骨关节损伤756例 CT 扫描分析

骨关节与软组织间密度差异大，具有良好的自然对比性，因而，X线平片对骨关节损伤及骨病的诊断具有重要的价值，常是首选的检查手段，但对复杂的骨关节损伤的诊断有一定的局限性。CT扫描能提供组织的断层影像，具有X线平片不可替代的优点，因而已被广泛应用。现将我院5年来756例CT检查资料分析如下。     

低剂量CT扫描对乳突病变的临床应用研究

目的：探讨低剂量高分辨率CT扫描对乳突病变的诊断价值。方法：低利量50mA扫描30例，其基准线为上颌窦后壁平行线做周围螺旋扫描，与用100mA常规扫描的30例进行比较，对图像质量及对诊断的影响进行评估。结果：低剂量组30例中良好片25张，占83．3％，一般片5张，占16.7％，差片0，与常规组基本一致。结论：低利量高分辨率CT扫描完全能满足临床对乳突病变的诊断要求。该扫描方法降低病人单次检查的接受辐射剂量，能延长球管的寿命，从而降低医疗成本，值得推广应用。     

肺部低剂量螺旋CT扫描的应用

随着人们健康意识的增强，CT价格的降低，其肺部检查率将显著增长，其常规扫描CT球管的负荷将加大，在不影响诊断的前提下有效的降低管电流可延长其使用寿命，为医院节省开支，有效的降低了病人的辐射剂量。本文着重探讨低剂量螺旋CT扫描在胸部的应用。     

鼻窦低剂量CT扫描对图像质量影响的研究

目的探讨鼻窦CT扫描时单纯降低mA值,晶体接受的射线剂量及其对图像质量的影响。方法将50例行鼻窦冠状面CT扫描者根据有无炎症分为正常组(32例)与炎症组(18例)。每组患者根据扫描的mA值设置分为200mA和50mA组。正常组有8例,炎症组有7例同时行高分辨重建。用镁铜磷氟化锂[LiF(Mg·Cu·P)]热释光探测器测量晶体受到的照射剂量。评价不同条件、不同算法(软组织算法和高分辨算法)时的图像质量。评价指标为中鼻甲、钩突、上颌窦开口、筛漏斗、额隐窝、筛板。评价标准为未显示,0分;显示、但不清楚,1分;清楚显示,2分。左右单独计分。结果当mA值由200减至50时,晶体所接受的射线剂量由7339mGy降至1108mGy。两组差异有统计学意义(P<001)。而图像质量无明显下降(P>005)。对于正常组,高分辨重建有助于细小解剖结构的显示,对于炎症组高分辨重建并不能增加细节的显示程度。结论在单纯降低mA值的条件下,受检者所接受的射线剂量明显减少,虽然图像噪声有所增加,但图像仍然保持较好的诊断质量。     

多层螺旋CT肺部低剂量扫描的应用价值

目的：探讨多层螺旋CT肺部低剂量扫描的应用价值。材料和方法：对77例体检者行多层螺旋CT常规剂量肺部扫描后再行低剂量扫描,对照分析其质量。结果：77例受检者中,两种检查方法均发现异常35例,无异常42例,对病变征象和正常结构的显示率均为45%和55%,图像质量均为优。低剂量扫描较常规剂量扫描的X线剂量少。结论：肺部多层螺旋CT低剂量扫描能提供与常规剂量扫描相近的诊断与鉴别诊断信息,适用于大规模体检及高危人群普查。     

低剂量辐射兴奋效应及其潜在的临床应用价值

一、低剂量辐射兴奋效应低剂量电离辐射对人体健康的影响是学术界长期有争议的课题 ,涉及的要点是辐射致癌是否存在阈值。线性无阈(LNT)假说认为 ,任何微小剂量的辐射均将增加致癌的危险 ,其基础是由高、中剂量辐射致癌的剂量效应 ,因为在低剂量范围内当时无论从流行病学调查或实验室研究 ,尚未获得肯定或否定的资料。近 2 0年来人们开始认识到并非任何低剂量辐射都对健康有害 ,Luckey[1]综述了 1976～ 1991年间的有关资料 ,引用了近 10 0 0篇报告 ,首先提出小剂量辐射兴奋效应的概念 ,认为适宜的低剂量辐射对人体存在有益作用。兴奋效应…     

