Dual-Source Computed Tomography of the Chest in Blunt Thoracic Trauma: Reduced Aortic Motion Using a Novel Temporal Resolution Optimization Method.

PURPOSE: The purpose of this study was to evaluate the clinical utility of temporal resolution optimization (TR-Opt), a computed tomography (CT) postprocessing technique, in reducing aortic motion artifacts in blunt thoracic trauma patients. MATERIALS AND METHODS: This was an IRB-approved study of 61 patients with blunt thoracic trauma carried out between February 18 and September 6, 2014; the patients had been imaged using a standardized dual-source high-pitch (DSHP) CT protocol. Image raw data were retrospectively postprocessed using the TR-Opt algorithm (DSHP-TR-Opt) and compared with conventional images (DSHP). Diagnostic ability to confidently identify and exclude potential injuries and qualitative aortic motion artifacts using a 5-point Likert scale (1=absence of motion artifacts; 5=severe motion artifact) was graded by 2 readers at multiple thoracic locations. Signal-to-noise and contrast-to-noise ratios were generated as quantitative indices of image quality. RESULTS: Motion artifacts degrading interpretation and limiting diagnosis of aortic injuries were present in 45% (442/976) of the assessed regions on DSHP. TR-Opt algorithm eliminated motion artifacts in 85% of the motion-degraded areas (375/442), leaving persistent motion artifacts in only 15% (67/442). Motion artifacts were most improved at the interventricular septum (1±1 vs. 3±1), aortic valve (2±1 vs. 4±1.5), and ascending aorta (1±1 vs. 3±2, P<0.005). Mean aorta noise (NAo) was 41.7% higher in the DSHP-TR-Opt images (26.5 vs. 18.7 HU, P<0.0001). CONCLUSIONS: Temporal resolution optimized reconstruction is a raw data-based CT postprocessing technique that can be used to remove the majority of thoracic aortic motion artifacts that commonly degrade interpretation when imaging blunt thoracic trauma patients.

Dual-Energy CT in Evaluation of the Acute Abdomen.

Evaluation of the nontraumatic acute abdomen with multidetector CT has long been accepted and validated as the reference standard in the acute setting. Dual-energy CT has emerged as a promising tool, with multiple clinical applications in abdominal imaging already demonstrated. With its ability to allow characterization of materials on the basis of their differential attenuation when imaged at two different energy levels, dual-energy CT can help identify the composition of internal body constituents. Therefore, it is possible to selectively identify iodine to assess the enhancement pattern of an organ, including the identification of hyperenhancement in cases of inflammatory processes, or ischemic changes secondary to vascular compromise. Quantification of iodine uptake with contrast material-enhanced dual-energy CT is also possible, and this quantification has been suggested to be useful in differentiating inflammatory from neoplastic conditions. Dual-energy CT can help determine the composition of gallstones and urolithiasis and can be used to accurately differentiate uric acid urinary calculi from non-uric acid urinary calculi. Moreover, dual-energy CT is capable of substantially reducing artifacts caused by metallic prostheses, to improve the imaging evaluation of abdominopelvic organs. The possibility of creating virtual nonenhanced images in the evaluation of acute aortic syndrome, gastrointestinal hemorrhage and ischemia, or pancreatic pathologic conditions substantially reduces the radiation dose delivered to the patient, by eliminating a true nonenhanced acquisition. Finally, by increasing the iodine conspicuity, contrast-enhanced dual-energy CT can render an area of free active extravasation or endoleak more visible, compared with conventional single-energy CT. This article reviews the basics of dual-energy CT and highlights its main clinical applications in evaluation of the nontraumatic acute abdomen. ©RSNA, 2019.

CCTA in patients with positive troponin and low clinical suspicion for ACS: a useful diagnostic option to exclude obstructive CAD.

