Sequential low-dose CT thorax scans to determine invasive pulmonary fungal infection incidence after allogeneic hematopoietic cell transplantation.

Invasive fungal disease (IFD) during neutropenia goes along with a high mortality for patients after allogeneic hematopoietic cell transplantation (alloHCT). Low-dose computed tomography (CT) thorax shows good sensitivity for the diagnosis of IFD with low radiation exposure. The aim of our study was to evaluate sequential CT thorax scans at two time points as a new reliable method to detect IFD during neutropenia after alloHCT. We performed a retrospective single-center observational study in 265/354 screened patients admitted for alloHCT from June 2015 to August 2019. All were examined by a low-dose CT thorax scan at admission (CT t0) and after stable neutrophil recovery (CT t1) to determine the incidences of IFD. Furthermore, antifungal prophylaxis medications were recorded and cohorts were analyzed for statistical differences in IFD incidence using the sequential CT scans. In addition, IFD cases were classified according to EORTC 2008. At CT t0 in 9.6% of the patients, an IFD was detected and antifungal therapy initiated. The cumulative incidence of IFD in CT t1 in our department was 14%. The use of Aspergillus-effective prophylaxis through voriconazole or posaconazole decreased CT thorax t1 suggesting IFD is statistically significant compared to prophylaxis with fluconazole (5.6% asp-azol group vs 16.3% fluconazole group, p = 0.048). In 86%, CT t1 was negative for IFD. Low-dose sequential CT thorax scans are a valuable tool to detect pulmonary IFDs and guide antifungal prophylaxis and therapies. Furthermore, a negative CT t1 scan shows a benefit by allowing discontinuation of antifungal medication sparing patients from drug interactions and side effects.

A retrospective, semi-quantitative image quality analysis of cone beam computed tomography (CBCT) and MSCT in the diagnosis of distal radius fractures.

OBJECTIVE: To compare image quality and diagnostic validity of CBCT and MSCT for distal radius fractures. METHODS: 35 CBCT and 33 MSCT scans were retrospectively reviewed with a visual grading scale regarding the depiction of cortical bone, trabecular bone, articular surfaces, and soft tissue. The extent and type of artefacts was analyzed. Agreement on AO classification and measurement of cortical disruption and length of the fracture gap was determined. Fracture reduction was evaluated in post-treatment x-rays. Statistical analysis was performed with visual grading characteristics (VGC), chi square tests, and Kendall's coefficient of concordance. RESULTS: CBCT performed significantly worse for cortical bone, articular surfaces, and especially soft tissue. Trabecular bone showed no significant difference. Significantly more CBCT images showed artefacts. Physics-based artefacts were the most common. CBCT scans also showed motion artefacts. There was no significant difference in agreement on AO classification. The agreement on measurements was substantial for both modalities. Slightly more fractures that had undergone MSCT imaging showed adequate reduction. CONCLUSION: This initial study of an orthopaedic extremity CBCT scanner showed that the image quality of a CBCT scanner remains inferior for most structures at standard settings. Diagnostic validity of both modalities for distal radius fractures seems similar. KEY POINTS: • Subjectively, CBCT remains inferior to MSCT in depicting most structures. • Similar diagnostic validity for CBCT and MSCT imaging of distal radius fractures. • CBCT is a possible alternative to MSCT in musculoskeletal imaging. • Visual grading characteristics (VGC) analysis proves useful in analyzing visual grading scales.

[Current reporting in radiology : what will happen tomorrow?]. / Befundung in der Radiologie heute : Was kommt morgen?

