Female breast radiation exposure during CT pulmonary angiography.

OBJECTIVE: The objective of our study was to estimate the effective radiation dose to the female breast during CT pulmonary angiography compared with other routine diagnostic imaging techniques. MATERIALS AND METHODS: We retrospectively reviewed the demographic data of patients who underwent CT pulmonary angiography between May 2000 and December 2002, the diagnostic yield of those studies, and the estimated effective radiation dose to the breast incurred during CT. The estimated effective radiation dose was calculated using the ImPACT CT (Impact Performance Assessment of CT) dosimetry calculator and the CT dose index (CTDI) and was compared with the average glandular dose for two-view screening mammography. RESULTS: During the study period, 1,325 CT pulmonary angiograms were obtained. Sixty percent (797) of the scans were obtained on female patients. The mean age of scanned females was 52.5 years (range, 15-93 years). Of the studies performed in females, 401 (50.31%) were negative, 151 (18.95%) were nondiagnostic, and 245 (30.74%) were positive for pulmonary thromboembolism. The calculated effective minimum dose to the breast of an average 60-kg woman during CT was 2.0 rad (20 mGy) per breast compared with an average glandular dose of 0.300 rad (3 mGy) for standard two-view screening mammography. CONCLUSION: CT pulmonary angiography delivers a minimum radiation dose of 2.0 rad (20 mGy) to the breasts of an average-sized woman. This greatly exceeds the American College of Radiology recommendation of < or = 0.300 rad (3 mGy) or less for standard two-view mammography. The potential latent carcinogenic effects of such radiation exposure at this time remain unknown. We encourage the judicious use of CT pulmonary angiography and lower doses and nonionizing radiation alternatives when appropriate.

The clinical significance of lung hypoexpansion in acute childhood asthma.

BACKGROUND: Many children experiencing acute asthmatic episodes have chest radiographs, which may show lung hyperinflation, hypoinflation, or normal inflation. Lung hypoinflation may be a sign of respiratory fatigue and poor prognosis. OBJECTIVE: To compare the clinical course in children with asthma according to the degree of lung inflation on chest radiographs. PATIENTS AND METHODS: We conducted a retrospective study during a 24-month period (from July 1999 to July 2001) of children aged 0-17 years, who presented to a pediatric emergency department or outpatient clinic with an asthma exacerbation. Chest radiographs obtained at presentation were reviewed independently by three pediatric radiologists who were blinded to the admission status of the patient. The correlation between hypoinflation and hospital admission was assessed in three age groups: 0-2 years, 3-5 years, and 6-17 years. RESULTS. Hypoinflation on chest radiographs was significantly correlated with hospital admission for children aged 6-17 years (odds ratio 16.00, 95% confidence interval 1.89-135.43). The inter-reader agreement for interpretation of these radiographs was strong, with a kappa score of 0.76. Hypoinflation was not correlated with admission in younger children. CONCLUSION: Lung hypoinflation is associated with a greater likelihood of hospital admission in children aged 6 years or older. Therefore, hypoinflation was a poor prognostic sign and may warrant more aggressive therapy.