scholarly journals Personalization of CM Injection Protocols in Coronary Computed Tomographic Angiography (People CT Trial)

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
N. G. Eijsvoogel ◽  
B. M. F. Hendriks ◽  
P. Nelemans ◽  
C. Mihl ◽  
J. Willigers ◽  
...  
Keyword(s):  
Image Quality ◽  
Cardiac Computed Tomography ◽  
Computed Tomographic Angiography ◽  
Categorical Variables ◽  
Tube Voltage ◽  
Chi Square ◽  
Cardiac Computed Tomography Angiography ◽  
Computed Tomographic ◽  
Scan Time ◽  
Significant Difference

Aim. To evaluate the performance of three contrast media (CM) injection protocols for cardiac computed tomography angiography (CCTA) based on body weight (BW), lean BW (LBW), and cardiac output (CO). Materials and methods. A total of 327 consecutive patients referred for CCTA were randomized into one of the three CM injection protocols, where CM injection was based on either BW (112 patients), LBW (108 patients), or CO (107 patients). LBW and CO were calculated via formulas. All scans were ECG-gated and performed on a third-generation dual-source CT with 70–120 kV (automated tube voltage selection) and 100 kVqual.ref/330 mAsqual.ref. CM injection protocols were also adapted to scan time and tube voltage. The primary outcome was the proportion of patients with optimal intravascular attenuation (325–500 HU). Secondary outcomes were mean and standard deviation of intravascular attenuation values (HU), contrast-to-noise ratio (CNR), and subjective image quality with a 4-point Likert scale (1 = poor/2 = sufficient/3 = good/4 = excellent). The t-test for independent samples was used for pairwise comparisons between groups, and a chi-square test (χ2) was used to compare categorical variables between groups. All p values were 2-sided, and a p<0.05 was considered statistically significant. Results. Mean overall HU and CNR were 423 ± 60HU/14 ± 3 (BW), 404 ± 62HU/14 ± 3 (LBW), and 413 ± 63HU/14 ± 3 (CO) with a significant difference between groups BW and LBW (p=0.024). The proportion of patients with optimal intravascular attenuation (325–500 HU) was 83.9%, 84.3%, and 86.9% for groups BW, LBW, and CO, respectively, and between-group differences were small and nonsignificant. Mean CNR was diagnostic (≥10) in all groups. The proportion of scans with good-excellent image quality was 94.6%, 86.1%, and 90.7% in the BW, LBW, and CO groups, respectively. The difference between proportions was significant between the BW and LBW groups. Conclusion. Personalization of CM injection protocols based on BW, LBW, and CO, and scan time and tube voltage in CCTA resulted in low variation between patients in terms of intravascular attenuation and a high proportion of scans with an optimal intravascular attenuation. The results suggest that personalized CM injection protocols based on LBW or CO have no additional benefit when compared with CM injection protocols based on BW.

scholarly journals Reducing Radiation Dose Without Compromising Image Quality in Preoperative Perforator Flap Imaging With CTA Using ASIR Technology

2014 ◽  
Vol 99 (4) ◽  
pp. 485-491 ◽  
Author(s):  
Vachara Niumsawatt ◽  
Andrew N. Debrotwir ◽  
Warren Matthew Rozen
Keyword(s):  
Image Quality ◽  
Radiation Dosage ◽  
Perforator Flap ◽  
Computed Tomographic Angiography ◽  
Preoperative Imaging ◽  
Diep Flap ◽  
Subjective Analysis ◽  
Computed Tomographic ◽  
Significant Difference ◽  
Tomographic Angiography

Abstract Computed tomographic angiography (CTA) has become a mainstay in preoperative perforator flap planning in the modern era of reconstructive surgery. However, the increased use of CTA does raise the concern of radiation exposure to patients. Several techniques have been developed to decrease radiation dosage without compromising image quality, with varying results. The most recent advance is in the improvement of image reconstruction using an adaptive statistical iterative reconstruction (ASIR) algorithm. We sought to evaluate the image quality of ASIR in preoperative deep inferior epigastric perforator (DIEP) flap surgery, through a direct comparison with conventional filtered back projection (FBP) images. A prospective review of 60 consecutive ASIR and 60 consecutive FBP CTA images using similar protocol (except for radiation dosage) was undertaken, analyzed by 2 independent reviewers. In both groups, we were able to accurately identify axial arteries and their perforators. Subjective analysis of image quality demonstrated no statistically significant difference between techniques. ASIR can thus be used for preoperative imaging with similar image quality to FBP, but with a 60% reduction in radiation delivery to patients.

