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ABSTRACT: Advances in computed tomography (CT) scanners and electrocardiographic gating techniques have resulted in superior image quality of the ascending aorta and increased the use of CT angiography for evaluating the postoperative ascending aorta. Several abnormalities of the ascending aorta and aortic arch often require surgery, and various open techniques may be used to reconstruct the aorta, such as the Wheat procedure, in which both an ascending aortic graft and an aortic valve prosthesis are implanted; the Cabrol and modified Bentall procedures, in which a composite synthetic ascending aorta and aortic valve graft are placed; the Ross procedure, in which the aortic valve and aortic root are replaced with the patient's native pulmonary valve and proximal pulmonary artery; valve-sparing procedures such as the T. David-V technique, which leaves the native aortic valve intact; and more extensive arch repair procedures such as the elephant trunk and arch-first techniques, in which interposition or inclusion grafts are implanted, with or without replacement of the aortic valve. Normal postoperative imaging findings, such as hyperattenuating felt pledgets, prosthetic conduits, and reanastomosis sites, may mimic pathologic processes. Postoperative complications seen at CT angiography that require further intervention include pseudoaneurysms, anastomotic stenoses, dissections, and aneurysms. Radiologists must be familiar with these procedures and their imaging features to identify normal postoperative appearances and complications.
Radiographics 01/2013; 33(1):73-85. · 2.85 Impact Factor
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ABSTRACT: The purpose of this study was to investigate gray-scale inversion in nodule detection on chest radiography. Simulated nodules were superimposed randomly onto normal chest radiographs. Six radiologists interpreted 144 chest radiographs during three reading sessions: traditional presentation, inverted gray-scale, and a choice session allowing use of traditional and gray-scale inverted views. Sensitivity and specificity were used to assess accuracy based on presence or absence of a nodule. Gray-scale inversion and choice display sessions resulted in significantly higher nodule detection specificity and decreased sensitivity compared to traditional display. Gray-scale inversion may decrease false-positive nodule findings during chest X-ray interpretation.
Clinical imaging 09/2012; 36(5):515-21. · 0.73 Impact Factor
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ABSTRACT: The purpose of this study was to assess the radiation dose distribution and image quality for organ-based dose modulation during adult thoracic MDCT.
Organ doses were measured using an anthropomorphic adult female phantom containing 30 metal oxide semiconductor field-effect transistor detectors on a dual-source MDCT scanner with two protocols: standard tube current modulation thoracic CT and organ-based dose modulation using a 120° radial arc. Radiochromic film measured the relative axial dose. Noise was measured to evaluate image quality. Breast tissue location across the anterior aspect of the thorax was retrospectively assessed in 100 consecutive thoracic MDCT examinations.
There was a 17-47% decrease (p = < 0.05) in anterior thoracic organ dose and a maximum 52% increase (p = < 0.05) in posterior thoracic organ dose using organ-based dose modulation compared with tube current modulation. Effective dose (SD) for tube current modulation and organ-based dose modulation were 5.25 ± 0.36 mSv and 4.42 ± 0.30 mSv, respectively. Radiochromic film analysis showed a 30% relative midline anterior-posterior gradient. There was no statistically significant difference in image noise. Adult female breast tissue was located within an average anterior angle of 155° (123-187°).
Organ-based dose modulation CT using an anterior 120° arc can reduce the organ dose in the anterior aspect of the thorax with a compensatory organ dose increase posteriorly without impairment of image quality. Laterally located breast tissue will have higher organ doses than medially located breast tissue when using organ-based dose modulation. The benefit of this dose reduction must be clinically determined on the basis of the relationship of the irradiated organs to the location of the prescribed radial arc used in organ-based dose modulation.
American Journal of Roentgenology 07/2012; 199(1):W65-73. · 2.78 Impact Factor
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ABSTRACT: The purpose of this study was to assess the difference in absorbed organ dose and image quality for MDCT neck protocols using automatic tube current modulation alone compared with organ-based dose modulation and in-plane thyroid bismuth shielding.
