ABSTRACT
Computed tomography (CT) examinations involve relatively high doses to patients. The objectives of this study were to optimise the radiation dose for patient during CT chest scan and to estimate the lifetime cancer risk. A total of 50 patients were studied: control group (A) (38 patients) and optimisation group (B) (12 patients). The optimisation protocol was based on CT pitch increment and lowering tube current. The mean volume CT dose index (CTDI vol) was 21.17 mGy and dose length product (DLP) was 839.0 mGy cm for Group A, and CTDI vol was 8.3 mGy and DLP was 339.7 for Group B. The overall cancer risk was estimated to be 8.0 and 3.0 cancer incidence per million for Groups A and B, respectively. The patient dose optimisation during CT chest was investigated. Lowering tube current and pitch increment achieved a radiation dose reduction of up to 60 % without compromising the diagnostic findings.
Subject(s)
Radiation Dosage , Radiation Protection/methods , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Body Mass Index , Female , Humans , Male , Middle Aged , Monte Carlo Method , Neoplasms, Radiation-Induced/prevention & control , Radiometry , Risk , Tomography Scanners, X-Ray Computed , Young AdultABSTRACT
PURPOSE: The aim of this study was to determine the outcome of lumbar punctures (LPs) in critically ill medical patients and how likely the results were to change case management. MATERIALS AND METHODS: A retrospective review was conducted on the medical records of all 168 patients who underwent LP during their medical intensive care unit (MICU) admission at a university hospital during a 4.5-year period beginning in January 2000. RESULTS: Lumbar puncture was performed a mean of 2.8 days after MICU admission. The most common symptoms that prompted LP were changes in mental status and fever. Seventy-four percent of patients were on antibiotics at the time of LP, and 98% of patients had a computed tomography scan of the head performed before the procedure. Lumbar puncture confirmed meningitis in 47 (30%) patients and provided a specific bacteriologic diagnosis in 5 (3%) patients. The results of the procedure led to a change in management in 50 (30%) patients. The presence of meningeal signs and use of antibiotics at the time of the procedure were the factors that predicted change in management. CONCLUSION: Although the likelihood that LP will yield a specific bacteriologic diagnosis in critically ill patients is low, the procedure frequently provides important information that can lead to a change in case management, most commonly de-escalation of antibiotic therapy.
Subject(s)
Meningitis/diagnosis , Meningitis/drug therapy , Spinal Puncture/methods , APACHE , Anti-Bacterial Agents/therapeutic use , Critical Illness , Female , Humans , Intensive Care Units , Logistic Models , Male , Meningitis/diagnostic imaging , Meningitis/microbiology , Middle Aged , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Formerly a fatal condition, Wegener's granulomatosis is now treated with good results. Although the annual incidence of Wegener's granulomatosis in the general population is not known, most European and American studies revealed an incidence in the range of one for every 250,000 of the population. The estimated total population of Bahrain as of June 1997 is 586,110; here we report the first diagnosed case of Wegener's granulomatosis in Bahrain. Our patient presented with epistaxis, and from the clinical features, the very high ESR, the operative, histopathological and the radiological findings, and a high index of suspicion we could confirm the diagnosis along with the appropriate immunological test (positive cANCA). Standard treatment with cytotoxic agents and corticosteroids has been used. On follow-up the patient has shown a progressive improvement in her clinical and laboratory parameters.