Abstract 6101: Cost Effectiveness of Cardiac Computed Tomography Compared to Myocardial Perfusion Imaging (MPI) as an Effective Gatekeeper to Cardiac Catheterization in the Evaluation of Asymptomatic Firefighters with an Abnormal Treadmill Test

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Matthew Budoff ◽  
Robert Karwasky ◽  
Naser Ahmadi MD Ahmadi ◽  
Cyrus A Nasserian ◽  
William W Chang ◽  
...  
Keyword(s):  
Los Angeles ◽  
Care Pathway ◽  
Cardiac Computed Tomography ◽  
Clinical Care ◽  
Invasive Coronary Angiography ◽  
Calcium Score ◽  
Computed Tomographic Angiography ◽  
Sensitivity Analyses ◽  
Computed Tomographic ◽  
Clinical Care Pathway

To identify CAD among patients who fail treadmill tests, the traditional clinical care pathway is MPI, then invasive coronary angiography (ICA). In a retrospective cohort study, we compared the direct costs for detecting CAD using the traditional clinical care pathway and an alternative that incorporates MDCT, with coronary calcium score (CCS) followed by computed tomographic angiography (CTA) and ICA. Over a 2-year period, 3,950 Los Angeles, CA Firefighters underwent wellness/fitness exams at 6 contracted medical facilities. A total of 495 cases had abnormal treadmill tests and were referred for follow-up cardiology evaluation. All cases received CCS, followed by CTA for calcium scores >10, and ICA for abnormal CTA (>50% obstruction in at least one vessel). MPI results were estimated based on the prior year’s experience, with abnormal MPI receiving ICA. Costs to detect CAD were calculated for both the MPI and MDCT pathways based on results for the cohort and current Medicare reimbursement costs. Sensitivity analyses were performed by varying each of the clinical and cost components of the model to “low” and “high” levels and computing net costs. Most model inputs were varied by ±50% of baseline values to gauge the robustness of the results. Among 495 cases with abnormal treadmill tests, 146 (29.5%) would have required ICA due to abnormal MPI tests; 131 (26.9%) had abnormal CCS (>10) and went to CTA; 40 (8.1%) had abnormal CTA (>50% stenosis) and went to ICA. ICA showed 38 (7.7%) cases of CAD. The computed cost to detect CAD was $1,376 per case for the traditional route with MPI as gatekeeper and $503 per case for CCS as gatekeeper. All sensitivity analyses showed lower costs for the MDCT compared to MPI pathways. The net cost to ICA-confirmed diagnosis of CAD is substantially lower with MDCT compared to MPI as gatekeeper to ICA.

Minimizing table time in patients with claustrophobia using focused ferumoxytol-enhanced MR angiography (f-FEMRA): a feasibility study

2021 ◽  
Vol 94 (1125) ◽  
pp. 20210430
Author(s):  
Puja Shahrouki ◽  
Kim-Lien Nguyen ◽  
John M. Moriarty ◽  
Adam N. Plotnik ◽  
Takegawa Yoshida ◽  
...  
Keyword(s):  
Image Quality ◽  
Mr Angiography ◽  
Signal To Noise Ratio ◽  
Diagnostic Image Quality ◽  
Diagnostic Confidence ◽  
Motion Artefact ◽  
Scan Time ◽  
Wilcoxon Rank Sum Test ◽  
Significant Difference ◽  
Noise Ratio

