Cholangiolocellular carcinoma of the liver: CT and MR findings

The authors report two cases of surgically proved cholangiolocellular carcinoma of the liver. Marked contrast enhancement was observed at the periphery of the tumor on CTs and MRIs obtained during the hepatic arterial and portal venous phases, with concentric filling on the delayed images. On T1-weighted and T2-weighted MRIs, the tumor was, respectively, hypointense and hyperintense, with a central hypointense area. Therefore, helical CT and MRI features of these cholangiolocellular carcinomas were thought to be similar to those of cholangiocarcinoma.     

Health policy analysis and magnetic resonance imaging. The case of the New York State Demonstration Project

In the absence of controlled clinical trials, the diffusion of magnetic resonance imaging (MRI) has been driven by market forces and the perceived benefits of this technology. To date, all projective needs for MRI use are based on a consensus impression of a medical panel on the role of MRI for DRG or International Classification of Diseases, Ninth Revision, codes. Since an impression of future utilization is not particularly precise, the focus of The New York State MRI Demonstration Project, which approved the acquisition of MRIs at 14 medical centers in 1983, was to determine the actual use of MRI in a medical setting. In a 3-year period, all sites performed 16,095 MRI examinations with 6647 subjects also receiving computed tomography (CT). The results of this study were as follows: (1) 88% of MRIs performed were of the central nervous system (CNS), (2) low level of utilization in the chest and abdomen reflects both a problem with MRI motion artifacts and the failure of MRI to compete with established diagnostic modalities such as mammography, CT scanning, and ultrasonography, (3) for the CNS 18% (1037/5876) studies were positive on MRI but negative by CT, (4) only 1.4% (n = 85) of cases were lesions detected by CT and missed by MRI, and (5) for 81% of the 4754 examinations, MRI and CT were in agreement. Based on the number of lesions observed, the image contrast, and the overall radiologist's impression, MRI was rated superior to CT in 50-60% of the CNS cases. The projected need, based on this study, is for one MRI per 430,000 population in New York State. Also as newer MR imaging protocols evolve, patient use should increase, with the technical cost per study becoming approximately +250 for a scanner performing 3900 studies per year with a +1 million operating expense. At the present time, the best predictive index of MRI utilization is the need for CNS examinations.     

The impact of introducing a no oral contrast abdominopelvic CT examination (NOCAPE) pathway on radiology turn around times,emergency department length of stay,and patient safety

This investigation evaluates the impact of the no oral contrast abdominopelvic CT examination (NOCAPE) on radiology turn around time (TAT), emergency department (ED) length of stay (LOS), and patient safety metrics. During a 12-month period at two urban teaching hospitals, 6,409 ED abdominopelvic (AP) CTs were performed to evaluate acute abdominal pain. NOCAPE represented 70.9 % of all ED AP CT examinations with intravenous contrast. Data collection included patient demographics, use of intravenous (IV) and/or oral contrast, order to complete and order to final interpretation TAT, ED LOS, admission, recall and bounce back rates, and comparison and characterization of impressions. The NOCAPE pathway reduced median order to complete TAT by 32 min (22.9 %) compared to IV and oral contrast AP CT examinations (traditional pathway) (P?P?P?=?0.003). Recall and bounce back rates were 3.2 %, and only one patient had change in impression after oral contrast CT was repeated. The NOCAPE pathway is associated with decreased radiology TAT and ED LOS metrics. The authors suggest that NOCAPE implementation in the ED setting is safe and positively impacts both radiology and emergency medicine workflow.     

