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Objective To characterize the configuration of incomplete proximal fractures of the proximal phalanx (P1) in horses not used for racing and compare radiographic with computed tomography (CT) findings. Study Design Historical cohort. Animals Twenty-four horses with incomplete fractures of P1. Methods Medical records of horses not used for racing diagnosed with an incomplete proximal fracture of P1 based on clinical and radiographic examination and confirmed by CT between 2008 and 2013 were retrieved. Radiographs and CT studies of these horses were analyzed using a subjective grading system and by measuring variables that characterized fracture configuration. Results Twenty-four horses were included (20 Warmbloods) with a mean age of 9.5 years and mean body weight of 574 kg. Fourteen forelimbs and 10 hind limbs were affected. Mean duration of lameness was 8.7 weeks. Computed tomography was superior to radiography in both identifying the fracture and determining fracture size and location. On CT, 92% of fractures were located in the mid-sagittal plane. Mean proximodistal length of the fracture was 13 mm. Fractures were frequently not bicortical. Fractures in forelimbs were located significantly more dorsally than fractures in hind limbs. A distinct fracture pattern with 2 subchondral lines running parallel in close proximity to each other was identified in 54% of cases. Conclusion Incomplete proximal fractures of P1 have significant variation in their configurations, especially their dorsopalmar/-plantar location. Computed tomography examination allowed clear identification of the fracture configurations and was superior to radiography.

Using advanced modern technology is considered one of the most important methods of scientific examination and registration. This should be used in the field of the conservation of mummies. Identifying the case of the mummy and putting the mummy outwardly or inwardly are the first stage of good prognosis of damage, which naturally lead to the development of an appropriate plan for the operations of treatment and conservation starting from the stage of cleaning until museum presentation, through a consistent process with the requirements of preventive conservation. Computed Tomography Scanning (CT Scanning) is a non-invasive technique that does not harm the mummies. It has become an important tool for studying many features of ancient Egyptian mummies. The Study of Ancient Egypt, and particularly the examination of mummies, are subjects of interest of scientist and the public. It is fortunate that modern diagnostic methods of the study of ancient human beings can be applied today. The last forty years have seen a large number of CT scanning studies of Egyptian mummies from different museums and collections in Egypt, Europe and the USA. There is no doubt that this technique has proved to be a powerful tool in the field of Egyptian human remains research. CT studies confirm that the ancient Egyptian used several methods for the degree of quality of mummification This started with the selection of the most Suitable material to act as a filler for the internal to the body. CT studies confirm that the ancient Egyptian has used methods to support the body and maintain the external shape of the mummy. Research also stresses on the need for a new reading of the science of mummification according to the latest scientific methods of examination without any destructive activities toward the components of the various mummies. The main aim of this research is to study thoroughly the Third Intermediate Period mummies to show the level of sophistication of the technique of the mummification reached in this period.

To systematically analyze the influence of technical parameters on quantification of epicardial fat volume (EATV) at cardiac CT.153 routine cardiac CT data sets were analyzed using three-dimensional pericardial border delineation. Three image series were reconstructed per patient: (a) CTAD: coronary CT angiography (CTA), diastolic phase; (b) CTAS: coronary CTA, systolic phase; (c) CaScD: non-contrast CT, diastolic phase. EATV was calculated using three different upper thresholds (-15HU, -30 HU, -45HU). Repeated measures ANOVA, Spearman's rho, and Bland Altman plots were used.Mean EATV differed between all three image series at a -30HU threshold (CTAD 87.2 ± 38.5 ml, CTAS 90.9 ± 37.7 ml, CaScD 130.7 ± 49.5 ml, P0.001). EATV of diastolic and systolic CTA reconstructions did not differ significantly (P=0.225). Mean EATV for contrast enhanced CTA at a -15HU threshold (CTAD15 102.4 ± 43.6 ml, CTAS15 105.3 ± 42.3 ml) could be approximated most closely by non-contrast CT at -45HU threshold (CaScD45 105.3 ± 40.8 ml). The correlation was excellent: CTAS15-CTAD15, rho=0.943; CTAD15-CaScD45, rho=0.905; CTAS15-CaScD45, rho=0.924; each P0.001). Bias values from Bland Altman Analysis were: CTAS15-CTAD15, 4.9%; CTAD15-CaScD45, -4.3%; CTAS15-CaScD45, 0.6%.Measured EATV can differ substantially between contrast enhanced and non-contrast CT studies, which can be reconciled by threshold modification. Heart cycle phase does not significantly influence EATV measurements.

English Bulldogs have been reported to demonstrate abnormal growth and development of the nasal turbinates, which contribute to an increase in airway resistance and hence clinical signs of brachycephalic airway syndrome. The purpose of this prospective, cross-sectional study was to assess the prevalence and severity of caudal aberrant turbinate protrusion via CT studies of English Bulldogs with, according to the owners, none or minimal clinical signs of brachycephalic airway syndrome. An additional objective was to propose a classification scheme for describing the degree of caudal aberrant turbinate protrusion in English Bulldogs and to apply this scheme in assessing the effect of gender, weight, and age on prevalence and severity of turbinate protrusion. The nasal cavities of 40 clinically healthy English Bulldogs were examined. The prevalence of caudal aberrant turbinates in this group was 100%. Using our proposed classification scheme, Grade 1 (minimal) was detected in 7 of 40 (17.5%), Grade 2 (mild) in 28 of 40 (70%), and Grade 3 (moderate) in 5 of 40 (12.5%) English Bulldogs. No significant effect of gender, weight, and age on degree of protrusion was found. In conclusion, this study identified minimal to moderate protrusion of caudal aberrant turbinates toward the nasopharynx in all the sampled English Bulldogs, despite the absence of clinical signs of brachycephalic airway syndrome.

