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ABSTRACT: Ovarian cancer is responsible for the largest proportion of deaths among patients with gynecologic cancer. This paper discusses fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in the imaging of ovarian cancer. We discuss and demonstrate how FDG PET/CT can be used to appropriately guide clinical management decisions in patients with ovarian cancer. In particular, FDG PET/CT shows great promise for the preoperative evaluation of women with primary ovarian cancer and for subsequent postoperative assessment for recurrence.
Frontiers in bioscience (Elite edition) 01/2013; E5:141-153.
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Brian Burns Ghoshhajra,
Leif-Christopher Engel,
Gyöngyi Petra Major,
Alexander Goehler,
Tust Techasith,
Daniel Verdini,
Synho Do,
Bob Liu,
Xinhua Li,
Michiel Sala, [......], Priyanka Prakash,
Manavjot S Sidhu,
Erin Corsini,
Dahlia Banerji,
David Wu,
Suhny Abbara,
Quynh Truong,
Thomas J Brady,
Udo Hoffmann,
Manudeep Kalra
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ABSTRACT: We aimed to assess the temporal change in radiation doses from coronary computed tomography angiography (CCTA) during a 6-year period. High CCTA radiation doses have been reduced by multiple technologies that, if used appropriately, can decrease exposures significantly.
A total of 1277 examinations performed from 2005 to 2010 were included. Univariate and multivariable regression analysis of patient- and scan-related variables was performed with estimated radiation dose as the main outcome measure.
Median doses decreased by 74.8% (P<.001), from 13.1 millisieverts (mSv) (interquartile range 9.3-14.7) in period 1 to 3.3 mSv (1.8-6.7) in period 4. Factors associated with greatest dose reductions (P<.001) were all most frequently applied in period 4: axial-sequential acquisition (univariate: -8.0 mSv [-9.7 to -7.9]), high-pitch helical acquisition (univariate: -8.8 mSv [-9.3 to -7.9]), reduced tube voltage (100 vs 120 kV) (univariate: -6.4 mSv [-7.4 to -5.4]), and use of automatic exposure control (univariate: -5.3 mSv [-6.2 to -4.4]).
CCTA radiation doses were reduced 74.8% through increasing use of dose-saving measures and evolving scanner technology.
The American journal of medicine 06/2012; 125(8):764-72. · 4.47 Impact Factor
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ABSTRACT: To assess the prevalence of brown fat in patients with cancer, compare demographic characteristics of those with and those without brown fat, and correlate these characteristics with the mean and maximum standardized uptake values of brown fat.
This case-control study was institutional review board approved and HIPAA compliant. Informed consent was waived. Reports of 12 195 consecutive positron emission tomography/computed tomography examinations performed in 6867 patients between January 2004 and November 2008 were reviewed for documented fluorodeoxyglucose (FDG) uptake in brown fat (n = 298). Control patients (n = 298) without brown fat were chosen and matched for age, sex, and month and year of examination. Age, sex, weight, body mass index, ethnicity, and examination stage (initial vs restaging) were compared between groups. Paired Student t test, χ(2) test, Pearson correlation coefficient, and analysis of variance were used for statistical analysis.
Uptake of FDG in brown fat was demonstrated in 298 of 6867 (4.33%) patients. Prevalence of brown fat was significantly higher in female (5.9% [211 of 3587]) than in male patients (2.65% [87 of 3280]; P < .001). Those with brown fat had significantly lower body weight (147.5 lb ± 3.8 vs 168.61 lb ± 5.0; P < .001) and body mass index (24.3 ± 0.54 vs 27.6 ± 0.77; P < .001) than control patients. There was no significant difference in the prevalence of brown fat among ethnic groups. The maximum standardized uptake value of brown fat had a significant inverse correlation with age (r = -0.3, P < .001).
Patients with brown fat were more likely to be female and thinner than those without brown fat. Younger patients were more likely to have higher maximum standardized uptake values of brown fat.
Radiology 06/2012; 263(3):836-42. · 5.73 Impact Factor
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ABSTRACT: Symptomatic bladder outlet obstruction and neurogenic bladder are common conditions that frequently necessitate suprapubic insertion of a bladder tube. The purpose of this study was to describe an experience with minimally invasive imaging-guided percutaneous suprapubic bladder tube placement and the clinical and technical success and complications encountered.