Shift in imaging modalities of the spine through 25 years and its impact on patient ionizing radiation doses

STUDY DESIGN: Retrospective. OBJECTIVE: To explore the shift in modalities when diagnosing the spine in the years 1979-2003. To see how this shift, together with a radiation protective policy, have influenced on the ionizing radiation doses. SUMMARY OF BACKGROUND DATA: The shift from CT/myelography to MR when diagnosing the spine is well known. To what extent this has changed the radiation doses has to our knowledge not yet been published. METHODS: Activity reports from a department of radiology have been reviewed. Relevant radiation doses estimates have been obtained from the Norwegian Radiation Protection Authority. RESULTS: MRI was introduced in 1992 and has been used increasingly since then. Conventional X-ray to the spine has been practically unchanged. Myelography and CT decreased markedly after the introduction of MRI. The total number of examinations of the spine has increased, but the radiation doses given have decreased since 1993. CONCLUSIONS: The introduction of MRI together with a radiation protective policy have reduced the ionizing radiation doses given to this population, in spite of an increase in the total number of examinations of the spine.     

Dose evaluation of MRI-based synthetic CT generated using a machine learning method for prostate cancer radiotherapy

Magnetic resonance imaging (MRI)-only radiotherapy treatment planning is attractive since MRI provides superior soft tissue contrast over computed tomographies (CTs), without the ionizing radiation exposure. However, it requires the generation of a synthetic CT (SCT) from MRIs for patient setup and dose calculation. In this study, we aim to investigate the accuracy of dose calculation in prostate cancer radiotherapy using SCTs generated from MRIs using our learning-based method. We retrospectively investigated a total of 17 treatment plans from 10 patients, each having both planning CTs (pCT) and MRIs acquired before treatment. The SCT was registered to the pCT for generating SCT-based treatment plans. The original pCT-based plans served as ground truth. Clinically-relevant dose volume histogram (DVH) metrics were extracted from both ground truth and SCT-based plans for comparison and evaluation. Gamma analysis was performed for the comparison of absorbed dose distributions between SCT- and pCT-based plans of each patient. Gamma analysis of dose distribution on pCT and SCT within 1%/1 mm at 10% dose threshold showed greater than 99% pass rate. The average differences in DVH metrics for planning target volumes (PTVs) were less than 1%, and similar metrics for organs at risk (OAR) were not statistically different. The SCT images created from MR images using our proposed machine learning method are accurate for dose calculation in prostate cancer radiation treatment planning. This study also demonstrates the great potential for MRI to completely replace CT scans in the process of simulation and treatment planning. However, MR images are needed to further analyze geometric distortion effects. Digitally reconstructed radiograph (DRR) can be generated within our method, and their accuracy in patient setup needs further analysis.     

Retrospective Analysis of Emergency Computed Tomography Imaging Utilization at an Academic Centre: An Analysis of Clinical Indications and Outcomes

PurposeTo explore resource utilization through evaluation of computed tomography (CT) imaging trends in the emergency department by examining common indications/outcomes for imaging in this setting.MethodsA retrospective analysis of clinical indications/outcomes for all CT imaging in 3 emergency departments over a 1-year period was conducted. Scans were divided by body part and the most common indications for each type of scan were determined. Clinical outcomes from each study were extracted from final interpretations by the reporting radiologist.ResultsA total of 4556 CT scans were performed in the emergency department over a 1-year period. A total of 3.6% of all-comers to our emergency departments underwent CT scan as part of their investigation. There were 2107 head CTs (46%), 1296 (28%) abdominal CTs, 468 (10%) CTs of the chest, 408 (9%) CTs of the neck/spine, and 101 (2%) extremity CTs performed. The most common clinical indication for performing a CT head was focal neurological defect comprising 1534 (73%) of all CT heads. Twenty-four percent of abdominal CTs were for investigation of right lower quadrant pain, followed by flank pain (19%). Chest pain and shortness of breath were the most common indications for CTs of the chest (315 [75%]) with 10% of these examinations for this indication positive for pulmonary embolism. Trauma was the most common indication for neck CTs (296 [73%]) and extremities (70 [69%]). Nil acute was the most common final interpretation in all categories (79% CT heads, 75% neck CTs, 38% abdominal CTs, 43% chest CTs).ConclusionsNil acute was the most common diagnosis; however, serious clinical outcomes were identified 40% of the time. Cross-sectional imaging remains an integral tool for triage and diagnosis in this environment as the cost of missing a diagnosis in this setting has a great impact on patient care.     

