Appropriate and safe use of diagnostic imaging.
ABSTRACT Risks of diagnostic imaging include cancer from radiation exposure and nephrogenic systemic fibrosis. The increase in volume of imaging between 1980 and 2006 has led to a sixfold increase in annual per capita radiation exposure. It is predicted that 2 percent of future cancers will be caused by radiation from computed tomography (CT) exposure. Gadolinium contrast media should be avoided in patients with stage 4 or 5 chronic kidney disease because of the risk of nephrogenic systemic fibrosis. Appropriate use of imaging based on guidelines for specific clinical conditions can reduce these risks. Although noncontrast CT of the head is needed to rule out bleeding in patients with suspected stroke within the first three hours of symptom onset, diffusion-weighted imaging with magnetic resonance of the head and neck is superior to CT within three to 24 hours of symptom onset. Headache merits neuroimaging in special circumstances only. Sestamibi radioisotope has less radiation than thallium for myocardial perfusion imaging. Use of intravenous contrast media with abdominopelvic CT significantly increases the diagnostic accuracy for appendicitis. Cholescintigraphy has better discrimination to diagnose acute cholecystitis than CT in patients with equivocal ultrasonography results. Limited three-view intravenous urography is recommended in pregnancy to evaluate urolithiasis if initial ultrasonography findings are negative or equivocal. Given that many asymptomatic adults have abnormal findings on lumbar spine magnetic resonance imaging, this modality generally should not be performed for nonspecific chronic low back pain in the absence of red flags. Whole body scanning is not supported by current evidence.
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ABSTRACT: Newer flat panel angiographic detector (FD) systems have the capability to generate parenchymal blood volume (PBV) maps. The ability to generate these maps in the angiographic suite has the potential to markedly expedite the triage and treatment of patients with acute ischemic stroke. The present study compares FP-PBV maps with cerebral blood volume (CBV) maps derived using standard dynamic CT perfusion (CTP) in a population of patients with stroke. 56 patients with cerebrovascular ischemic disease at two participating institutions prospectively underwent both standard dynamic CTP imaging followed by FD-PBV imaging (syngo Neuro PBV IR; Siemens, Erlangen, Germany) under a protocol approved by both institutional review boards. The feasibility of the FD system to generate PBV maps was assessed. The radiation doses for both studies were compared. The sensitivity and specificity of the PBV technique to detect (1) any blood volume deficit and (2) a blood volume deficit greater than one-third of a vascular territory, were defined using standard dynamic CTP CBV maps as the gold standard. Of the 56 patients imaged, PBV maps were technically adequate in 42 (75%). The 14 inadequate studies were not interpretable secondary to patient motion/positioning (n=4), an injection issue (n=2), or another reason (n=8). The average dose for FD-PBV was 219 mGy (median 208) versus 204 mGy (median 201) for CT-CBV. On CT-CBV maps 26 of 42 had a CBV deficit (61.9%) and 15 (35.7%) had a deficit that accounted for greater than one-third of a vascular territory. FD-PBV maps were 100% sensitive and 81.3% specific to detect any CBV deficit and 100% sensitive and 62.9% specific to detect any CBV deficit of greater than one-third of a territory. PBV maps can be generated using FP systems. The average radiation dose is similar to a standard CTP examination. PBV maps have a high sensitivity for detecting CBV deficits defined by conventional CTP. PBV maps often overestimate the size of CBV deficits. We hypothesize that the FP protocol initiates PBV imaging prior to complete saturation of the blood volume in areas perfused via indirect pathways (ie, leptomeningeal collaterals), resulting in an overestimation of CBV deficits, particularly in the setting of large vessel occlusion.Journal of Neurointerventional Surgery 08/2013; 6(6). DOI:10.1136/neurintsurg-2013-010840 · 2.77 Impact Factor
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ABSTRACT: Objective The purpose of this study was to investigate the reliability of the Goutallier classification system (GCS) for grading muscle fatty degeneration in the lumbar multifidus (LM) using magnetic resonance imaging (MRI) examinations. Methods Lumbar spine MRI scans were obtained retrospectively from the radiology department imaging system. Two examiners (a chiropractic diagnostic imaging resident and a board certified chiropractic radiologist with 30 years of experience) independently graded each LM at the L4/5 and L5/S1 intervertebral level. ImageJ pixel analysis software (version 1.47; National Institutes of Health, Bethesda, MD) was used independently by 2 observers to quantify the percent fat of the LM and allow correlation between LM percent fat and GCS grade. Twenty-five subject MRIs were randomly selected. Magnetic resonance imaging scans were included if they were obtained using a 1.5 T imaging system and were excluded if there was evidence of spinal infection, tumor, fracture, or postoperative changes. For all tests, P < .05 was defined as significant. Results Intraobserver reliability grading LM fat ranged from a weighted κ (κw) of 0.71 to 0.93. Mean interobserver reliability grading LM fat was κw, 0.76 to κw, 0.85. There was a significant (P < .001) correlation between LM percent fat and GCS grade. Furthermore, interobserver reliability in determining percent fat was between intraclass correlation coefficient, 0.73 to intraclass correlation coefficient, 0.90. Conclusions In this study, the GCS was reliable in grading LM fatty degeneration and correlated positively with a quantified percent fat value. In addition, ImageJ software (National Institutes of Health) was reliable between raters when quantifying LM percent fat.Journal of manipulative and physiological therapeutics 03/2014; 37(3). DOI:10.1016/j.jmpt.2013.12.010 · 1.25 Impact Factor
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ABSTRACT: Breastfeeding is a well-recognised investment in the health of the mother-infant dyad. Nevertheless, many professionals still advise breastfeeding mothers to temporarily discontinue breastfeeding after contrast media imaging. Therefore, we performed this review to provide health professionals with basic knowledge and skills for appropriate use of contrast media. A joint working group of the Italian Society of Radiology (SIRM), Italian Society of Paediatrics (SIP), Italian Society of Neonatology (SIN) and Task Force on Breastfeeding, Ministry of Health, Italy prepared a review of the relevant medical literature on the safety profile of contrast media for the nursing infant/child. Breastfeeding is safe for the nursing infant of any post-conceptional age after administration of the majority of radiological contrast media to the mother; only gadolinium-based agents considered at high risk of nephrogenic systemic fibrosis (gadopentetate dimeglumine, gadodiamide, gadoversetamide) should be avoided in the breastfeeding woman as a precaution; there is no need to temporarily discontinue breastfeeding or to express and discard breast milk following the administration of contrast media assessed as compatible with breastfeeding. Breastfeeding women should receive unambiguous professional advice and clear encouragement to continue breastfeeding after imaging with the compatible contrast media. aEuro cent Breastfeeding is a well-known investment in the health of the mother-infant dyad. aEuro cent Breastfeeding is safe after administration of contrast media to the mother. aEuro cent There is no need to temporarily discontinue breastfeeding following administration of contrast media.European Radiology 05/2014; 24(8). DOI:10.1007/s00330-014-3198-6 · 4.34 Impact Factor