An anthropomorphic female phantom with metal oxide semiconductor field effect transistor (MOSFET) detectors was scanned on a 64-MDCT scanner. The protocols included a reference neck CT protocol using automatic tube current modulation and three modified protocols: organ-based dose modulation, automatic tube current modulation with thyroid shield, and organ-based dose modulation with thyroid shield. Image noise was evaluated quantitatively with the SD of the attenuation value, and subjectively by two neuroradiologists.
Organ-based dose modulation, automatic tube current modulation with thyroid shield, and organ-based dose modulation with thyroid shield protocols reduced the thyroid dose by 28%, 33%, and 45%, respectively, compared with the use of automatic tube current modulation alone (p ≤ 0.005). Organ-based dose modulation also reduced the radiation dose to the ocular lens (33-47%) compared with the use of automatic tube current modulation (p ≤ 0.04). There was no significant difference in measured noise and subjective image quality between the protocols.
Both organ-based dose modulation and thyroid shields significantly reduce the thyroid organ dose without degradation of subjective image quality compared with automatic tube current modulation. Organ-based dose modulation has the additional benefit of dose reduction to the ocular lens.
American Journal of Roentgenology 05/2012; 198(5):1132-8. · 2.78 Impact Factor
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ABSTRACT: The purpose of this study was to assess the effect of peak kilovoltage on radiation dose and image quality in adult neck MDCT.
An anthropomorphic phantom with metal oxide semiconductor field effect transistor detectors was imaged with a 64-MDCT scanner. The reference CT protocol called for 120 kVp, and images obtained with that protocol were compared with CT images obtained with protocols entailing 80, 100, and 140 kVp. All imaging was performed with automatic tube current modulation. Organ dose and effective dose were determined for each protocol and compared with those obtained with the 120-kVp protocol. Image noise was evaluated objectively and subjectively for each protocol.
The highest organ doses for all protocols were to the thyroid, ocular lens, skin, and mandible. The greatest reductions in organ dose were for the bone marrow of the cervical spine and mandible: 43% and 35% with the 100-kVp protocol and 63% and 53% with the 80-kVp protocol. Effective dose decreased as much as 9% with the 100-kVp protocol and 12% with the 80-kVp protocol. Use of the 140-kVp protocol was associated with an increase in organ dose as high as 64% for bone marrow in the cervical spine and a 19% increase in effective dose. Image noise increased with lower peak kilovoltage. The measured noise difference was greatest at 80 kVp, absolute increases were less than 2.5 HU. There was no difference in subjective image quality among protocols.
Reducing the voltage from 120 to 80 kVp for neck CT can result in greater than 50% reduction in the absorbed organ dose to the bone marrow of the cervical spine and mandible without impairment in subjective image quality.
American Journal of Roentgenology 03/2012; 198(3):621-7. · 2.78 Impact Factor
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ABSTRACT: The purpose of this study was to identify an optimal cross-sectional neck diameter that correlates with image quality and radiation exposure in MDCT examinations of the neck performed with automatic tube current modulation.
Ninety-six adults underwent 64-MDCT of the neck with automatic tube current modulation at the same noise setting. On frontal and lateral scout images, maximal body diameters were measured in the transverse and anteroposterior planes at two levels: just below the mandible (upper neck) and at the lung apex (lower neck). Neck diameters were correlated with image quality on a subjective 4-point scale and with radiation exposure (volume CT dose index).
As continuous variables, both anteroposterior and transverse diameters in the lower neck were associated with image quality (p ≤ 0.0012). Diameters in the upper neck were not associated with image quality. When diameters in the lower neck were categorized into small, medium, and large, image quality grades were higher for smaller patients (p < 0.001). Images of 81% of small patients (lower neck transverse diameter < 40 cm) had a high image quality grade, compared with images of 7-20% of large patients (diameter > 48 cm). Transverse diameter in the lower neck correlated best with radiation dose measured as volume CT dose index (r = 0.78). When transverse diameter in the lower neck was used to categorize patients' size, the mean volume CT dose index for small patients was 34.1 mSv and that for large patients was 63.5 mSv.
Lower neck transverse diameter on the CT scout image best correlates with image quality and radiation exposure for neck MDCT examinations performed with automatic tube current modulation. Images of patients with a lower neck transverse diameter less than 40 cm are of higher quality than those of larger patients. Individualized dose reduction techniques therefore may be appropriate for smaller patients.