PURPOSE: It is uncertain whether patients with elevated troponin and non-classical presentation of acute coronary syndrome (ACS) should receive coronary CT angiography (CCTA). A proportion of these patients will have no coronary artery disease (CAD) and would benefit from non-invasive investigations and expedited discharge. Objectives were to determine most common diagnoses and rate of ACS among patients with positive troponin and low clinical suspicion of ACS who received CCTA. METHODS: IRB approved retrospective analysis of 491 consecutive patients in a level I trauma center ED referred for CCTA between April 4, 2015 to April 2, 2017. Patients were included if there was an elevated troponin (TnI > 0.045 µg/L) and atypical chest pain within 24 h prior to imaging. One hundred one patients met inclusion criteria; 17 excluded due to technical factors or history. Scans performed on dual-source CT. RESULTS: Eighty-four patients (47 men, 37 women) with median TnI of 0.11 ± 0.21 µg/L underwent CCTA 8.20 ± 6.41 h after first elevated Tn. Mean age was 53.2 ± 14.6 years. CCTA demonstrated absence of CAD in 39 patients (46.4%; 20 M, 19 F). CAD < 25% stenosis was observed in 24 (28.6%; 9 M, 15 F). CAD with 25-50% stenosis was observed in seven (8.3%; six M, one F). CAD > 50% stenosis was observed in 11 (13.1%; 9 M, 2 F), and non-diagnostic in three (3.6%, 3 M, 0 F). Forty-six (56.8%) were discharged directly from ED with median stay 15.82 ± 6.41 h. CONCLUSIONS: Use of CCTA in ED patients with elevated troponin and low clinical suspicion for ACS allowed obstructive CAD to be excluded in 83%.

Virtual monoenergetic reconstruction of contrast-enhanced CT scans of the abdomen and pelvis at 40 keV improves the detection of peritoneal metastatic deposits.

PURPOSE: To evaluate the role of virtual monoenergetic imaging (VMI) in the detection of peritoneal metastatic disease in contrast-enhanced computed tomography (CT) of the abdomen and pelvis and to compare this technique to the conventional 120 kV mixed dataset. MATERIALS AND METHODS: Institutional review board approval was obtained with no informed consent required for this retrospective analysis. 43 consecutive patients with histopathologically confirmed peritoneal disease were scanned using a standard protocol on a 128-section dual-source, dual-energy CT system (100/140 keV). Scans were retrospectively reconstructed at VMI energy levels from 40-110 keV in 10 keV increments and were analyzed both quantitatively and qualitatively. CNR values for peritoneal metastatic deposits were recorded using region of interest (ROI) analysis at each energy level for all VMI datasets. Subjective analysis was performed by two independent fellowship-trained readers with combined experience of greater than 15 years. Qualitative parameters included diagnostic acceptability, subjective noise, and contrast resolution and confidence. RESULTS: The contrast-to-noise ratios (CNRs) for peritoneal metastatic deposits at the different VMI energy levels were compared using a one-way ANOVA with Tukey Post Test, and the optimal CNR was observed at 40 keV (p < 0.0001). Qualitative parameters were compared using a Paired T Test. Subjective noise, diagnostic acceptability, and contrast resolution was significantly better on the conventional images, but readers reported increased confidence on VMI at 40 keV (p < 0.001). CONCLUSION: VMI reconstruction of contrast-enhanced dual-energy CT scans of the abdomen and pelvis at 40 keV maximizes the conspicuity of metastatic peritoneal deposits and improves radiologists' diagnostic confidence compared with conventional CT images. We recommend using virtual monoenergetic datasets at 40 keV as a tool for improving the detection of these lesions in routine clinical practice.

Evaluation of the proximal coronary arteries in suspected pulmonary embolism: diagnostic images in 51% of patients using non-gated, dual-source CT pulmonary angiography.

PURPOSE: This retrospective study reports the frequency and severity of coronary artery motion on dual-source high-pitch (DSHP), conventional pitch single-source (SS), and dual-source dual-energy (DE) CT pulmonary angiography (CTPA) studies. METHODS: Two hundred eighty-eight consecutive patients underwent CTPA scans for suspected pulmonary embolism between September 1, 2013 and January 31, 2014. One hundred ninety-four at DSHP scans, 57 SS scans, and 37 DE scans were analyzed. Coronary arteries were separated into nine segments, and coronary artery motion was qualitatively scored using a scale from 1 to 4 (non-interpretable to diagnostic with no motion artifacts). Signal intensity, noise, and signal to noise ratio (SNR) of the aorta, main pulmonary artery, and paraspinal muscles were also assessed. RESULTS: DSHP CTPA images had significantly less coronary artery motion, with 30.1% of coronary segments being fully evaluable compared to 4.2% of SS segments and 7.9% of DE segments (p < 0.05 for all comparisons). When imaging with DSHP, the proximal coronary arteries were more frequently evaluable than distal coronary arteries (51% versus 11.3%, p < 0.001). Without ECG synchronization and heart rate control, the distal left anterior descending coronary artery and mid right coronary artery remain infrequently interpretable (7% and 9%, respectively) on DSHP images. CONCLUSIONS: DSHP CTPA decreases coronary artery motion artifacts and allows for full evaluation of the proximal coronary arteries in 51% of cases. The study highlights the increasing importance of proximal coronary artery review when interpreting CTPA for acute chest pain.

