This document discusses the risks of low-level radiation exposure from medical imaging procedures like CT scans. It notes that while there is no scientific consensus on radiation risks, international organizations assume the linear no-threshold model which states that any increase in radiation dose, no matter how small, results in an incremental increase in risk. The document outlines strategies that radiologists can employ to optimize CT protocols and reduce radiation doses for patients, such as using automatic exposure control, iterative reconstruction techniques, indication-based protocols, and monitoring doses at the patient and department levels. Radiologists are urged to take the lead in minimizing radiation exposures from medical imaging when it is clinically appropriate.
Five pearls and pitfalls in using head CT for diagnosis of traumatic brain injury. This was presented at the 51st Annual Scientific Meeting of the Royal College of Radiologists of Thailand (6 Aug 2014)
Five pearls and pitfalls in using head CT for diagnosis of traumatic brain injury. This was presented at the 51st Annual Scientific Meeting of the Royal College of Radiologists of Thailand (6 Aug 2014)
Introduction to trauma imaging. Guidelines and highlights for different imagi...hazem youssef
Early imaging, rather than admission and observation for neurological deterioration, will reduce time to detection for life threatening complications and is associated with better outcomes
The age, creatinine, and ejection fraction score to riskVishwanath Hesarur
CTOs are the most challenging coronary lesions for PCI, with a success rate ranging from 55% to 100%.
Successful PCI of CTOs is associated with improved long-term clinical outcomes compared with conservative management.
Nevertheless, the clinical outcome even after successful recanalization remains worse compared with patients with non-CTO stenoses who underwent PCI.
There are two basic IVUS catheter designs: mechanical/rotational and solid state. The mechanical catheters (OptiCross IVUS catheter, Boston Scientific, Santa Clara, California; Revolution IVUS catheter, Volcano, Rancho Cordova, California; ViewIT IVUS catheter, Terumo, Tokyo, Japan; and Kodama HD IVUS catheter, ACIST Medical Systems, Eden Prairie, Minnesota) consist of a single transducer element located at the tip of a flexible drive cable housed in a protective sheath and operated by an external motor drive unit. The drive cable rotates the transducer around the circumference (1800rpm) and the transducer sends and receives the ultrasound signals at 1° increment to form the cross-sectional image. The imaging catheters operate at a central frequency of 40 MHz or 60 MHz and are 5F or 6F compatible [Figure 1]A. In the solid-state catheter design (Eagle Eye Catheter, Volcano), no rotating components are present. There are 64 transducer elements mounted circumferentially around the tip of the catheter. The transducer elements are sequentially activated with different time delays to produce an ultrasound beam that sweeps around the vessel circumference. The catheter works at a central frequency of 20 MHz and is 5F compatible
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon
the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have
persistence or recurrence of angina after angiographically successful percutaneous coronary intervention
(PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from
its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing
in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance
of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
Neurointerventional Therapy for Brain Aneurysms and Acute Stroke Allina Health
By Yasha Kadkhodayan, MD. Overview of interventional neuroradiology approaches to brain aneurysm and stroke care, discussion of processes in place at Abbott Northwestern to enhance the delivery of stroke care.
triple scan protocol (Dr. Gross) - a new and effective protocol for 3D planni...Michael Gross
triple scan protocol (Dr. Gross) - a new and effective protocol for 3D planning and guided surgery of partially edentulous cases
Cortex guide - complete service for advanced 3D planning and guided surgery of dental implants
Introduction to trauma imaging. Guidelines and highlights for different imagi...hazem youssef
Early imaging, rather than admission and observation for neurological deterioration, will reduce time to detection for life threatening complications and is associated with better outcomes
The age, creatinine, and ejection fraction score to riskVishwanath Hesarur
CTOs are the most challenging coronary lesions for PCI, with a success rate ranging from 55% to 100%.
Successful PCI of CTOs is associated with improved long-term clinical outcomes compared with conservative management.
Nevertheless, the clinical outcome even after successful recanalization remains worse compared with patients with non-CTO stenoses who underwent PCI.