American Journal of Roentgenology 11/2011; 197(5):W904-9. · 2.78 Impact Factor
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ABSTRACT: The purpose of this article is to compare the radiation dose of conventional fluoroscopy-guided lumbar epidural steroid injections (ESIs) and CT fluoroscopy (CTF)-guided lumbar ESI using both clinical data and anthropomorphic phantoms.
We performed a retrospective review of dose parameters for 14 conventional fluoroscopy ESI procedures performed by one proceduralist and 42 CTF-guided ESIs performed by three proceduralists (14 each). By use of imaging techniques similar to those for our clinical cohorts, a commercially available anthropomorphic male phantom with metal oxide semiconductor field effect transistor detectors was scanned to obtain absorbed organ doses for conventional fluoroscopy-guided and CTF-guided ESIs. Effective dose (ED) was calculated from measured organ doses.
The mean conventional fluoroscopy time for ESI was 37 seconds, and the mean procedural CTF time was 4.7 seconds. Calculated ED for conventional fluoroscopy was 0.85 mSv compared with 0.45 mSv for CTF. The greatest contribution to the radiation dose from CTF-guided ESI came from the planning lumbar spine CT scan, which had an ED of 2.90 mSv when z-axis ranged from L2 to S1. This resulted in a total ED for CTF-guided ESI (lumbar spine CT scan plus CTF) of 3.35 mSv.
The ED for the CTF-guided ESI was almost half that of conventional fluoroscopy because of the shorter fluoroscopy time. However, the overall radiation dose for CTF-guided ESIs can be up to four times higher when a full diagnostic lumbar CT scan is performed as part of the procedure. Radiation dose reduction for CTF-guided ESI is best achieved by minimizing the dose from the preliminary planning lumbar spine CT scan.
American Journal of Roentgenology 10/2011; 197(4):778-82. · 2.78 Impact Factor
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ABSTRACT: The purpose of this article is to assess whether iopamidol-370 provides superior vascular contrast of the coronaries and depiction of anatomic detail without affecting heart rate and beat-to-beat variability during coronary dual-source MDCT compared with iodixanol-320.
In this prospective trial, coronary CT angiography was performed on 60 adult patients using either iopamidol-370 or iodixanol-320. Cohorts were matched by age, habitus, sex, and baseline heart rate, with cohort sizes determined by power analysis. All studies were performed on a dual-source MDCT scanner with retrospective ECG-gating utilizing automatic pitch adjustment. Data assessment focused on heart rate variability during contrast administration statistically evaluated as Student t test comparisons within and between cohorts, coronary contrast-to-noise ratio analysis of the main coronary arteries utilizing Student t test comparisons between cohorts, and coronary branch depiction and distribution analysis in dual-reader consensus decisions between cohorts.
Thirty patients matched for age, habitus, sex, and heart rate were evaluated in each cohort. ECG analyses found a statistically significant (p = 0.013) decrease in heart rate during administration of iodixanol-320. Beat-to-beat variations, expressed as coefficient of variation, within and among cohorts were low (coefficient of variation, < 0.05). Contrast-to-noise ratio was significantly increased for iopamidol-370 versus iodixanol-320 (aortic root, p = 0.021; left main, p = 0.032; left anterior descending, p = 0.033; left circumflex, p = 0.039; and right, p = 0.009). Analysis of coronary branch visualization revealed improved depiction for iopamidol-370 compared with iodixanol-320.
Iopamidol-370, with its higher iodine concentration, provided greater vascular contrast of the arterial coronary tree and improved depiction of anatomic detail without significantly impacting cardiac heart rate during coronary MDCT imaging, as compared with iodixanol-320.
American Journal of Roentgenology 09/2011; 197(3):W445-51. · 2.78 Impact Factor
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ABSTRACT: The aim of this study was to measure the radiation dose of dual-energy and single-energy multidetector computed tomographic (CT) imaging using adult liver, renal, and aortic imaging protocols.
