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3D and Workflow: Scan Protocols Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ 3D and Workflow ❯ Scan Protocols

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  • OBJECTIVE. The purpose of this study was to evaluate the superiority of either of two protocols for combined contrast-enhanced thoracic and abdominal CT of patients with lung cancer by comparing contrast enhancement, contrast-related artifacts, image quality, and radiation dose. 


    CONCLUSION. A single 60-second delayed acquisition for thoracic and abdominal contrast-enhanced CT is associated with less contrast artifact and affords better visualization of lymph nodes at a lower radiation dose while acceptable vascular and hepatic contrast enhancement is maintained. 


    Best Protocol for Combined Contrast-Enhanced Thoracic and Abdominal CT for Lung Cancer: A Single-Institution Randomized Crossover Clinical Trial 
 Elena García-Garrigós et al.
 AJR 2018; 210:1226–1234
  • “Protocol A consisted of two acquisitions: one 35-second delayed CT acquisition for the chest followed by a 70-second delayed abdominal acquisition. Protocol B was a single 60-second delayed acquisition covering the chest and the abdomen. Attenuation and noise of the aorta, pulmonary artery, and liver were measured. Contrast-related artifacts, mediastinal lymph node visualization, liver enhancement, and noise were visually scored. Dose-length product was recorded."


    Best Protocol for Combined Contrast-Enhanced Thoracic and Abdominal CT for Lung Cancer: A Single-Institution Randomized Crossover Clinical Trial 
 Elena García-Garrigós et al.
 AJR 2018; 210:1226–1234
  • “For patients with lung cancer, a single 60-second delayed acquisition for contrast- enhanced CT of the chest and abdomen is preferable to two separate acquisitions. It decreases contrast-related perivenous artifact, facilitates evaluation of mediastinal lymph node stations and pleural lesions, and improves tumor delineation. These benefits are achieved while the same abdominal enhancement and quality are maintained at lower but acceptable thoracic vascular enhancement and a lower radiation dose."


    Best Protocol for Combined Contrast-Enhanced Thoracic and Abdominal CT for Lung Cancer: A Single-Institution Randomized Crossover Clinical Trial 
 Elena García-Garrigós et al.
 AJR 2018; 210:1226–1234
  • “Radiologists may not be aware of additional resources available at the scanner and the workstation to increase lesion conspicuity and detection as image quality and quantity decrease, including virtual noncontrast data sets from dual-energy CT, 3-D rendering (maximum intensity projection [MIP], volume rendering [VR], and cinematic rendering [CR]), computer-assisted diagnosis, and texture analysis.” 


    Enhancing Image Quality in the Era of Radiation Dose Reduction: Postprocessing Techniques for Body CT
Pamela T. Johnson, Elliot K. Fishman 
JACR (in press)

  • “Use of MIP renderings at the workstation can improve detection of lung nodules and renal calculi on noncontrast scans performed with low-dose techniques. For contrast-enhanced scans, MIP renderings increase conspicuity of small hypervascular hepatic metastases (such as neuro- endocrine tumor) on the arterial phase scan. 
MIP rendering of arterial phase data sets aids in characterization of solitary hepatic masses by confirming neovascularity in malignant tumors and depicting the classic feeding artery in focal nodular hyperplasia.”

    
Enhancing Image Quality in the Era of Radiation Dose Reduction: Postprocessing Techniques for Body CT
Pamela T. Johnson, Elliot K. Fishman 
JACR (in press)
  • “The newest 3-D rendering tool, CR, holds promise for even greater diagnostic capabilities with respect to tumor characterization. The enhanced anatomic detail made possible from CR provides greater textural information about solid organs and tumors than conventional VR.” 


    Enhancing Image Quality in the Era of Radiation Dose Reduction: Postprocessing Techniques for Body CT
Pamela T. Johnson, Elliot K. Fishman 
JACR (in press)
  • “A postprocessing tool that improves tumor characterization and the radiologist’s role in patient management is texture analysis. The technique provides detailed information about pathology that is beyond the discriminatory capability of the hu- man eye by evaluating pixel heterogeneity and, similar to 3-D rendering, requiring no additional radiation to generate diagnostically useful data. A number of studies have demonstrated that texture analysis correlates with tumor grade, angiogenesis, and other predictors of treatment response.”

