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Approximately ¼ of patients with thoracic aortic aneurysms (TAAs) have concomitant abdominal aortic aneurysms (AAAs), thereby justifying the addition of an abdominal CT scan to a chest CT scan in patients with a newly diagnosed or suspected TAA. However, the prevalence of pelvic artery aneurysms (PAAs) in these patients is unknown. The purpose of this study was to determine the prevalence of PAAs in patients with TAAs and to assess what patient specific factors were associated with PAAs, thereby providing insight into the usefulness of pelvic imaging in TAA patients. Consecutive non-operated patients seen in Cardiac Surgery clinic between 2008 and 2013 with a TAA and a CT scan of the chest/abdomen/pelvis were included. Scans of 371 patients were evaluated for PAAs using threshold diameters of 20 and 15 mm for common iliac artery aneurysms (CIAs) and internal iliac artery aneurysms (IIAs), respectively, on 3D analysis. The prevalence of PAAs was determined and multiple logistic regression was used to identify associated risk factors. 41 of 371 (11.1%) patients with a TAA had at least one PAA. Factors showing positive associations with PAAs included increased age (p = 0.0004), male gender (p = 0.0007), descending TAA location (p = 0.0024) and presence of an AAA (p

Background Repetitive transcranial magnetic stimulation (rTMS) was approved in 2008 in the United States, and there are relatively few studies describing its use in regular clinical practice since approval. Methods From April 2011 to October 2014, ten sites within the National Network of Depression Centers (NNDC) provided data on 62 evaluable patients with a depressive episode. Treatment was determined naturalistically. Response was assessed by the Quick Inventory of Depressive Symptoms, Self-Report (QIDS-SR) as the primary outcome, and the Patient Health Questionnaire-9 (PHQ-9) and the clinician-rated Clinical Global Impression (CGI) as secondary depression measures. Results Enrolled patients exhibited significant treatment resistance, with 70.2% reporting more than 4 prior depressive episodes. Most patients received treatment with standard parameters (10 Hz over the left dorsolateral prefrontal cortex), although 22.6% of the patients received 1 or 5 Hz stimulation at some point. Over 6 weeks of treatment, response and remission rates were 29.4% and 5.9%, respectively, for the QIDS-SR; 39.2% and 15.7%, respectively, for the PHQ-9; and 50.9% and 17.9%, respectively, for the CGI. Moderator analyses revealed no effect of prior depressive episodes, history of ECT or gender, although early life stress predicted a better response to rTMS therapy. Limitations The study was an open-label, registry trial, with relatively coarse clinical data, reflecting practice only in academic, depression-specialty centers. Because of the relatively small size and heterogeneity of the sample, type 2 errors are possible and positive findings are in need of replication. Conclusion rTMS demonstrates effectiveness in clinical practice within the NNDC, although remission rates appear slightly lower in comparison with other recent naturalistic studies.

Objective A modern imaging review is necessary to further define the anatomic origin of the juvenile nasopharyngeal angiofibroma. Methods After institutional review board approval, a search from January 1998 to January 2013 yielded 33 male patients (aged 10-23 years) with pathologically proven juvenile nasopharyngeal angiofibroma lesions, as well as pretreatment computed tomography/magnetic resonance imaging. Juvenile nasopharyngeal angiofibroma involvement was assessed in the following regions: sphenopalatine foramen, pterygopalatine fossa, vidian canal, nasopharynx, nasal cavity, sphenoid sinus, choana, pterygomaxillary fissure/masticator space, orbit, and sphenoid bone. Results The choana and nasopharynx were involved in all 33 patients. In contrast, only 22 lesions involved the pterygopalatine fossa, 24 lesions involved the sphenopalatine foramen, and 28 lesions involved the vidian canal. Conclusions Our results suggest that the juvenile nasopharyngeal angiofibroma origin is in the region of the choana and nasopharynx rather than the sphenopalatine foramen or pterygopalatine fossa.

