Evaluation and Treatment of the Child with Acute Back Pain.

Back pain is common, in up to 30% of children, increasing with age. Eighty percent is benign, mechanical type, improving within 2 weeks of conservative care. Required for those not improving is in-depth evaluation, including MRI, laboratory, and peer consultations. Spondylolysis and spondylolisthesis comprise almost 10% of pediatric back pain, often caused by lumbar hyperextension activities and treated conservatively in most cases. Osteoid osteomas and osteoblastomas constitute the most common benign spinal tumors in childhood. Aggressive and malignant tumors of the spine are rare but when present require tertiary care referral and a comprehensive oncology team for optimal life-sustaining outcomes.

Performance on the American Board of Physical Medicine and Rehabilitation certifying examinations: Rural and urban physicians.

BACKGROUND: Over 60 million people in the United States live in a rural community making up approximately 20% of the population. Data are minimal about the physiatrists who serve this rural population, their performance on certification examinations and how the American Board of Physical Medicine and Rehabilitation (ABPM&R) serves their ongoing educational, assessment, and practice needs. OBJECTIVE: To compare the performance of rural and urban physicians on the Part I, Part II, and maintenance of certification (MOC) examinations along with subspecialty preference and continuance of primary certification. DESIGN: Retrospective cross-sectional study. SETTING: Board-eligible PM&R physicians and certified diplomates of the ABPM&R. PARTICIPANTS: Physicians who participated in an initial certification or maintenance of certification examination with the ABPM&R between 2010 and 2019. METHODS: Comparisons of physician pass rates, mean scaled scores (aggregates), and program pass rates on ABPM&R certifying examinations were completed. Cross-reference to national database and ABPM&R practice site zip codes provided sociogeographic linkage. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Physician mean scaled scores, pass rates, subspecialty preferences, and primary certification status. RESULTS: There were no meaningful differences in performance on the ABPM&R Part I, II, and MOC examinations between rural and urban physiatrists. Most common subspecialty is the pain medicine certification whose diplomates most frequently drop their primary certification. Pediatric rehabilitation medicine certification is rare in rural localities and a health care disparity. CONCLUSION: The study found no meaningful differences in the performance of rural and urban physicians on the ABPM&R certifying examinations.

Health Parameters in Standing and Nonstanding Nonambulatory Adults With Cerebral Palsy.

OBJECTIVE: To assess effects of standing exercise on adults with cerebral palsy with a focus on bone density, transfer skills, quality of life, and related health parameters. DESIGN: Prospective case series; pilot study. SETTING: Outpatient multispecialty clinic. PARTICIPANTS: Nonambulatory adults with cerebral palsy, 13 standers and 7 nonstanders, comparable in age, sex, and other physical characteristics (N=20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Bone mineral density per dual energy x-ray absorptiometry, stand pivot transfers, comprehensive blood serum assessments, fractures, spasms, perceived pain, and quality of life. RESULTS: No appreciable differences could be detected between the standing and nonstanding groups from baseline and over a 2-year subsequent study with respect to bone density, range of motion, comprehensive chemistry, hematologic blood serum levels, fractures, spasms, perceived pain, continence of bowel and bladder, seizures, orthotics, and orthopedic surgery. All individuals reported positive life effects of standing with only 1 negative effect reported: increased fatigue at the end of the day. Midline independent head control >30 seconds was identified only in the standing group. Functional stand pivot transfers were seen only in individuals with a history of standing. CONCLUSIONS: The pilot data indicate no appreciable difference in measured outcome variables of a static nature between nonambulatory adults with cerebral palsy who stand compared with those who do not. We identified occurrences of improved head control and functional stand pivot transfers only in those with a history of standing. The value of a functional pivot transfer over the lifetime is difficult to overestimate. Encouragement is given toward future studies with a focus more toward functional outcome variables.

A comparison of embalming fluids on the structures and properties of tissue in human cadavers.