Low-Dose Computed Tomography for the Optimization of Radiation Dose Exposure in Patients with Crohn's Disease.

Magnetic resonance imaging (MRI) is the mainstay method for the radiological imaging of the small bowel in patients with inflammatory bowel disease without the use of ionizing radiation. There are circumstances where imaging using ionizing radiation is required, particularly in the acute setting. This usually takes the form of computed tomography (CT). There has been a significant increase in the utilization of computed tomography (CT) for patients with Crohn's disease as patients are frequently diagnosed at a relatively young age and require repeated imaging. Between seven and eleven percent of patients with IBD are exposed to high cumulative effective radiation doses (CEDs) (>35-75 mSv), mostly patients with Crohn's disease (Newnham E 2007, Levi Z 2009, Hou JK 2014, Estay C 2015). This is primarily due to the more widespread and repeated use of CT, which accounts for 77% of radiation dose exposure amongst patients with Crohn's disease (Desmond et al., 2008). Reports of the projected cancer risks from the increasing CT use (Berrington et al., 2007) have led to increased patient awareness regarding the potential health risks from ionizing radiation (Coakley et al., 2011). Our responsibilities as physicians caring for these patients include education regarding radiation risk and, when an investigation that utilizes ionizing radiation is required, to keep radiation doses as low as reasonably achievable: the "ALARA" principle. Recent advances in CT technology have facilitated substantial radiation dose reductions in many clinical settings, and several studies have demonstrated significantly decreased radiation doses in Crohn's disease patients while maintaining diagnostic image quality. However, there is a balance to be struck between reducing radiation exposure and maintaining satisfactory image quality; if radiation dose is reduced excessively, the resulting CT images can be of poor quality and may be nondiagnostic. In this paper, we summarize the available evidence related to imaging of Crohn's disease, radiation exposure, and risk, and we report recent advances in low-dose CT technology that have particular relevance.

Epiploic appendagitis: 7-year experience and relationship with visceral obesity.

PURPOSE: Location, size, and local inflammatory findings in primary epiploic appendagitis (EA) have not been reported outside of small studies. The association between EA and increased adiposity is controversial. The goals of this project are to compare demographics and imaging-based measurements of adiposity between patients with EA and patients with acute abdomen without EA, and to identify CT features of EA. METHODS: A consecutive sample of acute, primary EA (n = 100), and control (acute abdomen; n = 100) was selected retrospectively. Cases of suspected EA were included if they had the characteristic ovoid fatty mass and hyperattenuated ring sign on CT. Abdominal adipose volume (AAV), visceral adipose area (VAA), and subcutaneous adipose area (SAA) were quantified by CT. Location, size, and frequency of coexisting local inflammatory findings in EA patients were recorded. RESULTS: EA had 60% greater AAV, 117% greater VAA, and 35% greater SAA than control subjects (p < 0.0001). Males composed a great proportion of the EA group (67%) than the control group (41%) (p = 0.0002). Inflamed appendage was found in sigmoid colon in 49% of cases, descending colon in 23%, and right colon in 19%. Peritoneal thickening was frequent (76%) and bowel wall thickening was common (47%). Diverticulosis coexisted incidentally in 28%. CONCLUSION: EA is associated with increased abdominal adipose tissue. EA can occur in both sexes at any age, but occurs at age 50 on average and more frequently in males. Patient with EA exhibited central hyperdense dot (79%), peritoneal thickening (76%), and bowel wall thickening (47%).

Body composition determinants of radiation dose during abdominopelvic CT.

