The role of diagnostic imaging in PE is being increasingly undertaken by computed tomography pulmonary angiography (CTPA). 1), CTPA is the investigation of choice in patients with a high clinical suspicion of pulmonary embolus and in those with pre-existing pulmonary disease. Patients undergoing CTPA before (phase 1 group) or after (phase 2 group) the protocol change, were assessed. 73 Patients who had a CTPA over a two-month period (February & March 2015) were identi-fied from the radiology records . 2A , 2B ). Utilisation of CTPA in PE. Further imaging may be necessary, either repeating CTPA with an increased delay or pulmonary angiography. CT attenuation coefficients were measured in Hounsfield Units (HU) using regions of interest at the level of the pulmonary trunk. 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim ... . Methods: We will search PubMed, EMBASE, Web of Science, and Google Scholar from inception to October 1, 2018. Although this protocol optimized for imaging pregnant patients significantly improved pulmonary CTA image quality, two of the 20 patients in group B had nondiagnostic studies. Anterior Apical Apicoposterior Posterior . CT Protocols. Charbel is also an Adjunct Professor of Medical Imaging at the university of Canberra, Australia as well as editor in chief in the international journal of medical imaging and editorial board member at the Journal of Medical Imaging and Radiation Sciences. Transient interruption of the contrast bolus by unopacified blood from the IVC was a causative factor in one case and the second nondiagnostic study was caused by poor peak arterial enhancement. Correspondence afp@racgp.org.au. Walen S(1), de Boer E(2), Edens MA(3), van der Worp CA(2), Boomsma MF(2), van den Berg JW(4). This article discusses a hot topic on double low-dose protocol of computed tomography pulmonary angiography (CTPA) in the diagnosis of pulmonary embolism, with a special focus on a recent paper published in the British Journal of Radiology about the feasibility of this technique. Mandatory adherence to diagnostic protocol increases the yield of CTPA for pulmonary embolism. Radiology and hospital information database was utilized to identify patients that underwent CTPA between 2016 and 2018 meeting the inclusion/exclusion criteria. The role of diagnostic imaging in PE is being increasingly undertaken by computed tomography pulmonary angiography (CTPA). Downloads. Adherence to local Hospital protocol. Technique used for CTPA. 2016 Oct;7(5):727-34. doi: 10.1007/s13244-016-0509-2. For CTPA at our institution, we use a 16 or 64-detector CT scanner. In addition, dose models in the literature do not account for state-of-the-art low dose CT protocols utilizing tube current modulation of mA and kV, which significantly lower the dose of CTPA while preserving diagnostic accuracy. Retrospective audit was performed using the PACS com-puter information system. The aim of this study was to investigate optimal CTPA protocols for detection of PE based on a 3D printed pulmonary model.Methods: A patient-specific 3D printed pulmonary artery model was generated with thrombus placed in both main pulmonary arteries to represent PE. In conclusion, the split-bolus MDCT is a novel and emerging injection protocol technique in the radiology setting that could be considered even for CTPA. • Mandatory adherence to diagnostic protocol increases the yield of CTPA for PE • Previous DVT and signs of DVT were associated with a higher yield • No patients with a low Wells score and a low D-dimer had PE. Quantitative noise was lower in the phase 1 group (p<0.001). Results Of 250 scans, 74 were positive (29.6 % [95 % CI, 24.3-35.5 %]) and 175 were negative (70 %). Since CTPA is the first imaging modality in detecting PE in susceptible patients, ... All images were obtained using a 128-section multi-detector CT scanner based on the standard CTPA protocol for PE (detector width 40 mm, section thickness 0.625, rotation time 0.4 sec, 120 kVp, and 380 mAs) and 20 s after administration of 100 ml contrast media at a rate of 5 ml/sec. Each protocol was started with a 3.5ml/sec.-injection of 100ml of CM (300mgI/ml) via vein in upper limb. Inclusion criterion was patients getting CTPA exam to rule out PE. We use a collimation of 1.25 mm with a beam pitch of 1.35 (slice pitch 10.8; US Mode) and 0.5 sec. CTPA examinations were obtained in a multidetector CT scanner (Discovery CT750 HD, GE Healthcare) by using a dual-energy CTPA protocol (Gemstone Spectral Imaging GSI), with the following parameters: tube voltage 80–140 kV, 340 mA, pitch = 0.984, rotation time = 0.5 s, field of view = 512 mm × 512 mm, 64 × 0.625-mm detector configuration, and slice thickness = 1.25 mm. Question 1: CTPA is considered (Pick incorrect answer) Minimally invasive Highly sensitive for PE Highly specific for PE Low radiation dose . Multidetector computed tomography pulmonary angiography (CTPA) is now the primary imaging modality for evaluating acute PE 7, 41, 42; Demonstrates a pulmonary embolism by showing a filling defect within contrast filled pulmonary arteries ; New generation MDCT (64 slice helical scanners) with low tube currents (80kVp, 100kVp and 120kVp) with / without dose modulations have been shown to … The reference lists of the retrieved articles are also consulted. RECIST 1.1 - examples; RECIST 1.1 - and more; RECIST 1.1 - the basics; COVID-19 Imaging findings . COVID-19 CXR. Current data for absolute quantification of dose reduction is limited, although studies propose 30-75% reductions in effective dose with these techniques. Radiology Tutorials; Radiology Department; School Of Medicine; CT Pulmonary Angiography > Quiz. 11 The typical effective doses from CTPA are approximately around 8 mSv, 12 although a recent study has shown a possible dose reduction to an average of 3–4 mSv when the appropriate imaging parameters are chosen. 