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1.
Radiol Med ; 125(3): 272-279, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31784927

RESUMO

OBJECTIVE: The purpose of this study is to investigate the role of cervical radiography in the study of patients with vertigo and dizziness. PATIENTS: This is a retrospective single-institution case series study of 493 patients suffering from vertigo and dizziness who were referred (from January 2011 to December 2012) to the hospital to study those symptoms. METHODS: We studied cervical radiographies, CT and MRI of the cervical spine made in the sample and the radiological findings. We analyzed demographic characteristics, presence of psychiatric pathology and emergency assistance due to vertigo in patients who have undergone cervical study. RESULTS: A total of 57% of patients had cervical radiography made; this was more frequent in women, Spanish people, with psychiatric pathology and who have gone to the emergency department for vertigo (p < 0.05). Degenerative changes were found in 74.1% of the patients with radiography made, more frequently at an older age, osteophytes in 49.5% and abnormal cervical lordosis in 37.1%. CONCLUSIONS: There are sociodemographic factors that influence in the request for cervical radiographs in patients with vertigo and dizziness. Given the suspicion of cervical vertigo, we do not consider that the findings in the radiographs help in the diagnosis. In our opinion, an excessive use of cervical radiography is made in patients with vertigo and dizziness.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Tontura , Imagem por Ressonância Magnética/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Vertigem , Análise de Variância , Distribuição de Qui-Quadrado , Tontura/epidemiologia , Emergências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Espanha/epidemiologia , Vertigem/epidemiologia
2.
Radiol Med ; 125(3): 296-305, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845091

RESUMO

The advances in technology have led to a growing trend in population exposure to radiation emerging from the invention of high-dose procedures. It is, for example, estimated that annually 1.2% of cancers are induced by radiological scans in Norway. This study aims to investigate and discuss the frequency and dose trends of radiological examinations in Europe. European Commission (EC) launched projects to gain information for medical exposures in 2004 and 2011. In this study, the European Commission Radiation Protection (RP) reports No. 154 and 180 have been reviewed. The RP 154 countries' data were extracted from both reports, and the average variation trend of the number of examinations and effective doses were studied. According to the results, plain radiography and fluoroscopy witnessed a reduction in the frequency and effective dose per examination. Nevertheless, European collective dose encountered an average increase of 23%, which resulted from a growing tendency for implementation of high-dose procedures such as CT scans and interventional examinations. It is worth noting that most of the CT procedures have undergone an increase in effective dose per examination. Although demand and dose per examination in some radiological procedures (such as intravenous urography (IVU) have been reduced, population collective dose is still rising due to the increasing demand for CT scan procedures. Even though the individual risks are not considerable, it can, in a large scale, threaten the health of the people at the present time. Due to this fact, better justification should be addressed so as to reduce population exposure.


Assuntos
Exposição à Radiação/estatística & dados numéricos , Radiografia Intervencionista/tendências , Radiografia/tendências , Tomografia Computadorizada por Raios X/tendências , Europa (Continente)/epidemiologia , Fluoroscopia/estatística & dados numéricos , Fluoroscopia/tendências , Humanos , Neoplasias Induzidas por Radiação/epidemiologia , Noruega/epidemiologia , Doses de Radiação , Proteção Radiológica , Radiografia/estatística & dados numéricos , Radiografia Intervencionista/estatística & dados numéricos , Radiologia/tendências , Tomografia Computadorizada por Raios X/estatística & dados numéricos
3.
Ulus Travma Acil Cerrahi Derg ; 25(6): 622-627, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701501

RESUMO

BACKGROUND: In our study, we have tried to find out how necessary whole-body computed tomography (WBCT) is to detect other body injuries that may accompany the patients, evaluating head trauma cases with WBCT. METHODS: In our study, we included 198 patients, who were referred to our hospital's emergency service after head trauma, had brain lesions detected in brain tomography (BT), had no additional examination findings and who underwent WBCT. In this retrospective study, patients' age, gender, type of lesion in brain CT, Glasgow Coma Scale (GCS) values and WBCT findings were examined. RESULTS: In this study, 85.4% of the patients were male and the average age was 25.7 years. The most common cranial CT findings were fracture, followed by parenchymal bleeding. 67% of the patients' GCS were below 8. Additional trauma was detected in 78 of the patients (39.4%). The most common additional lesion was the thoracic contusion. The mean age of the patients with cervical injuries determined in CT was significantly high (p<0.05). Statistical significance was determined between cranial fracture, foreign body incidence and thoracic injuries (p<0.05). The incidence of cervical injuries was significantly higher in patients with brain contusion detected in CT (p<0.05). Fracture frequency and presence of additional lesions in WBCT were significantly high (p<0.05). There was no correlation between other cranial lesions and additional injury areas (p>0.05). CONCLUSION: The number of studies evaluating WBCT is high in the literature. However, our study is important concerning that to our knowledge this study is the first study to evaluate the WBCT findings in the head trauma cases without the additional lesions on their bodies. WBCT scan should be recommended in patients whose clinical evaluation could not be completed. WBCT is an important diagnostic tool for the diagnosis of many pathologies, especially for intrathoracic lesions.