OBJECTIVES: We designed a prospective study to investigate the in-vivo relationship between abdominal body composition and radiation exposure to determine the strongest body composition predictor of dose length product (DLP) at CT. METHODS: Following institutional review board approval, quantitative analysis was performed prospectively on 239 consecutive patients who underwent abdominopelvic CT. DLP, BMI, volumes of abdominal adipose tissue, muscle, bone and solid organs were recorded. RESULTS: All measured body composition parameters correlated positively with DLP. Linear regression (R2 = 0.77) revealed that total adipose volume was the strongest predictor of radiation exposure [B (95% CI) = 0.027(0.024-0.030), t=23.068, p < 0.001]. Stepwise linear regression using DLP as the dependent and BMI and total adipose tissue as independent variables demonstrated that total adipose tissue is more predictive of DLP than BMI [B (95% CI) = 16.045 (11.337-20.752), t=6.681, p < 0.001]. CONCLUSIONS: The volume of adipose tissue was the strongest predictor of radiation exposure in our cohort. MAIN MESSAGE: • Individual body composition variables correlate with DLP at abdominopelvic CT. • Total abdominal adipose tissue is the strongest predictor of radiation exposure. • Muscle volume is also a significant but weaker predictor of DLP.

Detection of Bone Marrow Edema in Nondisplaced Hip Fractures: Utility of a Virtual Noncalcium Dual-Energy CT Application.

Purpose To quantify the sensitivity and specificity of dual-energy computed tomographic (CT) virtual noncalcium images in the detection of nondisplaced hip fractures and to assess whether obtaining these images as a complement to bone reconstructions alters sensitivity, specificity, or diagnostic confidence. Materials and Methods The clinical research ethics board approved chart review, and the requirement to obtain informed consent was waived. The authors retrospectively identified 118 patients who presented to a level 1 trauma center emergency department and who underwent dual-energy CT for suspicion of a nondisplaced traumatic hip fracture. Clinical follow-up was the standard of reference. Three radiologists interpreted virtual noncalcium images for traumatic bone marrow edema. Bone reconstructions for the same cases were interpreted alone and then with virtual noncalcium images. Diagnostic confidence was rated on a scale of 1 to 10. McNemar, Fleiss κ, and Wilcoxon signed-rank tests were used for statistical analysis. Results Twenty-two patients had nondisplaced hip fractures and 96 did not have hip fractures. Sensitivity with virtual noncalcium images was 77% and 91% (17 and 20 of 22 patients), and specificity was 92%-99% (89-95 of 96 patients). Sensitivity increased by 4%-5% over that with bone reconstruction images alone for two of the three readers when both bone reconstruction and virtual noncalcium images were used. Specificity remained unchanged (99% and 100%). Diagnostic confidence in the exclusion of fracture was improved with combined bone reconstruction and virtual noncalcium images (median score: 10, 9, and 10 for readers 1, 2, and 3, respectively) compared with bone reconstruction images alone (median score: 9, 8, and 9). Conclusion When used as a supplement to standard bone reconstructions, dual-energy CT virtual noncalcium images increased sensitivity for the detection of nondisplaced traumatic hip fractures and improved diagnostic confidence in the exclusion of these fractures. © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 17, 2017.

CT of the head for acute stroke: Diagnostic performance of a tablet computer prior to intravenous thrombolysis.

INTRODUCTION: The authors propose that tablet computers could benefit patients with acute stroke in the remote care setting, where time to and accuracy of CT interpretation greatly influences patient outcome. METHODS: One hundred and fifty consecutive patients who presented to the Emergency Department of a tertiary referral neurosciences centre within a time window suitable for intravenous thrombolytic therapy were included. Images were wirelessly transmitted to a tablet computer (iPad 3rd Generation, model = A1430, Apple, Cupertino, CA) and were reviewed by radiologists with three levels of experience for signs of intracranial haemorrhage, large vessel occlusion and parenchymal infarction. Reference standard interpretation was performed by two neuroradiologists using a diagnostic monochrome display. RESULTS: Consensus neuroradiologist review on the tablet display found and correctly classified all of the 23 cases of intracranial haemorrhage including 21 cases of parenchymal haematoma, two cases of petechial haemorrhage and one patient with an acute subdural haematoma. Less experienced readers missed cases of petechial and subdural haematomas. There was excellent agreement between the tablet and diagnostic monochrome display in cases with no infarct or extensive parenchymal infarction. CONCLUSIONS: Tablet computers can be used to facilitate rapid preliminary CT interpretation in patients with acute stroke in the remote setting.

Top 50 Highly Cited Articles on Dual Energy Computed Tomography (DECT) in Abdominal Radiology: A Bibliometric Analysis.