CLINICAL/METHODICAL ISSUE: Reporting in radiology faces considerable changes in the near future that will be influenced by a broader understanding of the task and increasing technological possibilities. STANDARD RADIOLOGICAL METHODS: Until now a radiological report could be regarded as a text phrased by a radiologist after viewing imaging data. METHODICAL INNOVATIONS: New solutions will be accessed by advances in visualization of large datasets, in extracting, analyzing, and communicating metadata as well as by improved integration and interpretation of clinical information. PERFORMANCE: Virtual reality, texture analysis, growing networks, semantic annotation, data mining and context based presentation have the potential to extensively change the everyday working routine. ACHIEVEMENTS: Although many of these developments are still in a laboratory phase, the impact on the process of reporting can already be predicted. PRACTICAL RECOMMENDATIONS: As the leading community in information analysis and technology, radiology as a subject should strive to lead and shape these impending changes.

[CT-guided electrode placement for sacral nerve stimulation in the treatment of faecal incontinence (cSNS)]. / CT-gesteuerte Elektrodenplatzierung zur Sakralnervenstimulation bei Stuhlinkontinenz (cSNS).

BACKGROUND: The sacral nerve stimulation (SNS) can be performed in the screening phase under local anaesthesia. Implantation of the tined-lead electrodes is usually performed in an inpatient setting under general anaesthesia. An outpatient procedure for both PNE and implantation of the electrodes offers decisive advantages with respect to the accuracy of electrode placement. MATERIALS AND METHODS: From 2006 to 2011 a total of 51 patients was treated with SNS in an outpatient setting. RESULTS: Of 51 patients having the PNE, in four patients the procedure could not successfully be completed. In 39 of the 47 patients screened, the testing was positive. Eight times the screening was negative. The functional results show a significant decline in the Cleveland scores from 14.9 to 6.4. The manometric resting pressure improved from 23.4 mmHg to 43.81 mmHg, the squeezing pressure improved from 42.2 mmHg to 76.12 mmHg. Due to patients' perception and according to the response on the stimulus, the electrodes were placed on the left in S4 11 times, 23 times in the left S3, 3 times in the right S3, once in the left S2 and once in the right S2. CONCLUSION: CT-guided electrode placement is safe for temporary (subchronic) and permanent (chronic) sacral nerve stimulation and provides a valuable means for placement of the stimulating material.

Comparison of a novel Aspergillus lateral-flow device and the Platelia® galactomannan assay for the diagnosis of invasive aspergillosis following haematopoietic stem cell transplantation.

PURPOSE: The detection of galactomannan in serum is a cornerstone for the diagnosis of invasive fungal disease (IFD). Because a delay in treatment initiation is associated with a poor outcome, the results have to be available promptly. However, due to methodological and economic reasons, the test frequencies of the commonly used galactomannan assays vary between daily to weekly, meaning that results may be available too late to be clinically useful. The novel Aspergillus lateral-flow device (Aspergillus-LFD) is a rapid test that may overcome these limitations. METHODS: We compared the diagnostic performance of the Aspergillus-LFD and the Platelia® Aspergillus EIA (GM-EIA) in serum from 101 patients during and after allogeneic haematopoietic stem cell transplantation (HSCT). Clinical data and sera were collected prospectively and patients classified according to the European Organisation for Research and Treatment of Cancer (EORTC)/Mycoses Study Group (MSG) 2008 guidelines. RESULTS: By the end of hospitalisation, one proven, nine probable and 20 possible cases of IFD were identified. Depending on the number of positive serum samples required for test positivity, the sensitivities, specificities and diagnostic odds ratios in patients with proven and probable IFD were as follows. One positive serum required: Aspergillus-LFD 40.0 %, 86.8 % and 3.03; GM-EIA 40.0 %, 89.0 % and 3.64. Two positive sera required: Aspergillus-LFD 20.0 %, 97.8 % and 11.13; GM-EIA 30.0 %, 98.9 % and 38.57. Although the GM-EIA was positive in a higher percentage of samples, this did not result in an earlier diagnosis. CONCLUSIONS: If used as a screening test (one positive serum required for test positivity) or to rule out IFD, the Aspergillus-LFD has shown a comparable diagnostic performance to the GM-EIA. However, if the results have to be confirmed by a second positive serum, the GM-EIA exhibited superior sensitivity. In terms of practicability, the Aspergillus-LFD has demonstrated to be a quick (15 min) and easy-to-use test for single-patient detection of Aspergillus antigens.

