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At least 325 records · Page 18Linked to original sources

Low-dose spiral computed tomography of the thorax: comparison with the standard-dose technique.

RATIONALE AND OBJECTIVES: This study was conducted to determine whether significant reduction in radiation dose (250 mAs-->50 mAs), in chest computed tomography (CT) using volume acquisition affects image quality or the detectability of pathologic findings in the lung and mediastinum. METHODS: Phantom studies were conducted to evaluate resolution and noise level, then a patient study was then done. Fifty consecutive patients (10 normal and 40 abnormal) cases were examined. After a scan (250 mAs, 120OkVp) of the entire thorax, five additional slices (50 mAs, 120kVp) at the level of the abnormality were obtained. Three independent observers evaluated the visibility of normal lung and mediastinal structures, as well as image noise. The mean score was compared between the standard and low doses. In a second study, an independent evaluation of the presence or absence of pathologic findings was made by four observers. RESULTS: Lucite phantom studies demonstrated diminished low-contrast resolution and increased noise level for the low-dose technique. Observers assessed more noise in the low-dose images (P < 0.001). The normal structures were judged to be more visible with standard dose (P < 0.01), but the magnitude of the judged differences was small especially in the lung. No differences were found in the detection of lung and mediastinal abnormalities (P > 0.10). CONCLUSIONS: The low-dose technique was effective in demonstrating pathologic findings for the lung and mediastinum. Low-dose spiral CT should be considered as a viable alternative to standard-dose spiral CT.

Adult↗

MR imaging of the thorax: a comparison of axial, coronal, and sagittal imaging planes.

We performed direct multisection coronal and sagittal magnetic resonance (MR) images in addition to axial images to determine the value and limitations of coronal and sagittal planes compared with axial planes. Ninety-four MR examinations of the thorax were performed with a 0.3 T permanent magnet system (Fonar) by spin echo technique. The MR axial images were found superior to coronal in demonstrating prevascular adenopathy (one case), pretracheal nodes (nine cases), left paraaortic nodes (three cases), subcarinal nodes (three cases), and small pleural effusions (three cases). The coronal or sagittal planes were better to determine relationship of a mass at the lung apex (five cases) or an abnormality at the lung base (five cases). The anteroposterior displacement or compromise of great vessels and bronchi was best displayed on the axial plane whereas craniocaudal displacement of above structures was best seen on the coronal plane. The axial images were found most informative and we suggest that they be performed routinely. Coronal or sagittal planes may be added in selected cases.

Carcinoma, Bronchogenic↗

Malignant schwannomas of the thorax: CT findings.

We reviewed CT of eight patients with malignant schwannomas arising in the thorax. Only one patient had neurofibromatosis. Five lesions occurred in the posterior mediastinum, one lesion was in the middle mediastinum, and two lesions were in the chest wall. Common CT findings were the presence of low-density areas (six of eight), compression of adjacent structures (six of eight), pleural abnormalities (six of eight), such as pleural effusion or pleural nodules, and metastatic pulmonary nodules (five of eight). Pleural abnormalities or pulmonary nodules were detected in seven of eight patients. These CT findings can help in differentiating malignant schwannoma from benign neurogenic tumor.

Adult↗

CT surveillance of the thorax in patients with squamous cell carcinoma of the head and neck: a preliminary experience.

PURPOSE: Our goal was to determine the number of malignancies detected by thoracic CT in patients with head and neck squamous cell carcinoma (SCCA) in three clinical settings. METHOD: We retrospectively examined 168 thorax CT scans in 93 patients with head and neck SCCA and determined the number of malignancies (second primary cancers or metastasis) (a) at the time of diagnosis of the primary neck tumor (57 patients), (b) at approximately yearly intervals following treatment of the primary cancer (93 examinations in 43 patients), and (c) at the time of local/regional recurrence of the neck neoplasm (18 patients). RESULTS: CT detected malignancy in 9 of 57 patients examined during diagnosis of the neck tumor, in 9 of 43 patients during follow-up, and in 6 of 18 patients evaluated at the time of local/regional neck recurrence. CONCLUSION: Chest CT demonstrates a high number of additional malignancies in patients presenting with advanced SCCA of the head and neck.