There are two basic IVUS catheter designs: mechanical/rotational and solid state. The mechanical catheters (OptiCross IVUS catheter, Boston Scientific, Santa Clara, California; Revolution IVUS catheter, Volcano, Rancho Cordova, California; ViewIT IVUS catheter, Terumo, Tokyo, Japan; and Kodama HD IVUS catheter, ACIST Medical Systems, Eden Prairie, Minnesota) consist of a single transducer element located at the tip of a flexible drive cable housed in a protective sheath and operated by an external motor drive unit. The drive cable rotates the transducer around the circumference (1800rpm) and the transducer sends and receives the ultrasound signals at 1° increment to form the cross-sectional image. The imaging catheters operate at a central frequency of 40 MHz or 60 MHz and are 5F or 6F compatible [Figure 1]A. In the solid-state catheter design (Eagle Eye Catheter, Volcano), no rotating components are present. There are 64 transducer elements mounted circumferentially around the tip of the catheter. The transducer elements are sequentially activated with different time delays to produce an ultrasound beam that sweeps around the vessel circumference. The catheter works at a central frequency of 20 MHz and is 5F compatible
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon
the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have
persistence or recurrence of angina after angiographically successful percutaneous coronary intervention
(PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from
its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing
in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance
of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
Neurointerventional Therapy for Brain Aneurysms and Acute Stroke Allina Health
By Yasha Kadkhodayan, MD. Overview of interventional neuroradiology approaches to brain aneurysm and stroke care, discussion of processes in place at Abbott Northwestern to enhance the delivery of stroke care.
triple scan protocol (Dr. Gross) - a new and effective protocol for 3D planni...Michael Gross
triple scan protocol (Dr. Gross) - a new and effective protocol for 3D planning and guided surgery of partially edentulous cases
Cortex guide - complete service for advanced 3D planning and guided surgery of dental implants
Basic physics of multidetector computed tomography ( CT Scan) - how ct scan works, different generations of ct, how image is generated and displayed and image artifacts related to CT Scan.
Breast cancer research in animal models has long been hindered by the lack of a fast, portable,
high resolution, research and animal focused imaging system that can visualize 2D tumor size, 3D
tumor volume, neoangiogenesis and blood perfusion in vivo, in real-time and most importantly,
non-invasively.
In order to ameliorate this problem, VisualSonics has introduced a revolutionary micro-ultrasound
system that allows researchers to collect a plethora of important data over the lifespan of animals,
thereby significantly reducing the number of animals needed.
Breast cancer research in animal models has long been hindered by the lack of a fast, portable, high resolution, research and animal focused imaging system that can visualize 2D tumor size, 3D tumor volume, neoangiogenesis and blood perfusion in vivo, in real-time and most importantly, non-invasively.
General suggestions in ordering body CT in ED; vascular occlusion; aneurysm/pseudoaneurysm; bleeding and active contrast extravasation; extraluminal air
Practical Points in Emergency CT for Emergency PhysiciansRathachai Kaewlai
The handout describes some brief practical points on emergency CT, particularly for emergency physicians. They include imaging utilisation trends, radiation dose, contrast reaction, contrast-induced nephropathy, use of oral contrast medium and some caveats on emergency CT (esp. abdomen)
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
CT Radiation Management: Why and How
1. Rathachai Kaewlai, MD
Division of Emergency Radiology, Department of Radiology
Ramathibodi Hospital, Mahidol University, Bangkok
RCRT 2015 at Centara Grand @CentralPlaza Ladprao
2. ! Lack of scientific consensus
! Assumption of risk from atomic bomb survivors
! How to act? Two possible errors…
! Assume risks are real and to then discover that
they do not exist
! Assume risks are nonexistent and to
subsequently discover that they are real
Huda W. Radiation risks: what is to be done? AJR 2015 January
3. ! Lack of scientific consensus
! Assumption of risk from atomic bomb survivors
! How to act? Two possible errors…
! Assume risks are real and to then discover that
they do not exist
! Assume risks are nonexistent and to
subsequently discover that they are real
Huda W. Radiation risks: what is to be done? AJR 2015 January
4. ! Low-level radiation
(up to 100 mSv)
! 30-40X annual natural
background
! 10X a usual CT scan
! Linear no-threshold
hypothesis
! 12 cancers with significant lifetime excessive
risks: lung, liver, breast, prostate, stomach, colon,
thyroid and leukemia
Committee on the Biological Effects of Ionizing radiation of the US National Academy of Sciences (2005)
Figure from web.princeton.edu
5. ! At low doses, the risk = one
excess cancer in 100
exposed persons (100 mSv)
during their lifetime. Mortality
is about one-half.
