Awareness of radiation risks from CT scans among patients and providers and obstacles for informed decision-making.

INTRODUCTION: Using the study design from a prominent 2004 study, we aimed to reassess patient, provider, and radiologist awareness of CT radiation more than a decade later. METHODS: Adults presenting to the emergency department of a tertiary care center over a 2-week period with mild to moderate pain requiring an abdominopelvic CT scan were surveyed. Patients were asked if anyone had discussed the risks/benefits of the CT scan including radiation dose and were asked to estimate their dose compared to a chest X-ray. Emergency providers and radiologists were given similar surveys and were asked about potential obstacles to discussing CT radiation with patients. RESULTS: A total of 101 patients, 570 emergency providers, and 161 radiologists were surveyed. Twenty-three percent (14/61) of patients, 39% (219/568) of emergency providers, and 48% (77/161) of radiologists correctly selected the radiation dose range of an abdominopelvic CT. Seventy-eight percent (441/567) of emergency providers reported routinely discussing radiation dose with patients, while 20% (20/98) of patients reported that their emergency provider discussed radiation dose with them. Time limitation and concern of dissuading the patient from CT were the most commonly reported obstacles for discussing risks. CONCLUSIONS: Patients and providers in 2015 appear to be more aware of radiation dose from CT than they were in 2004. Discussion of CT scan radiation exposure and associated risks only occurs sometimes and may actually occur less frequently than perceived by emergency providers.

Survey of gadolinium-based contrast agent utilization among the members of the Society for Pediatric Radiology: a Quality and Safety Committee report.

BACKGROUND: Gadolinium-based contrast agents (GBCAs) have been used for magnetic resonance (MR) imaging over the last three decades. Recent reports demonstrated gadolinium retention in patients' brains following intravenous administration. Since gadolinium is a highly toxic heavy metal, there is a potential for adverse effects from prolonged retention or deposition, particularly in children. For this reason, the Society (SPR) for Pediatric Radiology Quality and Safety committee conducted a survey to evaluate the current status of GBCAs usage among pediatric radiologists. OBJECTIVE: To assess the usage of GBCAs among SPR members. MATERIALS AND METHODS: An online 15-question survey was distributed to SPR members. Survey questions pertained to the type of GBCAs used, protocoling workflow, requirement of renal function or pregnancy tests, and various clinical indications for contrast-enhanced MRI examinations. RESULTS: A total of 163 survey responses were compiled (11.1% of survey invitations), the majority of these from academic institutions in the United States. Ninety-four percent reported that MR studies are always or usually protocoled by pediatric radiologists. The most common GBCA utilized by survey respondents were Eovist (60.7%), Ablavar (45.4%), Gadovist (38.7%), Magnevist (34.4%) and Dotarem (32.5%). For several clinical indications, survey responses regarding GBCA administration were concordant with American College of Radiology (ACR) Appropriateness Criteria, including seizures, headache and osteomyelitis. For other indications, including growth hormone deficiency and suspected vascular ring, survey responses revealed potential overutilization of GBCAs when compared to ACR recommendations. CONCLUSION: Survey results demonstrate that GBCAs are administered judiciously in children, yet there is an opportunity to improve their utilization with the goal of reducing potential future adverse effects.

Effects of iopamidol-370 versus iodixanol-320 on coronary contrast, branch depiction, and heart rate variability in dual-source coronary MDCT angiography.

OBJECTIVE: The purpose of this article is to assess whether iopamidol-370 provides superior vascular contrast of the coronaries and depiction of anatomic detail without affecting heart rate and beat-to-beat variability during coronary dual-source MDCT compared with iodixanol-320. SUBJECTS AND METHODS: In this prospective trial, coronary CT angiography was performed on 60 adult patients using either iopamidol-370 or iodixanol-320. Cohorts were matched by age, habitus, sex, and baseline heart rate, with cohort sizes determined by power analysis. All studies were performed on a dual-source MDCT scanner with retrospective ECG-gating utilizing automatic pitch adjustment. Data assessment focused on heart rate variability during contrast administration statistically evaluated as Student t test comparisons within and between cohorts, coronary contrast-to-noise ratio analysis of the main coronary arteries utilizing Student t test comparisons between cohorts, and coronary branch depiction and distribution analysis in dual-reader consensus decisions between cohorts. RESULTS: Thirty patients matched for age, habitus, sex, and heart rate were evaluated in each cohort. ECG analyses found a statistically significant (p = 0.013) decrease in heart rate during administration of iodixanol-320. Beat-to-beat variations, expressed as coefficient of variation, within and among cohorts were low (coefficient of variation, < 0.05). Contrast-to-noise ratio was significantly increased for iopamidol-370 versus iodixanol-320 (aortic root, p = 0.021; left main, p = 0.032; left anterior descending, p = 0.033; left circumflex, p = 0.039; and right, p = 0.009). Analysis of coronary branch visualization revealed improved depiction for iopamidol-370 compared with iodixanol-320. CONCLUSION: Iopamidol-370, with its higher iodine concentration, provided greater vascular contrast of the arterial coronary tree and improved depiction of anatomic detail without significantly impacting cardiac heart rate during coronary MDCT imaging, as compared with iodixanol-320.

Novel technique for addressing streak artifact in gated dual-source MDCT angiography utilizing ECG-editing.

Streak artifact is an important source of image degradation in computed tomographic imaging. In coronary MDCT angiography, streak artifact from pacemaker leads in the SVC can render segments of the right coronary artery uninterpretable. With current technology in clinical practice, there is no effective way to eliminate streak artifact in coronary MDCT angiography entirely. We propose a technique to minimize the impact of streak artifact in retrospectively gated coronary MDCT angiography by utilizing small shifts in the reconstruction window. In our experience, previously degraded portions of the coronary vasculature were able to be well evaluated using this technique.

Gender differences in infective endocarditis: pre- and co-morbid conditions lead to different management and outcomes in female patients.

The impact of gender on the presenting characteristics, management, and outcomes in infective endocarditis (IE) has not been adequately studied. The goal of our study was to better understand differences in management and outcome of IE between genders. Data were obtained prospectively from 439 patients in the Duke Endocarditis Database from 1996 to 2004. Baseline characteristics of patients were examined using univariable analysis. Variables associated with gender, in-hospital surgery and long-term mortality in patients with IE were considered for multivariable analysis. Hemodialysis, diabetes mellitus, and immunosuppression were more frequent in female patients with IE. Intracardiac abscesses and new conduction abnormalities were more common in male patients. The following factors were predictive of short-term mortality through univariable analysis: female gender, age, diabetes mellitus, septic pulmonary infarcts, intracranial hemorrhage, infection with Staphylococcus aureus, and persistently positive blood cultures. Female gender was not associated with mortality in an adjusted analysis of short-term outcome. Age, diabetes mellitus, renal failure requiring hemodialysis, cancer, pulmonary edema, systemic embolization, persistently positive blood cultures, and chronic indwelling central catheters but not female gender were associated with long-term mortality using univariable and an adjusted analysis. In both analyses, surgery was associated with improved mortality. Female gender, a history of diabetes mellitus, hemodialysis, and immunosuppression therapy were predictive of a medical management without the use of surgery, although in the adjusted analysis there was no association between surgery and gender. In conclusion, differences between genders in treatment and outcomes frequently reported in patients with IE most likely result from pre- and co-existing conditions such as diabetes mellitus, renal failure requiring hemodialysis, and chronic immunosuppression.