Carcinoma, Squamous Cell↗

Penetrating wounds of the neck and upper thorax.

During the past decade, a method utilizing individual case assessment has been employed in the treatment of 51 patients with penetrating wounds of the neck and upper thorax. Only those wounds penetrating the platysma are included. Thirty-five patients (68.6%) underwent neck exploration; 16 patients (31.4%) were managed nonoperatively. Overall, five patients died, four patients following operative treatment and one treated nonoperatively, for a mortality rate of 9.8%. In the nonoperative group, a mortality of 6.2% (one death) compares favorably with an operative mortality of 11.4% (four deaths). Ten patients (29%) in the neck exploration group exhibited significant later morbidity compared to seven patients (44%) in the patients not explored. Therefore the morbidity from a negative neck exploration was only 2% (one of 20 patients). The techniques for exploring the neck are discussed. Adequate surgical exposure is largely dependent on the possibility of vascular injury, the most common cause of death in this series.

Adult↗

Prehospital advanced trauma life support for critical penetrating wounds to the thorax and abdomen.

The role of advanced trauma life support (ATLS) in the prehospital care of the critically injured is highly controversial. This study analyzes the efficacy of ATLS in the management of critical penetrating wounds of the thorax and abdomen. In the 2 1/2-year period ending July 1984, 203 consecutive patients underwent emergency laparotomy or thoracotomy for gunshot and stab wounds. All patients were treated in the field by advanced paramedics (EMT-P). For gunshot wounds the mean time (+/- S.E.M.) responding to the scene was 4.5 (+/- 0.29) minutes, on the scene 10.1 (+/- 0.41) minutes, and returning to the hospital 6.4 (+/- 0.32) minutes. For stab wounds the mean time responding to the scene was 4.8 (+/- 0.21) minutes, on the scene 9.5 (+/- 0.37) minutes, and returning to the hospital 5.7 (+ 0.30) minutes. The number of intravenous lines started averaged 1.8 per patient. Eighty-one patients had PASG applied and 28 patients underwent endotracheal intubation (21 orally, seven nasally). Thirty-three patients had no obtainable blood pressure, of whom six survived (18%). One hundred sixty (94%) of the remaining 170 patients who had any initial blood pressure survived. One hundred nine (55%) patients had an increase in BP greater than or equal to 10 mm Hg (average, 35.6 mm Hg), 64 (32%) had no significant change, and 25 (13%) had a fall greater than or equal to 10 mm Hg (average, 24.2 mm Hg) from the field to the emergency department. Twenty (80%) of the 25 patients with a fall in blood pressure survived.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗

Iatrogenic trauma to the thorax.

With more sophisticated medical procedures and treatment for the critically ill patient, iatrogenic damage to the thorax has become increasingly common. But simple radiologic procedures, such as chest radiography and fluoroscopy, permit diagnosis of unsuspected and clinically silent complications. A very important iatrogenic trauma to the lung depends on the increasing use of overpressure ventilation. Experimental evidence shows that the lung can be damaged with interstitial emphysema at peak pressures as low as 40 cm H2O. The chest radiograph may show and early pathognomonic finding of perivascular air collections. The respirator treatment should then be modified to avoid pneumomediastinum and pneumothorax. The placement of catheters, chest tubes, endotracheal tubes, and feeding tubes as well as pacemaker electrodes and counterpulsation balloons may cause serious complications. Follow-up chest radiography after these procedures is therefore important.

Barotrauma↗

Spiral CT of the thorax in daily practice: optimization of technique.

Effective utilization of spiral computed tomography (CT) technology in imaging of the thorax requires an understanding of technical parameters that affect image and scan quality. This article discusses how operator-controlled scan parameters can be optimized to achieve diagnostic and cost-effective examinations appropriate for daily clinical practice.

Contrast Media↗

Gunshot wound to the thorax with bullet embolization to the external carotid artery.

Gunshot wounds are associated with major morbidity and mortality rates. If the patient survives the initial insult, all gunshot wounds require an assessment of the organs at risk and localization of the projectile. This case of a gunshot wound to the thorax with bullet embolization from the left ventricle to the right external carotid artery provides an overview of the imaging in this clinical scenario. Typically, right cardiac perforation results in embolization into the pulmonary vasculature, whereas left cardiac perforation results in embolization into the extremities.