Dual-energy CT (DECT) imaging was performed on a conventional 64-detector CT scanner using a software upgrade (Volume Dual Energy) at tube voltages of 140 and 80 kVp (with tube currents of 385 and 675 mA, respectively), with a 0.8-second gantry revolution time in axial mode. Parameters for single-energy CT (SECT) imaging were a tube voltage of 140 kVp, a tube current of 385 mA, a 0.5-second gantry revolution time, helical mode, and pitch of 1.375:1. The volume CT dose index (CTDI(vol)) value displayed on the console for each scan was recorded. Organ doses were measured using metal oxide semiconductor field-effect transistor technology. Effective dose was calculated as the sum of 20 organ doses multiplied by a weighting factor found in International Commission on Radiological Protection Publication 60. Radiation dose saving with virtual noncontrast imaging reconstruction was also determined.
The CTDI(vol) values were 49.4 mGy for DECT imaging and 16.2 mGy for SECT imaging. Effective dose ranged from 22.5 to 36.4 mSv for DECT imaging and from 9.4 to 13.8 mSv for SECT imaging. Virtual noncontrast imaging reconstruction reduced the total effective dose of multiphase DECT imaging by 19% to 28%.
Using the current Volume Dual Energy software, radiation doses with DECT imaging were higher than those with SECT imaging. Substantial radiation dose savings are possible with DECT imaging if virtual noncontrast imaging reconstruction replaces precontrast imaging.
Academic radiology 08/2009; 16(11):1400-7. · 2.09 Impact Factor
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ABSTRACT: OBJECTIVE: The objective of our study was to review expected findings and complications after thoracic endovascular aortic repair on CT angiography (CTA). CONCLUSION: Luminal and extraluminal changes to the thoracic aorta occur after endovascular stent-grafting. The radiologist can facilitate appropriate management by detecting and differentiating expected CTA findings from complications.
American Journal of Roentgenology 03/2009; 192(2):515-24. · 2.78 Impact Factor
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Radiology 03/2009; 250(2):604-5. · 5.73 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of this article is to review open thoracic aortic surgical techniques and to describe the range of postoperative findings on CT angiography (CTA). CONCLUSION: An understanding of surgical thoracic aortic procedures will allow appropriate differentiation of normal from abnormal CTA findings on postoperative imaging.
American Journal of Roentgenology 02/2009; 192(1):W20-7. · 2.78 Impact Factor
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ABSTRACT: The purpose of this study was to assess whether radiation dose savings using a lower peak kilovoltage (kVp) setting, bismuth breast shields, and automatic tube current modulation could be achieved while preserving the image quality of MDCT scans obtained to assess for pulmonary embolus (PE).
CT angiography (CTA) examinations were performed to assess for the presence or absence of pulmonary artery emboli using a 64-MDCT scanner with automatic tube current modulation (noise level=10 HU), two kVp settings (120 and 140 kVp), and bismuth breast shields. Absorbed organ doses were measured using anthropomorphic phantoms and metal oxide semiconductor field effect transistor (MOSFET) detectors. Image quality was assessed quantitatively as well as qualitatively in various anatomic sites of the thorax.
Using a lower kVp (120 vs 140 kVp) and automatic tube current modulation resulted in a dose savings of 27% to the breast and 47% to the lungs. The use of a lower kVp (120 kVp), automatic tube current modulation, and bismuth shields placed directly on the anterior chest wall reduced absorbed breast and lung doses by 55% and 45%, respectively. Qualitative assessment of the images showed no change in image quality of the lungs and mediastinum when using a lower kVp, bismuth shields, or both.
The use of bismuth breast shields together with a lower kVp and automatic tube current modulation will reduce the absorbed radiation dose to the breast and lungs without degradation of image quality to the organs of the thorax for CTA detection of PE.
American Journal of Roentgenology 02/2009; 192(1):244-53. · 2.78 Impact Factor
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Seminars in roentgenology 02/2009; 44(1):52-62. · 0.70 Impact Factor
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ABSTRACT: The objective of our study was to correlate the estimated fetal absorbed radiation dose derived by directly measured uterine doses in the early first trimester and the volume CT dose index (CTDI(vol)) for 16-MDCT of the maternal chest, abdomen, and pelvis.