Techniques for and uncertainties of MRI-based reconstruction of titanium tandem and ring brachytherapy applicators

PurposeEliminating patient computed tomography (CT) scans for tandem and ring (T&R) brachytherapy can reduce overall procedure time and eliminates imaging dose. However, reconstructing titanium applicators in magnetic resonance imaging (MRI) is challenging. We evaluated the uncertainty of different applicator reconstruction workflows in MR-guided brachytherapy, and assessed the clinical impact of reconstruction uncertainties.Methods and materialsTitanium MRI-compatible T&Rs with aqueous gel in the buildup cap were reconstructed on CTs and MRIs to assess the uncertainties of four different workflows. Reconstruction was performed using (1) proton density–weighted MRIs with solid applicator from a library, (2) applicator-only reference CT fused with MRIs, (3) T2-weighted (T2W) MRIs following GEC-ESTRO guidelines, and (4) patient CTs fused with patient MRIs with in situ applicators. We evaluated dwell positions and plan quality differences using high-risk clinical target volume coverage, and EQD2 D_2cc of rectum, sigmoid, bladder, and small bowel.ResultsThe 2σ uncertainty for dwell positions for each workflow were (1) 2.7 mm for both ring and tandem, (2) 1.4 mm ring and 0.8 mm tandem, (3) 0.2 mm ring and 0.8 mm tandem, and (4) 1.9 mm ring and 0.4 mm tandem. Reconstruction uncertainties resulted in dose variations within acceptable levels (below 10%) except for (1) which resulted in larger dose to the rectum (20%). Dose uncertainties were similar between reference CT and patient CT.ConclusionsReconstruction with a reference CT results in similar uncertainty to a patient CT. T2W MRI plans have acceptable uncertainty levels for the applicator reconstruction and resulting dose distributions.     

Trends of CT Use in the Pediatric Emergency Department in a Tertiary Academic Hospital of Korea during 2001-2010

Objective

We wanted to assess the trends of computed tomography (CT) examinations in a pediatric emergency department (ED).

Materials and Methods

We searched the medical database to identify the pediatric patients who had visited the ED, and the number of CTs conducted from January 2001 to December 2010. We analyzed the types of CTs, according to the anatomic region, and the patients who underwent CT examinations for multiple regions. Data were stratified, according to the patient age (< 13 years and 13 ≤ ages < 18 years).

Results

The number of CTs performed per 1000 patients increased by 92% during the 10-year period (per 1000 patients, increased from 50.1 CTs in 2001 to 156.5 CTs in 2006, and then decreased to 96.0 CTs in 2010). Although head CTs were performed most often (74.6% of all CTs), facial bone CTs showed the largest rate of increase (3188%) per 1000 patients, followed by cervical CTs (642%), abdominal CTs (474%), miscellaneous CTs (236%), chest CTs (89%) and head CTs (39%). The number of patients who had CT examinations for multiple regions in the same day showed a similar pattern of increase, to that of overall CT examinations. Increase of CT utilization was more pronounced in adolescents than in pediatric patients younger than 13 years (189% vs. 59%).

Conclusion

The utilization of CTs increases from 2001 to 2006, and has declined since 2006. The increase of CTs is more pronounced in adolescents, and facial bone CTs prevail in increased number of examination followed by cervical CTs, abdominal CTs, miscellaneous CTs, chest CTs, and head CTs.     

Trends of CT Use in the Adult Emergency Department in a Tertiary Academic Hospital of Korea during 2001-2010

Objective

We wanted to assess the trends of CT examinations that were conducted in an adult emergency department (ED).

Materials and Methods

We searched the medical database to identify adult patients (≥ 18 years) who had visited the ED and the number of CT examinations of the patients during the period from January 2001 to December 2010. We also analyzed the types of CT scans performed in terms of body parts, they were as follows; head CTs, facial bone CTs, neckl CTs, chest CTs, abdominal CTs, and miscellaneous CTs. Further, miscellaneous CTs were subdivided as CT angiography and others.