Adult↗

Pitfalls in integrated CT-PET of the thorax: implications in oncologic imaging.

Integrated computed tomography-positron emission tomography (CT-PET) scanners improve localization of regions of increased [18F]-fluoro-2-deoxy-D-glucose (FDG) uptake and staging accuracy by allowing the near-simultaneous acquisition of coregistered, spatially matched functional and morphologic data in the same examination. However, many benign lesions can accumulate FDG and be potential pitfalls in interpretation. With the increased use of CT-PET in oncologic imaging, misinterpretation of these potential pitfalls can have significant clinical ramifications and alter staging and management. In this article, we review the physiologic uptake of FDG, normal variants, and potential pitfalls in the integrated CT-PET imaging of the thorax and their implications in oncologic imaging.

Artifacts↗

Temporal subtraction of thorax CR images using a statistical deformation model.

We propose a voxel-based nonrigid registration algorithm for temporal subtraction of two-dimensional thorax X-ray computed radiography images of the same subject. The deformation field is represented by a B-spline with a limited number of degrees of freedom, that allows global rib alignment to minimize subtraction artifacts within the lung field without obliterating interval changes of clinically relevant soft-tissue abnormalities. The spline parameters are constrained by a statistical deformation model that is learned from a training set of manually aligned image pairs using principal component analysis. Optimization proceeds along the transformation components rather then along the individual spline coefficients, using pattern intensity of the subtraction image within the automatically segmented lung field region as the criterion to be minimized and applying a simulated annealing strategy for global optimization in the presence of multiple local optima. The impact of different transformation models with varying number of deformation modes is evaluated on a training set of 26 images using a leave-one-out strategy and compared to the manual registration result in terms of criterion value and deformation error. Registration quality is assessed on a second set of validation images by a human expert rating each subtraction image on screen. In 85% of the cases, the registration is subjectively rated to be adequate for clinical use.

Algorithms↗

Cytology of diffuse mesothelioma in the thorax of a horse.

Examination of effusions from body cavities must include a search for neoplastic as well as inflammatory cells. Neoplastic cells found in the thorax are generally derived from adenocarcinomas or mesotheliomas. Mesotheliomas are relatively uncommon and the neoplastic cells found in effusions are difficult to differentiate from activated cells in inflammatory effusions. An ante-mortem diagnosis of mesothelioma was made in a mare on the basis of the large volume of fluid produced, the pleomorphic mesothelial cells, the polyp formation and the absence of PAS staining material after digestion of the cell impression with maltase diastase.

Animals↗

On the use of pediatric phantoms in the dose evaluation during computed tomography (CT) thorax examinations.

This paper presents the dosimetric results obtained during computed tomography (CT) thorax examinations, carried out using two different techniques, i.e., sequential CT (SQCT) and helical CT (HECT). The radiological examinations have been carried out on pediatric phantoms expressly designed and realized. Four different phantoms have been realized, according to the children shapes of 0, 2, 6, and 12 years old. The dosimetric measurements have been carried out using thermoluminescent dosimeters. The comparison of the dosimetric data obtained using the two different techniques shows that there is not any relevant difference between them as far as the entrance dose and the doses received by the critical organs are concerned.

Child↗

Radiographic assessment of pleuropulmonary disease in asbestos workers: posteroanterior, four view films, and computed tomograms of the thorax.