Assuntos
Traumatismos Craniocerebrais , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Imagem Corporal Total/estatística & dados numéricos , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/epidemiologia , Guias de Prática Clínica como Assunto , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/epidemiologia
4.
Acta Chir Orthop Traumatol Cech ; 86(5): 334-341, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748108

RESUMO

PURPOSE OF THE STUDY The study aimed to map the use of imaging techniques and results reporting in polytrauma patients by the trauma centres in the Czech Republic. MATERIAL AND METHODS The representatives of radiology departments and units of all 12 trauma centres in the Czech Republic completed a questionnaire regarding the imaging in polytrauma patients. RESULTS The Focused Assessment with Sonography for Trauma (FAST) as an initial imaging is used by all the centres, the WholeBody CT scan (WBCT) is the dominant imaging technique everywhere and all the centres have standards in place for its performance. The WBCT examination protocol varies across the centres, just like the evaluation procedures of the CT scan and reporting of the results over to the indicating physicians. In majority of centres, there is a high percentage of WBCT with normal findings. One of the centres which uses also X-rays as a part of imaging algorithm, reports a notably higher percentage of WBCT positive findings. DISCUSSION When considering the radiation dose, data and time necessary for WBCT, work required to assess the WBCT and a large number of negative findings, it is disputable whether in a number of cases the WBCT is a suitable method for polytrauma patient examination. Similar conclusions have been drawn also by other authors who recommend that the WBCT is always used for unconscious polytrauma patients, in whom a clinical examination is virtually impossible. In the other cases, based on the clinical parameters the other imaging techniques and the focused CT (and in the indicated cases also the wholebody CT) can be safely used. CONCLUSIONS he diagnostic procedure in a polytrauma patient is not uniform in trauma centres and even the procedure for urgent reporting of crucial WBCT findings to clinical physicians has not been standardised. In a number of cases the indication for WBCT seems to be unnecessary. A more careful consideration of indications for imaging examinations based on the clinical finding may reduce the radiation exposure of patients while maintaining the diagnostic accuracy. A structured report on WBCT in polytrauma is not used even though it is recommended by the European Society of Radiology. Key words:polytrauma, diagnostic imaging, Whole-Body Computed Tomography, structured report.


Assuntos
Traumatismo Múltiplo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Centros de Traumatologia/estatística & dados numéricos , República Tcheca/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Traumatismo Múltiplo/epidemiologia , Exposição à Radiação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
5.
S Afr Med J ; 109(9): 693-697, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31635596

RESUMO

BACKGROUND: There is growing realisation that human error contributes significantly to morbidity and mortality in modern healthcare. A number of taxonomies and classification systems have been developed in an attempt to categorise errors and quantify their impact. OBJECTIVES: To record and identify adverse events and errors as they impacted on acute trauma patients undergoing a computed tomography (CT) scan, and then quantify the effect this had on the individual patients. It is hoped that these data will provide evidence to develop error prevention programmes designed to reduce the incidence of human error. METHODS: The trauma database was interrogated for the period December 2012 - April 2017. All patients aged >18 years who underwent a CT scan for blunt trauma were included. All recorded morbidity for these patients was reviewed. RESULTS: During the period under review, a total of 1 566 patients required a CT scan at our institution following blunt trauma. Of these, 192 (12.3%, 134 male and 58 female) experienced an error related to the process of undergoing a CT scan. Of 755 patients who underwent a CT scan with intravenous contrast, detailed results were available for 312, and of these 46 (14.7%) had an acute deterioration in renal function. According to Chang's taxonomy, physical harm occurred as follows: grade I n=6, grade II n=62, grade III n=45, grade IV n=11, grade V n=27, grade VI n=21, grade VII n=15, grade VIII n=3 and grade IX n=2. Adverse events were performing an unnecessary scan (n=24), omitting an indicated scan (n=23), performing the scan incorrectly (n=8), scanning the wrong body part (n=7), equipment failure (n=18), omitting treatment following the scan (n=6), incorrect interpretation of the scan (n=65), deterioration during the scan (n=6) and others (n=35). The setting for the error was the ward (n=19), the radiology suite (n=126), the emergency department (n=45) and the operating theatre (n=2). The staff responsible for the adverse events were medical (n=155), nursing (n=4) and radiology staff (n=15). There were 67 errors of commission and 125 errors of omission. The primary cause was a planning problem in 78 cases and an execution problem in 114. CONCLUSIONS: Errors and adverse events related to obtaining a CT scan following blunt polytrauma are not uncommon and may impact significantly on the patient. Communication is essential to eliminate errors related to performing the wrong type of scan. The commonest errors relate to misinterpretation of the scan.