[Why radiologists should be concerned with semantics]. / Warum Radiologen sich mit Semantik befassen sollten.

Radiological image and data archives contain huge amounts of data which are barely utilized by current technologies. In the future semantic technologies currently under development will enable analysis of the contents not only on the level of individual patients but also along entire data collections thereby resulting in new applications that will benefit routine clinical practice, teaching activities and research. As a prerequisite the development of software for semantic analysis of image and report contents is necessary, i.e. an "understanding" of the contents by the software. Based on specific ontologies, standardized protocols and semantic image annotation new systems will be developed that make the content of these data archives accessible and support diagnosis, quality assurance, innovative research applications and last not least, the merging of data of different medical disciplines, such as radiology, pathology and clinical chemistry.

[Report template from the German Society of Urology and the German Radiological Society for standardized, structured reporting of native computed tomography scans in the diagnosis of urinary stones]. / Befundvorlage der Deutschen Gesellschaft für Urologie e. V. und der Deutschen Röntgengesellschaft zur standardisierten strukturierten Befundung von nativen Computertomographien in der Harnsteindiagnostik.

Standardized structured radiological reporting (SSRB) has been promoted in recent years. The aims of SSRB include that reports be complete, clear, understandable, and stringent. Repetitions or superfluous content should be avoided. In addition, there are advantages in the presentation of chronological sequences, tracking and correlations with structured findings from other disciplines and also the use of artificial intelligence (AI)-based methods. The development of the presented template for SSRB of native computed tomography for urinary stones followed the "process for the creation of quality-assured and consensus-based report templates as well as subsequent continuous quality control and updating" proposed by the German Radiological Society (DRG). This includes several stages of drafts, consensus meetings and further developments. The final version was published on the DRG website ( www.befundung.drg.de ). The template will be checked annually by the steering group and adjusted as necessary. The template contains 6 organ domains (e.g., right kidney) for which entries can be made for a total of 21 different items, mostly with selection windows. If "no evidence of stones" is selected for an organ in the first query, the query automatically jumps to the next organ, so that the processing can be processed very quickly despite the potentially high total number of individual queries for all organs. The German, European, and North American Radiological Societies perceive the establishment of a standardized structured diagnosis of tomographic imaging methods not only in oncological radiology as one of the current central tasks. With the present template for the description of computed tomographic findings for urinary stone diagnostics, we are presenting the first version of a urological template. Further templates for urological diseases are to follow.

[Variability of the screw position after 3D-navigated sacroiliac screw fixation. Influence of the surgeon's experience with the navigation technique]. / Variabilität der Schraubenlage bei 3D-navigierter Sakrumverschraubung. Einfluss der operateurspezifischen Navigationserfahrung.

BACKGROUND: The precision of sacroiliac screw placement can be improved with the use of navigation techniques. The purpose of this study was to evaluate the accuracy of 3D-navigated sacroiliac screw positioning in relation to the surgeon's experience with the navigation technique. PATIENTS AND METHODS: A consecutive series of 3D-navigated sacroiliac screw placements were prospectively evaluated between December 2005 and February 2008. Postoperatively the precision of screw placement was analyzed in relation to the surgeon's navigation experience with a CT-scan using the criteria of Smith. RESULTS: A total of 37 screws were implanted by 7 surgeons in 33 patients. In the group of surgeons with less experience in navigation techniques two cases of malpositioning led to revision of the screws. No screws which were implanted or assisted by surgeons experienced in navigation needed to be revised. There was no significant difference in the malposition rate. CONCLUSION: In the clinical setup a malpositioning of sacroiliac screws is possible even with the use of 3D navigation. One reason may be a low level of navigation experience of the surgeon in combination with low experience in the conventional technique. Therefore even in navigation-based placement of sacroiliac screws the malpositioning rate is dependent on the surgeon's experience with the navigation technique. The correct placement of the screws should be controlled intraoperatively using the 3D image intensifier.