To study the clinical usefulness of computed tomography (CT) scanning of the thorax in asbestos related pleuropulmonary disease, 127 long term asbestos workers of the mines and mills in the Eastern Townships of Québec were examined. The CT scan was compared with the standard posteroanterior (PA) chest film and the four view films using the ILO grading system for profusion of disease. Six lung areas and six pleural sites were studied. On the basis of the usual diagnostic criteria, 41% of the workers had asbestosis. For profusion of parenchymal disease, there was an excellent correlation (r = 0.96, p less than 0.001) between PA and four view films and the latter did not significantly increase the total profusion score; the CT scan correlated less well with the PA film (r = 0.79, p less than 0.01) and the scatter of the data was larger. In 10 of the 53 (19%) workers with asbestosis the pulmonary lesions were not recognised by CT scan. For profusion of pleural plaques, there was an excellent correlation (p = 0.91, p less than 0.001) between PA and four view films; scores were identical in 73%, higher for PA in 7%, and higher for four view films in 19%. CT scan scores, however, were identical with PA films in 31%, higher for CT scan in 13% (owing to higher scores on lateral pleural sites), and lower for CT scan in 56% (owing to lower scores at diaphragm and costophrenic angle sites). Pleural calcifications were identified in 24 workers for a total of 40 sites; 13 as possible, 31% identified by two modes, and 27 as definite. Of the latter, 14 were seen only on CT scan. In the workers with rigid pressure volume curve of the lung and increased Gallium-67 lung uptake only, CT scan total scores were not significantly higher than in those without these markers of early interstitial lung disease (5 +/- 1 v 4 +/- 1, p less than 0.05). Thus the four view films and CT scan appear to be useful mainly in the assessment of pleural disease. The four view film identifies more sites of pleural plaques and the CT scan more pleural calcified plaques.

Adult↗

Fundamentals of impact biomechanics: Part I--Biomechanics of the head, neck, and thorax.

This is the first of two chapters dealing with some 60 years of accumulated knowledge in the field of impact biomechanics. The regions covered in this first chapter are the head, neck, and thorax. The next chapter will discuss the abdomen, pelvis, and the lower extremities. Although the principal thrust of the research has been toward the mitigation of injuries sustained by automotive crash victims, the results of this research have applications in aircraft safety, contact sports, and protection of military personnel and civilians from intentional injury, such as in the use of nonlethal weapons. The reader should be keenly aware of the wide variation in human response and tolerance data in the cited results. This is due primarily to the large biological variation among humans and to the effects of aging. Average values are useful in design but cannot be applied to individuals.

Animals↗

Computed tomography of the thorax and abdomen; a preliminary report.

The utility of computed tomography (CT) in the study of the anatomy, physiology, and pathology of the human body has been the subject of considerable interest since the introduction of CT scanning. The advent of a new prototype scanning device has made it possible to examine a variety of abnormalities in the abdomen and thorax in a manner not previously possible. This development permits a remarkable insight into the study of human disease in vivo.

Aortography↗

Neural tumors of the thorax: subject review from the AFIP.

160 tumors of neural origin occurring in the thorax were analyzed. The major histological features of schwannoma, neurofibroma, neuroblastoma, ganglioneuroblastoma, ganglioneuroma, and paraganglioma are described. Radiological analysis emphasized shape and location. Calcification was relatively uncommon but may be specific. The comparatively low figures on incidence of rib and vertebral abnormalities might be increased by special studies, including vertebral tomography. Evidence of local spread such as pleura-based nodules and pleural effusion constitutes evidence of malignancy. Age may be the most important clinical parameter for distinguishing between histological types.

Adolescent↗

Clinical applications of radio-frequency tumor ablation in the thorax.

Minimally invasive alternatives to surgery for the treatment of malignancy are becoming more attractive owing to improvements in technology, reduced morbidity and mortality, and the ability to provide treatment in an outpatient setting. Radio-frequency (RF) ablation has become the imaging-guided ablative method of choice because of its relatively low cost, its capability of creating large regions of coagulative necrosis in a controlled fashion, and its relatively low toxicity. RF ablation in the thorax involves the use of computed tomography (CT) to localize the tumor and determine the optimal approach. The size of the tumor determines whether a cluster of electrodes or a single electrode of a particular length will be used to perform the ablation. CT fluoroscopy aids in guiding placement of the electrode. In patients with non-small cell lung malignancy who are not candidates for surgery owing to poor cardiorespiratory reserve, RF ablation alone or followed by conventional radiation therapy with or without chemotherapy may prove to be a treatment option. In patients with metastatic disease, RF ablation may be suitable for treatment of a small tumor burden or for palliation of larger tumors that cause symptoms such as cough, hemoptysis, or pain. Patients with chest wall or osseous metastatic tumors in whom other therapies have failed may benefit from RF ablation as an alternative to radiation therapy.

Catheter Ablation↗