The aim was to compare computed tomography (CT) features in acute and chronic aortic dissections (AADs and CADs) and determine if a certain combination of imaging features was reliably predictive of the acute versus chronic nature of disease in individual patients. Consecutive patients with aortic dissection and a chest CT scan were identified, and 120 CT scans corresponding to 105 patients were reviewed for a variety of imaging features. Statistical tests assessed for differences in the frequency of these features. A predictive model was created and tested on an additional 120 CT scans from 115 patients. Statistically significant features of AAD included periaortic confluent soft tissue opacity, curved dissection flap, and highly mobile dissection flap, and features of CAD included thick dissection flap, false lumen (FL) outer wall calcification, FL thrombus, dilated FL, and tear edges curling into the FL. The model predicted the chronicity of a dissection with an area under the curve of 0.98 (CI 0.98-1.00). AADs and CADs demonstrated significantly different CT imaging features.

Aortic aneurysms are a significant cause of mortality, and the presence of multiple aneurysms may affect treatment plans. The purpose of this study was to determine the frequency of abdominal aortic aneurysms (AAAs) in patients with thoracic aortic aneurysms (TAAs) and to establish whether patient specific factors, such as gender and comorbidities, influenced the frequency of AAAs, thereby indicating if and when abdominal aortic evaluation is justified. Electronic medical records were reviewed from 1000 patients with a computed tomography (CT) angiogram of the chest and abdomen and a clinical diagnosis of TAA from Cardiac Surgery clinic between 2008 and 2013. 538 patients with history of aortic intervention, dissection, rupture or trauma were excluded. The frequency of AAAs among the 462 remaining patients was established, and statistical analysis was used to elucidate differences in frequency based on age, gender, comorbidities, and TAA location. Overall, 104 of 462 (22.5 %) patients with a TAA also had an AAA. There were significant differences in the frequency of AAA based on TAA location, age, and comorbidities. The following comorbidities showed positive associations with AAA using logistic regression analysis: age ≥65 (P 0.0001; OR 30.1; CI 7.14-126.61), smoking history (P 0.0001; OR 4.1; 2.35-7.30), and hypertension (P = 0.024; OR 2.1; CI 1.11-4.16). Aneurysms in the proximal/mid descending (P 0.0001; OR 4.96; CI 2.32-10.61) and diaphragm level (P 0.0001; OR 38.4; CI 14.71-100.15) of the aorta also showed a positive association with AAAs when adjusted for age and gender. AAA screening in patients with TAA is a reasonable, evidence-based option regardless of the TAA location, with the strongest support in patientsage 55, with systemic hypertension, a smoking history and/or a TAA in the descending thoracic aorta.

In analysis of covariance with heteroscedastic slopes a picked-points analysis is often performed. Least-squares based picked-points analyses often lose efficiency (at times substantial) for nonnormal error distributions. Robust rank-based picked-points analyses are developed which are optimizable for heavy-tailed and/or skewed error distributions. The results of a Monte Carlo investigation of these analyses are presented. The situations include the normal model and models which violate it in one or several ways. Empirically the rank-based analyses appear to be valid over all these situations and more powerful than the least squares analysis for all the nonnormal models, while losing little efficiency at the normal model.

To determine whether intrathoracic fat volumes are associated with presence and chronicity of atrial fibrillation (AF) and radiofrequency ablation (RFA) treatment outcome. IRB approval was obtained and patient consent was waived for this HIPAA-compliant retrospective study. 169 patients with AF (75 non-paroxysmal and 94 paroxysmal) and 62 control patients underwent cardiac CT examination. Extrapericardial (EPFV) and epicardial fat volumes (EFV) were measured on CT, the sum of which is the total intrathoracic fat volume. Associations between these three fat volumes and presence and chronicity of AF, and outcome after RFA, were evaluated using logistic regression analysis. EFV was significantly associated with presence [OR 1.01 (95 % CI 1.003–1.03), p = 0.01], chronicity of AF [1.008 (1.001–1.020), p = 0.03] and AF recurrence after RFA [1.009 (1.001–1.01), p = 0.02] after adjustment for age, gender and BMI. Patients with a larger EFV had a shorter time to AF recurrence (p = 0.017) and a higher rate of recurrence (54 % vs 46 %) (p = 0.002) after RFA. EPFV had no significant associations. Increased epicardial fat is associated with the presence and chronicity of AF, a higher probability of AF recurrence after RFA and a shorter AF-free interval. • Increased epicardial fat is associated with presence and chronicity of atrial fibrillation • Extensive epicardial fat is associated with earlier recurrences of AF after ablation • Extensive epicardial fat may reduce transmurality of ablation by affecting current dynamics