低剂量CT扫描技术的胸部应用

1990年Naidich等 [1]率先提出低剂量CT扫描技术 ,1995年Mayo等[2 ]的研究表明 ,当毫安秒低于 80mAs时 ,图像质量有显著下降。他们的临床应用实践为低剂量CT扫描技术的胸部应用打开了前景。随着CT技术的不断完善 ,在不影响图像质量情况下 ,使得低剂量检查成为可能。笔者在分析60例低剂量扫描成像质量的基础上 ,将该技术在胸部检查中的应用作一评价 ,现报道如下。一、材料和方法1 材料 :选择有咳嗽 ,咯痰 ,胸痛等呼吸道症状者 ,可疑肺内有病变者 60例 ,男 44例 ,女 16例 ,年龄 2 3～ 78岁 ,平均55岁。2 仪器 :北京医疗器械研究所生产的B…     

多层螺旋CT肺部低剂量扫描的应用价值

1990年的统计，显示在世界范围内肺癌已成为发病率与死亡率最高的恶性肿瘤。早发现早治疗，显然是降低肺癌死亡率的关键。本研究通过本院71例体检者肺部低剂量与常规剂量多层螺旋CT扫描图像的对照分析，探讨多层螺旋CT肺部低剂量扫描的应用价值。皆在寻找一种较科学、经济的肺部检查。     

Patient dose considerations in computed tomography examinations

Ionizing radiation is extensively used in medicine and its contribution to both diagnosis and therapy is undisputable. However, the use of ionizing radiation also involves a certain risk since it may cause damage to tissues and organs and trigger carcinogenesis. Computed tomography (CT) is currently one of the major contributors to the collective population radiation dose both because it is a relatively high dose examination and an increasing number of people are subjected to CT examinations many times during their lifetime. The evolution of CT scanner technology has greatly increased the clinical applications of CT and its availability throughout the world and made it a routine rather than a specialized examination. With the modern multislice CT scanners, fast volume scanning of the whole human body within less than 1 min is now feasible. Two dimensional images of superb quality can be reconstructed in every possible plane with respect to the patient axis (e.g. axial, sagital and coronal). Furthermore, three-dimensional images of all anatomic structures and organs can be produced with only minimal additional effort (e.g. skeleton, tracheobronchial tree, gastrointestinal system and cardiovascular system). All these applications, which are diagnostically valuable, also involve a significant radiation risk. Therefore, all medical professionals involved with CT, either as referring or examining medical doctors must be aware of the risks involved before they decide to prescribe or perform CT examinations. Ultimately, the final decision concerning justification for a prescribed CT examination lies upon the radiologist. In this paper, we summarize the basic information concerning the detrimental effects of ionizing radiation, as well as the CT dosimetry background. Furthermore, after a brief summary of the evolution of CT scanning, the current CT scanner technology and its special features with respect to patient doses are given in detail. Some numerical data is also given in order to comprehend the magnitude of the potential radiation risk involved in comparison with risk from exposure to natural background radiation levels.     