3D-MSCT gastric pouch volumetry in bariatric surgery-preliminary clinical results.

BACKGROUND: Insufficient weight loss or persistent abdominal complaints are reasons for revisionary operations in bariatric surgery. The selection of the secondary procedure is influenced by clinical and by patho-anatomical factors like the size of the gastric pouch. The purpose of this study was to evaluate multi-slice computed tomography (MSCT)-based volumetric assessment of gastric pouches, gastric sleeves, and anastomoses in patients after bariatric surgery. METHODS: Twenty-six patients after bariatric surgery received abdominal MSCT immediately after oral administration of an ionic contrast agent solution and intravenous administration of buthylscopalamine. Indications were insufficient weight loss after primary operation, persistent upper abdominal complaints, and decline of bariatric analysis and reporting outcomes system (BAROS) score. The gastric volumes, diameter of the gastrojejunostomy, and the proximal part of the Roux limb were measured on volume rendering images and freely angulated reformations. RESULTS: Evaluation of gastric volumes was successful in 25 examinations (96%). The diameters of gastrojejunostomy as well as the dimensions of the Roux limb were evaluable in all cases. After gastric bypass surgery, a pouch volume >30 ml was found in ten, a widening of the gastrojejunostomy in eight, and a dilated Roux limb in six cases. Two patients presented a combination of a wide anastomosis and a strongly dilated Roux limb. Patients after biliopancreatic diversion had gastric volumes between 210 and 840 ml. Other findings were a fistula, an intragastral stenosis, and internal hernias. CONCLUSIONS: MSCT allows crucial patho-anatomical measurements and provides helpful information for selecting the appropriate revisionary operation after bariatric surgery.

[Efficient document management by introduction of a new, dynamic quality manual application according to DIN EN ISO 9001:2000]. / Effiziente Qualitätsmanagementdokumentation durch Einführung eines neuen, dynamischen Qualitätsmanagementhandbuchs nach DIN EN ISO 9001:2000.

PURPOSE: Evaluation of the impact of a new, dynamic computer-aided quality manual application (QMA) regarding the acceptance and efficiency of a quality management system (QMS) according to DIN EN ISO 9001:2000. MATERIALS AND METHOD: The QMA combines static pages of HTML with active content generated from an underlying database. Through user access rights, a hierarchy is defined to create and administer quality documents. Document workflow, feedback management and employee survey were analyzed to compare the performance of the new QMH with the formerly used static version. RESULTS: Integration of a document editor and automated document re-approval accelerated the document process by an average of 10 min. In spite of an increase of the yearly document changes of 60%, the administration effort was reduced by approximately 160 h. Integration of the feedback management system into the QMA decreased handling time from an average of 16.5 to 3.4 days. Simultaneously the number of feedback messages increased from 160 in 2005 to 306 in 2006. Employee satisfaction was raised (old: 3.19+/-1.02, new: 1.91+/-0.8). The number of users who partook in the QMA more than once a week also increased from 29.5% to 60%. CONCLUSION: The computer-aided quality manual application constitutes the basis for the success of our QMS. The possibility to actively participate in the quality management process has led to broad acceptance and usage by the employees. The administration effort was able to be tremendously decreased as compared to conventional QMS.

[The DICOM-CD-Project of the German Radiology Association--an overview of the content and results of a pilot study in 2006]. / Das DICOM-CD-Projekt der Deutschen Röntgengesellschaft--eine Ubersicht über die Inhalte und Ergebnisse des Pilottests 2006.