A total of 585 primary suprapubic bladder tube insertions and 439 exchanges of suprapubic bladder tubes were performed on 549 patients (469 men, 80 women; mean age, 66 years; range, 15-106 years). The details of percutaneous tube placement (indication, tube type, size at insertion and change, and method of insertion) were retrospectively recorded.
The technical success rate for primary suprapubic bladder tube insertion was 99.6% (547/549) and for exchanges was 92.3% (405/439). The clinical success rate for primary insertion was 98.1% (572/583), and symptoms were unresolved in 1.9% (11/583). Minor complications occurred in 7.2% (42/583) of cases at tube insertion and in 4.8% (21/439) at exchange. There was one major complication (a patient needed surgery because the small bowel was traversed by a catheter), and there was no procedure-related mortality.
Radiologic imaging-guided percutaneous suprapubic bladder tube placement is a safe and effective procedure.
American Journal of Roentgenology 01/2011; 196(1):182-8. · 2.78 Impact Factor
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American Journal of Roentgenology 08/2010; 195(2):W91-5. · 2.78 Impact Factor
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American Journal of Roentgenology 07/2010; 195(1):W5-W13. · 2.78 Impact Factor
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ABSTRACT: To compare visualization of subtle normal and abnormal findings at computed tomography (CT) of the chest for diffuse lung disease with images reconstructed with filtered back projection and adaptive statistical iterative reconstruction (ASIR) techniques.
In this HIPAA-compliant, institutional review board-approved study, 24 patients underwent 64-section multi-detector row CT of the chest for evaluation of diffuse lung disease. Scanning parameters included a pitch of 0.984:1 and 120 kVp in thin-section mode, with 2496 views per rotation compared with 984 views acquired for normal mode. The 0.625-mm-thick images were reconstructed with filtered back projection, ASIR, and ASIR high-definition (ASIR-HD) kernels. Two thoracic radiologists independently assessed the filtered back projection, ASIR, and ASIR-HD images for small anatomic details (interlobular septa, centrilobular region, and small bronchi and bronchioles), abnormal findings (reticulation, tiny nodules, altered attenuation, bronchiectasis), image quality (graded by using a six-point scale, where 1 = excellent image quality, and 5 = interpretation impossible), image noise, and artifacts. Data were tabulated for statistical testing.
For visualization of normal and pathologic structures, CT image series reconstructed with ASIR-HD were rated substantially better than those reconstructed with filtered back projection and ASIR (P < .001). ASIR-HD images were superior to filtered back projection images in 15 of 24 (62%) patients for visualization of normal structures and in 24 of 24 (100%) patients for pathologic findings. ASIR-HD was superior to ASIR in three of 24 (12%) images for normal anatomic findings and in seven of 24 (29%) images for pathologic evaluation. None of the images in the three groups were rated as unacceptable for noise (P < .001).
ASIR-HD reconstruction results in superior visualization of subtle and tiny anatomic structures and lesions in diffuse lung disease compared with ASIR and filtered back projection reconstructions.
Radiology 07/2010; 256(1):261-9. · 5.73 Impact Factor
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ABSTRACT: To assess imaging features of pericardial metastases on chest computed tomography (CT) scanning.
This institutional review board-approved retrospective study included 60 patients (24 men, 36 women; mean age, 62 [SD, 13] years). All chest CT scans for these patients were reviewed independently for presence of pericardial effusion, irregularity, enhancement, nodules, and masses and presence of coexistent cardiac lesions (metastasis). Location of pericardial nodules and irregularity and type and location of primary malignancy were recorded.
Of these 60 patients with pericardial metastasis, 54 (90%) had pericardial effusion (small in 23/54 and moderate to large in 31/54 patients); 14 (23%) of 60 patients had nodules or masses in the pericardium; 21 (35%) of 60 had pericardial enhancement; and 27 (45%) of 60 had pericardial thickening. Prepericardial lymph nodes were present in 39 (65%) of 60 patients. The most common location of pericardial nodules and irregularity was along the free wall of the right ventricle (6/14) and right atrioventricular groove (5/14). Other 3 of 14 patients had pericardial nodule over the left ventricle, in oblique sinus of the pericardium, and interventricular groove each.