Despite a recent focus on the preferential use of ultrasound over CT for pediatric appendicitis, most children transferred from community hospitals still undergo diagnostic CT scans. The purpose of this study was to evaluate CT techniques performed for children with acute appendicitis at nonpediatric treatment centers.All patients treated for acute appendicitis at our tertiary-care pediatric hospital from July 1, 2011, through June 30, 2012, were identified. Patient demographics, imaging modality used to diagnoses appendicitis (CT or ultrasound), location (home or referral institution), and CT technique parameters were collected. The estimated mean organ radiation dose, number of imaging phases, and use of contrast media were evaluated at home and referral institutions.During the study period, 1215 patients underwent appendectomies after imaging, with 442 (36.4%) imaged at referral facilities. Most referral patients received a diagnosis by CT (n=384, 87%), compared with 73 of 773 (9.4%) who received a diagnosis by CT at the home institution. The estimated mean (±SD) organ radiation dose was not statistically significantly different between home and referral institutions (13.5±7.3 vs 12.9±6.4 mGy; p=0.58) for single-phase examinations. Of 384 referral patients, 344 had images available for review. In total, 40% (138/344) of patients from referral centers were imaged with suboptimal CT techniques: 50 delayed phase only, 52 dual phase (eight of which were imaged twice in delayed phase), eight triple phase, and 36 without IV contrast agent.CT parameters and radiation doses from single-phase examinations in children with appendicitis were similar at nonpediatric treatment centers and a tertiary care children's hospital. Future educational outreach should focus on optimizing other technical parameters.

Objectives The purpose of this study was to verify whether application of a quantitative computed tomography (QCT) technique was helpful for quantitative measurement of bone density using dental cone-beam CT (CBCT).

Objective: To analyze standardized uptake values (SUVs) using three different tube current intensities for attenuation correction on 18FNaF PET/CT scans. Materials and Methods: A total of 254 18F-NaF PET/CT studies were analyzed using 10, 20 and 30 mAs. The SUVs were calculated in volumes of interest (VOIs) drawn on three skeletal regions, namely, right proximal humeral diaphysis (RH), right proximal femoral diaphysis (RF), and first lumbar vertebra (LV1) in a total of 712 VOIs. The analyses covered 675 regions classified as normal (236 RH, 232 RF, and 207 LV1). Results: Mean SUV for each skeletal region was 3.8, 5.4 and 14.4 for RH, RF, and LV1, respectively. As the studies were grouped according to mAs value, the mean SUV values were 3.8, 3.9 and 3.7 for 10, 20 and 30 mAs, respectively, in the RH region; 5.4, 5.5 and 5.4 for 10, 20 and 30 mAs, respectively, in the RF region; 13.8, 14.9 and 14.5 for 10, 20 and 30 mAs, respectively, in the LV1 region. Conclusion: The three tube current values yielded similar results for SUV calculation.

The aim of this study is to elucidate the relationship of laryngeal electromyography (LEMG) and computed tomographic (CT) parameters to improve the prognosis of recurrent laryngeal nerve injury. 22 patients clinically suspected of having recurrent laryngeal nerve injury were examined with LEMG and CT studies. Bilateral thyroarytenoid (TA) muscles were examined and findings were interpreted by a single blind technique. Laryngeal CT image analysis of the ventricle dilation symmetry determined TA muscle atrophy. Finally, a follow-up laryngoscopic examination determined improvement of vocal fold movement. Ventricle dilation symmetry and the dichotomized TA muscle atrophy parameter significantly relate to the improvement of vocal fold movement ( χ 2 =4.029, P =0.039, and χ 2 =3.912, P =0.048, respectively). When the severity of vocal fold impairment was classified as severe TA muscle atrophy or none/discrete MUAP recruitment, it was found to significantly relate with the improvement of vocal fold movement ( χ 2 =6.712, P =.010). From this study, image analysis of the ventricle dilation symmetry to determine the severity of TA muscle atrophy shows promise for the improved prognosis of vocal fold immobility.

In modern oncology, disease progression and response to treatment are routinely evaluated with a series of volumetric scans. The number of tumors and their volume (mass) over time provides a quantitative measure for the evaluation. Thus, many of the scans are follow-up scans. We present a new, fully automatic algorithm for lung tumors segmentation in follow-up CT studies that takes advantage of the baseline delineation. The inputs are a baseline CT scan and a delineation of the tumors in it and a follow-up scan; the output is the tumor delineations in the follow-up CT scan; the output is the tumor delineations in the follow-up CT scan. The algorithm consists of four steps: (1) deformable registration of the baseline scan and tumor’s delineations to the follow-up CT scan; (2) segmentation of these tumors in the follow-up CT scan with the baseline CT and the tumor’s delineations as priors; (3) detection and correction of follow-up tumors segmentation leaks based on the geometry of both the foreground and the background; and (4) tumor boundary regularization to account for the partial volume effects. Our experimental results on 80 pairs of CT scans from 40 patients with ground-truth segmentations by a radiologist yield an average DICE overlap error of 14.5 % ( $$\hbox {std}=5.6$$ ), a significant improvement from the 30 % ( $$\hbox {std}=13.3$$ ) result of stand-alone level-set segmentation. The key advantage of our method is that it automatically builds a patient-specific prior to the tumor. Using this prior in the segmentation process, we developed an algorithm that increases segmentation accuracy and robustness and reduces observer variability.

The goal was to improve Alzheimer′s 2-deoxy-2- 18 F-fluoro-D-glucose ( 18 F FDG)-positron emission tomography (PET)/computed tomography (CT) imaging through application of a novel, hybrid Fourier-wavelet windowed Fourier transform (WFT) restoration technique, in order to provide earlier and more accurate clinical results. General Electric Medical Systems downward-looking sonar PET/CT 16 slice system was used to acquire studies. Patient data were acquired according the Alzheimer′s disease Neuroimaging Initiative (ADNI) protocol. Here, we implemented Fourier-wavelet regularized restoration, with a Butterworth low-pass filter, order n = 6 and a cut-off frequency f = 0.35 cycles/pixel and wavelet (Daubechies, order 2) noise suppression. The original (PET-O) and restored (PET-R) ADNI subject PET images were compared using the Alzheimer′s discrimination analysis by dedicated software. Forty-two PET/CT scans were used in the study. They were performed on eleven ADNI subjects at intervals of approximately 6 months. The final clinical diagnosis was used as a gold standard. For three subjects, the final clinical diagnosis was mild cognitive impairment and those 13 PET/CT studies were not included in the final comparison, as the result was considered as inconclusive. Using the reminding 29 PET/CT studies (23 AD and 6 normal), the sensitivity and specificity of the PET-O and PET-R were calculated. The sensitivity was 0.65 and 0.96 for PET-O and PET-R, respectively, and the specificity was 0.67 and 0.50 for PET-O and PET-R. The accuracy was 0.66 and 0.86 for PET-O and PET-R, respectively. The results of the study demonstrated that the accuracy of three-dimensional brain F-18 FDG PET images was significantly improved by Fourier-wavelet restoration filtering.