Purpose To identify computed tomographic (CT) findings that are predictive of recurrence of colonic diverticulitis. Materials and Methods Institutional review board approval was obtained for this HIPAA-compliant, retrospective cohort study. Six abdominal fellowship-trained radiologists reviewed the CT studies of 440 consecutive subjects diagnosed with acute colonic diverticulitis between January 2004 and May 2008 to determine the involved segments, maximum wall thickness in the inflamed segment, severity of diverticulosis, presence of complications (abscess, fistula, stricture, or perforation), and severity of the inflammation. Electronic medical records were reviewed for a 5-year period after the patients' first CT study to determine clinical outcomes. Predictors of diverticulitis recurrence were assessed with univariate and multiple Cox proportional hazard regression models. Results Colonic diverticulitis most commonly involved the rectosigmoid (70%, 309 of 440) and descending (30%, 133 of 440) colon segments. Complicated diverticulitis was present in 22% (98 of 440) of patients. On the basis of the results of univariate analysis, significant predictors of diverticulitis recurrence were determined to be maximum colonic wall thickness in the inflamed segment (hazard ratio [HR], 1.07 per every millimeter of increase in wall thickness; P < .001), presence of a complication (HR, 1.75; P = .002), and subjective severity of inflammation (HR, 1.36 for every increase in severity category; P value for linear trend = .003). The difference in maximum wall thickness in the inflamed segment (HR, 1.05 per millimeter; P = .016) and subjective inflammation severity (HR, 1.29 per category; P = .018)remained statistically significant in a Cox multiple regression model. Conclusion Maximum colonic wall thickness and subjective severity of acute diverticulitis allow prediction of recurrent diverticulitis and may be useful for stratifying patients according to the need for elective partial colectomy. © RSNA, 2017 Online supplemental material is available for this article.

There is a paucity of data available regarding the repeatability and reproducibility of superficial shear wave speed (SWS) measurements at imaging depths relevant to the pediatric population. To assess the repeatability and reproducibility of superficial shear wave speed measurements acquired from elasticity phantoms at varying imaging depths using three imaging methods, two US systems and multiple operators. Soft and hard elasticity phantoms manufactured by Computerized Imaging Reference Systems Inc. (Norfolk, VA) were utilized for our investigation. Institution No. 1 used an Acuson S3000 US system (Siemens Medical Solutions USA, Malvern, PA) and three shear wave imaging method/transducer combinations, while institution No. 2 used an Aixplorer US system (SuperSonic Imagine, Bothell, WA) and two different transducers. Ten stiffness measurements were acquired from each phantom at three depths (1.0 cm, 2.5 cm and 4.0 cm) by four operators at each institution. Student’s t-test was used to compare SWS measurements between imaging techniques, while SWS measurement agreement was assessed with two-way random effects single-measure intra-class correlation coefficients (ICCs) and coefficients of variation. Mixed model regression analysis determined the effect of predictor variables on SWS measurements. For the soft phantom, the average of mean SWS measurements across the various imaging methods and depths was 0.84 ± 0.04 m/s (mean ± standard deviation) for the Acuson S3000 system and 0.90 ± 0.02 m/s for the Aixplorer system (P = 0.003). For the hard phantom, the average of mean SWS measurements across the various imaging methods and depths was 2.14 ± 0.08 m/s for the Acuson S3000 system and 2.07 ± 0.03 m/s Aixplorer system (P > 0.05). The coefficients of variation were low (0.5–6.8%), and interoperator agreement was near-perfect (ICCs ≥ 0.99). Shear wave imaging method and imaging depth significantly affected measured SWS (P