Variability of repeated coronary artery calcium scoring and radiation Dose on 64- and 16-slice computed tomography by prospective electrocardiographically-triggered axial and retrospective electrocardiographically-gated spiral computed tomography: a phantom study

RATIONALE AND OBJECTIVES: We sought to compare coronary artery calcium (CAC) scores, the variability and radiation doses on 64- and 16-slice computed tomography (CT) scanners by both prospective electrocardiographically (ECG)-triggered and retrospective ECG-gated scans. MATERIALS AND METHODS: Coronary artery models (n = 3) with different plaque CT densities (approximately 240 Hounsfield units [HU], approximately 600 HU, and approximately 1000 HU) of four sizes (1, 3, 5, and 10 mm in length) on a cardiac phantom were scanned three times in five heart rate sequences. The tube current-time products were set to almost the same on all four protocols (32.7 mAs for 64-slice prospective and retrospective scans, 33.3 mAs for 16-slice prospective and retrospective scans). Slice thickness was set to 2.5 mm to keep the radiation dose low. Overlapping reconstruction with a 1.25-mm increment was applied on the retrospective ECG-gated scan. RESULTS: The CAC scores were not different between the four protocols (one-factor analysis of variance: Agatston, P = .32; volume, P = .19; and mass, P = .09). Two-factor factorial analysis of variance test revealed that the interscan variability was different between protocols (P < .01) and scoring algorithms (P < .01). The average variability of Agatston/volume/mass scoring and effective doses were as follows: 64-slice prospective scan: 16%/15%/11% and 0.5 mSv; 64-slice retrospective scan: 11%/11%/8% and 3.7 mSv; 16-slice prospective scan: 20%/18%/13% and 0.6 mSv; and 16-slice retrospective scan: 16%/15%/11% and 2.9 to 3.5 mSv (depending on the pitch). CONCLUSION: Retrospective ECG-gated 64-slice CT showed the lowest variability. Prospective ECG-triggered 64-slice CT, with low radiation dose, shows low variability on CAC scoring comparable to retrospective ECG-gated 16-slice CT.     

Follow-up computed tomography scan in post-COVID-19 pneumonia

The coronavirus disease 2019 (COVID-19) global pandemic can be a severe illness that leads to morbidity and mortality. With the increasing number of COVID-19 pneumonia survivors, several long-term changes may persist, including abnormal imaging of lung parenchyma. In addition to the clinical course, it is vital to follow up on pulmonary imaging during the post-infectious period, which is not routinely required in other common pulmonary diagnoses. Computed tomography (CT) scan of the chest is an effective and diagnostic tool for pneumonia which gives an insight into structural abnormalities within the lungs, complications, and possible progression of the disease. Several studies have monitored COVID-19 pneumonia and its complications using serial CT chest imaging from the initial phase of infection, hospitalization, and post-discharge. Nonetheless, long-term follow-up imaging data in post-COVID-19 is still limited. We have summarized the findings utilizing a systematic review of the literature regarding COVID-19 pneumonia imaging, including long-term follow-up.     

Image quality and dose in computed tomography

Radiation exposure to the patient during CT is relatively high, and it is therefore important to optimize the dose so that it is as low as possible but still consistent with required diagnostic image quality. There is no established method for measuring diagnostic image quality; therefore, a set of image quality criteria which must be fulfilled for optimal image quality was defined for the retroperitoneal space and the mediastinum. The use of these criteria for assessment of image quality was tested based on 113 retroperitoneal and 68 mediastinal examinations performed in seven different CT units. All the criteria, except one, were found to be usable for measuring diagnostic image quality. The fulfilment of criteria was related to the radiation dose given in the different departments. By examination of the retroperitoneal space the effective dose varied between 5.1 and 20.0 mSv (milli Sievert), and there was a slight correlation between dose and high percent of “yes” score for the image quality criteria. For examination of the mediastinum the dose range was 4.4–26.5 mSv, and there was no significant increment of image quality at high doses. The great variation of dose at different CT units was due partly to differences regarding the examination procedure, especially the number of slices and the mAs (milli ampere second), but inherent dose variation between different scanners also played a part. Received 30 August 1995; Revision received 27 December 1995; Accepted 24 January 1995     