Results

A total of 113656 CT scans were examined for 409439 adult ED patients during a 10-year period, and the number of CT scans increased by 255% (from 4743 CTs in 2001 to 16856 CTs in 2010), while the adult ED patient volume increased by 34% during the same period. Although the head CTs proportionally occupied the most, the facial bone CTs had the largest rate of increase (3118%), followed by cervical CTs (1173%), chest CTs (455%), miscellaneous CTs (388%; 862% and 84% for CT angiography and others, respectively), abdominal CTs (315%) and head CTs (95%) per 1000 patients during the decade.

Conclusion

CT use in adult ED has increased at a rate that far exceeds the growth of ED patient volume, with facial bone CTs and cervical CTs having the largest increasing rate, followed by chest CTs, miscellaneous CTs, abdominal CTs and head CTs.     

Emergency medicine summary code for reporting CT scan results: implementation and survey results

Purpose

The purpose of the study was to assess the emergency department (ED) providers’ interest and satisfaction with ED CT result reporting before and after the implementation of a standardized summary code for all CT scan reporting.

Materials and methods

A summary code was provided at the end of all CTs ordered through the ED from August to October of 2016. A retrospective review was completed on all studies performed during this period. A pre- and post-survey was given to both ED and radiology providers.

Results

A total of 3980 CT scans excluding CTAs were ordered with 2240 CTs dedicated to the head and neck, 1685 CTs dedicated to the torso, and 55 CTs dedicated to the extremities. Approximately 74% CT scans were contrast enhanced. Of the 3980 ED CT examination ordered, 69% had a summary code assigned to it. Fifteen percent of the coded CTs had a critical or diagnostic positive result.

Conclusions

The introduction of an ED CT summary code did not show a definitive improvement in communication. However, the ED providers are in consensus that radiology reports are crucial their patients’ management. There is slightly increased satisfaction with the providers with less than 5 years of experience with the ED CT codes compared to more seasoned providers. The implementation of a user-friendly summary code may allow better analysis of results, practice improvement, and quality measurements in the future.

     

CT and MRI Protocol Variation and Optimization at an Academic Medical Center

PurposeTo reduce CT and MRI protocol variation across a multisite radiology practice at an academic medical center so that patients with similar clinical presentations are examined the same way.Materials and MethodsThis study was performed at a large academic radiology practice performing ∼800,000 radiology examinations annually. To diminish variability across the enterprise (2 general radiology divisions; 10 subspecialty imaging divisions), a Harmonization Oversight Committee was created and tasked with ensuring patients with similar clinical presentations undergo the same CT or MRI protocol, regardless of where they are imaged. A process for decision making and conflict resolution was established, supported by the department chair. Primary outcome measure was standardization of CT and MRI protocols across all sites. Secondary outcome was percent reduction of CT and MRI protocols postharmonization.ResultsOver the 5-month harmonization process, most conflicts arose for abdominal imaging protocols because they are performed in four distinct subspecialty divisions, but all were addressed effectively through the conflict resolution process. Overall, there was a 31% reduction in the total number of CT and MRI protocols (before harmonization 481, after harmonization 331). There was significant variation in reduction of protocols per workgroup (multiple P values; range <.0001 to .9) with largest reduction in workgroups that overlapped multiple divisions.ConclusionA structured, organ system– and consensus-based quality improvement process with unambiguous decision-making and conflict resolution processes can be used to harmonize imaging protocols across complex, matrixed, multisite radiology practices so that patients with similar clinical presentations are imaged with the same imaging protocol.     

