scholarly journals P034: Computed tomography rates for emergency department super-users

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S76-S76
Author(s):  
D. Savage ◽  
R. North ◽  
G. McKay ◽  
C. McMillan ◽  
R. Stonebridge ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Ct Scanner ◽  
High Resource ◽  
Thunder Bay ◽  
Patient Demographic Data ◽  
Exposure Risks ◽  
Super Users

Introduction: Most emergency departments (ED) in Canada have a population of high frequency users that present to the ED on a regular basis. These patients are well described in the literature and typically defined by a frequency of 8-10 visits/year. In Thunder Bay, Ontario we have a significant population of patients that present more often that we have termed “super-users”. These patients often are typically from a vulnerable population with multiple co-morbidities and a high mortality rate. Although their risk for poor health outcomes is well recognized, both the chronicity and complexity of their symptoms often contributes to diagnostic dilemmas. The decision to order a computed tomography (CT) scan can be a difficult balance between ruling out life threatening diagnoses and exposing the patient to excessive radiation. Our objective was to describe how often these super-users of the ED received a CT scan and what types of imaging were completed. Methods: The Thunder Bay Regional Health Sciences Centre is a geographically isolated hospital in Northwestern Ontario with the next closest hospital based CT scanner greater than 300 km away. Based on previous literature and our preliminary scoping of the super-user group, we have identified a minimum of 25 visits as the threshold. A retrospective chart review was conducted for the year 2017 using our electronic medical record. Patient demographic data was collected along with the type and number of CT scans into a standardized collection tool. Results: Our preliminary results showed that our total population of super-users was 75 patients with an average of 32 visits to the ED per year. A total of 76% of the patients had a CT scan completed at least once. On average these patients have a CT during 10% of their visits with head CT comprising 50% of the imaging and abdominal/pelvis imaging comprising another 45%. For 20% of these super-users, they had CTs on 20% of their visits. From this population, only 10% of the patients had surgery in 2017 while 7% of visits required admission to hospital. The most common diagnoses for these patient visits relate to mental health/addictions, gastrointestinal complaints and infection. Conclusion: This study has shown that a significant number of our super-user population are receiving multiple CTs. Our next step is collect data on individual radiation doses and calculate exposure risks. We hope to inform policy and decision-makers who are developing programs to treat the underlying cause of their high resource use.

scholarly journals Correlation between radiological and histopathological findings in patients undergoing nephrectomy for presumed renal cell carcinoma on computed tomography scan at Grey’s Hospital

2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Nompumelelo E. Mlambo ◽  
Nondumiso N.M. Dlamini ◽  
Ronald J. Urry
Keyword(s):  
Computed Tomography ◽  
Renal Cell Carcinoma ◽  
Ct Scan ◽  
Cell Carcinoma ◽  
South African ◽  
Renal Cell ◽  
Vascular Invasion ◽  
Retrospective Chart Review ◽  
Renal Masses ◽  
Cross Sectional

Background: The incidence of renal cell carcinoma (RCC) is increasing globally owing to the increased use of cross-sectional imaging. Computed tomography (CT) scan is the modality of choice in the diagnosis and pre-operative assessment of RCC. Nephrectomy is the standard treatment for RCC and pre-surgery biopsy is not routinely practised. The accuracy of CT diagnosis and staging in a South African population has not been established.Objectives: To determine the accuracy of CT scan in the diagnosis and pre-operative staging of RCC at Grey’s Hospital.Methods: A retrospective chart review was performed; CT scan reports and histopathological results of adult patients who underwent nephrectomy for presumed RCC on CT scan between January 2010 and December 2016 were compared.Results: Fifty patients met the inclusion criteria for the study. CT significantly overestimated the size of renal masses by 0.7 cm (p = 0.045) on average. The positive predictive value of CT for RCC was 81%. Cystic tumours and those 4 cm and smaller were more likely to be benign. CT demonstrated good specificity for extra-renal extension, vascular invasion and lymph node involvement, but poor sensitivity.Conclusion: In our South African study population, CT is accurate at diagnosing RCC, but false-positives do occur. Non-enhancing or poorly enhancing, cystic, fat-containing and small lesions (4 cm or smaller) are more likely to be benign and ultrasound-guided biopsy should be considered to avoid unnecessary surgery. CT assessment of extra-renal extension and vascular invasion is challenging and additional imaging modalities such as magnetic resonance imaging (MRI) venogram, duplex Doppler ultrasound or Positron emission tomography–computed tomography (PET/CT) may be beneficial.