Paediatric computed tomography radiation dose: A review of the global dilemma简

Computed tomography (CT) has earned a well-deserved role in diagnostic radiology, producing cross-sectional and three-dimensional images which permit enhanced diagnosis of many pathogenic processes. The speed, versatility, accuracy, and non-invasiveness of this procedure have resulted in a rapid increase in its use. CT imaging, however, delivers a substantially higher radiation dose than alternative imaging methodologies, particularly in children due to their smaller body dimensions. In addition, CT use in children produces an increased lifetime risk of cancer, as children’s developing organs and tissues are inherently more vulnerable to cellular damage than those of adults. Though individual risks are small, the increasing use of CT scans in children make this an important public health problem. Various organizations have recommended measures to minimize unnecessary exposures to radiation through CT scanning. These include elimination of multiple or medically unnecessary scans, development of patient-specific dosing guidelines, and use of alternative radiographic methodology wherever possible. Another important factor in excessive CT exposures, however, is a documented lack of awareness among medical practitioners of the doses involved in CT usage as well as its significant potential dangers. This review examines the effects of paediatric CT radiation, discusses the level of medical practitioner awareness of these effects, and offers recommendations on alternative diagnostic methods and practitioner education.     

Biological effects of low-dose radiation from computed tomography scanning

Abstract

Purpose: With the widespread use of computed tomography (CT), the risks of low-dose radiation from CT have been increasingly highlighted. This study aims to illustrate the CT-induced biological effects and analyze the potential beneficial or harmful outcomes so as to provide radiologists with reasonable advice on CT usage.

Materials and methods: The related literature was analyzed according to the topics of stochastic effect, hereditary effect, deterministic effect, accumulative injuries, hormesis and adaptive response; population epidemiology data were also analyzed.

Results: CT accounts for 9% of X-ray examinations and approximately 40–67% of medical-related radiation, the dose is within the range of low-dose radiation (LDR). Two opposite viewpoints exist nowadays regarding the biological effects of CT scanning: They are either harmful or harmless. Approximately 0.6% and 1.5% of the cumulative cancer risk could be attributed to diagnostic X-rays in the UK and Germany, respectively. The probability of CT scans induced-cancer is about 0.7% and CT angiography's risk is around 0.13%. It is estimated that approximately 29,000 cancers could be related to CT scans in the USA every year. Meanwhile, another investigation of 25,104 patients who underwent 45,632 CT scans in 4 years showed that the majority of CT-induced cancers were accidents rather than certainties of frequent CT scans.

Conclusion: Although the LDR effects of CT are still controversial, the current problems include the high frequency-use and abuse of CT scans, the increase of radiation dose and accumulative dose in high-accuracy CT, and the poor understanding of carcinogenic risks. The underlying biological basis needs further exploring and the ratio of risks and benefits should be considered.     

Radiation dose and cancer risk estimates in 16-slice computed tomography coronary angiography

Background  Recent advances have led to a rapid increase in the number of computed tomography coronary angiography (CTCA) studies performed. Whereas several studies have reported the effective dose, there are no data available on cancer risk for current CTCA protocols. Methods and Results  Effective and organ doses were estimated, by use of scanner-derived parameters and Monte Carlo methods, for 50 patients having 16-slice CTCA performed for clinical indications. Lifetime attributable risks were estimated with models developed in the National Academies’ Biological Effects of Ionizing Radiation VII report. The effective dose of a complete CTCA averaged 9.5 mSv, whereas that of a complete study, including calcium scoring when indicated, averaged 11.7 mSv. Calcium scoring increased effective dose by 25%, whereas tube current modulation reduced it by 34% and was more effective at lower heart rates. Organ doses to the lungs and female breast were highest. The lifetime attributable risk of cancer incidence from CTCA averaged approximately 1 in 1,600 but varied widely among patients, being highest in younger women. For all patients, the greatest risk was from lung cancer. Conclusions  CTCA is associated with non-negligible risk of malignancy. Doses can be reduced by careful attention to scanning protocol. This study was presented in part at the American College of Cardiology 55th Annual Scientific Session, Atlanta, Ga, March 13, 2006. This work was supported in part by a National Institutes of Health/National Center for Research Resources Clinical and Translational Science Award (1 UL1 RR-24156-01).     