Most frequent CT features of pericardial metastases include pericardial effusion, prepericardial lymph nodes, and pericardial thickening, enhancement, and nodules in order of decreasing frequency.
Journal of computer assisted tomography 07/2010; 34(4):554-8. · 1.38 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the image quality and diagnostic performance of simulated low-dose MDCT examinations in patients with Crohn's disease.
Thirty-five MDCT examinations from 25 patients (14 males and 11 females; age range, 16-86 years) with known or suspected Crohn's disease were retrospectively evaluated. The MDCT images (5 mm thickness) were modified by artificially introducing noise using volume CT noise simulation software to simulate low-dose MDCT data acquired with noise indexes (NIs) of 18-35. The 175 MDCT image data sets generated were then randomized and reviewed by two readers to assess the subjective image quality and diagnostic accuracy for confidently detecting Crohn's disease findings on a 5-point scale (1, definitely absent; 5, definitely present). The image quality, diagnostic performance, and radiation dose from the original MDCT examinations served as a reference standard for comparison.
The simulated low-dose CT images with elevated NIs of 18-25 yielded optimal image quality and concordant diagnostic accuracy with standard-dose scans with a mean baseline volume CT dose index of 16 +/- 3.34 (SD) mGy (image quality score, 4-4.9 vs 4.95, respectively; p = 0.4). Images simulating NIs of 30-35 were considered degraded because of excessive image noise and presented lower diagnostic performance (range of image quality score, 3-3.6; weighted kappa = 0.25-0.37; p < 0.001). Diagnostic performance and reader confidence for the determination of Crohn's disease manifestations in cases in which the reference standard was positive were higher at NIs of < or = 25 compared with NI of 30 (reader confidence score, 4.5 vs 3.6, respectively; p < 0.05) and an NI of 35 (3.2, p < 0.05). Compared with the standard-dose examination, a 31-64% reduction in radiation dose was estimated for NI levels of 18-25, which corresponds to image noise of 19-27 HU in subcutaneous fat.
Processed MDCT images with the introduction of noise to simulate low-dose MDCT examinations with NI levels of 18-25 allows substantial dose reduction for CT examinations in Crohn's disease without compromising diagnostic information.
American Journal of Roentgenology 07/2010; 195(1):78-88. · 2.78 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of this article is to review the role of FDG PET/CT in ovarian cancer, which is the leading cause of death among gynecologic cancers. CONCLUSION: FDG PET/CT can significantly modify the assessment of the extent of primary and recurrent ovarian cancer and, hence, often alters patient management substantially. FDG PET/CT has thus become a critical tool for the preoperative evaluation of women with primary ovarian cancer and for postoperative follow-up assessment for evidence of recurrence in these patients.
American Journal of Roentgenology 06/2010; 194(6):W464-70. · 2.78 Impact Factor
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ABSTRACT: To assess radiation dose reduction for abdominal computed tomography (CT) examinations with adaptive statistical iterative reconstruction (ASIR) technique.
With institutional review board approval, retrospective review of weight adapted abdominal CT exams were performed in 156 consecutive patients with ASIR and in 66 patients with filtered back projection (FBP) on a 64-slice MDCT. Patients were categorized into 3 groups of <60 kg (n = 42), 61 to 90 kg (n = 100), and >or=91 kg (n = 80) for weight-based adjustment of automatic exposure control technique. Remaining scan parameters were held constant at 1.375:1 pitch, 120 kVp, 55 mm table feed per rotation, 5 mm section thickness. Two radiologists reviewed all CT examinations for image noise and diagnostic acceptability. CT dose index volume, and dose length product were recorded. Image noise and transverse abdominal diameter were measured in all patients. Data were analyzed using analysis of variance.