2016 Oct;7(5):727-34. doi: 10.1007/s13244-016-0509-2. COVID-19 is a viral disease also known as SARS-CoV-2 or severe acute respiratory syndrome coronavirus 2. Protocols for CTPA and for lung scintigraphy should be aimed at minimizing radiation exposure to mother and fetus while maintaining the diagnostic quality of the exam. Analysis of CTPA studies in PCR positive patients, correlation with results of other investigations. Protocol released - please contact your local representative or TPD. Epub 2016 Jul 22. Yet, chest CT is often used in patients with known or suspected COVID-19 due to regional preferences, lack of … CTPA, DECT, MRI, V/Q Scan, and SPECT ... (CTEPH) patients via a protocol for systemic review and network meta-analysis. Author information: (1)Department of Pulmonology, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, The Netherlands. Protocol changes included: decreased kVp; increased contrast injection rate; imaging after shallow inspiration. Insights Imaging 2014;5(2):231–236). MATERIALS AND METHODS: 24 consecutive patients suspected PE underwent CTPAs using a 64-detector MDCT. Radiology Trainee Research Survey. Mean effective dose was 2.8±2.6 mSv and 13.5±7.8 mSv for CTPA and triple rule-out protocols, respectively. CTPA PROTOCOL OPTIMISATION AUDIT: CHALLENGES OF DOSE REDUCTION WITH MAINTAINED IMAGE QUALITY Alberto Nania, MD 1, Avril Weir, MSc 2, Nick Weir, MSc PhD 2, Gillian Ritchie, MB ChB MRCP FRCR 1, Christopher Rofe, FRCR 3, Edwin Van Beek, MD PhD FRCR 4 1Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK A short survey targeted at UK radiology trainees, that aims to characterise the current research experience. 1,2 Since the 1990s, CT pulmonary angiography (CTPA) has become the method of choice for imaging in suspected PE. CTPA Post-Test. The purpose of this study is to evaluate three injection protocols for CTPA to improve the image quality of rPA. CTPA diagnostic yield in terms of PE & alternative Dx. cm ± 34.1 and 7.0 mSv ± 0.6 for dual-energy CTPA, both P = .709). The diagnosis is made by a positive PCR test, which is highly specific. This study shows that CTPA has high diagnostic yield in the diagnosis of pulmonary embolism, hence justifying its appropriateness as a routine imaging modality. Survey Results. Radiology Tutorials; Radiology Department; School Of Medicine; CT Pulmonary Angiography > Pulmonary Embolus > Technique. CT contrast injection and protocols; RECIST 1.1. Semin Nucl Med 2010;40:442–54. As documented in the Royal College of Radiologists referral guidelines (Ref. Approximately 10 million patients present to emergency departments each year with symptoms raising concern of thromboembolism (VTE).1 The current gold standard for diagnosis of VTE is pulmonary angiography.2 As this study is invasive, alternative imaging protocols have been sought. Schembri GP, Miller AE, Smart R. Radiation dosimetry and safety issues in the investigation of pulmonary embolism. CTPA exposes patients to a small, but not negligible, amount of radiation, which has recently raised concern in view of the increasing demand in CTPA performances. Mandatory adherence to diagnostic protocol increases the yield of CTPA for pulmonary embolism Insights Imaging. RESULTS: Effective dose was lower in the phase 2 group (0.95 v 1.66 mSv; p<0.001). The model was scanned with 128-slice dual-source CT with slice thickness of 1 and 0.5 mm reconstruction interval. Insights Imaging. The average pixel value, standard deviation (SD), maximum, and minimum were recorded. 2–4 CTPA is a standard procedure that obtains a CT volume while intravenously injected iodinated contrast media (CM) opacifies the pulmonary arteries. CTPA is fast and generally well tolerated ... Matthews S. Imaging pulmonary embolism in pregnancy: what is the most appropriate imaging protocol? Question 2: The A1 segment of the RUL is the _____ segment. A CTPA is performed in the radiology department scanning room, with the patient lying flat (supine) ... A CTPA scan is a useful investigation for those patients with a moderate to high probablity of pulmonary embolism. Odds ratios were calculated as a measure of association between dichotomous variables and CTPA findings. + Learn More. The global pandemic of coronavirus disease 2019 (COVID-19) has upended the world with over 6.6 million infections and over 391,000 deaths worldwide. 50 patients with acute/chronic renal failure were examined on a 3 rd generation dual-source CT with an optimized DE CTPA protocol and a low CM injection protocol (5.4 g iodine). Pulmonary embolism (PE) is a common condition with high mortality and morbidity. As documented in the Royal College of Radiologists referral guidelines (Ref. 100 further patients were either examined with a standard CTPA protocol or a standard DE CTPA (32 g iodine). 1), CTPA is the investigation of choice in patients with a high clinical suspicion of pulmonary embolus and in those with pre-existing pulmonary disease. Reverse-transcription polymerase chain reaction (RT-PCR) assay is the preferred method of diagnosis of COVID-19 infection. Although the split-bolus injection protocols may appear sophisticated and complex in theory, in practice it can be stored on the injector system and selected from the menu of the stored protocol. Br J Radiol 2006;79:441–44. 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