Analysis of radiological examination request forms in conjunction with justification of X-ray exposures

OBJECTIVES: To evaluate the adequacy of patient data and clinical information transmitted to the radiological departments by the referring clinicians in view of the justification demands concerning the radiological examinations, as those are described in the Radiation Protection Regulations of the European Union Nations. MATERIALS AND METHODS: Request forms for 1708 patients referred to radiology department and 410 referred to the CT department were evaluated concerning the proper completion of the form fields. Furthermore, for CT examinations a more detailed evaluation was carried out, to assess the rationalistic use of CT within the diagnostic algorithm. RESULTS: Not properly completed request forms to both departments were observed, however, the omissions were more prominent for the referrals to the radiology department, where the age and the probable clinical diagnosis was not given in 81.5 and 46% of the forms, respectively. Furthermore, the emergency indication was less cautiously used compared to the CT requests. For the CT department 33.3% of requests were justified and the final diagnosis was included in the referring doctor's probable clinical diagnosis. U/S was the examination of choice in 51% of the cases where an examination should have been performed before CT and in 70.6% of the cases where an alternative examination was proposed. CONCLUSIONS: The inadequate transmission of clinical information and the large number of not fully justified CT requests observed in this study are typical examples of the various problems that radiologists have to face in order to apply the justification directives.     

Cost reduction using ultrasound in blunt abdominal trauma

Ultrasound (US) provides a rapid, portable, and noninvasive method for evaluating the blunt trauma patient. In 1993, US was introduced into the workup of blunt abdominal trauma (BAT) at our institution and has rapidly become the modality of choice over computed tomography (CT) and diagnostic peritoneal lavage (DPL). In this study, the cost effectiveness of utilizing US in BAT was evaluated.We compared the number of DPLs and CTs performed during the 6-month period in 1993 preceding the incorporation of US with the number of CTs, DPLs, and USs performed during the last 6 months of 1994. Costs were determined by the finance department based on actual expenditures by the hospital, excluding physician fees, in 1994 U.S. dollars.Six hundred twenty-six patients were evaluated for BAT during the 6-month period in 1993. In this group, 450 patients had CT examinations, 160 had DPL, and 16 had both. This resulted in a cost of $254,316. During the last 6 months in 1994,564 patients were evaluated for BAT, including 470 USs, 175 CTs, and 11 DPLs. The cost for this group was $133,077, with a decrease in hospital expenditure of $170 per patient.We conclude that utilizing US in the evaluation of BAt leads to a significant cost reduction. Extrapolated over 1 year, with 1100 blunt abdominal trauma patients, the cost savings would be over $187,000.     

Transfer Patient Imaging: Assessment of the Impact of Discrepancies Identified by Emergency Radiologists

PurposeAdvanced imaging examinations of emergently transferred patients (ETPs) are overread to various degrees by receiving institutions. The practical clinical impact of these second opinions has not been studied in the past. The purpose of this study is to determine if emergency radiology overreads change emergency medicine decision making on ETPs in the emergency department (ED).MethodsAll CT and MRI examinations on patients transferred to a level I trauma center during calendar year 2018 were routinely overread by emergency radiologists and discrepancies with the outside report electronically flagged. All discrepant reports compared with the outside interpretations were reviewed by one of four emergency medicine physicians. Comparing the original and final reports, reviewers identified changes in patient management that could be attributed to the additional information contained in the final report. Changes in patient care were categorized as affecting ED management, disposition, follow-up, or consulting services.ResultsOver a 12-month period, 5,834 patients were accepted in transfer. Among 5,631 CT or MRI examinations with outside reports available, 669 examinations (12%) had at least one discrepancy in the corresponding outside report. In 219 examinations (33%), ED management was changed by discrepancies noted on the final report; patient disposition was affected in 84 (13%), outpatient follow-up in 54 (8%), and selection of consulting services in 411 (61%), and ED stay was extended in 544 (81%). Discrepant findings affected decision making in 613 of 669 of examinations (92%).ConclusionEmergency radiology overreading of transferred patients’ advanced imaging examinations provided actionable additional information to emergency medicine physicians in the care of 613 of 669 (92%) examinations with discrepant findings. This added value is worth the effort to design workflows to routinely overread CT and MRI examinations of ETPs.     