Assuntos
Erros Médicos/estatística & dados numéricos , Traumatismo Múltiplo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , África do Sul , Tomografia Computadorizada por Raios X/efeitos adversos , Centros de Traumatologia
6.
Tidsskr Nor Laegeforen ; 139(14)2019 10 08.
Artigo em Norueguês | MEDLINE | ID: mdl-31592615

RESUMO

BACKGROUND: Acute dizziness may have a number of causes, including cerebrovascular stroke which can present as isolated acute vestibular syndrome. It is recommended that acute episodic dizziness be assessed using positioning tests, and acute persistent dizziness with a focus on the HINTS (Head Impulse, Nystagmus, Test of Skew) battery of tests, which can distinguish cerebrovascular stroke from vestibular neuritis. We wished to identify the prevalence, diagnostic spectrum and approach to acute dizziness in a neurological department. MATERIAL AND METHOD: We undertook a retrospective review of the medical records of all patients with acute dizziness as the primary symptom who where admitted to the department of neurology at Sørlandet Hospital, Kristiansand in 2015. RESULTS: Of 2 231 patients admitted to the department of neurology in 2015, altogether 243 (11 %) had dizziness as the primary symptom. A total of 106 patients (44 %) were examined using HINTS in its entirety. A cranial CT was performed in 213 (88 %) and MRI in 91 (37 %), and these showed relevant pathology in 1 and 4 patients, respectively. Upon discharge, 122 patients (50 %) were given a non-specific symptom diagnosis, 59 (24 %) received the diagnosis vestibular neuritis, 41 (17 %) benign paroxysmal positional vertigo, and 5 (2 %) were diagnosed with cerebrovascular stroke. Four out of five cases of cerebrovascular stroke could be classified retrospectively as acute vestibular syndrome, whereof three had typical findings determined by the HINTS test. INTERPRETATION: Acute dizziness is a frequent symptom in patients admitted to the department of neurology. Evidence-based diagnostic recommendations for the assessment of acute dizziness were not satisfactorily implemented in practice.


Assuntos
Tontura , Departamentos Hospitalares , Neurologia , Doença Aguda , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/diagnóstico , Tontura/diagnóstico , Tontura/etiologia , Medicina Baseada em Evidências , Medições dos Movimentos Oculares , Teste do Impulso da Cabeça , Humanos , Registros Médicos , Noruega , Nistagmo Patológico/diagnóstico , Admissão do Paciente , Posicionamento do Paciente , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Neuronite Vestibular/complicações , Neuronite Vestibular/diagnóstico
7.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31533974

RESUMO

BACKGROUND: Computed tomography (CT) is commonly used for children when there is concern for traumatic brain injury (TBI) and is a significant source of ionizing radiation. Our objective was to determine the feasibility and accuracy of fast MRI (motion-tolerant MRI sequences performed without sedation) in young children. METHODS: In this prospective cohort study, we attempted fast MRI in children <6 years old who had head CT performed and were seen in the emergency department of a single, level 1 pediatric trauma center. Fast MRI sequences included 3T axial and sagittal T2 single-shot turbo spin echo, axial T1 turbo field echo, axial fluid-attenuated inversion recovery, axial gradient echo, and axial diffusion-weighted single-shot turbo spin echo planar imaging. Feasibility was assessed by completion rate and imaging time. Fast MRI accuracy was measured against CT findings of TBI, including skull fracture, intracranial hemorrhage, or parenchymal injury. RESULTS: Among 299 participants, fast MRI was available and attempted in 225 (75%) and completed in 223 (99%). Median imaging time was 59 seconds (interquartile range 52-78) for CT and 365 seconds (interquartile range 340-392) for fast MRI. TBI was identified by CT in 111 (50%) participants, including 81 skull fractures, 27 subdural hematomas, 24 subarachnoid hemorrhages, and 35 other injuries. Fast MRI identified TBI in 103 of these (sensitivity 92.8%; 95% confidence interval 86.3-96.8), missing 6 participants with isolated skull fractures and 2 with subarachnoid hemorrhage. CONCLUSIONS: Fast MRI is feasible and accurate relative to CT in clinically stable children with concern for TBI.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Pré-Escolar , Estudos de Viabilidade , Feminino , Hematoma Subdural/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Hemorragias Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Estudos Prospectivos , Exposição à Radiação/prevenção & controle , Reprodutibilidade dos Testes , Fraturas Cranianas/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos
8.
JAMA ; 322(9): 843-856, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31479136