Objectives: To assess the feasibility of a rapid, focused ferumoxytol-enhanced MR angiography (f-FEMRA) protocol in patients with claustrophobia. Methods: In this retrospective study, 13 patients with claustrophobia expressed reluctance to undergo conventional MR angiography, but agreed to a trial of up to 10 min in the scanner bore and underwent f-FEMRA. Thirteen matched control patients who underwent gadolinium-enhanced MR angiography (GEMRA) were identified for comparison of diagnostic image quality. For f-FEMRA, the time from localizer image acquisition to completion of the angiographic acquisition was measured. Two radiologists independently scored images on both f-FEMRA and GEMRA for arterial and venous image quality, motion artefact and diagnostic confidence using a 5-point scale, five being best. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the aorta and IVC were measured. The Wilcoxon rank-sum test, one-way ANOVA with Tukey correction and two-tailed t tests were utilized for statistical analyses. Results: All scans were diagnostic and assessed with high confidence (scores ≥ 4). Average scan time for f-FEMRA was 6.27 min (range 3.56 to 10.12 min), with no significant difference between f-FEMRA and GEMRA in diagnostic confidence (4.86 ± 0.24 vs 4.69 ± 0.25, p = 0.13), arterial image quality (4.62 ± 0.57 vs 4.65 ± 0.49, p = 0.78) and motion artefact score (4.58 ± 0.49 vs 4.58 ± 0.28, p > 0.99). f-FEMRA scored significantly better for venous image quality than GEMRA (4.62 ± 0.42 vs 4.19 ± 0.56, p = 0.04). CNR in the IVC was significantly higher for steady-state f-FEMRA than GEMRA regardless of the enhancement phase (p < 0.05). Conclusions: Comprehensive vascular MR imaging of the thorax, abdomen and pelvis can be completed in as little as 5 min within the magnet bore using f-FEMRA, facilitating acceptance by patients with claustrophobia and streamlining workflow. Advances in knowledge: A focused approach to vascular imaging with ferumoxytol can be performed in patients with claustrophobia, limiting time in the magnet bore to 10 min or less, while acquiring fully diagnostic images of the thorax, abdomen and pelvis.

Attitude towards online classes among school and college going students during lockdown due to COVID-19 pandemic

2021 ◽  
Vol 8 (7) ◽  
pp. 3446
Author(s):  
Saurav Kumar ◽  
Shiv Prakash ◽  
Mona Srivastava
Keyword(s):  
Family Income ◽  
Cross Sectional Study ◽  
Categorical Variables ◽  
Online Classes ◽  
Online Questionnaire ◽  
Chi Square ◽  
Cross Sectional ◽  
Academic Level ◽  
College Going ◽  
Significant Difference

Background: The aim of the study was to assess the attitude of the school and college-going students towards online classes. Methods: An online cross-sectional study was conducted on 228 school and college-going students fulfilling inclusion and exclusion criteria selected through purposive sampling methods. A semi-structured online questionnaire consisting of a socio-demographic questionnaire and Attitude towards online classes (ATOC) questionnaire was prepared by the researcher using Google form. The link of the questionnaire was sent to all the selected respondents through WhatsApp messages and emails. The data was analyzed using the IBM SPSS version 20 software. The reliability of the attitude questionnaire was assessed using Cronbach’s alpha test. The association between categorical variables was assessed using Chi-square tests. The comparison between variables was assessed using the students independent t-test.Results: More than half of the respondents (51.32%) were found with a positive attitude towards online classes. There was a significant association found between attitude towards online classes and socio-demographic variables such as age (p<0.05), academic level (p<0.05), and family income (p<0.01). The respondents who attended online classes (p<0.05), have technical knowledge (p<0.01), and got supported by their parents in the study (p<0.05) were found significantly high positive attitudes towards online classes. There was a significant difference found in the attitude of the respondents who faced psychological disturbances such as a decline in attention-concentration (p<0.05), irritation-anger (p<0.01), and tension (p<0.05) due to online classes.Conclusions: Although, online classes are more beneficial for the students and teachers in their academic activities during the lockdown period due to the COVID-19 pandemic but it can’t take place of traditional face-to-face classes. 