This study aims to identify the 50 most highly cited articles on dual energy computed tomography (DECT) in abdominal radiology Thomson Reuters Web of Science All Databases was queried without year or language restriction. Only original research articles with a primary focus on abdominal radiology using DECT were selected. Review articles, meta-analyses, and studies without human subjects were excluded. Fifty articles with the highest average yearly citation were identified. These articles were published between 2007 and 2017 in 12 journals, with the most in Radiology (12 articles). Articles had a median of 7 authors, with all first authors but one primarily affiliated to radiology departments. The United States of America produced the most articles (16), followed by Germany (13 articles), and China (7 articles). Most studies used Dual Source DECT technology (35 articles), followed by Rapid Kilovoltage Switching (14 articles), and Sequential Scanning (1 article). The top three scanned organs were the liver (24%), kidney (16%), and urinary tract (15%). The most commonly studied pathology was urinary calculi (28%), renal lesion/tumor (23%), and hepatic lesion/tumor (20%). Our study identifies intellectual milestones in the applications of DECT in abdominal radiology. The diversity of the articles reflects on the characteristics and quality of the most influential publications related to DECT.

Accurate tissue characterization in low-dose CT imaging with pure iterative reconstruction.

INTRODUCTION: We assess the ability of low-dose hybrid iterative reconstruction (IR) and 'pure' model-based IR (MBIR) images to maintain accurate Hounsfield unit (HU)-determined tissue characterization. METHODS: Standard-protocol (SP) and low-dose modified-protocol (MP) CTs were contemporaneously acquired in 34 Crohn's disease patients referred for CT. SP image reconstruction was via the manufacturer's recommendations (60% FBP, filtered back projection; 40% ASiR, Adaptive Statistical iterative Reconstruction; SP-ASiR40). MP data sets underwent four reconstructions (100% FBP; 40% ASiR; 70% ASiR; MBIR). Three observers measured tissue volumes using HU thresholds for fat, soft tissue and bone/contrast on each data set. Analysis was via SPSS. RESULTS: Inter-observer agreement was strong for 1530 datapoints (rs > 0.9). MP-MBIR tissue volume measurement was superior to other MP reconstructions and closely correlated with the reference SP-ASiR40 images for all tissue types. MP-MBIR superiority was most marked for fat volume calculation - close SP-ASiR40 and MP-MBIR Bland-Altman plot correlation was seen with the lowest average difference (336 cm3 ) when compared with other MP reconstructions. CONCLUSIONS: Hounsfield unit-determined tissue volume calculations from MP-MBIR images resulted in values comparable to SP-ASiR40 calculations and values that are superior to MP-ASiR images. Accuracy of estimation of volume of tissues (e.g. fat) using segmentation software on low-dose CT images appears optimal when reconstructed with pure IR.

Dual-Energy CT for the Musculoskeletal System.

The principal advantages of dual-energy computed tomography (CT) over conventional CT in the musculoskeletal setting relate to the additional information provided regarding tissue composition, artifact reduction, and image optimization. This article discusses the manifestations of these in clinical practice-urate and bone marrow edema detection, metal artifact reduction, and tendon analysis, with potential in arthrography, bone densitometry, and metastases surveillance. The basic principles of dual-energy CT physics and scanner design will also be discussed. © RSNA, 2016.

Low-Dose Carotid Computed Tomography Angiography Using Pure Iterative Reconstruction.

UNLABELLED: The aim of this study was to assess if a low-dose carotid computed tomography angiography (CTA) performed with pure iterative reconstruction (IR) is comparable to a conventional dose CTA protocol. METHODS: Twenty patients were included. Radiation dose was divided into a low-dose acquisition reconstructed with pure IR and a conventional dose acquisition reconstructed with 40% hybrid IR. Dose, image noise, contrast resolution, spatial resolution, and carotid artery stenosis were measured. RESULTS: Mean effective dose was significantly lower for low-dose than conventional dose studies (1.84 versus 3.71 mSv; P < 0.001). Subjective image noise, contrast resolution, and spatial resolution were significantly higher for the low-dose studies. There was excellent agreement for stenosis grading accuracy between low- and conventional dose studies (Cohen κ = 0.806). CONCLUSIONS: A low-dose carotid CTA protocol reconstructed with pure IR is comparable to a conventional dose CTA protocol in terms of image quality and diagnostic accuracy while enabling a dose reduction of 49.6%.

Virtual monoenergetic reconstruction of contrast-enhanced dual energy CT at 70keV maximizes mural enhancement in acute small bowel obstruction.

