Retrospective analysis of dose delivered to the uterus during CT examination in pregnant women.

PURPOSE: The purpose of this study was to analyze the dose to the uterus (UD) calculated for pregnant women per computed tomography (CT) acquisition and per CT examination in our Institution. MATERIALS AND METHODS: Consecutive pregnant women who underwent CT examination from June 2014 to February 2022 and for whom UD calculation was performed by a medical physicist were retrospectively included. UDs were computed per CT acquisition using the CT Expo 2.4 software and were summed up to obtain the total UD per CT examination. The CTDIvol and dose-length product (DLP) values were retrieved from the dose report and compared with those calculated by the software. RESULTS: A total of 256 pregnant women with a mean age of 29.4 ± 5.5 (SD) years (range: 18-48) at 24.5 ± 10.4 (SD) weeks of amenorrhea (range: 1-40) were included. UDs were computed for 339 CT acquisitions. The CTDIvol and DLP computed by the software were significantly greater than those retrieved from the dose reports (P < 0.05). The greatest UDs were reported for the abdomen-pelvis (10.93 ± 5.74 [SD] mGy; range: 1.2-24.1), chest-abdomen-pelvis (9.79 ± 7.09 [SD] mGy; range: 3.9-22.1), pelvis (18.50 ± 17.96 [SD] mGy; range: 5.8-31.2) and lumbar spine (10.24 ± 11.38 [SD] mGy; range: 2.3-29.6) CT examinations. The total UDs per CT examination were > 20 mGy for 10 pregnant women and the maximum total UD was 52.3 mGy. CONCLUSION: Greatest UDs during CT examinations are observed when the pelvis is directly exposed to X-rays. With current dose levels and in optimized practices, UDs per CT acquisition and CT examination are always below 100 mGy. UD calculations cannot be performed for CT examinations that do not directly expose the pelvis (i.e., those < 1 mGy).

Pulmonary alveolar proteinosis in children on La Réunion Island: a new inherited disorder?

BACKGROUND: Pulmonary alveolar proteinosis (PAP) is very rare in children. Only a few small series have been published, with little information about long-term progression. The objective of our study was to describe the clinical, radiological and pathological features, and the long-term course of PAP in a cohort of 34 children from La Réunion Island. METHODS: Data were retrospectively collected from medical files. Radiological and pathological elements were reviewed by two pediatric radiologists and three pathologists, respectively. RESULTS: Thirteen cases were familial and 32/34 (94%) cases were family connected. Disease onset occurred in the first six months of life in 82% of the patients. Thoracic computed tomography scans showed the typical "crazy-paving" pattern in 94% of cases. Respiratory disease was associated with a liver disorder, with the detection of liver enlargement at diagnosis in 56% of cases. The course of the disease was characterized by frequent progression to chronic respiratory insufficiency, accompanied by the appearance of cholesterol granulomas and pulmonary fibrosis. Overall prognosis was poor, with a mortality of 59% and an overall five-year survival rate from birth of 64%. Whole-lung lavages were performed in 21 patients, with no significant effect on survival. Liver disease progressed to cirrhosis in 18% of children, with no severe complication. CONCLUSIONS: PAP in children from la Réunion Island is characterized by an early onset, associated liver involvement, poor prognosis and frequent progression to lung fibrosis, despite whole-lung lavages treatment. The geographic clustering of patients and the detection of many familial links between most of the cases strongly suggest a genetic etiology, with an autosomal recessive mode of inheritance.