Cadaveric material has long been used to teach anatomy and more recently to train students in clinical skills. The aim of this study was to develop a systematic approach to compare the impact of four embalming solutions on the tissues of human cadavers. To this end, a formalin-based solution, Thiel, Genelyn and Imperial College London soft-preservation (ICL-SP) solution were compared. The effect of these chemicals on the properties of the tissue was assessed by measuring the range of motion (ROM) of joints and measuring the dimensions of different structures on computed tomography (CT) images before and after embalming. The mean changes in the ratio (angle to ROM) differed statistically between embalming methods (Welch Statistic 3,1.672  = 67.213, p = 0.026). Thiel embalmed cadavers showed an increase in range of motion while ICL-SP cadavers remained relatively the same. Genelyn and formalin embalmed cadavers registered a notable decrease in range of motion. Furthermore, investigation into the impact of the embalming chemicals on the dimensions of internal organs and vessels revealed that Thiel embalming technique leads to a decrease in the dimension of the cardiovascular system alone while formalin-based solutions maintain the shape of the organs and vessels investigated. Our findings suggest that the joints of cadavers' embalmed using ICL-SP technique may faithfully mimic that of unembalmed cadavers and that formalin is necessary to retain shape and size of the organs and vessels investigated in this study. Despite this, a study with larger numbers of cadavers is required to confirm these findings.

Body composition determinants of radiation dose during abdominopelvic CT.

OBJECTIVES: We designed a prospective study to investigate the in-vivo relationship between abdominal body composition and radiation exposure to determine the strongest body composition predictor of dose length product (DLP) at CT. METHODS: Following institutional review board approval, quantitative analysis was performed prospectively on 239 consecutive patients who underwent abdominopelvic CT. DLP, BMI, volumes of abdominal adipose tissue, muscle, bone and solid organs were recorded. RESULTS: All measured body composition parameters correlated positively with DLP. Linear regression (R2 = 0.77) revealed that total adipose volume was the strongest predictor of radiation exposure [B (95% CI) = 0.027(0.024-0.030), t=23.068, p < 0.001]. Stepwise linear regression using DLP as the dependent and BMI and total adipose tissue as independent variables demonstrated that total adipose tissue is more predictive of DLP than BMI [B (95% CI) = 16.045 (11.337-20.752), t=6.681, p < 0.001]. CONCLUSIONS: The volume of adipose tissue was the strongest predictor of radiation exposure in our cohort. MAIN MESSAGE: • Individual body composition variables correlate with DLP at abdominopelvic CT. • Total abdominal adipose tissue is the strongest predictor of radiation exposure. • Muscle volume is also a significant but weaker predictor of DLP.

An Assessment of the Quality of CT Radiation Dose Information on the Internet.

OBJECTIVES: Our goal was to ascertain the quality of health information related to CT radiation exposure using a simulated Internet search and from incident information that may be available during day-to-day Internet usage. METHODS: We entered 14 terms relating to information on CT dose into the most commonly used Internet search engine and analyzed the first 100 web page results for each. A Rich Search Site (RSS) feed search was also used to evaluate incidental information over a 12-week period in 2014. Each web page was classified as being "completely accurate," "somewhat accurate," or "inaccurate." RESULTS: Of 1,400 web pages, 290 were relevant and accessible. We deemed 12.8% of these pages as inaccurate and 67.2% of pages as completely accurate. The highest proportion of web pages was from media sources, which, along with discussion forums, commercial websites, and blogs, were found to have proportionally the largest amount of inaccurate information. Of 1,943 posts, 136 (7.0%) identified by the RSS were relevant, 9.6% were deemed inaccurate, and only 29.9% were deemed completely accurate. The results of our simulated query highlight the importance of public education regarding Internet usage when researching topics relating to radiation exposure associated with CT.

Performance of Pediatric Rehabilitation Medicine Candidates on the Subspecialty Board Certification Examination from 2003 to 2015.