PURPOSE: In patients with small bowel obstruction (SBO), it is challenging to detect early ischemia. The purpose of this study is to evaluate the quantitative and qualitative benefits of virtual monoenergetic image (VMI) reconstruction in the assessment of small bowel mural enhancement on dual source dual energy computed tomography (CT) scans of the abdomen. MATERIALS AND METHODS: Institutional review board approval was obtained, for this retrospective analysis. 72 consecutive patients with acute SBO were scanned using a second generation 128-slice dual source, CT system. Images were reconstructed at VMI energy levels from 40 to 110keV in 10keV increments and were analysed quantitatively and qualitatively. Contrast to noise ratios (CNR) and signal to noise ratios (SNR) for mural enhancement were recorded for all VMI datasets and compared to conventional polychromatic images (PCI) at 120kVp. Subjective analysis of mural enhancement on VMI and PCI was performed by 3 blinded readers. RESULTS: Optimal CNR values for small intestinal mural enhancement were observed at 70keV. Qualitative assessment revealed that there was no statistical difference in diagnostic accuracy between VMI and PCI. All readers reported improved confidence when assessing the contrast enhancement on the 70keV VMI dataset and in our series, 2 additional cases of ischemia were identified on this reconstruction. CONCLUSION: Contrast-enhanced dual source dual energy CT with VMI reconstruction at 70keV maximizes the CNR of small bowel mural enhancement and increases the overall diagnostic confidence in assessing mural enhancement in patients with SBO.

Pure Iterative Reconstruction Improves Image Quality in Computed Tomography of the Abdomen and Pelvis Acquired at Substantially Reduced Radiation Doses in Patients With Active Crohn Disease.

UNLABELLED: We assessed diagnostic accuracy and image quality of modified protocol (MP) computed tomography (CT) of the abdomen and pelvis reconstructed using pure iterative reconstruction (IR) in patients with Crohn disease (CD). METHODS: Thirty-four consecutive patients with CD were referred with suspected extramural complications. Two contemporaneous CT datasets were acquired in all patients: standard protocol (SP) and MP. The MP and SP protocols were designed to impart radiation exposures of 10% to 20% and 80% to 90% of routine abdominopelvic CT, respectively. The MP images were reconstructed with model-based IR (MBIR) and adaptive statistical IR (ASIR). RESULTS: The MP-CT and SP-CT dose length product were 88 (58) mGy.cm (1.27 [0.87] mSv) and 303 [204] mGy.cm (4.8 [2.99] mSv), respectively (P < 0.001). Median diagnostic acceptability, spatial resolution, and contrast resolution were significantly higher and subjective noise scores were significantly lower on SP-ASIR 40 compared with all MP datasets. There was perfect clinical agreement between MP-MBIR and SP-ASIR 40 images for detection of extramural complications. CONCLUSIONS: Modified protocol CT using pure IR is feasible for assessment of active CD.

Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan.

In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior training drills. Over the recent decades, imaging has increasingly been used to evaluate critically ill patients. It can also be used to increase the accuracy of triaging MCI victims, since overtriage (falsely higher triage category) and undertriage (falsely lower triage category) can severely impact resource availability and mortality rates, respectively. This article emphasizes the importance of including the radiology department in hospital preparations for a MCI and highlights factors expected to influence performance during hospital DMP activation including issues pertinent to effective simulation, such as establishing proper learning objectives. After-action reviews including performance evaluation and debriefing on issues are invaluable following simulation drills and DMP activation, in order to improve subsequent preparedness. Historically, most hospital DMPs have not adequately included radiology department operations, and they have not or to a little extent been integrated in the DMP activation simulation. This article aims to increase awareness of the need for radiology department engagement in order to increase radiology department preparedness for DMP activation after a MCI occurs.

Getting the Most From Your Dual-Energy Scanner: Recognizing, Reducing, and Eliminating Artifacts.

OBJECTIVE: Dual-energy CT (DECT) is an innovative imaging modality that allows superior detection of pulmonary embolism, enhanced detection of urate in gout, and improved assessment of metal prostheses when compared with conventional CT. CONCLUSION: The primary aim of this review is to describe these DECT protocols and compare each to its respective diagnostic reference standards. Moreover, this review will describe how to recognize, reduce, and eliminate DECT artifacts, thereby maximizing its diagnostic capabilities.