! Higher risk in female and
children
Committee on the Biological Effects of Ionizing radiation of the US National Academy of Sciences (2005)
6. ! “Most recent data for the
survivors of the atomic
bombings are largely
consistent with linear or
linear-quadratic dose trends
over a wide range of doses”
United Nations Scientific Committee on the Effects of Atomic Radiation (2006)
7. ! “….the practical system of
radiation protection
recommended by the
Commission will continue to be
based on the assumption that, at
doses below about 100 mSv, a
given increment in dose will
produce a directly proportionate
increment in the probability of
incurring cancer.”
International Commission on Radiological Protection (2007)
8. ! Do we agree on the risk of radiation?
! Do we agree on our role in it?
Radiologists’
professional role
9. Today: IMAGING 2.0 Tomorrow: IMAGING 3.0TM
Volume-based Value-based
Transactional Consultative
Radiologist centered Patient centered
Interpretation focused Outcomes focused
Commoditized Integral
Invisible Accountable
IMAGING 3.0TM is a trademark of the American College of Radiology
10. Today: IMAGING 2.0 Tomorrow: IMAGING 3.0TM
Volume-based Value-based
Transactional Consultative
Radiologist centered Patient centered
Interpretation focused Outcomes focused
Commoditized Integral
Invisible Accountable
IMAGING 3.0TM is a trademark of the American College of Radiology
11. IMAGING 3.0TM is a trademark of the American College of Radiology
13. ! Low-level radiation is a
health hazard – LNT
hypothesis
! Radiologists have a critical
role in optimizing CT
radiation exposure (should
be a leader of the team)
14. ! Why CT?
! CT parameters and radiation units
! Ramathibodi Emergency Radiology
experience
! Case examples (acute abdomen)
! Step-by-step guide to manage CT
radiation
15. ! Medical radiation is now the majority of
radiation exposure in human
! CT accounts for most of this
! CT volume on the rise
! No dose penalty in CT
! CT radiation dose is intrinsically high
! No binding regulations on CT doses
! CT radiation errors made into headlines
16.
17.
18. ! Case volume
! Many sensitive
organs
! Patient population
who gets scanned
! It’s frequently where
the Unnecessaries
occur
Brenner DJ, Hall EJ. N Engl J Med 2007
19. ! Assuming radiation risks are real
! Doing CT is weighing this risk with benefit
! If benefit > risk means a justified examination
! Providing other diagnostic options
! Using as low radiation as possible to
obtain needed diagnostic information
(ALARA)
20. Imaging exam ordered
by referring physician
Vetting/protocoling by
radiologist
Scanning
Post-processing
Monitoring of quality
Assetprotectionlawjournal.com
Massgeneralimaging.org
Medicineworld.orgJenkinsclinic.org
Blog.vpi-corp.com
21. " Educate physicians about radiation
risks
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
23. " Import exams from outside hospitals
to PACS
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
! Patients transferred to trauma
center 38/137 (28%) received
duplicated scans in 24 hours
! Most common reason for
duplication = lack thin-
section data on CD (37%)
! Additional radiation 10.2 mSv
! Additional charge $409
24. Can we use radiation-free imaging
(US, MRI) instead of CT for this
clinical scenario?
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
Make ultrasound
(by radiologist) available
and easily accessible 24/7
25. Can we use radiation-free imaging
(US, MRI) instead of CT for this
clinical scenario?