Hibernoma is a rare benign lipogenic tumor of brown fat that develops in a wide variety of locations. Although the features of hibernoma demonstrated by MRI resemble those of liposarcoma, recent FDG-PET/CT studies have documented higher radiotracer uptake than liposarcoma, suggesting that FDG/PET/CT is useful for differentiating hibernoma from liposarcoma. Here we report two cases of hibernoma that showed relatively lower SUVs than those reported previously, lying within the range for liposarcoma. Our findings emphasize that hibernoma needs to be included in the differential diagnosis of any fat-containing tumor showing intense accumulation by FDG-PET/CT. Although it is unlikely that such a rare condition could be reasonably diagnosed on the basis of MRI and FDG-PET/CT alone due to possible SUV overlap between hibernoma and liposarcoma, it is important to recognize this extremely rare lipogenic tumor for accurate diagnosis and appropriate management.

Background and Purpose: A common perception is that increased on-call workload leads to increased resident mistakes. To test this, we evaluated whether increased imaging volume has led to increased errors by residents. Materials and Methods: A retrospective review was made of all overnight neuroradiology CT exams with a primary resident read from 2006-2010. All studies were over-read by staff neuroradiologists next morning. As the volume is higher on Friday through Sunday nights, weekend studies were examined separately. Discrepancies were classified as either minor or major. “Major” discrepancy was defined as a discrepancy that the staff radiologist felt was significant enough to potentially affect patient care, necessitating a corrected report and phone contact with the ordering physician and documentation. The total number of major discrepancies was recorded by quarter. In addition, the total number of neuroradiology CT studies read overnight on-call was noted. Results: The mean number of cases per night during the weekday increased from 3.0 in 2006 to 5.2 in 2010 (p Conclusion: Despite an increase in neuroradiology exam volumes, there continues to be a low major discrepancy rate for primary resident interpretations. While continued surveillance of on-call volumes is crucial to the educational environment, concern of increased major errors should not be used as sole justification to limit autonomy.

Heterogeneous patchy marrow uptake on fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in a histologically proven case of lymphoma is usually considered a virtually pathognomonic sign of lymphomatous involvement. Here, we present a young male patient of T-cell-rich non-Hodgkin lymphoma (NHL), an uncommon morphologic variant of diffuse large B-cell lymphoma (DLBCL), who had undergone three sequential PET/CT scans at our department during the course of his therapy. These images depict the need for careful direct comparison of the current study with the previous PET/CT studies to avoid erroneous interpretation.

Impact injuries of cartilage may initiate post-traumatic degeneration, making early detection of injury imperative for timely surgical or pharmaceutical interventions. Cationic (positively-charged) CT contrast agents detect loss of cartilage proteoglycans (PGs) more sensitively than anionic (negatively-charged) or non-ionic (non-charged, i.e., electrically neutral) agents. However, degeneration related loss of PGs and increase in water content have opposite effects on the diffusion of the cationic agent, lowering its sensitivity. In contrast to cationic agents, diffusion of non-ionic agents is governed only by steric hindrance and water content of cartilage. We hypothesize that sensitivity of an iodine(I)-based cationic agent may be enhanced by simultaneous use of a non-ionic gadolinium(Gd)-based agent. We introduce a quantitative dual energy CT technique (QDECT) for simultaneous quantification of two contrast agents in cartilage. We employ this technique to improve the sensitivity of cationic CA4+ (q =+4) by normalizing its partition in cartilage with that of non-ionic gadoteridol. The technique was evaluated with measurements of contrast agent mixtures of known composition and human osteochondral samples (n = 57) after immersion (72 h) in mixture of CA4+ and gadoteridol. Samples were arthroscopically graded and biomechanically tested prior to QDECT (50/100 kV). QDECT determined contrast agent mixture compositions correlated with the true compositions (R2= 0.99, average error = 2.27%). Normalizing CA4+ partition in cartilage with that of gadoteridol improved correlation with equilibrium modulus (from ρ = 0.701 to 0.795). To conclude, QDECT enables simultaneous quantification of I and Gd contrast agents improving diagnosis of cartilage integrity and biomechanical status.

Computed Tomography (CT) system with Linear Detector Array (LDA) generates a thin crosssectional image (slice) of an object where as with Flat Panel Detector (FPD) directly generates 3D volume from 2D X-ray projections. Further, CT images are free from overlying and underlying areas of the object and are highly sensitive to small density differences (

OBJECTIVE. The standard of care for the diagnosis and follow-up of urolithiasis is unenhanced CT. The hypothesis of this study was that that by using image fusion of subsequent ultrasound (US) with the initial unenhanced CT, ureteral stones can be precisely localized. CONCLUSION. Of the 25 stones founds on unenhanced CT studies, 22 (88%) were confidently identified using US–unenhanced CT fusion within 72 hours after the initial CT scan was obtained. US–unenhanced CT fusion might obviate the need for repeated CT scans for monitoring urolithiasis.

The purpose of this study was to review and compare the image quality and radiation dose of split-bolus single-pass computed tomography(CT) in the assessment of trauma patients in comparison to standard multi-phase CT techniques. An online electronic database was searched using the MESH terms “split-bolus,” “dual phase,” and “single pass.” Inclusion criteria required the research article to compare a split contrast bolus protocol in a single-pass scan in the assessment of trauma patients. Studies using split-bolus CT technique in non-traumatic injury assessment were excluded. Six articles met the inclusion criteria. Parenchymal and vascular image qualities, as well as subjective image quality assessments, were equal or superior in comparison to non-split-bolus multi-phase trauma CT protocols. Split-bolus single-pass CT decreased radiation exposure in all studies. Further research is required to determine the superior split-bolus protocol and the specificity and sensitivity of detecting blunt cerebrovascular injury screening, splenic parenchymal vascular lesions, and characterization of pelvic vascular extravasation.