Timing of exposure in angiographic computed tomography

Visualization of heart chambers or the abdominal arterial phase on one of two CT-scans was achieved in 89.4% of 169 injections (91 patients) using only 30 ml of contrast medium (370 mg iodine/ml), when the start of scanning was accurately timed at predicted bolus peak concentration. Normal arrival times and numer of transit cycles to the bolus concentration maximum in the right (RV) and left ventricle (LV) after injection of a small radionuclide bolus of technetium-99 m were related to the patient's heart rate (HR) in a group of 200 patients. For the RV, mean arrival times varied significantly between 2.31 (HR: 90–109 beats per minute) and 3.46 seconds (HR: 50–59 beats per minute), mean number of transit cycles between 4.1 and 3.5. For the LV, mean arrival times varied significantly between 6.92 (HR: 90–109 beats per minute) and 11.37 seconds (HR: 50–59 beats per minute), and the mean number of transit cycles between 11.5 and 10.7. Washout from the LV lasted between an average of 9.2 (HR: 90–109 beats per minute) and 8.5 cycles (HR: 50–59 beats per minute). Contrary to actual transit times, there was no significant difference in the number of transit heart cycles for heart rates between 60 and 109 beats per minute, so that to determine the scan starting time, the patient's cycle length (60 divided by heart rate) had only to be multiplied by the corresponding normal value of transit cycles, i.e., four for the RV, 11 for the LV, and 13 for the abdominal arteries. By applying the estimated values, the result was negative on two successive scans in only 10.6% because of failure in coordination on the part of the operators or bolus transit delays (due to severe heart failure, severe lung disease, recent thoracotomy, or small veins disease). With automatic triggering of the scanner by a timer and injector and with a flush of saline after injection, results can be further improved. Radionuclide studies supported by grant of the Internal Department of the Government of the Federal Republic of Germany     

CARE技术在128层螺旋CT冠状动脉造影中的应用

目的：探讨CARE技术即自动综合选择管电压（CAREkV）和四维实时剂量调节CAREDose4D技术对冠脉CTA辐射剂量和图像质量的影响。方法将78例患者随机分成两组,采用西门子64排128层DefinitionAS螺旋CT机行回顾性心电门控螺旋扫描。A组41例,由CAREkV选择输出管电压;B组37例,管电压人为设定120kVp。两组均采用CAREDose4D技术,其他扫描参数两组相同。应用t检验比较两组CT容积剂量指数（CTDIvol）、剂量长度乘积（DLP）、有效辐射剂量（ED）、图像质量评分、信噪比（SNR）和对比噪声比（CNR）,P＜0．05认为有统计学差异。结果A和B两组CTDIvol分别为（17．15±10．87）mGy和（29．97±7．80）mGy;DLP分别为（261．43±176．49）mGy×cm和（469．61±119．66）mGy×cm;ED分别为（3．62±2．98）mSv和（6．58±2．03）mSv,两组间CTDIvol、DLP和ED值差异有统计学意义（P＜0．05）,且A组ED降低44．98％。A和B两组图像质量评分分别为（3．58±0．27）和（3．63±0．31）,差异无统计学意义（P＞0．05）;主动脉根部管腔的SNR分别为（18．14±4．27）和（17．96±3．37）,差异无统计学意义（P＞0．05）;A组RCA和LM近端管腔的CNR分别为（23．07±8．89）和（27．26±9．57）,B组分别为（17．23±7．35）和（21．27±8．43）,差异有统计学意义（P＜0．05）,A组CNR大于B组。结论应用于冠状动脉造影的CARE技术,在保证图像质量的同时,可降低受检者44．98％的有效辐射剂量,具有临床意义。