Sensitivity of High-Resolution Computed Tomography in Otosclerosis Patients undergoing Primary Stapedotomy

2020 ◽  
Vol 129 (9) ◽  
pp. 918-923
Author(s):  
Anne K. Maxwell ◽  
Mohamed Hosameldeen Shokry ◽  
Adam Master ◽  
William H. Slattery
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
High Resolution Computed Tomography ◽  
Acoustic Reflexes ◽  
Negative Report ◽  
Unexplained Symptoms ◽  
Rule Out

Objective: To determine the incidence of abnormal otospongiotic or otosclerotic findings on high-resolution computed tomography (HRCT) as read by local radiologists in patients with surgically-confirmed otosclerosis. Study design: Retrospective chart review. Setting: Tertiary-referral private otology-neurotology practice. Patients: Adults (>18 years old) with surgically-confirmed otosclerosis between 2012 and 2017 with a HRCT performed preoperatively. Intervention: Preoperative HRCT then stapedotomy. Main outcome measures: Positive identification and location of radiographic otosclerosis as reported by the local radiologist. We then correlated the CT with surgical location as documented at time of surgery. Audiometry, demographic data, intraoperative findings, and surgical technique were secondarily reviewed. Results: Of the 708 stapes surgeries were performed during the study time frame. Preoperative HRCT scans were available for 68 primary stapedotomy surgeries performed in 54 patients. Otosclerosis was reported in 20/68 (29.4%). Following a negative report by the local radiologist, a re-review by the surgeon and/or collaborating neuroradiologist confirmed otosclerosis in 12/48 additional cases (25.0%). There was an overall sensitivity of 47.1%. Intraoperatively, cases with negative reads tended to have more limited localization at the ligament (8.7%) or anterior crus (39.1%), compared with positive reads, which demonstrated more extensive involvement, with bipolar foci (30.0%) or diffuse footplate manifestations (20.0%) more common. Acoustic reflexes were characteristically absent. Conclusions: While HRCT may aid in the diagnosis of otosclerosis and rule out concomitant pathology in certain cases of clinical uncertainty or unexplained symptoms, its sensitivity for otosclerosis remains low. HRCT should not be relied upon to diagnose routine fenestral otosclerosis.

Isolated Inflammatory Sphenoid Sinus Disease: A Revisitation of Computed Tomography Indications based on Presenting Findings

2005 ◽  
Vol 19 (6) ◽  
pp. 627-632 ◽  
Author(s):  
Young H. An ◽  
Giridhar Venkatraman ◽  
John M. DelGaudio
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Sphenoid Sinus ◽  
Disease Process ◽  
Retrospective Chart Review ◽  
Neurological Complications ◽  
Common Finding ◽  
Sinus Disease ◽  
Presenting Symptoms ◽  
Ct Evaluation

Background Isolated inflammatory sphenoid sinus disease (IISSD) can be difficult to diagnose. Frequently, history and physical are inadequate in establishing a diagnosis. Computed tomography (CT) is an excellent screening tool; however, it often is obtained late in the disease process because of vague symptoms at presentation. Identifying the most common presenting symptoms of IISSD may allow earlier detection and avoidance of more severe sequelae by determining earlier indications for CT. Presently, headache is not an indication for sinus CT. Methods A retrospective chart review of IISSD presentation was performed at our institution. A literature review was performed also to quantitatively document trends in presentation of IISSD, including characterization of headache symptoms by location. Cumulative findings were then compared with current CT indications to determine if presentation patterns warrant a change in indications for CT. Results A total of 361 cases were evaluated by our inclusion criteria. Headache was the most common finding (81.7%), particularly peri/retro-orbital, vertex, and frontal headache. Ocular changes (17.5%) and cranial nerve involvement (16.1%) were common also, but headache frequently was a solitary finding (42.6%). Twenty-six IISSD cases were reviewed at our institution over 7 years, with similar results. Under current guidelines, the only IISSD findings that are indications for CT scan are the ophthalmologic and neurological complications. Conclusion Not every headache necessitates a CT scan. However, the deep-seated vertex, frontal, and, particularly, peri/ retro-orbital headaches, especially when aggravated by head movement and refractory to analgesics, as is often seen in IISSD, should be an indication for CT evaluation. (American Journal of Rhinology 19, 627–632, 2005)

scholarly journals Assessment of Masseter Muscle Thickness in OSMF Patients - A Computed Tomography Study

