Determination of a suitable low-dose abdominopelvic CT protocol using model-based iterative reconstruction through cadaveric study.

INTRODUCTION: Cadaveric studies provide a means of safely assessing new technologies and optimizing scanning prior to clinical validation. Reducing radiation exposure in a clinical setting can entail incremental dose reductions to avoid missing important clinical findings. The use of cadavers allows assessment of the impact of more substantial dose reductions on image quality. Our aim was to identify a suitable low-dose abdominopelvic CT protocol for subsequent clinical validation. METHODS: Five human cadavers were scanned at one conventional dose and three low-dose settings. All scans were reconstructed using three different reconstruction algorithms: filtered back projection (FBP), hybrid iterative reconstruction (60% FBP and 40% adaptive statistical iterative reconstruction (ASIR40)), and model-based iterative reconstruction (MBIR). Two readers rated the image quality both quantitatively and qualitatively. RESULTS: Model-based iterative reconstruction images had significantly better objective image noise and higher qualitative scores compared with both FBP and ASIR40 images at all dose levels. The greatest absolute noise reduction, between MBIR and FBP, of 34.3 HU (equating to a 68% reduction) was at the lowest dose level. MBIR reduced image noise and improved image quality even in CT images acquired with a mean radiation dose reduction of 62% compared with conventional dose studies reconstructed with ASIR40, with lower levels of objective image noise, superior diagnostic acceptability and contrast resolution, and comparable subjective image noise and streak artefact scores. CONCLUSION: This cadaveric study demonstrates that MBIR reduces image noise and improves image quality in abdominopelvic CT images acquired with dose reductions of up to 62%.

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.

Methodology to Calibrate Disc Degeneration in the Cervical Spine During Cyclic Fatigue Loading.

Prolonged exposure to vibrational working conditions can cause neck, back, and shoulder pain. Mechanical degradation of soft tissues resulting from this type of fatigue was experimentally shown to contribute to endplate and compression fractures. However, effects of repetitive subfailure loading on intervertebral disc (IVD) behavior have not been well defined. This manuscript describes a methodology to experimentally characterize changes in cervical spine IVD material properties under fatigue. Bone-disc-bone spinal units with intact ligaments obtained from human cervical spines were obtained and a lack of bony or soft tissue degeneration was confirmed using X-ray and MRI scans. Cranial and caudal specimen extents were fixed in PMMA to facilitate attachment to testing devices. Baseline response was quantified using flexion/extension pure moment protocols. Specimens were immersed in a 34-deg-C saline bath and allowed to acclimate for one hour. A stress-relaxation test was then performed and viscoelasticity quantified using a quasi linear viscoelastic (QLV) material model. Fatigue testing was performed for up to 50,000 cycles with intermittent viscoelasticity, pure moment testing, and imaging scans performed to quantify cycle-dependent changes in disc properties. Preliminary results demonstrated progressive changes in viscoelasticity and bending response of cervical spine segments with increasing number of load cycles. This procedure will be used to quantify degradation of the IVD under repetitive compressive loads, focusing on effects of loading magnitude and frequency.