BACKGROUND: Pediatric rehabilitation medicine (PRM) physicians enter the field via several pathways. It is unknown whether different training pathways impact performance on the American Board of Physical Medicine and Rehabilitation (ABPMR) PRM Examination and Maintenance of Certification (MOC) Examination. OBJECTIVES: To describe the examination performance of candidates on the ABPMR PRM Examination according to their type of training (physiatrists with a clinical PRM focus, accredited or unaccredited fellowship training, separate pediatric and physical medicine and rehabilitation residencies, or combined pediatrics/physical medicine and rehabilitation residencies) and to compare candidates' performance on the PRM Examination with their initial ABPMR certification and MOC Examinations. DESIGN: A retrospective cohort study. SETTING: American Board of Physical Medicine and Rehabilitation office. PARTICIPANTS: A total of 250 candidates taking the PRM subspecialty certification examination from 2003 to 2015. METHODS: Scaled scores on the PRM Examination were compared to the examinees' initial certification scores as well as their admissibility criteria. Pass rates and scaled scores also were compared for those taking their initial PRM certification versus MOC. MAIN OUTCOME MEASUREMENTS: Board pass rates and mean scaled scores for initial PRM Examination and MOC. RESULTS: The 250 physiatrists who took the subspecialty PRM Examination had an overall first-time pass rate of 89%. There was no significant difference between first-time PRM pass rates or mean scaled scores for individuals who completed an Accreditation Council for Graduate Medical Education-accredited fellowship versus those who did not. First time PRM pass rates were greatest among those who were also certified by the American Board of Pediatrics (100%). Performance on Parts I and II of the initial ABPMR Certification Examination significantly predicted PRM Examination scores. There was no difference in mean scaled scores for initial PRM certification versus taking the PRM Examination for MOC. CONCLUSIONS: Several pathways to admissibility to the PRM Examination afforded similar opportunity for diplomates to gain the knowledge necessary to pass the PRM Examination. Once certified, physicians taking the PRM Examination for MOC have a high success rate of passing again in years 7-10 of their certification cycle. LEVEL OF EVIDENCE: III.

C-reactive protein and radiographic findings of lower respiratory tract infection in infants.

AIM: To evaluate the association between C-reactive protein (CRP) and radiological evidence of lower respiratory tract infection (LRTI) in infants. METHODS: All patients aged less than 4 years who presented with suspected lower respiratory tract infection, who received a peri-presentation chest radiograph and CRP blood measurement over an 18-mo period were included in the study. Age, gender, source of referral, CRP, white cell count, neutrophil count along with the patients' symptoms and radiologist's report were recorded. RESULTS: Three hundred and eleven patients met the inclusion criteria. Abnormal chest radiographs were more common in patients with elevated CRP levels (P < 0.01). Radiologic signs of LRTI were identified in 73.7% of chest radiographs when a patient had a CRP level between 50-99 mg/L. CRP levels were a better predictor of positive chest radiograph findings for those aged greater than I year compared to those 1 year or less. CONCLUSION: CRP may be used in patients with suspected LRTI diagnosis to select those who are likely to have positive findings on chest radiograph, thus reducing unnecessary chest radiographs.

Accurate tissue characterization in low-dose CT imaging with pure iterative reconstruction.

INTRODUCTION: We assess the ability of low-dose hybrid iterative reconstruction (IR) and 'pure' model-based IR (MBIR) images to maintain accurate Hounsfield unit (HU)-determined tissue characterization. METHODS: Standard-protocol (SP) and low-dose modified-protocol (MP) CTs were contemporaneously acquired in 34 Crohn's disease patients referred for CT. SP image reconstruction was via the manufacturer's recommendations (60% FBP, filtered back projection; 40% ASiR, Adaptive Statistical iterative Reconstruction; SP-ASiR40). MP data sets underwent four reconstructions (100% FBP; 40% ASiR; 70% ASiR; MBIR). Three observers measured tissue volumes using HU thresholds for fat, soft tissue and bone/contrast on each data set. Analysis was via SPSS. RESULTS: Inter-observer agreement was strong for 1530 datapoints (rs > 0.9). MP-MBIR tissue volume measurement was superior to other MP reconstructions and closely correlated with the reference SP-ASiR40 images for all tissue types. MP-MBIR superiority was most marked for fat volume calculation - close SP-ASiR40 and MP-MBIR Bland-Altman plot correlation was seen with the lowest average difference (336 cm3 ) when compared with other MP reconstructions. CONCLUSIONS: Hounsfield unit-determined tissue volume calculations from MP-MBIR images resulted in values comparable to SP-ASiR40 calculations and values that are superior to MP-ASiR images. Accuracy of estimation of volume of tissues (e.g. fat) using segmentation software on low-dose CT images appears optimal when reconstructed with pure IR.

Effects of oral contrast on dose in abdominopelvic computed tomography with pure iterative reconstruction.