The effect of acquisition geometry in digital breast tomosynthesis (DBT) was evaluated with studies of contrast-to-noise ratios (CNRs) and observer preference. Contrast-detail (CD) test objects in 5 cm thick phantoms with breast-like backgrounds were imaged. Twelve different angular acquisitions (average glandular dose for each ~1.1 mGy) were performed ranging from narrow angle 16° with 17 projection views (16d17p) to wide angle 64d17p. Focal slices of SART-reconstructed images of the CD arrays were selected for CNR computations and the reader preference study. For the latter, pairs of images obtained with different acquisition geometries were randomized and scored by 7 trained readers. The total scores for all images and readings for each acquisition geometry were compared as were the CNRs. In general, readers preferred images acquired with wide angle as opposed to narrow angle geometries. The mean percent preferred was highly correlated with tomosynthesis angle (R=0.91). The highest scoring geometries were 60d21p (95%), 64d17p (80%), and 48d17p (72%); the lowest scoring were 16d17p (4%), 24d9p (17%) and 24d13p (33%). The measured CNRs for the various acquisitions showed much overlap but were overall highest for wide-angle acquisitions. Finally, the mean reader scores were well correlated with the mean CNRs (R=0.83).

The purpose of this study was to evaluate the outcomes and cancer rate in solid palpable masses with benign features assessed as BI-RADS 3 or 4A. This study was Institutional Review Board approved. Mammography and breast ultrasound reports in our Radiology Information System were searched for solid, palpable masses with benign features described from 1/1/2000 to 12/31/2009, and retrospectively reviewed. Those masses prospectively assessed as BI-RADS 3 or 4A, or suggestive of a fibroadenoma or other benign pathology were retrieved. Chart review was used to assess outcomes and cancer rate. Basic summary measures were summarized and compared between BI-RADS 3 and 4A groups using Wilcoxon Rank Sum test for continuous data or Fisher’s exact test for categorical data. The cancer rate across age quartiles was assessed using Cochran-Armitage trend test. 573 solid palpable masses with benign features in 487 women were identified. There were 197 BI-RADS 3 and 376 BI-RADS 4A masses. The overall cancer rate was 1.6 % (9/573). All cancers were BI-RADS 4A (cancer rate 2.4 %—9/376). Smaller mean size and younger age at presentation in BI-RADS 3 women was found compared to BI-RADS 4A (P

The purpose of this study was to quantify changes in renal length, volume, and function over time after upper abdominal radiation therapy.Imaging and clinical data were retrospectively reviewed for 27 adults with abdominal radiation therapy between 2001 and 2012. All had two kidneys, radiation exposure to one kidney, and survival of at least 1 year after therapy. Mean prescribed dose was 52 ± 9 Gy to extrarenal targets. Length and volume of exposed and unexposed kidneys were measured on CT scans before treatment (baseline) and at intervals 0-3, 3-6, 6-12, 12-24, 24-36, and more than 36 months after completion of radiotherapy. Serum creatinine was correlated at each interval. Mixed-models ANOVA was used to test renal length and volume, serum creatinine, and time against multiple models to assess for temporal effects; specific time intervals were compared in pairwise manner.Mean follow-up duration was 35 months (range, 5-94 months). Exposed kidney length and volume progressively decreased from baseline throughout follow-up, with mean loss of 23% (p0.001) and 47% (p0.001), respectively. Slight increase in unexposed kidney length was not significant. Mean serum creatinine increased from 0.86 ± 0.18 mg/dL at baseline to 1.12 ± 0.27 mg/dL at 12-24 months (p0.001), then stabilized.Kidneys exposed to radiation during therapy of adjacent malignancies exhibited continuous progressive atrophy for the entire follow-up period, nearly 8 years. Volume changes were twice as great as length changes. Renal function also declined. To accurately interpret follow-up studies in cancer survivors, radiologists should be aware of the potential for progressive renal atrophy, even many years after radiation therapy.