2020 ◽  
Vol 7 (52) ◽  
pp. 3176-3179
Author(s):  
Choubarga Naik ◽  
Bimal Krishna Panda ◽  
Anisha Avijeeta ◽  
Barnanshu Pattnaik ◽  
Subha Soumya Dany ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Masseter Muscle ◽  
Oral Submucous Fibrosis ◽  
Precancerous Lesion ◽  
Muscle Thickness ◽  
Ct Scans ◽  
P Value ◽  
Ct Scanner ◽  
Medical College

BACKGROUND Oral submucous fibrosis (OSMF) is the most common precancerous lesion, prevalent mostly in South East Asia. The habit of betel nut or gutkha chewing is the main cause for this. There is a direct association between gutkha chewing habit and development of OSMF, the reason being exaggerated forces on the masseter muscle due to vigorous chewing for prolonged period of time. So, the present study was done to evaluate the thickness of masseter muscle in OSMF patients. METHODS A total of 25 subjects were included in the study from January 2015 to December 2017. 25 OSMF patients belonging to the age group of 25-50 years who attended the outpatient department of Veer Surendra Sai Medical College and Hospital, Burla, with masseteric hypertrophy and betelnut or gutkha chewing habit for more than 5 years, were included in the study. The computed tomography (CT) scans were obtained using Siemens Somatom Sensation 4-slice CT scanner. During the scanning period, the patients were asked to keep their mouth gently closed and relaxed. Axial sections of the CT scans were assessed for masseter muscles. The thickness of the muscle was calculated using image-analysing software and the measurements made were in millimeter (mm). Tabulation was done and statistical analysis was done using Mann-Whitney U test. RESULTS The thickness of masseter muscle of right side was found to be more than the left side in all patients except for one patient and the outcome was statistically significant with one tailed p value < 0.01. CONCLUSIONS The duration and frequency of the habit were found to be directly proportional to masseter muscle thickness and also with the clinical progression of the disease. Similarly, we also concluded from our study that there exists an association of masseter muscle hypertrophy with OSMF, and CT scan meas KEYWORDS OSMF, Masseter Muscle, CT Scan

Intracerebellar Hemorrhage in a Premature Newborn: Diagnosis by Real-Time Ultrasound and Correlation with Autopsy Findings

PEDIATRICS ◽  
1983 ◽  
Vol 71 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Jeffrey M. Perlman ◽  
James S. Nelson ◽  
William H. McAlister ◽  
Joseph J. Volpe
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Premature Infant ◽  
Brain Imaging ◽  
Real Time ◽  
Critically Ill ◽  
Ultrasound Scan ◽  
Ultrasound Scanning ◽  
Ct Scanner

The identification of intracerebellar hemorrhage in a living premature infant by real-time ultrasound scan and confirmation of the findings at autopsy are described. This represents the first demonstration of the value of this noninvasive, convenient, and safe means of brain imaging in diagnosis of this lesion. Previous studies have described the role of the computed tomography (CT) scan in identification of intracerebellar hemorrhage in the newborn. Because infants with intracerebellar hemorrhage are usually critically ill, a means of identification of the lesion that could be utilized at the bedside rather than an approach that requires transport to a CT scanner is needed. This study indicates that portable real-time ultrasound scanning can satisfy that need.

Finite Element Mesh Generation With Computed Tomography Scan Data

1991 ◽  
Author(s):  
C. Stan Wei ◽  
Clark D. Skinner
Keyword(s):  
Computed Tomography ◽  
Finite Element ◽  
Ct Scan ◽  
General Procedure ◽  
Variational Model ◽  
Ct Scanner ◽  
Element Mesh ◽  
Single Region ◽  
Scan Data ◽  
Mesh Models

Abstract This report presents a new finite element meshing approach, put forth by Q-Mesh, to producing 3-D mesh models for solid objects whose geometries can be captured with an industrial computed tomography (CT) scanner. The Q-Mesh system utilizes a series of deformable grid templates and component solid regions to create a 3-D global mesh that can be divided into subregions of connected meshes located within the component solids. It provides an interactive graphics interface through which the user can design and visualize 3-D, multiregion meshes consisting of well-formed wedge and hexahedron elements. The unique solid-modeling algorithm implemented in Q-Mesh allows the system to generate, automatically, matching finite element meshes across any number of solid regions. This unique feature makes Q-Mesh an ideal mesh generator for finite element solvers geared to the simulation of general multiregion problems. Furthermore, the use of a multiregion mesh model as the source for analysis models representing variations of a single-region mesh, as unions of selected subregions, has proven more time efficient and cost effective than the single-region alternative where each variational model has to be regenerated from scratch. This report focuses on the utility of a CT scanner as a geometry input processor to Q-Mesh. The generation of finite element models for a solid object represented in the form of sliced CT scan data involves two phases: (1) converting the sliced CT scan data into a series of stacked solids; and (2) utilizing Q-Mesh’s interactive design tools to build mesh models based on the reconstructed solids. A number of examples are given to demonstrate the general procedure and unique capabilities of the new meshing approach.