ASIR allowed for an overall average decrease of 25.1% in CT dose index volume compared with the FBP technique (ASIR, 11.9 +/- 3.6 mGy; FBP, 15.9 +/- 4.3 mGy) (P < 0.0001). In each of the 3 weight categories, CT examinations reconstructed with ASIR technique were associated with significantly lower radiation dose compared with FBP technique (P < 0.0001). There was also significantly less objective image noise with ASIR (6.9 +/- 2.2) than with FBP (9.5 +/- 2.0) (P < 0.0001). For the subjective analysis, all ASIR and FBP reconstructed abdominal CTs had optimal or less noise. However, 9% of FBP and 3.8% of ASIR reconstructed CT examinations were diagnostically unacceptable because of the presence of artifacts. Use of ASIR reconstruction kernel results in a blotchy pixilated appearance in 39% of CT sans which however, was mild and did not affect the diagnostic acceptability of images. The critical reproduction of visually sharp anatomic structures was preserved in all but one ASIR 40% reconstructed CT examination.
ASIR technique allows radiation dose reduction for abdominal CT examinations whereas improving image noise compared with the FBP technique.
Investigative radiology 02/2010; 45(4):202-10. · 4.85 Impact Factor
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ABSTRACT: To assess radiation dose reduction and image quality for weight-based chest computed tomographic (CT) examination results reconstructed using adaptive statistical iterative reconstruction (ASIR) technique.
With local ethical committee approval, weight-adjusted chest CT examinations were performed using ASIR in 98 patients and filtered backprojection (FBP) in 54 weight-matched patients on a 64-slice multidetector CT. Patients were categorized into 3 groups: 60 kg or less (n = 32), 61 to 90 kg (n = 77), and 91 kg or more (n = 43) for weight-based adjustment of noise indices for automatic exposure control (Auto mA; GE Healthcare, Waukesha, Wis). Remaining scan parameters were held constant at 0.984:1 pitch, 120 kilovolts (peak), 40-mm table feed per rotation, and 2.5-mm section thickness. Patients' weight, scanning parameters, and CT dose index volume were recorded. Effective doses (EDs) were estimated. Image noise was measured in the descending thoracic aorta at the level of the carina. Data were analyzed using analysis of variance.
Compared with FBP, ASIR was associated with an overall mean (SD) decrease of 27.6% in ED (ASIR, 8.8 [2.3] mSv; FBP, 12.2 [2.1] mSv; P < 0.0001). With the use of ASIR, the ED values were 6.5 (1.8) mSv (28.8% decrease), 7.3 (1.6) mSv (27.3% decrease), and 12.8 (2.3) mSv (26.8% decrease) for the weight groups of 60 kg or less, 61 to 90 kg, and 91 kg or more, respectively, compared with 9.2 (2.3) mSv, 10.0 (2.0) mSv, and 17.4 (2.1) mSv with FBP (P < 0.0001). Despite dose reduction, there was less noise with ASIR (12.6 [2.9] mSv) than with FBP (16.6 [6.2] mSv; P < 0.0001).
Adaptive statistical iterative reconstruction helps reduce chest CT radiation dose and improve image quality compared with the conventionally used FBP image reconstruction.
Journal of computer assisted tomography 01/2010; 34(1):40-5. · 1.38 Impact Factor
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ABSTRACT: The purpose of this study was to assess the role of PET/CT in the diagnosis of pulmonary lymphangitic carcinomatosis.
Integrated PET/CT images of 35 patients (15 men, 20 women; mean age, 64.5 years) with pulmonary lymphangitic carcinomatosis confirmed at follow-up chest CT or histopathologic examination were analyzed retrospectively. Standardized uptake value based on body weight and the initial injected activity was measured in the affected lung, the normal lung, and the mediastinal blood pool. Two radiologists independently assessed abnormal PET activity in the lungs. Both radiologists reviewed the CT images to determine the presence, size, location, and extent of pulmonary lymphangitic carcinomatosis. The data were analyzed to determine the sensitivity and specificity of PET for pulmonary lymphangitic carcinomatosis.