PURPOSE This study aimed to evaluate pretreatment whole-tumor mean apparent diffusion coefficient (ADC) and ADC histogram as predictors of outcome to chemoradiation in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Patients with HNSCC underwent pretreatment 3-T diffusion-weighted magnetic resonance imaging with calculation of mean ADC and ADC histograms. Outcomes were determined 2 years after chemoradiation. Positive outcome was defined as no abnormal 18-fluoro deoxy glucose uptake on posttherapy computed tomography-positron emission tomography (or abnormal uptake that was proven benign), no locoregional recurrence or metastatic disease, and no requirement for salvage surgery. Negative outcome was defined as residual abnormal 18-fluoro deoxy glucose avidity that was proven malignant, salvage surgery requirement, locoregional recurrence or metastatic disease, death, or a combination of these. A 2-sample t test was used to compare the mean ADC between patients with positive and negative outcomes. The ADC cut point for dividing the groups was determined by looking at its distribution. A Kaplan-Meier plot was produced, and a log-rank test was conducted with calculation of sensitivity, specificity, and positive and negative predictive values. RESULTS Nine patients showed positive and 8 showed negative outcomes. Significant difference (P = 0.03) was seen in mean ADC (in 10 mm/s) between patients showing positive and negative outcomes (1.18 and 1.43, respectively). According to the log-rank test, tumors with greater than 45% of their volume below the ADC threshold of 1.15 × 10 mm/s were more likely to have a positive outcome (accuracy, 77%). CONCLUSIONS Patients with HNSCC demonstrating lower pretreatment ADC and with greater than 45% of volume below ADC threshold of 1.15 × 10 mm/s may have better outcome to chemoradiation at 2 years.

Rationale and Objectives To assess practice patterns in evaluating incidental findings at chest computed tomography (CT) to determine the need for further education. Materials and Methods A survey was given to 1600 radiologists, presenting four clinical case questions regarding the evaluation/significance of the following incidental findings at chest CT: thyroid lesion; enlarged mediastinal lymph nodes; asymptomatic, small pulmonary embolus; and small lung nodule. The respondents' answers were compared with “truth,” as defined by the best evidence available in the medical literature. Additional questions elicited the respondents' demographics and comfort levels in addressing the findings. Analysis of variance models with a Tukey correction for post hoc comparisons and chi-square tests were used to determine if any demographic factors or comfort levels were predictive of higher correct response rates. Results The overall survey response rate was 28% (445/1600). Correct case response rates ranged from 26% (115/442) to 79% (343/445). Only 6% (28/438) of respondents chose the correct answers for all cases. Up to 80% (353/440) of respondents felt comfortable in addressing findings, and only 57% (252/443) of respondents felt that they needed more training in this area. Fellowship training in cardiothoracic radiology, working in a teaching practice, and subspecialization in abdominal or cardiothoracic radiology were predictive of higher correct response rates. Except for one case question, the comfort level was not predictive of correct response rate. Conclusions There was considerable variability among radiologists and substantial deviation from best medical practice with regard to the interpretation/evaluation of incidental findings at chest CT, signifying a significant need for further education.

Fletcher JJ, Bergman K, Watcharotone K, Jacobs TL, Brown DL. Lack of association between decompressive craniectomy and conversion to donor status. Clin Transplant 2011: 25: 83–89. © 2010 John Wiley & Sons A/S. Abstract: There has been a recent resurgence in the use of decompressive craniectomy (DC) following severe brain injury. The aim of this study was to evaluate any association between DC and solid organ donation. We performed a retrospective, single-center, cohort study involving referrals to the local organ procurement organization, excluding those with anoxic brain injury. Of subjects referred, 64 (53%) were deemed eligible for donation and 29 (24%) converted to donor status. DC was performed with similar frequency in donors and non-donors (41% vs. 29%; p = 0.23). Patients with DC had similar odds of donation as those without DC (odds ratio 1.70, 95% CI 0.72–4.03), including after adjustment for age and Glasgow Coma Scale score (odds ratio 1.31, 95% CI 0.53–3.24). The most common reason eligible patients failed to convert to donor status was failure to pursue organ procurement because of the belief that the patient would not progress to neurological death or be a candidate for donation following cardiac death. Decompressive craniectomy was not uncommon among referrals to organ procurement organizations who ultimately become solid organ donors. Continued communication between the organ donation coordinators and the treating team has potential to decrease missed opportunities for organ donation.

The purpose of this study was to assess efficacy and safety of 3 doses (6.25 mg, 12.5 mg, 25 mg) of intravenous (IV) promethazine in treatment of established nausea and vomiting (N/V) in hospitalized elderly patients. Study participants agedor =65 years received at least 1 dose of IV promethazine for treatment of N/V. Outcomes were degree of efficacy and safety. Efficacy was measured by time to relief and whether relief occurred. Safety was measured by the incidence of adverse drug reactions (ADRs). The results showed no difference in the time to relief and proportion of patients who felt relief between the 6.25-mg and 12.5-mg groups. The median frequency of ADRs in the 6.25-mg group, based on total administrations, was significantly less than the 12.5-mg group (P = .048). This study suggests a starting dose of 6.25 mg IV promethazine is as effective as higher doses and has fewer ADRs.