AIM: To assess the effect of neutral (NC) and positive (PC) oral contrast use on patient dose in low-dose abdominal computed tomography (CT). METHODS: Low-dose clinically indicated CTs were performed on 79 Crohn's patients (35 = PC, 1 L 2% gastrografin; 44 = NC, 1.5 L polyethylene glycol). Scanner settings for both acquisitions were identical apart from 25 s difference in intravenous contrast timing. Body mass index (BMI), scan-ranges, dose-length product and size-specific dose estimated were recorded. Data was reconstructed with pure model-based iterative reconstruction. Image quality was objectively and subjectively analysed. Data analysis was performed with Statistical Package for Social Scientists. RESULTS: Higher doses were seen in neutral contrast CTs (107.60 ± 78.7 mGy.cm, 2.47 ± 1.21 mGy vs 85.65 ± 58.2 mGy.cm, 2.18 ± 0.96 mGy). The difference was significant in 2 of 4 BMI groups and in those that had both NC and PC investigations. Image-quality assessment yielded 6952 datapoints. NC image quality was significantly superior (P < 0.001) (objective noise, objective signal to noise ratio, subjective spatial resolution, subjective contrast resolution, diagnostic acceptability) at all levels. NC bowel distension was significantly (P < 0.001) superior. CONCLUSION: The use of polyethylene glycol as a neutral OC agent leads to higher radiation doses than standard positive contrast studies, in low dose abdominal CT imaging. This is possibly related to the osmotic effect of the agent resulting in larger intraluminal fluid volumes and resultant increased overall beam attenuation.

Low-Dose Carotid Computed Tomography Angiography Using Pure Iterative Reconstruction.

UNLABELLED: The aim of this study was to assess if a low-dose carotid computed tomography angiography (CTA) performed with pure iterative reconstruction (IR) is comparable to a conventional dose CTA protocol. METHODS: Twenty patients were included. Radiation dose was divided into a low-dose acquisition reconstructed with pure IR and a conventional dose acquisition reconstructed with 40% hybrid IR. Dose, image noise, contrast resolution, spatial resolution, and carotid artery stenosis were measured. RESULTS: Mean effective dose was significantly lower for low-dose than conventional dose studies (1.84 versus 3.71 mSv; P < 0.001). Subjective image noise, contrast resolution, and spatial resolution were significantly higher for the low-dose studies. There was excellent agreement for stenosis grading accuracy between low- and conventional dose studies (Cohen κ = 0.806). CONCLUSIONS: A low-dose carotid CTA protocol reconstructed with pure IR is comparable to a conventional dose CTA protocol in terms of image quality and diagnostic accuracy while enabling a dose reduction of 49.6%.

Cumulative radiation exposure from diagnostic imaging in intensive care unit patients.

AIM: To quantify cumulative effective dose of intensive care unit (ICU) patients attributable to diagnostic imaging. METHODS: This was a prospective, interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center. Demographic and clinical data including age, gender, date of ICU admission, primary reason for ICU admission, APACHE II score, length of stay, number of days intubated, date of death or discharge, and re-admission data was collected on all patients admitted over a 1-year period. The overall radiation exposure was quantified by the cumulative effective radiation dose (CED) in millisieverts (mSv) and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board. Pediatric patients were selected for subgroup-analysis. RESULTS: A total of 2737 studies were performed in 421 patients. The total CED was 1704 mSv with a median CED of 1.5 mSv (IQR 0.04-6.6 mSv). Total CED in pediatric patients was 74.6 mSv with a median CED of 0.07 mSv (IQR 0.01-4.7 mSv). Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED. Computed tomography (CT) accounted for 16% of all studies performed and contributed 97% of total CED. Trauma patients received a statistically significant higher dose [median CED 7.7 mSv (IQR 3.5-13.8 mSv)] than medical [median CED 1.4 mSv (IQR 0.05-5.4 mSv)] and surgical [median CED 1.6 mSv (IQR 0.04-7.5 mSv)] patients. Length of stay in ICU [OR = 1.12 (95%CI: 1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mSv. CONCLUSION: Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs. CED should be minimized where feasible, especially in young patients.

Feasibility of low-dose CT with model-based iterative image reconstruction in follow-up of patients with testicular cancer.