RESUMO

Importance: Medical imaging increased rapidly from 2000 to 2006, but trends in recent years have not been analyzed. Objective: To evaluate recent trends in medical imaging. Design, Setting, and Participants: Retrospective cohort study of patterns of medical imaging between 2000 and 2016 among 16 million to 21 million patients enrolled annually in 7 US integrated and mixed-model insurance health care systems and for individuals receiving care in Ontario, Canada. Exposures: Calendar year and country (United States vs Canada). Main Outcomes and Measures: Use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear medicine imaging. Annual and relative imaging rates by imaging modality, country, and age (children [<18 years], adults [18-64 years], and older adults [≥65 years]). Results: Overall, 135 774 532 imaging examinations were included; 5 439 874 (4%) in children, 89 635 312 (66%) in adults, and 40 699 346 (30%) in older adults. Among adults and older adults, imaging rates were significantly higher in 2016 vs 2000 for all imaging modalities other than nuclear medicine. For example, among older adults, CT imaging rates were 428 per 1000 person-years in 2016 vs 204 per 1000 in 2000 in US health care systems and 409 per 1000 vs 161 per 1000 in Ontario; for MRI, 139 per 1000 vs 62 per 1000 in the United States and 89 per 1000 vs 13 per 1000 in Ontario; and for ultrasound, 495 per 1000 vs 324 per 1000 in the United States and 580 per 1000 vs 332 per 1000 in Ontario. Annual growth in imaging rates among US adults and older adults slowed over time for CT (from an 11.6% annual percentage increase among adults and 9.5% among older adults in 2000-2006 to 3.7% among adults in 2013-2016 and 5.2% among older adults in 2014-2016) and for MRI (from 11.4% in 2000-2004 in adults and 11.3% in 2000-2005 in older adults to 1.3% in 2007-2016 in adults and 2.2% in 2005-2016 in older adults). Patterns in Ontario were similar. Among children, annual growth for CT stabilized or declined (United States: from 10.1% in 2000-2005 to 0.8% in 2013-2016; Ontario: from 3.3% in 2000-2006 to -5.3% in 2006-2016), but patterns for MRI were similar to adults. Changes in annual growth in ultrasound were smaller among adults and children in the United States and Ontario compared with CT and MRI. Nuclear medicine imaging declined in adults and children after 2006. Conclusions and Relevance: From 2000 to 2016 in 7 US integrated and mixed-model health care systems and in Ontario, rates of CT and MRI use continued to increase among adults, but at a slower pace in more recent years. In children, imaging rates continued to increase except for CT, which stabilized or declined in more recent periods. Whether the observed imaging utilization was appropriate or was associated with improved patient outcomes is unknown.


Assuntos
Diagnóstico por Imagem/tendências , Abdome/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Diagnóstico por Imagem/estatística & dados numéricos , Cabeça/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/estatística & dados numéricos , Imagem por Ressonância Magnética/tendências , Pessoa de Meia-Idade , Ontário , Cintilografia/estatística & dados numéricos , Cintilografia/tendências , Coluna Vertebral/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Tomografia Computadorizada por Raios X/tendências , Ultrassonografia/estatística & dados numéricos , Ultrassonografia/tendências , Estados Unidos , Adulto Jovem
9.
Int J Chron Obstruct Pulmon Dis ; 14: 1583-1593, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31409984

RESUMO

Purpose: Quantitative analysis of CT scans has proven to be a reproducible technique, which might help to understand the pathophysiology of chronic obstructive pulmonary disease (COPD) and combined pulmonary fibrosis and emphysema. The aim of this retrospective study was to find out if the lung function of patients with COPD with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III or IV and pulmonary emphysema is measurably influenced by high attenuation areas as a correlate of concomitant unspecific fibrotic changes of lung parenchyma. Patients and methods: Eighty-eight patients with COPD GOLD stage III or IV underwent CT and pulmonary function tests. Quantitative CT analysis was performed to determine low attenuation volume (LAV) and high attenuation volume (HAV), which are considered to be equivalents of fibrotic (HAV) and emphysematous (LAV) changes of lung parenchyma. Both parameters were determined for the whole lung, as well as peripheral and central lung areas only. Multivariate regression analysis was used to correlate HAV with different parameters of lung function. Results: Unlike LAV, HAV did not show significant correlation with parameters of lung function. Even in patients with a relatively high HAV of more than 10%, in contrast to HAV (p=0.786) only LAV showed a significantly negative correlation with forced expiratory volume in 1 second (r=-0.309, R2=0.096, p=0.003). A severe decrease of DLCO% was associated with both larger HAV (p=0.045) and larger LAV (p=0.001). Residual volume and FVC were not influenced by LAV or HAV. Conclusion: In patients with COPD GOLD stage III-IV, emphysematous changes of lung parenchyma seem to have such a strong influence on lung function, which is a possible effect of concomitant unspecific fibrosis is overwhelmed.


Assuntos
Pulmão , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Fibrose Pulmonar , Testes de Função Respiratória/métodos , Tomografia Computadorizada por Raios X , Idoso , Correlação de Dados , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/etiologia , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/etiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
10.
Transplant Proc ; 51(7): 2373-2378, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31402250

RESUMO

BACKGROUND: In living-donor liver transplantation, donor hepatic steatosis is crucial for both the donor and the recipient. Body mass index (BMI) and the unenhanced computed tomography liver attenuation index (CT LAI) are noninvasive methods to predict hepatic steatosis in living-donor liver candidates. AIM: To analyze the diagnostic accuracy of CT LAI in conjunction with different BMI values for macrovesicular steatosis in living-donor liver candidates. METHODS: A total of 264 potential liver donors were included. The diagnostic accuracy of 2 CT LAI cut-offs and 3 BMI cut-off values for the assessment of hepatic steatosis ≥15% and ≤5% was determined. RESULTS: Using CT LAI, the area under the receiver operating characteristic curve was 0.97 (95% CI = 0.89-0.99) for hepatic steatosis ≥15% in donors with BMI <25 kg/m2. For detecting hepatic steatosis ≥15%, a CT LAI ≤0 had specificities of 100%, 76.2%, and 55.6% and positive predictive values of 100%, 95.5%, and 93.5% for patients with BMI values <25 kg/m2, 25 to 29.9 kg/m2, and ≥30 kg/m2, respectively. According to logistic regression analyses, only CT LAI ≤0 was found to be independently associated with hepatic steatosis ≥15%. CONCLUSIONS: In donors with BMI <30 kg/m2 and a CT LAI value >6, liver biopsy might be avoided. Biopsy may be reserved solely for donors with CT LAI value >0 and BMI ≥30 kg/m2 as the diagnostic accuracy of computed tomography for predicting hepatic steatosis decreases with increasing BMI.


