Low-Dose CT Imaging of the Pelvis in Follow-up Examinations-Significant Dose Reduction and Impact of Tin Filtration: Evaluation by Phantom Studies and First Systematic Retrospective Patient Analyses.

OBJECTIVES: Low-dose (LD) computed tomography (CT) is still rarely used in musculoskeletal (MSK) radiology. This study evaluates the potentials of LD CT for follow-up pelvic imaging with special focus on tin filtration (Sn) technology for normal and obese patients with and without metal implants. MATERIALS AND METHODS: In a phantom study, 5 different LD and normal-dose (ND) CT protocols with and without tin filtration were tested using a normal and an obese phantom. Iterative reconstruction (IR) and filtered back projection (FBP) were used for CT image reconstruction. In a subsequent retrospective patient study, ND CT images of 45 patients were compared with follow-up tin-filtered LD CT images with a 90% dose reduction. Sixty-four percent of patients contained metal implants at the follow-up examination. Computed tomography images were objectively (image noise, contrast-to-noise ratio [CNR], dose-normalized contrast-to-noise ratio [CNRD]) and subjectively, using a 6-point Likert score, evaluated. In addition, the figure of merit was calculated. For group comparisons, paired t tests, Wilcoxon signed rank test, analysis of variance, or Kruskal-Wallis tests were used, where applicable. RESULTS: The LD Sn protocol with 67% dose reduction resulted in equal values in qualitative (Likert score) and quantitative image analysis (image noise) compared with the ND protocol in the phantom study. For follow-up examinations, dose could be reduced up to 90% by using Sn LD CT scans without impairment in the clinical study. However, metal implants resulted in a mild impairment of Sn LD as well as ND CT images. Cancellous bone ( P < 0.001) was assessed worse and cortical bone ( P = 0.063) equally in Sn LD CT images compared with ND CT images. Figure of merit values were significant ( P ≤ 0.02) lower and hence better in Sn LD as in ND protocols. Obese patients benefited in particular from tin filtration in LD MSK imaging in terms of image noise and CNR ( P ≤ 0.05). CONCLUSIONS: Low-dose CT scans with tin filtration allow maximum dose reduction while maintaining high image quality for certain clinical purposes, for example, follow-up examinations, especially metal implant position, material loosening, and consolidation controls. Overweight patients benefit particularly from tin filter technology. Although metal implants decrease image quality in ND as well as in Sn LD CT images, this is not a relevant limitation for assessability.

A third component causing random variability beside environment and genotype. A reason for the limited success of a 30 year long effort to standardize laboratory animals?

This paper is a review of experiments, performed in our laboratory during the past 20 years, designed to analyse the significance of different components of random variability in quantitative traits in laboratory rats and mice. Reduction of genetic variability by using inbred strains and reduction of environmental variability by highly standardized husbandry in laboratory animals did not remarkably reduce the range of random variability in quantitative biological traits. Neither did a tremendous increase of the environmental variability (i.e., living in a natural setting) increase it. Therefore, the postnatal environment cannot be that important as the source of random variability. Utilizing methods established in twin research, only 20-30% of the range of the body weight in inbred mice were directly estimated to be of environmental origin. The remaining 70-80% were due to a third component creating biological random variability, in addition to the genetic and environmental influences. This third component is effective at or before fertilization and may originate from ooplasmic differences. It is the most important component of the phenotypic random variability, fixing its range and dominating the genetic and the environmental component. The Gaussian distribution of the body weights observed, even in inbred animals, seems to be an arrangement supporting natural selection rather than the consequence of heterogeneous environmental influences. In a group of inbred rats, the males with the highest chance of parenting the next generation were gathered in the central classes of the distribution of the body weight.