PURPOSE: We examine the performance of pure model-based iterative reconstruction with reduced-dose CT in follow-up of patients with early-stage testicular cancer. METHODS: Sixteen patients (mean age 35.6 ± 7.4 years) with stage I or II testicular cancer underwent conventional dose (CD) and low-dose (LD) CT acquisition during CT surveillance. LD data was reconstructed with model-based iterative reconstruction (LD-MBIR). Datasets were objectively and subjectively analysed at 8 anatomical levels. Two blinded clinical reads were compared to gold-standard assessment for diagnostic accuracy. RESULTS: Mean radiation dose reduction of 67.1% was recorded. Mean dose measurements for LD-MBIR were: thorax - 66 ± 11 mGy cm (DLP), 1.0 ± 0.2 mSv (ED), 2.0 ± 0.4 mGy (SSDE); abdominopelvic - 128 ± 38 mGy cm (DLP), 1.9 ± 0.6 mSv (ED), 3.0 ± 0.6 mGy (SSDE). Objective noise and signal-to-noise ratio values were comparable between the CD and LD-MBIR images. LD-MBIR images were superior (p < 0.001) with regard to subjective noise, streak artefact, 2-plane contrast resolution, 2-plane spatial resolution and diagnostic acceptability. All patients were correctly categorised as positive, indeterminate or negative for metastatic disease by 2 readers on LD-MBIR and CD datasets. CONCLUSIONS: MBIR facilitated a 67% reduction in radiation dose whilst producing images that were comparable or superior to conventional dose studies without loss of diagnostic utility.

Imaging of Cystic Fibrosis and Pediatric Bronchiectasis.

1. CT is superior to pulmonary function tests and chest radiography for the assessment and monitoring of cystic fibrosis (CF)-related lung disease and, also, of pediatric bronchiectasis not caused by CF (hereafter referred to as non-CF bronchiectasis). 2. Low-dose CT protocols that impart radiation doses similar to those used in chest radiography are feasible for the surveillance of patients with bronchiectasis. 3. Chest radiography is still most commonly used as the first-line imaging examination of choice for the assessment of acute complications related to bronchiectasis. 4. Pulmonary MRI, with or without the use of inhaled hyperpolarized gas, can be performed to obtain functional information, and, in dedicated centers, it may yield imaging results comparable to those obtained by CT. 5. Gastrointestinal and pancreaticobiliary manifestations of CF are observed with greater frequency in adults, because of increased life expectancy.

Pure Iterative Reconstruction Improves Image Quality in Computed Tomography of the Abdomen and Pelvis Acquired at Substantially Reduced Radiation Doses in Patients With Active Crohn Disease.

UNLABELLED: We assessed diagnostic accuracy and image quality of modified protocol (MP) computed tomography (CT) of the abdomen and pelvis reconstructed using pure iterative reconstruction (IR) in patients with Crohn disease (CD). METHODS: Thirty-four consecutive patients with CD were referred with suspected extramural complications. Two contemporaneous CT datasets were acquired in all patients: standard protocol (SP) and MP. The MP and SP protocols were designed to impart radiation exposures of 10% to 20% and 80% to 90% of routine abdominopelvic CT, respectively. The MP images were reconstructed with model-based IR (MBIR) and adaptive statistical IR (ASIR). RESULTS: The MP-CT and SP-CT dose length product were 88 (58) mGy.cm (1.27 [0.87] mSv) and 303 [204] mGy.cm (4.8 [2.99] mSv), respectively (P < 0.001). Median diagnostic acceptability, spatial resolution, and contrast resolution were significantly higher and subjective noise scores were significantly lower on SP-ASIR 40 compared with all MP datasets. There was perfect clinical agreement between MP-MBIR and SP-ASIR 40 images for detection of extramural complications. CONCLUSIONS: Modified protocol CT using pure IR is feasible for assessment of active CD.

Impact of body composition parameters on clinical outcomes in patients with metastatic castrate-resistant prostate cancer treated with docetaxel.