    
Enhancing Image Quality in the Era of Radiation Dose Reduction: Postprocessing Techniques for Body CT
Pamela T. Johnson, Elliot K. Fishman 
JACR (in press)
  • “Computer-aided detection is an important adjuvant for low-dose chest CT, harnessing automated lung nodule detection to augment radiologists’ interpretations. Ultra low-dose screening CT with computer-aided detection has been shown to be equivalent in sensitivity to standard dose for identification of lung nodules.” 


    Enhancing Image Quality in the Era of Radiation Dose Reduction: Postprocessing Techniques for Body CT
Pamela T. Johnson, Elliot K. Fishman 
JACR (in press)
  • “Body CT imagers must embrace the pledge for responsible patient selection and protocol design put forth by the Image Wisely Campaign and the ACR’s newest Choosing Wisely recommendations. The tools described herein can be used to enhance interpretative performance in the face of reductions in image quality that result from low- dose techniques. Innovations such as texture mapping and CR are equally important, because they advance management guidance and further poise radiologists to serve as valuable members of the patient care team.” 


    Enhancing Image Quality in the Era of Radiation Dose Reduction: Postprocessing Techniques for Body CT
Pamela T. Johnson, Elliot K. Fishman 
JACR (in press)
  • “Protocol review plays a critical role in CT quality assurance, but large numbers of protocols and inconsistent protocol names on scanners and in exam records make thorough protocol review formidable. In this investigation, we report on a data-driven cataloging process that can be used to assist in the reviewing and management of CT protocols.”

    Data-Driven CT Protocol Review and Management-Experience From a Large Academic Hospital.
    Zhang D et al.
    J Am Coll Radiol. 2015 Jan 7 [Epub ahead of print]
  • “From the percentage-of-usage data, we found that, on average, 18, 33, and 49 core protocols per scanner covered 80%, 90%, and 95%, respectively, of all exams. These numbers are one order of magnitude smaller than the typical numbers of protocols that are loaded on a scanner (200-300, as reported in the literature). Duplicated, outdated, and rarely used protocols on the scanners were easily pinpointed in the cataloging process.”

    Data-Driven CT Protocol Review and Management-Experience From a Large Academic Hospital.
    Zhang D et al.
    J Am Coll Radiol. 2015 Jan 7 [Epub ahead of print]
  • “Structured reporting of pancreatic multiphasic CT provided superior evaluation of pancreatic cancer and facilitated surgical planning. Surgeons were more confident regarding decisions about tumor resectability when they reviewed structured reports before review of multiphasic CT images.”

    Structured Reporting of Multiphasic CT for Pancreatic Cancer: Potential Effect on Staging and Surgical Planning.
    Brook OR et al.
    Radiology. 2015 Feb;274(2):464-72. 
  • “Surgeons had sufficient information for surgical planning in 96%, 69%, and 98% of structured and 31%, 43%, and 25% of nonstructured reports (P < .001, .009, and < .001). When surgeons reviewed reports in combination with multiphasic CT images, they were more likely to convert an answer of "unsure" regarding resectability to a definitive answer (i.e., resectable or unresectable) when the reports were structured than when they were nonstructured.”

    Structured Reporting of Multiphasic CT for Pancreatic Cancer: Potential Effect on Staging and Surgical Planning.
    Brook OR et al.
    Radiology. 2015 Feb;274(2):464-72.

 

  • “ Detection of GIST recurrence may be enhanced by adjusting the timing of the CT scans with the hazard of recurrence. This method may be applicable to other human tumor types.”
    Gastrointestinal Stromal Tumor: A method for Optimizing the Timing of CT Scans in the Follow-up of Cancer Patients
    Joensuu H et al.
    Radiology 2014; 271:96-103
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