The purpose was to compare first-pass and delayed-phase thoracic computed tomography (CT) venography for the evaluation of suspected central thoracic venous pathology.CT images and medical records of all patients who underwent thoracic CT venography over a 5-year period were retrospectively reviewed. Both first-pass (18s) and delayed-phase (60s) venous images were obtained in all patients. The images were reviewed in random order by three readers using a semiquantitative visual grading scheme for image quality, including artifacts and the uniformity of venous enhancement. In addition, enhancement was quantitatively evaluated. The presence and type of venous pathology, and overall diagnostic confidence were recorded and compared. Reference verification was performed when available.Eighteen patients formed the study group, mean age 49.5years and 28% male. Dual-arm injection was successful in 72% of exams. All readers reported more streak artifacts on first-pass imaging than delayed imaging (72%-94% vs. 27%-44%, respectively; P.05). First-pass imaging had significantly higher measured enhancement across all central venous segments than delayed imaging (mean HU range 212-906 HU vs. 173-414 HU; P.05) but also had significantly more heterogeneous enhancement (mean S.D. range 75-1058 HU vs. 67-378 HU; P.05). For overall diagnosis, reader agreement, accuracy, and confidence levels were higher for delayed-phase images (P.05).Indirect thoracic CT venography using delayed-phase imaging alone may be sufficient for evaluating clinically suspected central venous abnormality.

Over the last decade there has been escalating concern regarding the increasing radiation exposure stemming from CT exams, particularly in children. Adaptive statistical iterative reconstruction (ASIR) is a relatively new and promising tool to reduce radiation dose while preserving image quality. While encouraging results have been found in adult head and chest and body imaging, validation of this technique in pediatric population is limited.The objective of our study was to retrospectively compare the image quality and radiation dose of pediatric head CT examinations obtained with ASIR compared to pediatric head CT examinations without ASIR in a large patient population.Retrospective analysis was performed on 82 pediatric head CT examinations. This group included 33 pediatric head CT examinations obtained with ASIR and 49 pediatric head CT examinations without ASIR. Computed tomography dose index (CTDIvol) was recorded on all examinations. Quantitative analysis consisted of standardized measurement of attenuation and the standard deviation at the bilateral centrum semiovale and cerebellar white matter to evaluate objective noise. Qualitative analysis consisted of independent assessment by two radiologists in a blinded manner of gray-white differentiation, sharpness and overall diagnostic quality.The average CTDIvol value of the ASIR group was 21.8 mGy (SD = 4.0) while the average CTDIvol for the non-ASIR group was 29.7 mGy (SD = 13.8), reflecting a statistically significant reduction in CTDIvol in the ASIR group (P 0.01). There were statistically significant reductions in CTDI for the 3- to 12-year-old ASIR group as compared to the 3- to 12-year-old non-ASIR group (21.5 mGy vs. 30.0 mGy; P = 0.004) as well as statistically significant reductions in CTDI for the12-year-old ASIR group as compared to the12-year-old non-ASIR group (29.7 mGy vs. 49.9 mGy; P = 0.0002). Quantitative analysis revealed no significant difference in the homogeneity of variance in the ASIR group compared to the non-ASIR group. Radiologist assessment of gray-white differentiation, sharpness and overall diagnostic quality in ASIR examinations was not substantially different compared to non-ASIR examinations.The use of ASIR in pediatric head CT examinations allows for a 28% CTDIvol reduction in the 3- to 12-year-old age group and a 48% reduction in the12-year-old age group without substantially affecting image quality.