The aims of the current study were to draw a portrait of the delivered dose in selected nuclear medicine studies in Quebec province and to assess the degree of change between an earlier survey performed in 2010 and a later survey performed in 2014. Methods: Each surveyed nuclear medicine department had to complete 2 forms: the first, about the administered activity in selected nuclear medicine studies, and the second, about the CT parameters used in SPECT/CT imaging, if available. The administered activities were converted into effective doses using the most recent conversion factors. Diagnostic reference levels were computed for each imaging procedure to obtain a benchmark for comparison. Results: The distributions of administered activity in various nuclear medicine studies, along with the corresponding distribution of the effective doses, were determined. Excluding 131I for thyroid studies, 67Ga-citrate for infectious workups, and combined stress and rest myocardial perfusion studies, the remainder of the 99mTc-based studies delivered average effective doses clustered below 10 mSv. Between the 2010 survey and the 2014 survey, there was a statistically significant decrease in delivered dose from 18.3 to 14.5 mSv. 67Ga-citrate studies for infectious workups also showed a significant decrease in delivered dose from 31.0 to 26.2 mSv. The standardized CT portion of SPECT/CT studies yielded a mean effective dose 14 times lower than the radiopharmaceutical portion of the study. Conclusion: Between 2010 and 2014, there was a significant decrease in the delivered effective dose in myocardial perfusion and 67Ga-citrate studies. The CT portions of the surveyed SPECT/CT studies contributed a relatively small fraction of the total delivered effective dose.

The purpose of this article is to compare radiation doses and conspicuity of anatomic landmarks of the temporal bone between the CT technique using spectral beam shaping at 150 kVp with a dedicated tin filter (150 kVp-Sn) and the conventional protocol at 120 kVp.25 patients (mean age, 46.8 ± 21.2 years) were examined using the 150-kVp Sn protocol (200 reference mAs using automated tube current modulation, 64 × 0.6 mm collimation, 0.6 mm slice thickness, pitch 0.8), whereas 30 patients (mean age, 54.5 ± 17.8 years) underwent the 120-kVp protocol (180 mAs, 128 × 0.6 mm collimation, 0.6 mm slice thickness, pitch 0.8). Radiation doses were compared between the two acquisition techniques, and dosimetric data from the literature were reviewed for comparison of radiation dose reduction. Subjective conspicuity of 23 anatomic landmarks of the temporal bone, expressed by 5-point rating scale and objective conspicuity by signal-to-noise ratio (SNR) which measured in 4 different regions of interest (ROI), were compared between 150-kVp Sn and 120-kVp acquisitions.The mean dose-length-product (DLP) and effective dose were significantly lower for the 150-kVp Sn scans (0.26 ± 0.26 mSv) compared with the 120-kVp scans (0.92 ± 0.10 mSv, p 0.001). The lowest effective dose from the literature-based protocols was 0.31 ± 0.12 mSv, which proposed as a low-dose protocol in the setting of spiral multislice temporal bone CT. SNR was slightly superior for 120-kVp images, however analyzability of the 23 anatomic structures did not differ significantly between 150-kVp Sn and 120-kVp scans.Temporal bone CT performed at 150 kVp with an additional tin filter for spectral shaping markedly reduced radiation exposure when compared with conventional temporal bone CT at 120 kVp while maintaining anatomic conspicuity. The decreased radiation dose of the 150-kVp Sn was also lower in comparison to the previous literature-based low-dose temporal bone CT protocol.

In the past, numerous studies have documented the possibility of intraindividual differing appearances of the paired age-marker “medial clavicular ossification” in borderline adults. However, the extent of the divergences is rarely mentioned. Against that the article describes this phenomenon from a large sample of 2595 male persons by means of thin-slice CT imaging of the sternoclavicular regions. For determining the ossification stage of the medial clavicles, the two accepted classifications by Schmeling et al. (five main stages) and Kellinghaus et al. (six substages) were applied and buildings deviating from that labelled as atypical “norm variants”. The longstanding observation could be confirmed that intraindividual stage discrepancies of this age indicator are generally moderate and do not exceed one main stage or two substages of the respective classifications. It is concluded that stage determination should be scrutinized, if a dissimilarity seems to show larger differences.

For the past several years, increased levels of imaging radiation and cumulative radiation to children has been a significant concern. Although several measures have been taken to reduce radiation dose during computed tomography (CT) scan, the newer dose reduction software adaptive statistical iterative reconstruction (ASIR) has been an effective technique in reducing radiation dose. To our knowledge, no studies are published that assess the effect of ASIR on extremity CT scans in children. To compare radiation dose, image noise, and subjective image quality in pediatric lower extremity CT scans acquired with and without ASIR. The study group consisted of 53 patients imaged on a CT scanner equipped with ASIR software. The control group consisted of 37 patients whose CT images were acquired without ASIR. Image noise, Computed Tomography Dose Index (CTDI) and dose length product (DLP) were measured. Two pediatric radiologists rated the studies in subjective categories: image sharpness, noise, diagnostic acceptability, and artifacts. The CTDI (p value = 0.0184) and DLP (p value

