"All-in-one" window/level whole-body computed tomography scan - A faster way to evaluate trauma cases.

PURPOSE: To investigate the accuracy and total assessment time (TAT) of the "All-in-one" (AIO)-window/level setting for whole-body computed tomography (CT) image compared to multiple tissue-specific window/level settings conventionally used for detection of traumatic injuries. METHOD: Contrast-enhanced chest, abdomen, and pelvic CT scans of 50 patients who presented to our emergency department (ED) for major trauma were retrospectively selected. In a simulation of a "wet read" performed at the CT scanner console, 6 readers with different levels of experience had up to 3 min to describe any traumatic finding identified on the CTs. The readers reviewed each patient in two different sessions separated by a washout period to suppress any recall bias from one session to the next. Each scan was reviewed once using the AIO-window/level setting and another time using the conventional bone, lung, and soft tissue window/level display settings, in a randomized order. The CT reports were used as reference standard. RESULTS: Overall, there was no statistically significant difference in the assessment accuracy of the review based on the AIO or the conventional window/level settings (0.89 ± 0.09 vs 0.90 ± 0.08). Using the AIO-window/level settings, TAT was 14.3 s faster when compared with the conventional window/level settings (2.33 ± 0.63 vs 2.57 ± 0.51 min; p < 0.001). CONCLUSIONS: In a time-delimited image review, similar diagnostic accuracy was reached faster using the AIO vs the conventional window/level settings. When providing a "wet read" at the CT console, the ability to identify traumatic injury using a single AIO-window/level may help expedite patient management.

Comparison of detection of trauma-related injuries using combined "all-in-one" fused images and conventionally reconstructed images in acute trauma CT.

OBJECTIVES: To compare the accuracy of lesion detection of trauma-related injuries using combined "all-in-one" fused (AIO) and conventionally reconstructed images (CR) in acute trauma CT. METHODS: In this retrospective study, trauma CT of 66 patients (median age 47 years, range 18-96 years; 20 female (30.3%)) were read using AIO and CR. Images were independently reviewed by 4 blinded radiologists (two residents and two consultants) for trauma-related injuries in 22 regions. Sub-analyses were performed to analyze the influence of experience (residents vs. consultants) and body region (chest, abdomen, skeletal structures) on lesion detection. Paired t-test was used to compare the accuracy of lesion detection. The effect size was calculated (Cohen's d). Linear mixed-effects model with patients as the fixed effect and random forest models were used to investigate the effect of experience, reconstruction/image processing, and body region on lesion detection. RESULTS: Reading time of residents was significantly faster using AIO (AIO: 266 ± 72 s, CR: 318 ± 113 s; p < 0.001; d = 0.46) while no significant difference was observed in the accuracy of lesion detection (AIO: 93.5 ± 6.0%, CR: 94.6 ± 6.0% p = 0.092; d = - 0.21). Reading time of consultants showed no significant difference (AIO: 283 ± 82 s, CR: 274 ± 95 s; p = 0.067; d = 0.16). Accuracy was significantly higher using CR; however, the difference and effect size were very small (AIO 95.1 ± 4.9%, CR: 97.3 ± 3.7%, p = 0.002; d = - 0.39). The linear mixed-effects model showed only minor effect of image processing/reconstruction for lesion detection. CONCLUSIONS: Residents at the emergency department might benefit from faster reading time without sacrificing lesion detection rate using AIO for trauma CT. KEY POINTS: • Image fusion techniques decrease the reading time of acute trauma CT without sacrificing diagnostic accuracy.

Lesion measurement on a combined "all-in-one" window for chest CT: effect on intra- and interobserver variability.

PURPOSE: A newly developed image processing technique fuses conventional windows into a single 'All-In-One' (AIO) window. This study aims to evaluate variability of CT measurement of lesions in thoracic oncology patients on this novel AIO-window. METHODS: Six radiologists with different levels of expertise measured 368 lesions of various size, origin and sharpness. All lesions were measured twice on the AIO-window and twice on the conventional window settings. Intraclass correlation coefficients and Bland-Altman plots were used to assess intra- and interobserver variability. RESULTS: Overall intra-observer agreement for lesion diameters on the AIO-window and conventional window settings was 0.986 (95% Confidence interval (CI): 0.983-0.989) and 0.991 (95% CI 0.989-0.993) respectively. For interobserver agreement this was 0.982 (95% CI 0.979-0.985) (AIO) and 0.979 (95% CI 0.957-0.982) (conventional). For both the AIO and conventional windows, intra- and interobserver agreement were dependent on size, sharpness and reader experience. Measurement variability decreased with increasing lesion size. Regarding sharpness, inter- and intra-observer agreement ranged from 0.986-0.989 (AIO) and 0.985-0.992 (conventional) for well-defined lesions and from 0.978-0.983 (AIO) and 0.974-0.991 (conventional) for ill-defined lesions. CONCLUSIONS: Lesion diameters were consistently smaller on the AIO-window compared to conventional window settings. Overall intra- and interobserver variability rates were similar for the AIO-window and conventional window settings. We conclude that the AIO-window offers a reliable and reproducible alternative for measurement of thoracic lesions.

Improved visualization of peripherally inserted central catheters on chest radiographs of neonates using fractional multiscale image processing.

BACKGROUND: Peripherally inserted central catheters (PICCs) provide secure intravenous access for the delivery of life-sustaining medications and nutrition. They are commonly used in pediatrics. Confirmation of correct central catheter tip position is crucial. Verification is usually done by a radiograph. The aim of this study is to evaluate the ability of Fractional Multiscale image Processing (FMP) to detect PICC tips on the digital chest radiographs of neonates. METHODS: A total of 94 radiographs of 47 patients were included in the study. 29 patients were male, 18 were female. The mean age of all examined children was 9.2 days (range 0-99 days). In total, six readers (two radiologists, two residents in radiology, one last year medical student, one neonatologist) evaluated 94 unprocessed and catheter-enhanced radiographs using a 5-point Likert scale (1 = poor catheter tip visualization, 5 = excellent catheter tip visualization). Additionally, the two radiologists evaluated the diagnostic confidence for chest pathologies using a 5-point Likert scale (1 = poor diagnostic confidence, 5 = excellent diagnostic confidence). Radiographs were evaluated on a dedicated workstation. RESULTS: In all cases, the catheter-enhanced radiograph rated higher than (n = 471), or equal (n = 93) to, the unprocessed radiograph when visualizing catheter tips. 87% of the catheter-enhanced radiographs obtained a rating of 4 or higher, while only 42% of unprocessed radiographs received 4 or more points. Regarding diagnostic confidence for chest pathologies one radiologist rated two catheter-enhanced radiographs higher than the unprocessed radiographs, while all other 186 evaluations rated the catheter-enhanced radiographs equal to (n = 78) or lower than (n = 108) the unprocessed radiographs. Only 60% of the catheter-enhanced radiographs yielded a diagnostic confidence of 4 or higher, while 90% of the unprocessed images received 4 or more points. CONCLUSION: Catheter-enhanced digital chest radiographs demonstrate improved visualization of low contrast PICC tips in neonates compared to unprocessed radiographs. Furthermore, they enable detection of accompanying chest pathologies. However, definitive diagnosis of chest pathologies should be made on unprocessed radiographs.