Knowledge of the Costs of Diagnostic Imaging: A Survey of Physician Trainees at a Large Academic Medical Center

PurposeTo study the awareness of postgraduate physician trainees across a variety of specialties regarding the costs of common imaging examinations.MethodsDuring early 2016, we conducted an online survey of all 1,238 physicians enrolled in internships, residencies, and fellowships at a large academic medical center. Respondents were asked to estimate Medicare national average total allowable fees for five commonly performed examinations: two-view chest radiograph, contrast-enhanced CT abdomen and pelvis, unenhanced MRI lumbar spine, complete abdominal ultrasound, and unenhanced CT brain. Responses within ±25% of published amounts were deemed correct. Respondents were also asked about specialty, postgraduate year of training, previous radiology education, and estimated number of imaging examinations ordered per week.ResultsA total of 381 of 1,238 trainees returned complete surveys (30.8%). Across all five examinations, only 5.7% (109/1,905) of responses were within the correct ±25% range. A total of 76.4% (291/381) of all respondents incorrectly estimated every examination’s cost. Estimation accuracy was not associated with number of imaging examinations ordered per week or year of training. There was no significant difference in cost estimation accuracy between those who participated in medical school radiology electives and those who did not (P = .14). Only 17.5% of trainees considered their imaging cost knowledge adequate. Overall, 75.3% desire integration of cost data into clinical decision support and/or computerized physician order entry systems.ConclusionsPostgraduate physician trainees across all disciplines demonstrate limited awareness of the costs of commonly ordered imaging examinations. Targeted medical school education and integration of imaging cost information into clinical decision support / computerized physician order entry systems seems indicated.     

Computed tomography findings of acute gastric peptic ulcer

PurposeTo report the computed tomography (CT) findings of acute peptic ulcer disease (PUD) and to evaluate the usefulness of contrast media for diagnosis.MethodsThis retrospective study included 51 patients diagnosed with acute gastric peptic ulcer by endoscopy. Using a κ analysis, two radiologists independently reviewed contrast-enhanced emergency CTs performed within 24 h of endoscopy. Evaluation findings included low-attenuation wall thickening, focal wall thickening, focal luminal outpouching, perigastric fat stranding, ascites, adjacent lymphadenopathy, and high-density gastric contents. Of the 51 patients, 48 underwent both non–contrast-enhanced and contrast-enhanced CT, and two radiologists also evaluated the presence or absence of these findings on a non-contrast-enhanced CT. McNemar's test was used to evaluate the contrast media's usefulness.ResultsInterobserver variability of perigastric fat stranding revealed substantial agreement between evaluators, and other findings had almost perfect agreement. High-density gastric contents were the most recognized findings (60%). Low-attenuation focal wall thickening and focal luminal outpouching were observed in relatively large numbers (~50%) of the cases on contrast-enhanced CT. The CT examinations using contrast media provided significantly higher detectability of low-attenuation wall thickening and focal luminal outpouching than CT examinations without using contrast media.ConclusionAcute PUD can be suspected in patients with nonspecific abdominal symptoms in whom emergency CT shows high-density gastric contents, focal low-attenuation wall thickening, and/or focal luminal outpouching. Our study showed that contrast media are useful for diagnosis.     

Impact of Radiologist-Driven Change-Order Requests on Outpatient CT and MRI Examinations