Purpose To evaluate an objective computed tomographic (CT) criterion for distinguishing between part-solid (PS) and nonsolid (NS) lung nodules. Materials and Methods This study received institutional review board approval, and patients gave informed consent. Preoperative CT studies in all patients who underwent surgery for subsolid nodules between 2008 and 2015 were first reviewed by two senior radiologists, who subjectively classified the nodules as PS or NS. A second reading performed 1 month later used predefined classification criteria and involved a third senior radiologist as well as three junior radiologists. Subsolid nodules were classified as PS if a solid portion was detectable in the mediastinal window setting (nonmeasurable, 50% of the entire nodule) and were otherwise classified as NS (subclassified as pure or heterogeneous). Interreader agreement was assessed with κ statistics and the intraclass correlation coefficient (ICC). Results A total of 99 nodules measuring a median of 20 mm (range, 5-47 mm) in lung window CT images were analyzed. Senior radiologist agreement on the PS/NS distinction increased from moderate (κ = 0.54; 95% confidence interval [CI]: 0.37, 0.71) to excellent (κ = 0.89; 95% CI: 0.80, 0.98) between the first and second readings. At the second readings, agreement among senior and junior radiologists was excellent for PS/NS distinction (ICC = 0.87; 95% CI: 0.83, 0.90) and for subcategorization (ICC = 0.82; 95% CI: 0.77, 0.87). When a solid portion was measurable in the mediastinal window, the specificity for adenocarcinoma invasiveness ranged from 86% to 96%. Conclusion Detection of a solid portion in the mediastinal window setting allows subsolid nodules to be classified as PS with excellent interreader agreement. If the solid portion is measurable, the specificity for adenocarcinoma invasiveness is high. © RSNA, 2017 Online supplemental material is available for this article.

Nasal anatomic variations are relevant during nasal surgical and endoscopic procedures. The extent of imaging methods, such as the cone beam computed tomography (CBCT), allows a better characterization of such peculiar anatomic traits. The bifid inferior turbinate (BIT) is a rare finding, being previously reported less than ten times. It was found and described on CT scans of patients, being usually associated with the absence of the uncinate process (UP). We hereby report for the first time a bilateral true BIT which differs from the previously reported BITs by the fact that the UPs were present and the bifidity was oriented laterally. In the light of this new find, we consider that the variant resulted from UP displacement should be regarded as a false bifid, or double, inferior turbinate. Bifidity of the inferior turbinate was not previously evaluated in CBCT, as well as in three-dimensional volume renderizations. So, CBCT proves as an efficient tool to investigate prevalence of rare anatomical variants. Noteworthy, CT studies of patients on a case-by-case basis allows a better performance of surgical and endoscopic procedures.

To determine how much money could potentially be saved by re-evaluating a patient’s prior recent abdominal CT for lumbar spine pathology instead of ordering a lumbar spine MRI. Abdominal CT studies, from all consecutive patients who had an abdominal CT within 12 months prior to a lumbar spine MRI obtained between 11/1/15 and 5/30/16, were retrospectively reviewed in a blinded fashion for the presence of any significant lumbar spine abnormalities. CT studies that accurately reflected all normal and abnormal findings when compared to the standard of reference, the prospectively interpreted lumbar spine MR imaging reports, were used to indicate which lumbar spine MRI studies potentially could have been avoided and to calculate the potential cost savings. Of the 81 abdominal CT studies that met the inclusion criteria of this study, 62% (50/81) were TP, 28% (23/81) were TN, 5% (4/81) were FP, and 5% (4/81) were FN studies. 90% (73/81) of the lumbar spine MRI studies could potentially have been avoided during the 7 months of this study. The predicted savings by reviewing the abdominal CT for lumbar spine abnormalities prior to ordering a lumbar spine MRI are an estimated 1.2–3.4 billion dollars per year. Recent abdominal CT studies should be reviewed for lumbar spine pathology prior to a patient undergoing lumbar spine MRI. Avoiding unnecessary lumbar spine MRI studies could potentially save the U.S. healthcare system an estimated 1.2–3.4 billion dollars per year.

To analyze the accuracy of radiological diagnosis in MRI and CT studies of salivary gland tumors depending on the radiologist’s experience. Three radiologists with differing experience (R1 > 20, R2 > 11, and R3 > 7 years, respectively) retrospectively reviewed 128 cases (116 MRI, 12 CT studies) with suspected salivary gland tumors regarding dignity and classification using histopathology as a reference standard. Sensitivity, specificity, positive/negative predictive value and inter-observer agreement (using Cohen’s κ) were calculated to compare diagnostic performance. Lesions were benign in 87 and in 23 cases malignant. Neoplasia was absent in 18 cases (15 cases without neoplasia and 3 cases without disease). The highest inter-observer agreement for determining dignity using CT was found between R1 and R2 (κ = 0.74, p

Purpose To investigate pulmonary venous anomaly as a cause of pulmonary arteriovenous malformation (PAVM) misdiagnosis. Materials and methods We reviewed adult patients within a 7.5-year period with CT scans initially diagnosed with PAVM and subsequent conventional pulmonary angiograms. Results Pulmonary arteriography showed no PAVM on arterial phase for 10 out of 99 patients, comprising the misdiagnosed group. Four misdiagnosed patients had pulmonary venous anomalies and six had nodular lesions on CT. Conclusion Pulmonary venous anomalies are vascular mimics of PAVMs that may lead to misdiagnosis. Optimal CT technique and careful imaging review are necessary to minimize inappropriate invasive angiography.

Nuclear Medicine (NM) imaging plays a major role in the assessment of infection and inflammation. Tracers, including single photon emitting radionuclides for Single Photon Emission Tomography (SPECT) and agents for positron emission tomography (PET), reflect primarily tissue and cellular function or metabolism. In the specific clinical setting of a patient with suspected infectious or inflammatory process, planar scintigraphy, SPECT or PET procedures are used to support a clinically suspected diagnosis. Integrating metabolic and anatomic information using a single SPECT/CT or PET/CT technique has substantially improved the diagnostic accuracy of these imaging tests and advanced the NM technology to be a significant and important tool in the field of infection and inflammation. Diabetes, one of the most prevalent diseases, has a direct relationship with the development of various infection related condition. Due to alterations in different metabolic pathways, imaging of the diabetic patient may be subject to specific pitfalls and obstacles which should be taken into consideration. This review aimed at describing the impact of diabetes and hyperglycemia on NM imaging, with an emphasis on FDGPET/ CT, in specific infectious conditions related to diabetes.