Assuntos
Fígado Gorduroso/etiologia , Hepatectomia/efeitos adversos , Doadores Vivos , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Feminino , Hepatectomia/métodos , Humanos , Fígado/diagnóstico por imagem , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Curva ROC , Coleta de Tecidos e Órgãos/métodos , Tomografia Computadorizada por Raios X/métodos
11.
Urology ; 133: 50-56, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31404583

RESUMO

OBJECTIVE: To describe trends in computed tomography (CT) use and estimate the radiation exposure among stone formers using a national insurance claims database. METHODS: Within MarketScan, adult stone patients from 2007 to 2013 were identified using International Classification of Diseases-Revision 9, International Classification of Diseases-Revision 10, and Current Procedural Terminology codes. Patients were classified as "active" (≥2 diagnosis codes for nephrolithiasis, or receipt of stone surgery) or "inactive" (1 stone diagnosis) and compared to age- and gender-matched controls. CT utilization was tracked over 3 years for each group. Annual CT-related radiation exposure was estimated using previously published dose values and compared using Kruskal-Wallis and χ2 tests. Demographic factors associated with greater CT exposure were identified on multivariate logistic regression. RESULTS: Of active stone patients, 112,140 underwent surgery and 215,376 were managed nonoperatively. There were 175,228 inactive stone patients and 502,744 controls. On average, active stone patients received nearly 10 times as many CTs as controls at 3 years (P <.001), and more acute imaging (P <.001). About 25% and 15% of operative and nonoperative patients, respectively, received ≥3 CTs in 3 years. This was associated with female gender. For nonoperative patients, this was also associated with age, residence in the North-Central or South regions, and inversely associated with metropolitan residence (all P <.01). Over 10% of active stone patients are estimated to receive >20 mSv in the first year alone. CONCLUSION: CT use and nonsurgical radiation exposure for active stone patients is significant. Over 10% are estimated to exceed occupational limits in the first year. Judicious CT imaging and low-dose protocols are critical for stone patients.


Assuntos
Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/tendências , Exposição à Radiação/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Cálculos Urinários/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Crit Care Resusc ; 21(3): 212-219, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462208

RESUMO

OBJECTIVE: Ionising radiation is a valuable tool in modern medicine including for patients in an intensive care unit (ICU). However, clinicians are faced with a trade-off between benefit of information received from procedure versus risks associated with radiation. As a first step to understanding the risk and benefits of radiation exposure to ICU patients, we aimed to assess the cumulative levels of ionising radiation patients receive during their ICU stay. DESIGN: Retrospective audit. SETTING: A single tertiary care ICU in South Australia. PARTICIPANTS: This audit included 526 patients admitted to the ICU at Flinders Medical Centre, Adelaide, SA, for longer than 120 hours (long stay) over a 12-month period from April 2015 to April 2016. MAIN OUTCOME MEASURES: Cumulative radiation exposure to ICU patients. RESULTS: The 526 patients audited underwent 4331 procedures totalling 5688.45 mSv of ionising radiation. The most frequent procedure was chest x-ray (82%), which contributed 1.2% to cumulative effective dose (CED). Although only 3.6% of the total procedures, abdominal and pelvic computed tomography (CT) contributed the most to CED (68%). Over 50% of patients received less than 1 mSv CED during their stay in the ICU. However, 6% received > 50 mSv and 1.3% received > 100 mSv CED. Trauma patients received significantly higher CED compared with other admission diagnoses, and CED increased with length of stay. CONCLUSION: Most ICU patients received low CED during their stay, with the majority receiving less than the recommended limit for members of the public (1 mSv). These results may educate clinicians regarding radiation exposures in ICU settings, highlighting the relatively low exposures and thus low risk to the patients.