Among the 35 patients with pulmonary lymphangitic carcinomatosis, 17 (49%), 13 (37%), and five (14%) patients had diffuse, focal, and bilateral pulmonary lymphangitic carcinomatosis, respectively. Thirty of the 35 patients had nodular septal thickening as the chief CT finding of pulmonary lymphangitic carcinomatosis. Subjective assessment showed a visually identifiable increase in uptake in the region of pulmonary lymphangitic carcinomatosis in 30 of the 35 patients (86%). Four of the other five patients had focal pulmonary lymphangitic carcinomatosis, and one patient had diffuse pulmonary lymphangitic carcinomatosis of the right lung. The specificity of PET/CT for pulmonary lymphangitic carcinomatosis was 100%, and the sensitivity was 86%. The mean standardized uptake value in the region of pulmonary lymphangitic carcinomatosis (1.37+/-0.64) was significantly greater than that in normal lung (0.51+/-0.29) (p<0.0001). The standardized uptake ratio of mediastinal blood pool to lymphangitic lung was 1.26+/-0.45, and that of blood pool to normal lung was 3.78+/-1.37.
FDG PET/CT has high specificity in the detection of pulmonary lymphangitic carcinomatosis. Focal pulmonary lymphangitic carcinomatosis close to a primary malignant tumor, however, can be missed at PET.
American Journal of Roentgenology 01/2010; 194(1):231-6. · 2.78 Impact Factor
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ABSTRACT: Abstract
Purpose: To assess radiation dose reduction and image quality for weight based chest CT examinations reconstructed with adaptive statistical iterative reconstruction (ASIR) technique.
Materials and Methods: With local ethical committee approval, weight adjusted chest CT examinations were performed in 98 patients with ASIR and in 54 weight-matched patients with filtered back projection (FBP) on a 64-slice MDCT. Patients were categorized into three groups of <60 kg (n=32), 61-90 kg (n= 77), and >91 kg (n= 43) for weight based adjustment of automatic exposure control technique. Remaining scan parameters were held constant at 0.984:1 pitch, 120 kVp, 40 mm table feed per rotation, 2.5 mm section thickness. Patients’ weight, scanning parameters, CT dose index volume- CTDI vol, and dose length product - DLP were recorded. Image noise was measured in the descending thoracic aorta at the level of the carina. Data were analyzed using analysis of variance (ANOVA).
Results: Compared to FBP, ASIR was associated with an overall average decrease of 27.9% in CTDI vol (ASIR, 14.3± 2.9 mGy; FBP, 19.8±3.2 mGy) (p<0.0001). Despite dose reduction, there was less noise with ASIR (12.6 ± 2.9) than with FBP (16.6 ± 6.2) (p<0.0001).With the use of ASIR, the CTDIvol values were 10.6±2.9 (32.5% decrease), 11.8±2.6 (25.8% decrease) and 20.5±3.3 (26.5 % decrease) mGy, for <60, 61-90 and >91 kg weight groups, respectively, compared to 15.7 ± 3.8, 15.9 ± 3.1, and 27.9 ± 2.7 mGy with FBP (p<0.0001).
Conclusion: ASIR helps reduce chest CT radiation dose and improve image quality compared to the conventionally used FBP image reconstruction.
JCAT. 08/2009;
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ABSTRACT: Abstract
Purpose: Automatic exposure control (AEC) techniques automatically modulate tube current based on patient size and regional body anatomy. The purpose of our study was to assess if weight based adjustment of AEC is necessary for reducing radiation dose associated with chest CT scanning.
Materials and Methods: With local ethical committee approval, 66 patients were scanned using weight adjusted AEC and 55 weight matched patients were scanned with constant AEC on a 64-slice MDCT with remaining parameters held constant at 0.984:1 pitch, 0.5 second rotation time, 40 mm table feed per rotation, 2.5 mm section thickness at 2.5 mm interslice gap, and 64*0.625mm detector configuration. Patients were categorized into three weight categories, namely, less than 60 kg (n=23), 61-90 kg (n= 49), and greater than 91 kg (n= 49) categories. Patients’ weight, scanning parameters, CT dose index volume- CTDI vol, and dose length product - DLP were recorded for all studies. Image noise was measured in the descending thoracic aorta at the level of the carina. Data were analyzed using Student’s t test.