The purpose of this study was to conduct longitudinal analyses of radiation dose data from adult patients undergoing clinically indicated, repeat identical thoracoabdominal CT examinations.Radiation dose data were electronically collected from 2851 subjects undergoing 12,635 repeat identical CT scans (mean number of scans per patient, 4.8; range, 2-33) in one health system. Included CT protocols were chest-abdomen-pelvis with contrast administration (n = 4621 CT studies of 1064 patients), abdomen-pelvis with contrast administration (n = 876 CT studies of 261 patients), renal stone (n = 1053 CT studies of 380 patients), and chest (n = 6085 CT studies of 1146 patients) without contrast administration. A radiation-tracking software infrastructure was adopted to extract data from DICOM headers in PACS. Size-specific dose estimate (SSDE) was calculated.A trend was observed toward global reduction in SSDE values with all protocols investigated (chest-abdomen-pelvis slope, -1.78; abdomen-pelvis slope, -0.82; renal stone slope, -0.83; chest slope, -0.47; p0.001 for all comparisons). The intraindividual analyses of radiation dose distribution showed widespread variability in SSDE values across the four protocols investigated (chest-abdomen-pelvis mean coefficient of variance, 14.02 mGy; abdomen-pelvis mean coefficient of variance, 10.26 mGy; renal stone mean coefficient of variance, 34.18 mGy; chest mean coefficient of variance, 6.74 mGy).Although there is a trend toward global reduction in radiation doses, this study showed widespread variability in the radiation dose that each patient undergoing identical repeat thoracoabdominal CT protocols absorbs. These data may provide a foundation for the future development of best-practice guidelines for patient-specific radiation dose monitoring.

Rheumatoid arthritis is a chronic disease characterised by joint inflammation causing damage to the bones, including those of the fingers. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a new CT technique only used in research settings that allows detailed imaging of the bones. This dissertation shows that HR-pQCT is a reliable and sensitive technique. In the future, HR-pQCT may be used to monitor and evaluate treatment effects in clinical trials. HR-pQCT may also be used to study bone abnormalities in other rheumatic diseases.

Contrast-enhanced CT studies are highly diagnostic and involve little physiological stress. To obtain the best results, protocols for contrast enhancement must take into consideration the patient factors, CM factors, and scan factors for contrast enhancement.

CT enterography is a high spatial and temporal resolution multidetector CT exam of the abdomen and pelvis, following the administration of a large volume of enteric contrast agent that distends the small bowel. It provides exquisite images of the small bowel wall, lumen, and perienteric tissues. It can be routinely performed in the outpatient setting in nearly all radiology departments to evaluate for inflammatory bowel disease and other small bowel diseases. Improvements in CT technology have enabled greater adaptation of CT technique to clinical questions and dramatically reduced radiation dose. Over the past decade, CT enterography has become a widely available test with interpreted with local expertise, and there is emerging standardization of acquisition techniques and image interpretation methods, especially with relation to the staging of Crohn’s disease [1, 2]. CT enterography is complementary to other imaging modalities, and provides unique information that impacts clinical management of patients with inflammatory bowel disease.

The purpose of this study is confirmed to usefulness between division exam and combine exam of chest and abdomen according to comparing chest and abdomen radiation dose of division exam and combine exam in CT exam method. This study was conducted on patients who were admitted to the E hospital from July 2013 to March 2014 underwent CT studies for the diagnosis of chest and abdomen disease. In study result, male dose were more higher than female dose according to gender analysis of exposure dose that combine exam effective dose were male 33.10±2.75 mSv, female 31.66±3.12 mSv and chest exam effective dose were male 9.07±2.62 mSv, female 8.30±2.18 mSv (p 0.05). And, combine exam effective dose, only chest exam effective dose, only abdomen exam effective dose were more higher than DRL(Diagnostic Reference Level) in comparison of patient exposure dose with DRL (p

Using the advanced modern technology is considered to be one of the most important methods ofscientific examination and registration. This should be used in the field of the conservation of themummies. Identifying the case of the mummy and putting the mummy outwardly or inwardly is the firststage in the good prognosis of damage, which naturally leads to the development of an appropriateplan for the operations of treatment and conservation starting from the stage of cleaning till museumpresentation consistent with the requirements of preventive conservation. Computed TomographyScanning (CT scanning) since it is non-invasive and does not harm the mummies, has become animportant tool for studying many features of ancient Egyptian mummies. Study of ancient Egypt, andparticularly the examination of mummies, excites many people from all aspects of life We have beenfortunate to be able to apply modern diagnostic methods to the study of ancient human beings.“Tayuheret" mummy the Subject of paper, dates back to the Third Intermediate Period, 21st dynastywhich was discovered in Deir al-Bahari in Luxor in southern Egypt in 1881,now housed in theEgyptian Museum. The study was divided into a full examination of the body from the head, Thorax,abdomen, pelvis and even district legs, CT studies confirm the ancient Egyptian used several methodsfor the degree of quality of mummification starting from the selection of Suitable materials fillerinternal to the body, CT studies confirm ancient Egyptian used methods to support the body andmaintain the external shape of the mummy's body, research stressed the need for a new reading of thescience of mummification according to the latest scientific methods of examination without anydestructive effect on the components of the mummies.

The purpose of this retrospective investigation is to characterize and illustrate the appearances of celiomesenteric trunk (CMT) and hepatosplenomesenteric trunk (HSMT) using CT with three-dimensional volume-rendering with attention to the proximal branching patterns. We also correlate our results with an embryologic model and assess the accuracy of radiologists in recognizing these entities. CT studies on 36 adult subjects with CMT and 10 with HSMT were analyzed to determine the proximal branching patterns and lengths of the common vascular trunks. The official reports in appropriately selected cases were reviewed to ascertain if the interpreting radiologists recognized the anomalies. Two types of CMT were found. In 29 of 36 cases (81%), the CMT bifurcated into the celiac trunk and superior mesenteric artery (Type A CMT), while in 7 cases the left gastric artery (LGA) arose from the CMT proximal to the hepatosplenic trunk and superior mesenteric artery (Type B CMT). Type A trunks (mean length = 10.4 mm) were significantly shorter (p = 0.007) than Type B trunks (mean length = 17.8 mm). Short common trunks (less than 1.0 cm) were only seen with Type A CMT. Branching patterns in all 10 cases of HSMT were identical with no short common trunks. The CMT was not mentioned in the radiology reports in 88% of the cases assessed. The location of the LGA origin distinguishes the two variants of CMT and differentiates CMT from HSMT. These anomalies are easily overlooked during evaluation of routine clinical cases.

