The use of central venous catheters for intravenous contrast injection for CT examinations.
Br J Radiol. 2011 Mar;84(999):197-203
Authors: Plumb AA, Murphy G
The use of intravenous (i.v.) contrast media in CT examinati…

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Justifying multidetector CT in abdominal sepsis: time for review?

Br J Radiol. 2009 Mar;82(975):190-7

Authors: Meeson S, Alvey CM, Golding SJ

The further development of multidetector row CT (MDCT) has led to changes in the application and examination technique, leading to a need to justify the level and frequency of radiation exposure associated with MDCT. A literature review of how the use of modern scanners has affected diagnosis was undertaken, followed by a year-long retrospective study of MDCT scans of patients presenting with symptoms of abdominal sepsis. The diagnostic accuracy of detecting causes of abdominal sepsis using this technology was sought. Scans were performed using a LightSpeed 16 system (GE Healthcare Medical Systems, Slough, UK and Milwaukee, WI). Clinical diagnoses were based upon surgical and histopathological findings, treatment outcome and follow-up scans. System dose parameters recorded were the dose-length product (DLP) and volume CT dose index. The literature on investigating suspected abdominal sepsis has not been updated significantly since the time of conventional CT. 94 patients were included in the study; causes of abdominal sepsis could be detected with a sensitivity of 0.95 and a specificity of 0.91. Repeat examination and cumulative exposure was a key finding. Patients with abscesses and acute pancreatitis had the highest number of scanner visits; patients with diverticular disease had the lowest number of visits, lowest cumulative DLP and shortest stay in hospital. Cumulative DLP was affected by scan length, number of scans and patient size. In conclusion, diagnostic accuracy data for MDCT scans using 16 slices confirm that CT remains a suitable modality for imaging abdominal sepsis but scope for dose constraint exists.

PMID: 18955415 [PubMed - indexed for MEDLINE]

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Cancer risks from diagnostic radiology.

Br J Radiol. 2008 May;81(965):362-78

Authors: Hall EJ, Brenner DJ

In recent years, there has been a rapid increase in the number of CT scans performed, both in the US and the UK, which has fuelled concern about the long-term consequences of these exposures, particularly in terms of cancer induction. Statistics from the US and the UK indicate a 20-fold and 12-fold increase, respectively, in CT usage over the past two decades, with per caput CT usage in the US being about five times that in the UK. In both countries, most of the collective dose from diagnostic radiology comes from high-dose (in the radiological context) procedures such as CT, interventional radiology and barium enemas; for these procedures, the relevant organ doses are in the range for which there is now direct credible epidemiological evidence of an excess risk of cancer, without the need to extrapolate risks from higher doses. Even for high-dose radiological procedures, the risk to the individual patient is small, so that the benefit/risk balance is generally in the patients’ favour. Concerns arise when CT examinations are used without a proven clinical rationale, when alternative modalities could be used with equal efficacy, or when CT scans are repeated unnecessarily. It has been estimated, at least in the US, that these scenarios account for up to one-third of all CT scans. A further issue is the increasing use of CT scans as a screening procedure in asymptomatic patients; at this time, the benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established.

PMID: 18440940 [PubMed - indexed for MEDLINE]

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A pictorial review of hypovolaemic shock in adults.

Br J Radiol. 2008 Mar;81(963):252-7

Authors: Tarrant AM, Ryan MF, Hamilton PA, Benjaminov O

Hypovolaemic shock is an infrequently encountered entity found on CT of victims of severe trauma. Early abdominal and pelvic CT can show diffuse abnormalities owing to hypovolaemia that may alert radiologists to the presence of hypovolaemic shock. In this pictorial review, we present the imaging findings of hypovolaemic shock, as seen on CT of the abdomen. A spectrum of vascular and visceral CT signs is described. Vascular signs include diminished inferior vena cava diameter, diminished aortic diameter and abnormal vascular enhancement. Hollow visceral abnormalities include diffuse increased mucosal enhancement of both the small and large bowel, diffuse thickening of the small bowel wall, and small bowel dilatation. Solid visceral abnormalities include both decreased and increased end organ enhancement. This report should increase radiologists’ awareness of the CT manifestations of hypovolaemic shock.

PMID: 18180262 [PubMed - indexed for MEDLINE]

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