Results: Compared to the constant AEC, the weight adjusted AEC technique resulted in an average decrease of 30% in CTDI vol and 27% in DLP (p<0.0001). With weight based adjustment AEC CTDI vol decreased to 13.1, 15.9 and 27.3 mGy for <60, 61-90 and >91 kg weight groups, respectively, compared to corresponding doses of 20.3, 27.5 and 32.8 mGy with constant AEC. There was no significant difference in objective image noise between chest CT acquired with constant (15.0±3) and weight adjusted (16.3±5.5) AEC technique (p>0.05).
Conclusion: AEC technique should be tailored according to the patient weight. Without weight based adjustment of AEC techniques, small patients (<60 kg) receive 35% higher dose and average size patients (61-90 kg) are exposed to 42% higher radiation dose from chest CT scanning.
ARRS 09, Boston; 04/2009
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ABSTRACT: To determine the effects of arm position on the appearance of structures in the upper chest as seen on computed tomography (CT), such as clavicular angle, course of axillary vessels, pectoralis major muscle, and bicipital groove.
The study consisted of 52 chest CT examinations (32 from men and 20 from women; mean [SD] age, 64 [20] years) performed with 1 or both arms at or above the shoulder (n = 44 arms) or by the side of the body (n = 60 arms). Three chest radiologists assessed randomized CT examinations for specific anatomical structures including orientation of the bicipital groove of the humerus, appearance of the pectoralis major muscle, and the course of the axillary vessels. Orientation of the clavicle and the scapula were assessed by measuring their angles with the mid-sagittal plane. Data were analyzed using the Student t test.
There was a significant difference in the mean angle of the clavicles with the mid-sagittal plane in arms at or above the shoulder level (41.3 +/- 11.7 degrees) compared with arms-by-side position (54.8 +/- 14.7 degrees; P < 0.0001), but no significant difference was found in scapular angles (P = 0.4). All 3 radiologists found anteriorly directed bicipital groove, flat pectoralis major, and straight course of the axillary vessels from the chest to the axilla when arms were by the side. With arms at or above the level of the shoulder, however, the bicipital groove was directed posteromedially, the pectoralis major was buckled, and the axillary vessels had an angulated course.
The bicipital groove, the pectoralis muscles, the axillary vessels, or the angle of the clavicle with the mid-sagittal plane on transverse CT images can help predict the position of the arms in patients undergoing chest CT.
Journal of computer assisted tomography 34(2):285-9. · 1.38 Impact Factor
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ABSTRACT: To assess the effects of radiation dose reduction in the chest CT using a weight-based adjustment of the automatic exposure control (AEC) technique.
With Institutional Review Board Approval, 60 patients (mean age, 59.1 years; M:F = 35:25) and 57 weight-matched patients (mean age, 52.3 years, M:F = 25:32) were scanned using a weight-adjusted AEC and non-weight-adjusted AEC, respectively on a 64-slice multidetector CT with a 0.984:1 pitch, 0.5 second rotation time, 40 mm table feed/rotation, and 2.5 mm section thickness. Patients were categorized into 3 weight categories; < 60 kg (n = 17), 60-90 kg (n = 52), and > 90 kg (n = 48). Patient weights, scanning parameters, CT dose index volumes (CTDIvol) and dose length product (DLP) were recorded, while effective dose (ED) was estimated. Image noise was measured in the descending thoracic aorta. Data were analyzed using a standard statistical package (SAS/STAT) (Version 9.1, SAS institute Inc, Cary, NC).
Compared to the non-weight-adjusted AEC, the weight-adjusted AEC technique resulted in an average decrease of 29% in CTDIvol and a 27% effective dose reduction (p < 0.0001). With weight-adjusted AEC, the CTDIvol decreased to 15.8, 15.9, and 27.3 mGy for the < 60, 60-90 and > 91 kg weight groups, respectively, compared to 20.3, 27.9 and 32.8 mGy, with non-weight-adjusted AEC. No significant difference was observed for objective image noise between the chest CT acquired with the non-weight-adjusted (15.0 +/- 3.1) and weight-adjusted (16.1 +/- 5.6) AEC techniques (p > 0.05).
The results of this study suggest that AEC should be tailored according to patient weight. Without weight-based adjustment of AEC, patients are exposed to a 17 - 43% higher radiation-dose from a chest CT.
Korean journal of radiology: official journal of the Korean Radiological Society 11(1):46-53. · 1.32 Impact Factor