DICOM-CDs are frequently used for medical image data transfer. Many different potential advantages are known, such as improved image quality, handling simplification, and cost optimization. However, there are numerous restrictions in the daily routine. While testing DICOM-CDs at the 2006 German Radiology Congress, we found that more than 70 % of CDs have discrepancies with respect to data structure or content. The German Radiological Association and OFFIS started an initiative to improve the quality of DICOM-CDs. There are three main objectives: To provide requirements for vendors of CD-writing systems, to establish user guidelines for the handling of DICOM-CDs, and to develop a test procedure for DICOM-CDs. Radiologists using such systems should be aware of these developments and use them for RFP's.

Comparison of the Radiation Dose from Cone Beam Computed Tomography and Multidetector Computed Tomography in Examinations of the Hand.

PURPOSE: Comparison of radiation dose of cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) in examinations of the hand. MATERIALS AND METHODS: Dose calculations were carried out by means of Monte Carlo simulations in MDCT and CBCT. A corpse hand was examined in a 320-row MDCT scanner and a dedicated extremities CBCT scanner with standard protocols and multiple low-dose protocols. The image quality of the examinations was evaluated by 5 investigators using a Likert scale from 1 (very good) to 5 (very poor) regarding depiction of cortical bone, cancellous bone, joint surfaces, soft tissues and artifacts. For a sum of ratings of all structures < 50 a good overall image quality was expected. The studies with at least good overall image quality were compared with respect to the dose. RESULTS: The dose of the standard examination was 13.21 (12.96 to 13.46 CI) mGy in MDCT and 7.15 (6.99 to 7.30 CI) mGy in CBCT. The lowest dose in a study with good overall image quality was 4.54 (4.43 to 4.64 CI) mGy in MDCT and 5.72 (5.59 to 5.85 CI) mGy in CBCT. CONCLUSION: Although the dose of the standard protocols in the CBCT is lower than in the MDCT, the MDCT can realize a good overall image quality at a lower dose than the CBCT. Dose optimization of CT examination protocols for the hand is useful in both modalities, the MDCT has an even greater potential for optimization. KEY POINTS: • Low dose examinations of the hand are feasible in CBCT and MDCT.• In default settings CBCT has a lower dose than MDCT.• MDCT enables a good image quality at a lower dose than CBCT. Citation Format: • Neubauer J, Neubauer C, Gerstmair A et al. Comparison of the Radiation Dose from Cone Beam Computed Tomography and Multidetector Computed Tomography in Examinations of the Hand. Fortschr Röntgenstr 2016; 188: 488 - 493.

[Application possibilities and initial experience with digital volume tomography in hand and wrist imaging]. / Digitale Volumentomografie (DVT) des knöchernen Handskeletts: Erste Erfahrungen und Anwendungsmöglichkeiten.

During the last decade, DVT (digital volume tomography) imaging has become a widely used standard technique in head and neck imaging. Lower radiation exposure compared to conventional computed tomography (MDCT) has been described. Recently, DVT has been developed as an extremity scanner and as such represents a new imaging technique for hand surgery. We here describe the first 24 months experience with this new imaging modality in hand and wrist imaging by presenting representative cases and by describing the technical background. Furthermore, the method's advantages and disadvantages are discussed with reference to the given literature.

Comparison between a screen-film system and a selenium radiography system. An ROC study using simulated thoracic lesions.

RATIONALE AND OBJECTIVES: To evaluate the diagnostic image quality of the hard copies of a commercially available selenium detector-based computed radiography system compared to that of a conventional screen-film system. METHODS: Ten radiographs of an anthropomorphic chest phantom with simulated nodular and linear-reticular lesions were produced using either system. Each radiograph was subdivided into 15 fields containing zero lesions, one nodular lesion, one linear-reticular lesion, or both lesions. The total of 150 fields for each modality was reviewed by six radiologists, and receiver operating analysis was performed. RESULTS: The conventional screen-film system performed significantly better for nodular lesions, whereas no statistically significant difference was found between the detection rates of both systems for linear-reticular lesions. CONCLUSIONS: The better detection of nodules with the dedicated selenium detector can be explained by the higher dynamic range of the system. Detection of linear-reticular lesions was slightly but not significantly better with the screen-film system, but the detection rate of the selenium detector might be further improved with a different image processing technique.