Assuntos
Estado Terminal , Diagnóstico por Imagem/estatística & dados numéricos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Doses de Radiação , Exposição à Radiação , Radiação Ionizante , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Austrália , Feminino , Humanos , Masculino , Estudos Retrospectivos
13.
Br J Radiol ; 92(1102): 20190344, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31359789

RESUMO

OBJECTIVE: To assess the frequency and impact of incidental findings (IF) on CT during work-up for transcatheter aortic valve intervention (TAVI). METHODS: A consecutive cohort of patients referred for consideration of TAVI who underwent a CT scan between 2009 and 2018 were studied retrospectively. CT reports were reviewed for the presence of IFs and categorised based upon their clinical significance: (a) insignificant-findings that did not require specific treatment or follow-up; (b) intermediate-findings that did not impact on the decision-making process but required follow-up; (c) significant-findings that either required urgent investigation or meant that TAVI was clinically inappropriate. RESULTS: A total of 652 patients were included, whose median age was 82 years. One or more insignificant IF was found in 95.6% of patients. Intermediate IFs were documented in 5.4%. 91 (14%) patients had at least one significant IF. These included possible malignancy in 67 (74%). The ultimate decision to offer aortic valve intervention was only changed by the presence of an IF in 3.5% of cases. CONCLUSION: Clinically significant IFs are detected in more than 1 in 10 of patients undergoing CT as part of a TAVI work-up, although just over half of these patients still receive aortic valve intervention. ADVANCES IN KNOWLEDGE: This study is the largest UK cohort, which, when combined with a review of existing literature, provides a clear picture of the frequency and clinical impact of IFs found at CT for TAVI assessment.


Assuntos
Achados Incidentais , Cuidados Pré-Operatórios , Tomografia Computadorizada por Raios X , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Estudos de Coortes , Feminino , Humanos , Masculino , Neoplasias/diagnóstico por imagem , Prevalência , Estudos Retrospectivos , Risco , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Reino Unido
14.
Am J Surg ; 218(4): 716-721, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31350004

RESUMO

BACKGROUND: We implemented a protocol to evaluate pediatric patients with suspected appendicitis using ultrasound as the initial imaging modality. CT utilization rates and diagnostic accuracy were evaluated two years after pathway implementation. METHODS: This was a retrospective observational study of patients <18 years evaluated for suspected appendicitis. CT rates were compared before and after implementation of the protocol, and monthly CT rates were calculated to assess trends in CT utilization. RESULTS: CT use decreased significantly following pathway implementation from 94.2% (130/138) to 27.5% (78/284; p < 0.001). Linear regression of monthly CT utilization demonstrated that CT rates continued to trend down two years after pathway implementation. Adherence to the pathway was 89.8% (255/284). Negative appendectomy rate was 2.4% (2/85) in the post-pathway period. CONCLUSIONS: Adherence to a pathway designed to evaluate pediatric patients with suspected appendicitis using ultrasound as the primary imaging modality has led to a sustained decrease in CT use without compromising diagnostic accuracy.


Assuntos
Apendicite/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Apendicectomia , Apendicite/cirurgia , Criança , Pré-Escolar , Protocolos Clínicos , Procedimentos Clínicos , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Sensibilidade e Especificidade , Ultrassonografia
15.
Eur Radiol ; 29(12): 6805-6815, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31227881

RESUMO

OBJECTIVES: The conceptus dose during diagnostic imaging procedures for pregnant patients raises health concerns owing to the high radiosensitivity of the developing embryo/fetus. The aim of this work is to develop a methodology for automated construction of patient-specific computational phantoms based on actual patient CT images to enable accurate estimation of conceptus dose. METHODS: We developed a 3D deep convolutional network algorithm for automated segmentation of CT images to build realistic computational phantoms. The neural network architecture consists of analysis and synthesis paths with four resolution levels each, trained on manually labeled CT scans of six identified anatomical structures. Thirty-two CT exams were augmented to 128 datasets and randomly split into 80%/20% for training/testing. The absorbed doses for six segmented organs/tissues from abdominal CT scans were estimated using Monte Carlo calculations. The resulting radiation doses were then compared between the computational models generated using automated segmentation and manual segmentation, serving as reference. RESULTS: The Dice similarity coefficient for identified internal organs between manual segmentation and automated segmentation results varies from 0.92 to 0.98 while the mean Hausdorff distance for the uterus is 16.1 mm. The mean absorbed dose for the uterus is 2.9 mGy whereas the mean organ dose differences between manual and automated segmentation techniques are 0.07%, - 0.45%, - 1.55%, - 0.48%, - 0.12%, and 0.28% for the kidney, liver, lung, skeleton, uterus, and total body, respectively. CONCLUSION: The proposed methodology allows automated construction of realistic computational models that can be exploited to estimate patient-specific organ radiation doses from radiological imaging procedures. KEY POINTS: • The conceptus dose during diagnostic radiology and nuclear medicine imaging procedures for pregnant patients raises health concerns owing to the high radiosensitivity of the developing embryo/fetus. • The proposed methodology allows automated construction of realistic computational models that can be exploited to estimate patient-specific organ radiation doses from radiological imaging procedures. • The dosimetric results can be used for the risk-benefit analysis of radiation hazards to conceptus from diagnostic imaging procedures, thus guiding the decision-making process.