Introduction In nuclear medicine, single-photon-emission computed tomography (SPECT) is often combined with ‘simultaneous’ low-dose CT (LDCT) to provide complementary anatomical and functional correlation. As a consequence, numerous incidental and unexpected findings may be detected on LDCT. Recognition of these findings and appropriate determination of their relevance can add to the utility of SPECT/CT. We aimed to evaluate the prevalence and categorise the relevance of incidental and unexpected findings on LDCT scans performed as part of routine SPECT/CT studies. Methods All available LDCT scans performed as part of SPECT/CT studies at St. Vincent's Hospital Melbourne in the year 2013 were retrospectively reviewed. Two qualified radiologists independently reviewed the studies and any previous available imaging and categorised any detected incidental findings. Results A total of 2447 LDCT studies were reviewed. The relevance of the findings was classified according to a modified version of a scale used in the Colonography Reporting and Data System: E1 = normal or normal variant (28.0%); E2 = clinically unimportant (63.5%); E3 = likely unimportant or incompletely characterised (6.2%); E4 = potentially important (2.5%). Conclusion Imaging specialists need to be cognisant of incidental and unexpected findings present on LDCT studies performed as part of SPECT/CT. Appropriate categorisation of findings and communication of potentially important findings to referring clinicians should form part of routine practice. The overall prevalence of potentially significant incidental and unexpected findings in our series was 8.7% (E3, 6.2%; E4, 2.5%) and was comparable to rates in other published imaging series.

OBJECTIVE. Lifelong postprocedural imaging surveillance is necessary after endovascular abdominal aortic aneurysm repair (EVAR) to assess for complications of endograft placement, as well as device failure and continued aneurysm growth. Refinement of the surveillance CT technique and development of ultrasound and MRI protocols are important to limit radiation exposure. CONCLUSION. A comprehensive understanding of EVAR surveillance is necessary to identify life-threatening complications and to aid in secondary treatment planning.

Background : The primary aim of this study was to examine if factors such as renal function, height, weight and age could affect the uptake of sodium fluoride-18 (NaF-18) by the normal bone. This is the first study to examine the possible factors that can influence NaF-18 uptake in the normal bone. Methods: A retrospective study was done on NaF - 18 PET/CT bone scans from January 2010 to May 2012 at our institution. All NaF - 18 PET/CT studies used the same clinical protocol. Our excluding criteria w ere patients with abnormal renal function and patients with past history of cancer and metabolic bone diseases. Spearman ’ s correlation was used to analyze the data. Results: From our study (n = 11 patients), no correlation was found between SUV max and serum creatinine and between SUV max and age. However, significant correlations were found between SUV max and height (cm) and between SUV max and weight (kg) for thoracic 5, 7, 12 and lumbar 2 vertebral levels. Conclusion: Based on our findings, SUV max values in NaF-18 PET/CT bone scans can vary depending on the patient’s height, weight and bone region. This information can be helpful in diagnosing and monitoring bone pathologies and can help explain the clinical findings. J Clin Med Res. 2014;6(6):435-442 doi: http://dx.doi.org/10.14740/jocmr1901w

Background: There are several published computed tomography (CT) classification systems for calcaneus fractures, each validated by a different standard. The goal of this study was to measure which system would best predict clinical outcomes as measured by a widely used and validated musculoskeletal health status questionnaire. Methods: Forty-nine patients with isolated intra-articular joint depression calcaneus fractures more than 2 years after treatment were identified. All had preoperative CT studies and were treated with open reduction and plate fixation using a lateral extensile approach. Four different blinded reviewers classified injuries according to the CT classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders. Functional outcomes evaluated with a Musculoskeletal Functional Assessment (MFA). The mean follow-up was 4.3 years. Results: The mean MFA score was 15.7 (SD = 11.6), which is not significantly different from published values for midfoot injuries, hindfoot injuries, or both, 1 year after injury (mean = 22.1, SD = 18.4). The classification systems of Crosby and Fitzgibbons, Eastwood, and Sanders, the number of fragments of the posterior facet, and payer status were not significantly associated with outcome as determined by the MFA. The Sanders classification trended toward significance. Anterior process comminution and surgeon’s overall impression of severity were significantly associated with functional outcome. Conclusions: The amount of anterior process comminution was an important determinant of functional outcome with increasing anterior process comminution significantly associated with worsened functional outcome ( P = .04). In addition, the surgeon’s overall impression of severity of injury was predictive of functional outcome ( P = .02), as determined by MFA. Level of Evidence: Level III, comparative series.

Standardization of FDG PET-CT is becoming a reality, at least in centers that perform clinical trials. Non-FDG radiopharmaceuticals used with PET/CT are far from standard in clinical trials and in clinical use. This article only gives an example of different protocols and indications related to the availability of different radiopharmaceuticals. This scenario will be probably the reality in the near future in many centers throughout the world. Starting from the FDG experience, it will be easy to implement standards for acquisition and interpretation of PET/CT studies with other radiopharmaceuticals.