Purpose: A study was performed to evaluate the accuracy of a combined dual-energy/single-energy QCT optimization model for estimating the volume fractions of fat, cholesterol, protein, fibrous tissue, and calcium in coronary artery plaque. Methods: This model uses 80kVp-140kVp CT# data to distinguish calcium, and Gaussian component analysis based on the 140kVp CT#’s of the pure materials to distinguish the other constituents. An experimental study was performed with a thorax section phantom (CIRS, Inc.) containing various mixtures of 0.8–3.2mm thick plastic slabs simulating plaque components. The Z(eff), ρ(g/cc) properties of the plaque components and plaque-simulating plastics are: [fat(5.82,0.92), LDPE(5.44, 0.92)], [cholesterol(5.65,1.067), polystyrene(5.62,1.05)], protein(6.73,1.38), Delrin (7.07,1.42)], fibrous(7.51, 1.05), nylon(6.21, 1.14]). Two water-equivalent plastics containing CaCO3 (13% and 22% CaCO3) were also used. Scans of 6.4-mm-thick slabs of each plastic alone within the phantom were acquired to determine the CT#’s of the pure materials. All scans were repeated 3 times under each condition and reconstructed with standard (STD) and BONE kernels on a GE CT750HD CT scanner using a 10-cm reconstruction FOV. Results: The minimum RMS errors for the various plaque-simulating slab mixtures were 2.2% (BONE kernel) and 4.2% (STD kernel) for a 1.6mm 13% CaCO3, 3.2mm polystyrene, 3.2mm delrin, 3.2mm nylon slab mixture (total=11.2mm). Maximum RMS errors were 7.5% (BONE) and 13.7% (STD) for a mixture containing 1.6mm slabs of 13% CaCO3, LDPE, delrin, and nylon (total=6.4mm). Conclusion: The accuracy of the method decreased as the thicknesses of the slabs decreased, due to volume averaging. Accuracy was better for the BONE kernel that has higher spatial resolution. Even for this kernel, the errors are substantial for a mixture that is about the size of the coronary artery lumen (2–6mm). Higher spatial resolution and more quantitative reconstruction methods are needed to improve the accuracy of the method. NIH RO1 HL106545

To determine the variability in CT measurements of proximal thoracic aortic diameters obtained using double-oblique short axis and semiautomatic centerline analysis techniques. Institutional review board approval, with waiver of informed consent, was obtained for this HIPAA-compliant, retrospective study. Cardiac gated thoracic aortic CT scans were evaluated in 25 patients. Maximum aortic diameter measurements at the annulus, sinuses, sinotubular junction and ascending aorta were generated using double-oblique short axis and semiautomatic centerline analysis techniques. Intraobserver and interobserver variability and variability between techniques were assessed using the Wilcoxon signed rank test, Spearman's correlation coefficients and Bland-Altman plots. Mean intraobserver diameter differences using double oblique views ranged from -0.3 to 0.6 mm. The 95 % confidence interval for difference in diameters was ±2.4 to ±5.1 mm for radiologist #1 and ±2.6 to ±5.2 mm for radiologist #2, depending on location. Mean intraobserver diameter differences using centerline analysis ranged from 0.2 to 2.3 mm, and the 95 % confidence interval for difference in diameters was ±2.0 to ±4.6 mm, depending on location. Significant interobserver differences were seen for both double oblique views and centerline analysis. Measurements obtained using the two methods were strongly correlated (r = 0.81-0.99), although they were consistently larger using centerline analysis (95 % confidence interval, ±1.8 to ±3.2 mm). Although measurement variability of the proximal thoracic aorta was generally low using double oblique and centerline analysis techniques, differences of up to approximately 5 mm in diameter occurred within the 95 % confidence interval. Neither technique was clearly more reliable than the other.

Rationale and Objective: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a diagnostically challenging, severe, and life-threatening condition, which is currently lacking a "gold standard." Our aim with this study is to look for magnetic resonance (MR) perfusion differences in NPSLE, SLE, and healthy control (HC) patients and correlate our findings with clinical parameters. Materials and Methods: Twenty-four NPSLE patients, 21 SLE patients, and 21 HC underwent dynamic susceptibility contrast enhanced MR perfusion using a 3-T scanner. Nine prospectively selected intracranial regions of interest were placed in white and gray matter and the cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MU) values were calculated. Subjects underwent clinical evaluation with SLEDAI and serum antibodies. Results: The SLE patients had higher CBF and CBV compared to the HC overall (P =.01) and in specific areas (P =.03-.048). SLE patients with signs of active disease (elevated SLEDAI and anti-double-stranded DNA) had significantly elevated CBV, CBF, and MU in the posterior cingulate gyrus (P =.01-.02). No significant difference was seen in the magnetic resonance perfusion measurements of NPSLE patients compared to SLE and HC, although the NPSLE patients also showed higher CBV variability compared to the SLE (P =.0004) and HC cohort (P