Pelvic imaging with a selenium-based detector (Thoravision). Comparison with screen-film radiography in 75 patients.

OBJECTIVE: To evaluate whether the selenium detector (Thoravision) provides sufficient diagnostic confidence in digital pelvic imaging compared with a conventional screen-film combination. METHODS: In 75 patients, pelvic imaging with conventional screen-film and isodose selenium radiography using a dedicated postprocessing mode was compared independently by three radiologists. The depiction of cortical and cancellous bone was evaluated in the iliac wings, sacral and pubic bones, acetabulum, femoral head, and trochanter. Demarcation of soft tissue was assessed in the iliac and trochanteric region. RESULTS: Visualization of cortical bone and soft tissue in the iliac area as well as soft tissue and cortical and cancellous bone in the trochanteric region was significantly superior with the selenium detector. However, conventional imaging was better in the trabecular bone of the sacral region, where results with the selenium system were particularly poor. CONCLUSIONS: The selenium detector (Thoravision) is advantageous in imaging soft tissue adjacent to the iliac wings and the trochanter, but results for the cancellous sacral bone are poor. Further modifications of postprocessing modes may lead to improved depiction of this critical pelvic area.

[Image quality of paper prints compared to film copies in CT investigations]. / Bildqualität von Papierausdrucken zur Befunddokumentation im Vergleich zu Laserfilmen bei MSCT-Untersuchungen.

PURPOSE: Evaluation of image quality of paper prints in routine CT investigations. METHOD: The image quality of paper prints from 104 CT scans of daily routine investigations was analysed by three observer three observers according to a five-point ranking scale for contrast, grey level, spatial resolution, and subjective confidence in correct evaluation. Each study was rated "acceptable" or "not acceptable for documentation". RESULTS: In 312 ratings the mean grade for contrast was 2.7, for grey levels 3.2, and for spatial resolution 3.3. Grades ranged from 1 = very good to 5 = insufficient. Subjective confidence in correct evaluation was rated as "certain" in 77.4 %, "likely" in 18.4 % and "impossible to evaluate" in 4.2 % of cases. 93.7 % of printed CT images were rated "acceptable for documentation". CONCLUSION: Image quality of paper prints does not reach the quality of laser films concerning its contrast, grey levels, and spatial resolution. Nevertheless, paper prints are acceptable for documentation of findings in most CT investigations. A high confidence in correct evaluation was found. Limitations are found in documentation of small coin lesions of the lung and ischemic lesions of the neurocranium.

Background suppression using magnetization preparation for contrast-enhanced 3D MR angiography of the pelvic and lower leg arteries.

PURPOSE: To develop and evaluate non-slab-selective magnetization preparation in contrast-enhanced 3D-MR angiography. METHODS: An ultrafast spoiled mr angiography sequence (FLASH) with non-selective inversion prepulses for background suppression was implemented on a 1.5 T MR system. In 11 patients gadobenate dimeglumine-enhanced mr-angiography of the pelvic and lower leg arteries was performed using the AngioSURF device. Source data was evaluated for contrast-to-noise-ratio, image quality and the extent of background suppression. RESULTS: Background suppression and selective vessel contrast was excellent in all vascular levels. The mr protocol was comfortable and easy-to-handle. Abandonment of precontrast-series acquisition simplified the examination procedure markedly. CONCLUSIONS: Magnetization preparation provides efficient suppression of the background signal in contrast-enhanced 3D mr angiography of the pelvic and lower leg arteries. Since no subtraction technique is needed, moving-bed and whole body MRA-protocols can be simplified significantly.