Assuntos
Doses de Radiação , Radiografia Abdominal/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Simulação por Computador , Feminino , Humanos , Pessoa de Meia-Idade , Método de Monte Carlo , Imagens de Fantasmas , Gravidez , Radiografia Abdominal/métodos , Radiometria/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
16.
Emerg Med J ; 36(8): 485-492, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31239315

RESUMO

OBJECTIVES: To determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician's experience (≤10 vs >10 years). METHODS: Early thoracic CT Scan for Community-Acquired Pneumonia at the Emergency Department is an interventional study conducted from November 2011 to January 2013 in four French emergency departments, and included suspected patients with CAP. We analysed changes in emergency physician CAP diagnosis classification levels before and after CT scan; and their agreement with an adjudication committee. We performed univariate analysis to determine the factors associated with modifying the diagnosis classification level to be consistent with the radiologist's CT scan interpretation. RESULTS: 319 suspected patients with CAP and 136 emergency physicians (75% less experienced with ≤10 years, 25% with >10 years of experience) were included. The percentage of patients whose classification was modified to become consistent with CT scan radiologist's interpretation was higher among less-experienced than experienced emergency physicians (54.2% vs 40.2%; p=0.02). In univariate analysis, less emergency physician experience was the only factor associated with changing a classification to be consistent with the CT scan radiologist's interpretation (OR 1.77, 95% CI 1.01 to 3.10, p=0.04). After CT scan, the agreement between emergency physicians and adjudication committee was moderate for less-experienced emergency physicians and slight for experienced emergency physicians (k=0.457 and k=0.196, respectively). After CT scan, less-experienced emergency physicians modified patient management significantly more than experienced emergency physicians (36.1% vs 21.7%, p=0.01). CONCLUSIONS: In clinical practice, less-experienced emergency physicians were more likely to accurately modify their CAP diagnosis and patient management based on thoracic CT scan than more experienced emergency physicians. TRIAL REGISTRATION NUMBER: NCT01574066.


Assuntos
Competência Clínica/normas , Infecções Comunitárias Adquiridas/terapia , Medicina de Emergência/normas , Acontecimentos que Mudam a Vida , Adulto , Competência Clínica/estatística & dados numéricos , Infecções Comunitárias Adquiridas/complicações , Tomada de Decisões , Medicina de Emergência/métodos , Medicina de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/terapia , Estudos Prospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/estatística & dados numéricos
17.
BMC Gastroenterol ; 19(1): 111, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248366

RESUMO

BACKGROUND: Irritable bowel syndrome (IBS) can be responsible for alteration in quality of life and economic burden. The aim of this study was to evaluate healthcare use related to this disorder in France. METHODS: The French health data system was used to select adults covered by the general health scheme (87% of population) through their first IBS hospitalization in 2015. We studied the healthcare refunded during the previous 5 years, 1 year before and after hospitalization. RESULTS: Among 43.7 million adults who used refunded healthcare in 2015, 29,509 patients were identified (0.07, 33% males, 67% females, mean age 52 years, 30% admitted through emergency room). During their hospitalization, 33% had upper endoscopy and 64% colonoscopy. Over the five previous years, 3% had at least one hospitalization with an IBS diagnosis, 58% had abdominal ultrasonography, 27% CT scan, 21% upper endoscopy, 13% colonoscopy and 83% a gastroenterologist visit. The year before, these rates were respectively: 0, 36, 16, 6, 4 and 78%. Some of those rates decreased the year after the hospitalization with respectively: 1, 27, 13, 5, 4 and 19%. The year before, 65% had at least one CRP dosage (13% three or more), 58% a TSH dosage (7%) and 8% a test for coeliac diseases (1%) and the year after: 44% (8%), 43% (5%) and 3% (0.3%). At least one refund of a drug used to treat IBS was found for 85% of patients 5 years before, 65% one year before and 51% one year after. CONCLUSION: This first study using French health data system for healthcare consumption assessment in IBS points out the repetition of outpatient visits, examinations and in particular radiological examinations, without a strong decrease after hospitalization for IBS and gastroenterologist visit.


Assuntos
Hospitalização/estatística & dados numéricos , Síndrome do Intestino Irritável/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Proteína C-Reativa/metabolismo , Doença Celíaca/diagnóstico , Técnicas de Laboratório Clínico/estatística & dados numéricos , Colonoscopia/estatística & dados numéricos , Bases de Dados Factuais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , França , Gastroenterologia/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde , Síndrome do Intestino Irritável/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Tireotropina/sangue , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos
18.
Pediatr Emerg Care ; 35(7): 506-508, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31206506

RESUMO

BACKGROUND: There is an increased emphasis on reducing exposure to ionizing radiation in pediatric patients. Guidelines from the Pediatric Emergency Care Applied Research Network help practitioners identify patients at low risk for clinically important traumatic brain injury after head injury. OBJECTIVES: We seek to determine whether the institution of a pediatric track staffed by pediatric emergency medicine physicians (PEMs) within a community emergency department (ED) impacts the overall utilization of head computed tomography (CT) on children younger than 15 years with head injury. METHODS: We used a retrospective cohort analysis of patients under the age of 15 years presenting to a community ED in the year before and the year of institution of a pediatric emergency track. Relative risk estimates were used to determine the risk of CT use associated with nonpediatric-trained emergency providers. RESULTS: The community ED saw 11,094 patients and 14,639 patients younger than 15 years in fiscal years 2014-2015 and 2015-2016, respectively. In the year before PEMs, there were 312 children younger than 15 years seen for head injury; 47.09% received head CTs. After PEM coverage, there were 396 children younger than 15 years seen for head injury; 17.17% received head CTs. Pediatric patients with head injury were 2.2 times more likely to receive CTs before the institution of the pediatric track (95% confidence interval, 1.8-2.6). CONCLUSION: The implementation of a pediatric emergency track demonstrated a significant decrease in CT utilization for head injury. Continued development of pediatric tracks in community EDs can lead to reduction of CTs.