To assess practice patterns in evaluating incidental findings at chest computed tomography (CT) to determine the need for further education.A survey was given to 1600 radiologists, presenting four clinical case questions regarding the evaluation/significance of the following incidental findings at chest CT: thyroid lesion; enlarged mediastinal lymph nodes; asymptomatic, small pulmonary embolus; and small lung nodule. The respondents' answers were compared with "truth," as defined by the best evidence available in the medical literature. Additional questions elicited the respondents' demographics and comfort levels in addressing the findings. Analysis of variance models with a Tukey correction for post hoc comparisons and chi-square tests were used to determine if any demographic factors or comfort levels were predictive of higher correct response rates.The overall survey response rate was 28% (445/1600). Correct case response rates ranged from 26% (115/442) to 79% (343/445). Only 6% (28/438) of respondents chose the correct answers for all cases. Up to 80% (353/440) of respondents felt comfortable in addressing findings, and only 57% (252/443) of respondents felt that they needed more training in this area. Fellowship training in cardiothoracic radiology, working in a teaching practice, and subspecialization in abdominal or cardiothoracic radiology were predictive of higher correct response rates. Except for one case question, the comfort level was not predictive of correct response rate.There was considerable variability among radiologists and substantial deviation from best medical practice with regard to the interpretation/evaluation of incidental findings at chest CT, signifying a significant need for further education.

There has been a recent resurgence in the use of decompressive craniectomy (DC) following severe brain injury. The aim of this study was to evaluate any association between DC and solid organ donation. We performed a retrospective, single-center, cohort study involving referrals to the local organ procurement organization, excluding those with anoxic brain injury. Of subjects referred, 64 (53%) were deemed eligible for donation and 29 (24%) converted to donor status. DC was performed with similar frequency in donors and non-donors (41% vs. 29%; p = 0.23). Patients with DC had similar odds of donation as those without DC (odds ratio 1.70, 95% CI 0.72-4.03), including after adjustment for age and Glasgow Coma Scale score (odds ratio 1.31, 95% CI 0.53-3.24). The most common reason eligible patients failed to convert to donor status was failure to pursue organ procurement because of the belief that the patient would not progress to neurological death or be a candidate for donation following cardiac death. Decompressive craniectomy was not uncommon among referrals to organ procurement organizations who ultimately become solid organ donors. Continued communication between the organ donation coordinators and the treating team has potential to decrease missed opportunities for organ donation.

Injury prevention is an essential part of any trauma program. Trauma Nurses Talk Tough (TNTT) is an injury prevention program utilized at many trauma centers targeting school-aged children from kindergarten through 12th grade. We hypothesized that TNTT would increase knowledge of safety strategies and change behavior with a prospective, correlational study using TNTT for 6th- to 8th-grade (n = 372) and 9th- to 12th-grade (n = 158) students, respectively. The TNTT injury prevention program had an effect on all students of 6th to 12th grades; however, the effect was more pronounced in the 6th- to 8th-grade group.

Sleep deprivation and subsequent effects on health restoration have been documented in the literature. The purpose of this experimental pilot study was to examine the feasibility of implementing specific nursing interventions to promote sleep in hospitalized older adults. The experimental group received a sleep protocol intervention while the control group received usual nighttime care. While no differences were noted in sleep quality and duration between groups, the experimental group experienced better sleep quality (P = .001), ability to remain asleep (P = .018) and used fewer sleep medications than the control group (P = .044). In addition, those taking sleep medications experienced more awakenings and fewer sleep hours. Experimental group patients identified preferences such as personal hygiene, awareness of normal bedtime, receiving a back rub, straightening bed linens, and receiving a bedtime snack. This pilot provides initial support for the feasibility and utility of implementing a sleep protocol in an acute care setting.