BACKGROUND: Body composition may influence clinical outcomes of certain chemotherapeutic agents. We examined the prognostic significance of skeletal muscle mass and adipose tissue on docetaxel toxicity and overall survival in patients with metastatic castrate resistant prostate cancer (mCRPC). METHODS: A retrospective review of patients medical records with mCRPC, treated with docetaxel was conducted. Body composition parameters (skeletal muscle mass, muscle attenuation [MA], visceral and subcutaneous adipose tissue) were measured at L3 by computed tomography (CT) and defined using previously established cut points. Toxicity profile was assessed after 3 cycles of the drug and graded according to the National Cancer Institute Common Toxicity Criteria (version 4). Overall survival was analysed. RESULTS: Overall 63 patients, mean age 69 years (SD 8.3), were included. Sarcopenia was present in 47% (n = 30) and of these 26.7% (8/30) were sarcopenic obese. Common toxicities (all grades) observed included fatigue (80.9%), pain (46%), and constipation (34.9%). DLT occurred in 22 (34.9%) patients; of these 10 patients (15.8%) experienced dose reductions and 12 patients (19%) experienced dose terminations. Measurements of adiposity were not predictive of DLT, however 59.1% patients who had a combination of both sarcopenia and low MA experienced DLT compared to 29.3% of patients without sarcopenia and low MA (p = 0.021). Skeletal muscle index and MA were significantly lower in patients who experienced neutropenia (grade I-II) (46.5 cm2/m2 vs. 51.2 cm2/m2, p = 0.005) compared to their counterparts (24.6 HU vs. 32.2 HU, p = 0.044). Neither sarcopenia nor sarcopenic obesity was associated with overall survival. In multivariate analysis, BMI ≥25 kg/m2 (HR: 0.349, CI: 0.156-0.782, p = 0.010) was a significant predictor of longer overall survival and both visceral fat index ≥ median 58.7 cm2/m2 (HR: 2.266 CI: 1.066-4.814, p = 0.033) and anaemia (HR: 2.81, CI: 1.297-6.091, p = 0.009) were significant predictors of shorter overall survival. CONCLUSIONS: Sarcopenia and low MA are associated with neutropenia (grade I-II). Furthermore, presence of anaemia, high volume of visceral fat and BMI <25 kg/m2 are associated with reduced survival in patients with castrate resistant prostate cancer being treated with docetaxel chemotherapy.

Model-Based Iterative Reconstruction in CT Enterography.

OBJECTIVE: The purpose of this study was to analyze the performance of pure model-based iterative reconstruction (MBIR) in low-dose CT enterography. SUBJECTS AND METHODS: Forty-four patients with Crohn disease referred for CT enterography were included. Low-dose modified-protocol and conventional-protocol CT datasets were contemporaneously acquired. Conventional-protocol image formation was performed with 40% adaptive statistical iterative reconstruction (ASIR). Modified-protocol data were reconstructed with 100% MBIR and 40% ASIR. Image quality was assessed subjectively and objectively at six levels. Independent clinical interpretations by two fully blinded radiologists were compared with reference standard consensus reviews by two nonblinded readers who had access to clinical information, previous imaging studies, and medical records. RESULTS: A 74.7% average radiation dose reduction was seen: low-dose modified-protocol effective dose, 1.61 ± 1.18 mSv (size-specific-dose-estimate, 2.47 ± 1.21 mGy); conventional-protocol effective dose, 6.05 ± 2.84 mSv (size-specific-dose-estimate, 9.25 ± 2.9 mGy). Image quality assessment yielded 9372 data points. Objective noise on modified-protocol MBIR images was superior (p < 0.05) to that with the conventional protocol at three of six levels and comparable at the other three levels. Modified-protocol images were superior to conventional-protocol ASIR images (p < 0.05 in all cases) for subjective noise, spatial resolution, contrast resolution, streak artifact, and diagnostic acceptability on coronal reconstructions. Axial diagnostic acceptability was superior for conventional-protocol ASIR (p = 0.76). For both readers, modified-protocol MBIR clinical readings agreed more closely with reference standard readings than did conventional-protocol ASIR readings with regard to bowel wall disease assessment (κ = 0.589 and 0.700 vs 0.583 and 0.564). Overall Crohn disease activity grade (κ = 0.549 and 0.441 vs 0.315 and 0.596) and detection of acute complications (κ = 1.0 and 0.689 vs 0.896 and 0.896) were comparable when evaluated on conventional-protocol ASIR and modified-protocol MBIR images. CONCLUSION: Low-dose CT enterography with MBIR yields images that are comparable to or superior to conventional images.

Imaging of Ischemia, Obstruction and Infection in the Abdomen.

Intestinal ischemia is a serious condition that continues to be associated with mortalities in excess of 70%. Intestinal obstruction and gastrointestinal tract sepsis are common conditions, accounting for a large proportion of patients admitted to emergency departments with acute abdominal symptoms. This article discusses the imaging methods and key findings of these entities in the emergency radiology department. The article includes imaging examples, diagnostic options, protocol selections, diagnostic criteria, and differential diagnoses.