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
26. If CT needed, design protocols
specific to answer questions
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
27. “Routine” protocol with minimum scanning
phases. Nonroutine done by add-ons
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
28. " Avoid Z-creep (unnecessary coverage
and scan phases)
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
! Radiation dose is directly
proportional to scan volume
! Kalra et al, Radiology 2004
! 106 abdomen/pelvic CTs
! 97% had extra images
! 12 extra images/CT
29. Make standard protocols available in CT
workstations for every techs to use
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
iacionline.com
31. Use automatic tube current modulationCT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
32. " Reduce kVP
(esp for CTA,
stone protocol)
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
! Effect on both
noise and
attenuation
0
10
20
30
40
50
60
0 50 100 150
Changes in CTDIw as a Function
of kVp
CTDIw Head (mGy)
CTDIw Body (mGy)
Fixed mAs
35. Incorporate patient size, age and
indication into making a protocol (work
with your physicists)
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
! Image noise
increases with
less kVp but noise
is less in smaller
phantoms
Seigel MJ, et al. Radiology 2004
36. Incorporate patient
size, age and
indication into
making a protocol
(work with your
physicists)
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
Partnersradiology.org
39. " Send “Dose Report” into PACSCT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
40. " Educate radiologists and trainees
about dose parameters and standards
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
41. " Regular updates of CT protocolsCT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
libraries.psu.edu
42. o Use decision support tools
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
Sanjay Saini, MD. MGH
Sistrom CL et al. Radiology 2009
43. Systemwide tackle of defensive medicine
and self referral
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
Texler.deviantart.com
44. Streamlined vetting and protocoling
processes
CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
Claimruler.com
Managingamericans.com
45. CT order
Vetting/
protocoling
Scanning
Post-
processing
Monitoring
Color zones:
- Pink = routine, R/O situation
- Green = F/U CT with one prior
- Red = bone evaluation or
multiple priors
- Yellow = kidney stone
- Blue = subtle or small lesions
suspected or identified with other
imaging
- Gray = vascular assessment
with CTA
kVp mA Noise Index
Singh S, et al. Radiology 2009
47. Take the lead
Decide to change
Form a team
Do it!
Monitor the results
It’s radiologists’ professional role.
Our job, nobody else…
o Tell technologists to send dose
report to PACS
o Check 10-20 reports of all organ
systems
o Compare your doses with
standard DRLs
o Convince your Superior/Head
48. Take the lead
Decide to change
Form a team
Do it!
Monitor the results
It’s radiologists’ professional role.
Our job, nobody else…
o Form a team (you + other
radiologists + techs + (physicist)
o Select the target exam type (high
doses, high volume)
o Invite referring physician to join
the team
o Set your goal
49. Take the lead
Decide to change
Form a team
Do it!
Monitor the results
It’s radiologists’ professional role.
Our job, nobody else…
o Clinical guidelines
o Technical parameters
o Scan coverage, phases
o Indication-based, size-based
protocols
o Additional techniques (IR)
50. Take the lead
Decide to change
Form a team
Do it!
Monitor the results
It’s radiologists’ professional role.
Our job, nobody else…
o Team monitoring of dose
o Repeat the processes
52. ! Estimated dose x conversion
factor = SSDE
! Closer to “real” dose
! Thinner patients get more dose
compared with obese patients
of the same DLP
! Based on our own unpublished
data, SSDE is 30%+ that of
estimated dose
53. ! New techniques for further dose reduction
MGH Radiology Rounds, mghradrounds.org
54. ! New techniques for further dose reduction
MGH Radiology Rounds, mghradrounds.org
120 kVp, FBP 100 kVp, advanced IR
55. ! 1- and sub-mSv scan
MGH Radiology Rounds, mghradrounds.org
56. ! It is not a “choice” to reduce CT radiation. As
a radiologist, it is a responsibility to our
patients
! No more best-looking images. Images
should be “enough for diagnostic purpose”
! Multiphase CT should not be “routine”.
! CT dose is manageable: take a lead, make
a decision, form a team and “just do it”.
Editor's Notes
“…current scientific evidence is consistent with the hypothesis that there is a linear dose-response relationship between exposure to ionizing radiation and the development of radiation induced solid cancers”
At low doses, the risk, though increased, is small, one excess cancer in 100 exposed persons during their lifetime. Mortality, as opposed to incidence, would be about one-half.
For Radiation Protection Purposes, We Must Act on the Assumption That Radiation Risk Exists
Images good enough for diagnostic purposes
As a radiologist, it is a responsibility to our patients to reduce CT radiation
Old habits die hard – must force a change
https://farm3.staticflickr.com/2879/10926532254_039008b467.jpg
Importance of educating radiology personnel, patients and referring physicians about concerns over CT radiation
Commonly used CT parameters and radiation units
Dedicated radiology team to manage CT radiation
Specific technique to minimize radiation whie providing diagnostic examinations
In an age in which we can download movies and music from the cloud, it is inexcusable to subject patients to avoidable cost and radiation exposure when the technology exists to ensure that images are readily accessible. Zane RD. JWatch Emergency Medicine