scholarly journals The Use of Milrinone Versus Conventional Treatment for the Management of Life-Threatening Bronchial Asthma

2019 ◽  
Vol 13 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Amr Sobhy ◽  
Doaa M. K. Eldin ◽  
Hany V. Zaki
Keyword(s):  
Bronchial Asthma ◽  
Conventional Treatment ◽  
Controlled Trial ◽  
Blood Gases ◽  
Categorical Variables ◽  
Chi Square ◽  
Arterial Blood ◽  
Number Of Patients ◽  
Significant Difference ◽  
Life Threatening

Background and Aims: In our study, we investigated the effectiveness of intravenous milrinone in life-threatening bronchial asthma as compared to conventional treatment. Methods: Fifty patients aged 18-50 years, presenting with life-threatening asthma were enrolled in a Randomised Controlled Trial (RCT). They were randomly allocated into Group C (25 patients): who received the standard pharmacotherapy and placebo, and Group M (25 patients): who in addition to the standard therapy, received 25 μg milrinone as an initial slow IV bolus diluted in 10 ml of normal saline. The following data were recorded: PEFR (Peak Expiratory Flow Rate) expressed as a percentage of the patient’s previous value, Respiratory Rate (RR), MABP (Mean Arterial Blood Pressure), arterial blood gases, and the number of patients requiring mechanical ventilation. Differences between groups were tested using Analysis of Variance (ANOVA) for quantitative variables with post hoc using the Least Significant Difference (LSD) test, and Chi square test for categorical variables. Results: Group M showed marked improvement in PEFR that was highly significant (P < 0.001) 10 min after injection and significant after one hour from the start of treatment in comparison to Group C. There was also an improvement in RR and PO2 that was significant in group M. Milrinone was associated with a reduction in MABP only after 10 min from injection, and showed a statistically significant decrease in the number of patients requiring mechanical ventilator support (P ˂ 0.05). Conclusion: Milronine is a promising agent as a rescue drug in the treatment of life-threatening bronchial asthma.

scholarly journals Randomized clinical study comparing active heating methods for prevention of intraoperative hypothermia in gastroenterology

2019 ◽  
Vol 27 ◽  
Author(s):  
Regina Maria da Silva Feu Santos ◽  
Ilka de Fatima Santana Ferreira Boin ◽  
Cristina Aparecida Arivabene Caruy ◽  
Eliane de Araújo Cintra ◽  
Nathalia Agostini Torres ◽  
...  
Keyword(s):  
Categorical Variables ◽  
Chi Square ◽  
Randomized Clinical Study ◽  
Intraoperative Hypothermia ◽  
Forced Air Warming ◽  
Significant Difference ◽  
Chi Square Test ◽  
Intraoperative Period ◽  
The Difference ◽  
The Times

ABSTRACT Objective: to compare the efficacy of three active heating methods in the prevention of intraoperative hypothermia in open gastroenterological surgeries. Method: randomized clinical trial with a sample of 75 patients, whose initial body temperature measured by a tympanic thermometer. Esophageal temperature <36ºC was considered hypothermic. Patients were divided into three groups using: thermal mattress, underbody forced-air warming blanket and heated infusion system. The tympanic and esophageal temperatures were measured at different times of the intraoperative period, but the temperature considered gold standard was the esophageal. To evaluate the homogeneity of the groups, we used chi-square test (categorical variables). In the comparison of temperature measurements over time, the analysis of variance (ANOVA) and the contrast profile test were used for the difference in temperature between the times. The non-parametric Kruskal-Wallis test was used to compare the three groups. The level of significance was 5%. Results: regarding the studied variables, the groups were not homogeneous as to the categorical variable sex. All patients presented hypothermia during the intraoperative period (p> 0.05). Conclusion: there was no significant difference between the heating methods in the prevention of intraoperative hypothermia. REBEC - Brazilian Registry of Clinical Trials (RBR- no. 52shjp).

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