatment SUVmax of the primary disease and nodal disease was 0 (mean: 0.8, range: 0-7.7) and 0 (mean: 0.7, range: 0-9.5), respectively. Median post-treatment percent reduction in SUVmax for the primary site and lymph node was 100% (mean: 94%, range: 31.3-100%) and 100% (mean: 89%, range: 23-100%), respectively. Eleven patients had a positive post-treatment PET/CT with one biopsy-proven recurrence. Negative and positive predictive values (NPV and PPV) were 98% and 9.1%, respectively. There were no factors associated with positive post-treatment PET/CT.

Conclusion: Similar to patients treated with photon-based radiation therapy, post-treatment PET/CT has a high NPV for patients with p16+OPC treated with definitive proton therapy and should be used to guide patient management. Additional patients and more events are needed to confirm the PPV of a post-treatment PET/CT in this favorable patient cohort.