PurposeTo assess impact of electronic medical record–embedded radiologist-driven change-order request on outpatient CT and MRI examinations.MethodsOutpatient CT and MRI requests where an order change was requested by the protocoling radiologist in our tertiary care center, from April 11, 2017, to January 3, 2018, were analyzed. Percentage and categorization of requested order change, provider acceptance of requested change, patient and provider demographics, estimated radiation exposure reduction, and cost were analyzed. P < .05 was used for statistical significance.ResultsIn 79,310 outpatient studies in which radiologists determined protocol, change-order requests were higher for MRI (5.2%, 1,283 of 24,553) compared with CT (2.9%, 1,585 of 54,757; P < .001). Provider approval of requested change was equivalent for CT (82%, 1,299 of 1,585) and MRI (82%, 1,052 of 1,283). Change requests driven by improper contrast media utilization were most common and different between CT (76%, 992 of 1,299) and MRI (65%, 688 of 1,052; P < .001). Changing without and with intravenous contrast orders to with contrast only was most common for CT (39%, 505 of 1,299) and with and without intravenous contrast to without contrast only was most common for MRI (26%, 274 of 1,052; P < .001). Of approved changes in CT, 51% (661 of 1,299) resulted in lower radiation exposure. Approved changes frequently resulted in less costly examinations (CT 67% [799 of 1,198], MRI 48% [411 of 863]).ConclusionOutpatient CT and MRI orders are deemed incorrect in 2.9% to 5% of cases. Radiologist-driven change-order request for CT and MRI are well accepted by ordering providers and decrease radiation exposure associated with imaging.     

Improved pediatric multidetector body CT using a size-based color-coded format

OBJECTIVE: CT technique should be adjusted while scanning infants and children. One format that has proven successful in simplifying pediatric care and reducing medical error is the size-based, color-coded Broselow-Luten pediatric system. This color-coded system can serve as a format for CT protocols. The purpose of this investigation was to compare variation (or error) occurrence and technologist preference for conventional and color-coded formats for pediatric multidetector body CT protocols. MATERIALS AND METHODS: Multidetector CT examinations were set up using either a conventional or a color-coded format for a period of 6 weeks each. Variations (errors) from protocol parameters (including tube current, detector configuration, table speed, and IV contrast media dose) were tabulated. Qualitative assessment consisted of a survey of CT technologists (n = 20) for preference in six areas related to ease of use and clarity of the formats. RESULTS: There were 44 CT examinations (n = 30 infants and children) in the conventional group and 55 CT examinations (n = 31 infants and children) in the color-coded protocol format group. Overall, the number of errors was significantly less in the color-coded group (p < 0.01), with a significantly lower error percentage in individual parameters affecting radiation dose, including tube current, detector configuration, and table speed (p < 0.05). In all areas, the color-coded format was preferred over the conventional format (p < 0.0003). CONCLUSION: Color-coded CT formatting is an extension of a clinical color-coded system. This system provides an easy, expeditious, consistent, and preferable format for general pediatric body CT protocols. Most importantly, the color-coded system can reduce variations (errors) in the radiology department.     

Repeated sinus CT imaging after recent head imaging

ObjectivesExcessive use of sinus CT is a significant problem in medical imaging, resulting in unnecessary costs and radiation exposure. This study assesses frequency of sinus CT performed after recent head imaging has already adequately evaluated the sinuses.MethodsA retrospective search of the PACS database of an academic medical center was performed to identify cases of sinus CT imaging in 2017. Cases were excluded if sinus CT was performed related to trauma, tumor, operative evaluation, or acute infection other than sinusitis (orbital cellulitis, intracranial abscess). Studies with separate imaging covering the sinuses ordered at the same time as sinus CT or performed previously within 4 weeks were identified and clinical information was recorded.ResultsOf 735 sinus CTs performed, 19 (5%) had same-day head imaging and 30 (8%) had previous head imaging within 4 weeks, adding up to a cumulative 13% of cases with recent head imaging. The average patient age was 42, with 13 pediatric cases. Of ordering providers, residents ordered the highest percentage of sinus CTs with same-day head imaging (84%) and previous imaging within 4 weeks (63%). The sinuses were described in all head CT radiology reports, while 10 of 12 brain MRI reports did not mention the sinuses.ConclusionIn one year, 13% of patients receiving sinus CTs at our institution had recent head imaging. A focused education effort for ordering providers to avoid repeating sinus imaging, and for radiology to comment on sinuses on head imaging, may reduce unnecessary sinus CTs.