Estimated absorbed fetal dose was measured using a metal oxide semiconductor field effect transistor (MOSFET) dosimeter that was placed in the uterus of an adult female anthropomorphic phantom. The phantom was scanned on a 16-MDCT scanner using three protocols. The scanning parameters for protocol A (trauma) were detector configuration, 16 x 0.625 mm; pitch, 1.75:1; rotation time, 0.5 second; 140 kVp; and 340 mA. The scanning parameters for protocol B (CT angiography) were detector configuration, 16 x 1.25 mm; pitch, 1.38:1; rotation time, 0.6 second; 140 kVp; and 300 mA. The scanning parameters for protocol C, which is the automated tube current modulation (ATCM) protocol previously used in the literature, were detector configuration, 16 x 1.25 mm; pitch, 0.938:1; rotation time, 0.5 second; 140 kVp; and 380 mA. The protocols were also modified for the ATCM mode; the CTDI(vol) was documented from the scanner's console. Correlation between these data was tested with a goodness-of-fit model.
Absorbed fetal radiation dose in the early first trimester correlated with the CTDI(vol) via a linear regression equation. For a constant tube current and peak voltage of 140 kVp, fetal dose (mGy) = 1.665 x CTDI(vol) (mGy) - 7.059. For the ATCM mode and a constant kVp of 140, fetal dose (mGy) = 2.151 x CTDI(vol) (mGy) - 2.200. The goodness of fit (R(2)) for the equations is 0.99 and 0.91, respectively.
In both the manual and ATCM modes, absorbed fetal radiation dose can be estimated from the CTDI(vol) obtained at the time of scanning independent of pitch and tube current-time product (mAs).
American Journal of Roentgenology 05/2008; 190(4):860-4. · 2.78 Impact Factor
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ABSTRACT: To measure prospectively and directly both organ dose and effective dose (ED) for adult cardiac and pulmonary computed tomographic (CT) angiography by using current clinical protocols for 64-detector CT in an anthropomorphic female phantom and to estimate lifetime attributable risk of breast and lung cancer incidence on the basis of measured ED and organ dose.
Cardiac and pulmonary 64-detector CT angiography was performed by using current clinical protocols to evaluate the pulmonary veins (electrocardiographically [ECG] gated, 64 sections at 0.625-mm collimation, 120 kVp, 300 mA, 0.35-second tube rotation), native coronary arteries (ECG gated; 64 sections at 0.625 mm; 120 kVp; maximum current, 500-750 mA; minimum, 100-350 mA; 0.35-second tube rotation) and pulmonary embolus (64 sections at 1.25 mm, 140 kVp, 645 mA, 0.5-second tube rotation). Absorbed organ doses were measured by using an anthropomorphic female phantom and metal oxide semiconductor field effect transistor detectors. ED was calculated from measured organ doses and the dose-length product.
ED for current adult cardiac and pulmonary 64-detector CT angiography protocols were 12.4-31.8 mSv. Overall, skin, breast, and esophagus and heart had the highest recorded absorbed organ doses. Relative risk for breast cancer incidence for girls and women was 1.004-1.042 for a single examination. Relative risk for lung cancer incidence for men and women was 1.005-1.076 from a single examination.
EDs and organ doses from 64-detector CT are higher than those previously reported for adult cardiac and pulmonary CT angiography protocols. Risk for breast and lung cancer induction from these studies is greatest for the younger patient population.
Radiology 01/2008; 245(3):742-50. · 5.73 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of this article is to illustrate the common congenital cardiac lesions that are characterized by right-sided heart enlargement that may be seen on routine thoracic or cardiac imaging. CONCLUSION: A systematic approach to the evaluation of the right heart and an understanding of the congenital abnormalities causing right chamber enlargement will allow the radiologist to diagnose unsuspected cardiac abnormalities on routine clinical thoracic and cardiac imaging as well as accurately identify these defects on dedicated cardiac CT or MRI examinations.
American Journal of Roentgenology 10/2007; 189(3):592-601. · 2.78 Impact Factor
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ABSTRACT: The purpose of our study was to determine a dose range for cardiac-gated CT angiography (CTA) in children.