Assuntos
Traumatismos Craniocerebrais/diagnóstico por imagem , Serviço Hospitalar de Emergência/organização & administração , Medicina de Emergência Pediátrica , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , California , Criança , Pré-Escolar , Mão de Obra em Saúde , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Admissão e Escalonamento de Pessoal , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
19.
BMC Gastroenterol ; 19(1): 87, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31195984

RESUMO

BACKGROUND: The relationship between visceral adiposity and acute pancreatitis (AP) has not been completely elucidated. This study evaluated the significance of visceral adipose tissue (VAT) and the ratio of VAT to skeletal muscle tissue (VAT/SMT) in the prognosis of AP patients. METHODS: Based on a 1:2 propensity score matching, 306 hospitalized patients were enrolled in the study analysis from 2010 to 2017. VAT, subcutaneous adipose tissue (SAT), and SMT were measured using unenhanced computed tomography (CT). Cox proportional hazards models were applied for the analysis. RESULTS: VAT and the VAT/SMT ratio were significantly higher in the severe AP (SAP) and moderately severe AP (MSAP) groups compared to the mild AP (MAP) group (both p < 0.001). Intensive care transfer, AP severity, systemic complications, and prognostic scores (Acute Physiology and Chronic Health Evaluation II [APACHE-II] score ≥ 8, Ranson's score ≥ 3, Bedside Index of Severity in Acute Pancreatitis [BISAP] score ≥ 3, and the systemic inflammatory response syndrome [SIRS] score ≥ 2) significantly correlated with VAT and the VAT/SMT ratio in AP patients. The multivariate adjusted hazard ratios (HRs) for VAT and the VAT/SMT ratio in the relationship of body parameters and AP mortality were 1.042 (95% confidence interval (CI), 1.019-1.066) and 7.820 (95% CI, 1.978-30.917), respectively. Compared with other prognostic scores, VAT had the highest area under the curve of receiver operating characteristics (ROC) (0.943, 95% CI, 0.909-0.976). CONCLUSION: High VAT and VAT/SMT ratio are independent negative prognostic indicators of AP. TRIAL REGISTRATION: Clinical study registration number: NCT03482921 . Date of registration: 03/23/2018.


Assuntos
Gordura Intra-Abdominal/patologia , Músculo Esquelético/patologia , Pancreatite/patologia , Gordura Subcutânea/patologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , APACHE , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Pancreatite/diagnóstico por imagem , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Curva ROC , Gordura Subcutânea/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica
20.
J Comput Assist Tomogr ; 43(4): 605-611, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162230

RESUMO

OBJECTIVE: To perform a clinical and payer-based analysis of the value of dual-energy computed tomography (DECT) for workup of incidental abdominal findings. METHODS: This was a single-center, retrospectively designed, Health Insurance Portability and Accountability Act-compliant study approved by our institutional review board. Sixty-nine examinations in 69 patients (45 men, 24 women; mean age, 57.7 years) who underwent single-phase postcontrast abdominal DECT studies between January 1, 2011, and December 31, 2017, were included. Two radiologists, blinded to study objective and design, reviewed all cases and identified incidental abdominal findings needing further imaging. All incidental findings were reviewed by 2 other investigators, who determined whether an imaging-based diagnosis could be made using DECT virtual noncontrast images and iodine maps. Additional studies and associated payer-reimbursement amounts avoided by use of DECT were estimated. All imaging costs were estimated based on the US Centers for Medicare & Medicaid Services reimbursement amounts. RESULTS: Thirty-four incidental findings (renal mass, n = 20; adrenal nodule, n = 8; pancreatic cystic lesions, n = 3; others, n = 3) were identified in 19 (27.5%) of 69 patients. Dual-energy computed tomography characterized 27 incidental findings in 15 patients and accounted for cost savings of 15 additional imaging examinations (abdominal magnetic resonance imaging, n = 11; abdominal computed tomography, n = 4). Based on Centers for Medicare & Medicaid Services reimbursement amounts, we estimated that, by abolishing the need for additional imaging use, DECT saved US $84.95 per patient. CONCLUSIONS: Dual-energy computed tomography can provide an imaging-based diagnosis of incidental abdominal findings, otherwise incompletely characterized on routine abdominal computed tomography, in approximately 21% of patients. In select patients, the monetary savings from abolishing additional imaging may reduce payer costs associated with use of DECT.


Assuntos
Achados Incidentais , Radiografia Abdominal , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Tomografia Computadorizada por Raios X , Abdome/diagnóstico por imagem , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Abdominal/economia , Radiografia Abdominal/estatística & dados numéricos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/economia , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/estatística & dados numéricos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos
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