Use and Accuracy of Computed Tomography Scan in Diagnosing Perforated Appendicitis

2015 ◽  
Vol 81 (4) ◽  
pp. 404-407 ◽  
Author(s):  
Richa Verma ◽  
Vadim Grechushkin ◽  
Dorothy Carter ◽  
Matthew Barish ◽  
Aurora Pryor ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Wall Thickness ◽  
Perforated Appendicitis ◽  
Retrospective Chart Review ◽  
Multivariate Statistical ◽  
Highly Correlated ◽  
Low Sensitivity ◽  
Operative Findings ◽  
Extraluminal Air

Perforated appendicitis has major implications on patient care. The ability of computed tomography (CT) scan to distinguish perforation in the absence of phlegmon or abscess is unknown. The purpose of this study is to assess the use and accuracy of CT scans in diagnosing perforated appendicitis without phlegmon or abscess. A retrospective chart review of 102 patients who underwent appendectomy from 2011 to 2013 was performed. Patient demographics and operative and postoperative course were recorded. Two radiologists were then blinded to operative findings and CTscans reread and results correlated. Findings on CTscan were also analyzed for correlation with perforation. Univariate and multivariate statistical analysis was performed. Of the 102 patients, 49 were perforated and 53 nonperforated. Analysis of patient populations demonstrated patients with perforation were significantly older (45 vs 34 years, P = 0.002), had longer operative times (132 vs 81 minutes, P = 0.001), and longer length of stay (8.2 vs 1.5 days, P < 0.001). Nineteen perforations (37%) were correctly diagnosed by CT scan. The sensitivity of CT scan to detect perforation was 38 per cent, specificity 96 per cent, and positive predictive value of 90 per cent. After multivariate analysis of significant variables, three were demonstrated to significantly correlate with presence of perforation: presence of extraluminal air (odds ratio [OR], 28.9; P = 0.02); presence of intraluminal fecalith (OR, 5.7; P = 0.03); and wall thickness greater than 3 mm (OR, 3.2; P = 0.02). CT scan has a low sensitivity for diagnosing perforated appendicitis without abscess or phlegmon. Presence of extraluminal air bubbles, increased wall thickness, and intra-luminal fecalith should increase suspicion for perforation and are highly correlated with outcomes after appendectomy.

scholarly journals Comparison of Intraoperative 3-Dimensional Fluoroscopy With Standard Computed Tomography for Stereotactic Frame Registration

2019 ◽  
Author(s):  
Terrance Peng ◽  
Daniel R Kramer ◽  
Morgan B Lee ◽  
Michael F Barbaro ◽  
Li Ding ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Three Dimensional ◽  
Ct Scanner ◽  
3 Dimensional ◽  
Lead Placement ◽  
Stereotactic Frame ◽  
Mri Scans ◽  
Marginal Means ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND Three-dimensional fluoroscopy via the O-arm (Medtronic, Dublin, Ireland) has been validated for intraoperative confirmation of successful lead placement in stereotactic electrode implantation. However, its role in registration and targeting has not yet been studied. After frame placement, many stereotactic neurosurgeons obtain a computed tomography (CT) scan and merge it with a preoperative magnetic resonance imaging (MRI) scan to generate planning coordinates; potential disadvantages of this practice include increased procedure time and limited scanner availability. OBJECTIVE To evaluate whether the second-generation O-arm (O2) can be used in lieu of a traditional CT scan to obtain accurate frame-registration scans. METHODS In 7 patients, a postframe placement CT scan was merged with preoperative MRI and used to generate lead implantation coordinates. After implantation, the fiducial box was again placed on the patient to obtain an O2 confirmation scan. Vector, scalar, and Euclidean differences between analogous X, Y, and Z coordinates from fused O2/MRI and CT/MRI scans were calculated for 33 electrode target coordinates across 7 patients. RESULTS Marginal means of difference for vector (X = −0.079 ± 0.099 mm; Y = −0.076 ± 0.134 mm; Z = −0.267 ± 0.318 mm), scalar (X = −0.146 ± 0.160 mm; Y = −0.306 ± 0.106 mm; Z = 0.339 ± 0.407 mm), and Euclidean differences (0.886 ± 0.190 mm) remained within the predefined equivalence margin differences of −2 mm and 2 mm. CONCLUSION This study demonstrates that O2 may emerge as a viable alternative to the traditional CT scanner for generating planning coordinates. Adopting the O2 as a perioperative tool may offer reduced transport risks, decreased anesthesia time, and greater surgical efficiency.