To determine radiation dose indexes for computed tomography (CT) performed with renal colic protocols in the United States, including frequency of reduced-dose technique usage and any institutional-level factors associated with high or low dose indexes.The Dose Imaging Registry (DIR) collects deidentified CT data, including examination type and dose indexes, for CT performed at participating institutions; thus, the DIR portion of the study was exempt from institutional review board approval and was HIPAA compliant. CT dose indexes were examined at the institutional level for CT performed with a renal colic protocol at institutions that contributed at least 10 studies to the registry as of January 2013. Additionally, patients undergoing CT for renal colic at a single institution (with institutional review board approval and informed consent from prospective subjects and waiver of consent from retrospective subjects) were studied to examine individual renal colic CT dose index patterns and explore relationships between patient habitus, demographics, and dose indexes. Descriptive statistics were used to analyze dose indexes, and linear regression and Spearman correlations were used to examine relationships between dose indexes and institutional factors.There were 49 903 renal colic protocol CT examinations conducted at 93 institutions between May 2011 and January 2013. Mean age ± standard deviation was 49 years ± 18, and 53.9% of patients were female. Institutions contributed a median of 268 (interquartile range, 77-699) CT studies. Overall mean institutional dose-length product (DLP) was 746 mGy ⋅ cm (effective dose, 11.2 mSv), with a range of 307-1497 mGy ⋅ cm (effective dose, 4.6-22.5 mSv) for mean DLPs. Only 2% of studies were conducted with a DLP of 200 mGy ⋅ cm or lower (a "reduced dose") (effective dose, 3 mSv), and only 10% of institutions kept DLP at 400 mGy ⋅ cm (effective dose, 6 mSv) or less in at least 50% of patients.Reduced-dose renal protocol CT is used infrequently in the United States. Mean dose index is higher than reported previously, and institutional variation is substantial.

To investigate the potential of virtual non-contrast CT (VNCT) from dual-energy CT to replace true nonenhanced CT (TNCT) for the detection of enlarged cervical lymph nodes.Thirty-nine patients with 94 histopathologically proven cervical lymph nodes were imaged with the dual-energy CT technique. VNCT images from the arterial [VNCT-A] and venous phases [VNCT-V] were obtained with the liver VNC application. The mean CT number and signal-to-noise ratio (SNR) were compared. Image quality was evaluated with a score scale of 1-5. Effective dose (ED) was calculated and compared.Mean CT numbers of cervical lymph nodes were higher on VNCT than on TNCT (P = 0.034). There was no difference in the SNR among three sets of non-enhanced CT images, but the CNR of VNCT images was higher than that of TNCT images (P0.001). Image quality of VNCT from two phases was comparable to that of TNCT (P = 0.070). There was no difference in image quality of three sets of non-enhanced CT images (P0.05). ED from dual-phase dual-energy CT was lower than that from tri-phase CT scans (P0.001).VNCT images from dual-energy CT of the neck had diagnostic image quality; they have the potential to replace TNCT, thus reducing the radiation dose.

The increasing use of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in oncology has led to: improved sensitivity and specificity in detecting localized and metastatic disease, increased ability to target biopsies to the site of most aggressive disease, and development of a noninvasive biomarker to assess prognosis and effects of therapy. However, for correct interpretation of FDG-PET/CT studies, an understanding of both normal and abnormal imaging appearances commonly encountered in oncology patients is important. This article discusses commonly seen normal variations and benign findings on FDG-PET/CT of the abdomen.

a b s t r a c t Objective: To describe the clinical impact of PET/CT in the management of patients with vulvar cancer. Material and methods: Retrospective analysis of 13 PET/CT studies with

Background We examined trends in utilization of computed tomography (CT) among Medicaid enrollees in North Carolina, the clinical setting in which those CT scans were performed, and the number of enrollees known to have undergone 10 or more scans in a given year. Methods North Carolina Medicaid claims were analyzed to determine the number of CT studies performed between January 1, 2007, and December 31, 2012. We assessed the number of "high exposure" patients--those who received 10 or more CT scans in a given calendar year--and divided this group into patients with a diagnosis of cancer and patients without a diagnosis of cancer. We also determined the type of site at which each CT scan was performed. Results Over the 6-year period 2007-2012, the percentage of all enrollees who underwent any CT study ranged from 8.0% to 9.6% (126,082-177,425 enrollees). The number of CT scans performed annually increased from 2007 to 2009 and then plateaued. The number of high-exposure patients increased gradually, from 2,171 in 2007 to 4,017 in 2012. The majority of CT scans of high--exposure patients--150,241 of 251,052 (59.8%)--were performed in non office outpatient settings, such as emergency departments or urgent care centers. Conclusion Although the number of CT scans performed annually in the North Carolina Medicaid population stabilized in the late 2000s (as did CT use nationally), the percentage of high-exposure patients has continued to rise. Physicians and patients need to be further educated in order to promote radiation safety and to decrease unnecessary radiation exposure.

To assess the frequency of clinically significant incidental CT findings on PET/CT. Reports of 345 cases of baseline standard skull base to thighs PET/CT exams done over the course of a 6 month period at an outpatient facility affiliated with a large tertiary care level 1 trauma medical center were retrospectively reviewed. Incidental CT findings were assigned a level of clinical significance on a scale of 1–5, from doubtful significance to very significant. CT findings already known from prior CT reports were not included. CT findings corresponding to PET findings were also excluded. A score of 3 or greater was considered significant and reportable. Out of 345 cases, 171 (50%) had a least one CT finding rated at or above a score of 3 on our scale of significance, while 96 (28%) were found to have at least one CT finding with score at or above 4, and 25 cases (7%) showed at least one CT finding rated 5. A substantial percentage of baseline PET/CT studies contain previously undiagnosed, significant incidental findings on the CT images.

Computed Tomography (CT) is extensively used as a medical diagnostic tool, and increasingly adopted for scientific and industrial research. In the wood industry, there is a growing interest in using the CT technique to assess the quality of logs entering a sawmill to enable the material to be appropriately processed into maximum value products. Internal features of interest include knots, heartwood/sapwood boundary, rot and splits. Most commercially available CT scanning systems are modeled on medical designs and provide high spatial and density resolution. They are very complex and delicate devices with correspondingly high cost. However, log scanning has its own distinctive characteristics: specific overall and feature geometries and relatively coarse scanning resolution requirement. To fit these characteristics, the novel geometry-based coarse-resolution CT scanning approach described here has been developed and implemented. The models, algorithms, scanner design and result validation are presented in detail. The resulting CT reconstructions for an example log using the proposed geometry-based coarse-resolution approach compare well with CT reconstructions for same log using the same data with conventional filtered back projection inversion. The good comparison gives confidence in the usefulness and applicability of the proposed CT method for industrial use in sawmills for log quality assessment.