ECG-gated cardiac CTA simulating scanning of the heart was performed on an anthropomorphic phantom of a 5-year-old child on a 16-MDCT scanner using variable parameters (small field of view; 16 x 0.625 mm configuration; 0.5-second gantry cycle time; 0.275 pitch; 120 kVp at 110, 220, and 330 mA; and 80 kVp at 385 mA). Metal oxide semiconductor field effect transistor (MOSFET) technology measured 20 organ doses. Effective dose calculated using the dose-length product (DLP) was compared with effective dose determined from measured absorbed organ doses.
Highest organ doses included breast (3.5-12.6 cGy), lung (3.3-12.1 cGy), and bone marrow (1.7-7.6 cGy). The 80 kVp/385 mA examination produced lower radiation doses to all organs than the 120 kVp/220 mA examination. MOSFET effective doses (+/- SD) were as follows: 110 mA: 7.4 mSv (+/- 0.6 mSv), 220 mA: 17.2 mSv (+/- 0.3 mSv), 330 mA: 25.7 mSv (+/- 0.3 mSv), 80 kVp/385 mA: 10.6 mSv (+/- 0.2 mSv). DLP effective doses for diagnostic runs were as follows: 110 mA: 8.7 mSv, 220 mA: 19 mSv, 330 mA: 28 mSv, 80 kVp/385 mA: 12 mSv. DLP effective doses exceeded MOSFET effective doses by 9.7-17.2%.
Radiation doses for a 5-year-old during cardiac-gated CTA vary greatly depending on parameters. Organ doses can be high; the effective dose may reach 28.4 mSv. Further work, including determination of size-appropriate mA and image quality, is important before routine use of this technique in children.
American Journal of Roentgenology 08/2007; 189(1):12-8. · 2.78 Impact Factor
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ABSTRACT: This report describes a review of the available scientific evidence through 2005 on direct noninvasive imaging tests (NITs) for coronary artery disease. In particular, the report addresses 6 key questions provided by the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services. The questions examine the degree to which current evidence supports confident judgments about the use of NITs in the assessment of native coronary artery stenosis in clinical practice. The 2 NITs that are examined in detail in this report are 16 (and higher)-multidetector computed tomography angiography and 1.5-T magnetic resonance angiography to evaluate for stenosis in native coronary arteries. Reported sensitivity of NITs ranged from 68% to 100%; reported specificity ranged from 57% to 100% (patient-based analysis). Limitations include the exclusion of significant numbers of segments and patients, with often only the proximal coronary segments visualized. There is no direct evidence assessing the clinical use of NITs in terms of the incremental benefits or risks compared to alternative testing strategies. Although the ability of noninvasive direct coronary imaging technologies is promising-particularly the 64-multidetector computed tomography angiography-the evidence does not provide strong guidance on whether and how such technologies should be used in the population generally, or for Medicare beneficiaries specifically. Informed clinical and policy decision making will require further study of these technologies in well-characterized clinical contexts, in typical practice settings, and with attention to impact on management and health outcomes.
American heart journal 03/2007; 153(2):161-74. · 4.65 Impact Factor
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ABSTRACT: The objective of our study was to determine the radiation dose to the female breast from current 16-MDCT body examinations.
Metal oxide semiconductor field effect transistor (MOSFET) detectors were placed in four quadrants of the breast of a female-configured anthropomorphic phantom to determine radiation dose to the breast. Imaging was performed on a 16-MDCT scanner (LightSpeed, GE Healthcare) using current clinical protocols designed to assess pulmonary embolus (PE) (140 kVp, 380 mA, 0.8-sec rotation, 16 x 1.25 mm collimation), appendicitis (140 kVp, 340 mA, 0.5-sec rotation, 16 x 0.625 mm collimation), and renal calculus (140 kVp, 160 mA, 0.5-sec rotation, 16 x 0.625 mm collimation).
Radiation dose to the breast ranged from 4 to 6 cGy for the PE protocol and up to 1-2 cGy in the inferior aspect of the right breast and lateral aspect of the left breast for the appendicitis protocol. The renal calculus protocol yielded less than 150 microGy absorbed breast dose.
Current clinical chest and abdomen protocols result in vairable radiation doses to the breast. The magnitude of exposure may have implications for imaging strategies.
American Journal of Roentgenology 07/2006; 186(6):1718-22. · 2.78 Impact Factor