scholarly journals Comparing computed tomography (CT) angiography versus digital subtraction angiography for the screening of traumatic pseudoaneurysms in transcranial stab injuries

2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Susan W. Karanja ◽  
Rohen Harrichandparsad ◽  
Duncan Royston ◽  
Samson M. Motebejane ◽  
Ayesha Mitha
Keyword(s):  
Computed Tomography ◽  
South Africa ◽  
Digital Subtraction Angiography ◽  
Screening Tool ◽  
Head Injuries ◽  
Retrospective Chart Review ◽  
Neurological Deficits ◽  
Digital Subtraction ◽  
Ct Scanner ◽  
Stab Injuries

Introduction: Transcranial stab injuries among the civilian population in South Africa are more common than in the West. In a study conducted in Durban, South Africa, in 1992, transcranial stab injuries accounted for 6% of all head injuries admitted to the neurosurgical unit. Digital subtraction angiography (DSA) has been the gold standard for diagnosing traumatic pseudoaneurysms. Its use as a screening tool is, however, limited and carries risks of neurological deficits. We postulate that the newer generation computed tomography (CT) scanner would serve as a better screening tool for traumatic pseudoaneurysms following transcranial stab injuries with the blade removed, provided the image quality is good.Methods: All patients admitted with a stab to the head with total calvarial penetration from September 2014 to January 2016 were included in the study. Those with a retained metallic fragment, incomplete imaging protocols, no penetration of the blade into the brain parenchyma or other causes of penetrating head injury were not included in the study. A retrospective chart review was then done on a prospectively recruited patient cohort. All CT angiograms were performed using a dual source CT scanner.Results: A total of 26 patients met the inclusion criteria. There were seven vascular injuries identified on DSA: three traumatic pseudoaneurysms and four vessel cut-offs. One traumatic pseudoaneurysm was missed on computed tomography angiography (CTA) because of a poor quality scan. The average sensitivity and specificity of CTA compared with DSA was 67% and 95.5%, respectively. Negative predictive value for CTA was 99.5%.Conclusion: A good quality CTA carried out on the newer generation CT scanners allows for use of CTA as a screening tool for patients with a transcranial stab injury and no retained blade or metallic foreign bodies.

scholarly journals Physician’s Knowledge on X-ray Exposure from CT Scans in a Moroccan Hospital

2019 ◽  
pp. 1-6
Author(s):  
Bouchra Amaoui ◽  
Abdennasser El Kharras ◽  
Slimane Semghouli
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Radiation Protection ◽  
Health Risks ◽  
Demographic Data ◽  
Radiation Doses ◽  
X Rays ◽  
Potential Health ◽  
X Ray

Background: Computed tomography (CT) is a major source of ionizing radiation exposure in medical diagnostic.  Patients more exposed related to radiation are supposed to be more susceptible to health risks. Purpose: The aim of this study was to assess physician’s knowledge of radiation doses and potential health risks of radiation exposure from CT. Materials and Methods: A standardized questionnaire was distributed to physicians. The questionnaire covered the demographic data of the prescriber, the frequency of referrals for CT scan examinations, the physicians’ knowledge of radiation doses, the potential health risks of radiation exposure from CT scan and training on patients’ radiation   protection. The data were analyzed using the Statistical Package for the Microsoft Office Excel 2007. Results: A total of 72 physicians (55%) completed the questionnaire. Ninety nine percent of the practitioners’ prescribe CT examinations for patients during their exercises but only 10% of physicians use the guideline during CT prescriptions. Thirty eight percent of prescribers took into account the ratio benefit/risk related to x-rays during radiological exam prescription. While 4% of prescribers’ explained the risk related to x-rays to the patients during radiological exam prescription, 14% of physicians have correctly estimated the effective dose received during an abdomen pelvic scan compared to the dose of a standard chest x-ray radiograph in an adult.  Fifty four percent of doctors underestimated the lifetime risk of fatal cancer attributable to a single computed tomography scan of the abdomen pelvic and 8% of practitioners have received formal training on risks to patients from radiation exposure. Conclusion: The present study showed the limited knowledge of radiation exposure for the Physicians. Recurrent training in advanced radiation protection of patients could lead to significant improvements in knowledge and practice of CT prescribers.

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