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European Journal of Radiology Aug 2011To assess the effect of positive enteric contrast administration on automatic exposure control (AEC) CT radiation exposure in (1) a CT phantom, and (2) a retrospective...
OBJECTIVE
To assess the effect of positive enteric contrast administration on automatic exposure control (AEC) CT radiation exposure in (1) a CT phantom, and (2) a retrospective review of patients.
MATERIALS AND METHODS
We scanned a CT phantom containing simulated bowel that was sequentially filled with water and positive enteric contrast, and recorded the mean volume CT dose index (CTDIvol). We also identified 17 patients who had undergone 2 technically comparable CT scans of the abdomen and pelvis, one with positive enteric contrast and the other with oral water. Paired Student's t-tests were used to compare the mean CTDIvol between scans performed with and without positive enteric contrast. Both the phantom and patient CT scans were performed using AEC with a fixed noise index.
RESULTS
The mean CTDIvol for the phantom with simulated bowel containing water and positive enteric contrast were 8.2 ± 0.2 mGy, and 8.7 ± 0.1 mGy (6.1% higher than water, p=0.02), respectively. The mean CTDIvol for patients scanned with oral water and with positive enteric contrast were 11.8 mGy and 13.1 mGy, respectively (p=0.003). This corresponded to a mean CTDIvol which was 11.0% higher (range: 0.0-20.7% higher) in scans with positive enteric contrast than those with oral water in patients.
CONCLUSIONS
When automatic exposure control is utilized for abdominopelvic CT, the radiation exposure, as measured by CTDIvol, is higher for scans performed with positive enteric contrast than those with oral water.
Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Diatrizoate Meglumine; Female; Humans; Intestinal Diseases; Intestines; Iohexol; Male; Middle Aged; Phantoms, Imaging; Radiation Dosage; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 21493028
DOI: 10.1016/j.ejrad.2011.03.059 -
Canadian Journal of Surgery. Journal... Apr 2011Gastrografin (GG) has been shown to accelerate the resolution of adhesive small bowel obstruction (ASBO) and decrease length of stay (LOS) in hospital. Consequently, we...
BACKGROUND
Gastrografin (GG) has been shown to accelerate the resolution of adhesive small bowel obstruction (ASBO) and decrease length of stay (LOS) in hospital. Consequently, we instituted a protocol recommending the routine use of GG in patients with ASBO. This study reviews patient outcomes after protocol implementation.
METHODS
We conducted a retrospective review of all patients with ASBO from January 1997 to December 2007. Data were categorized by admission date and use of GG. The outcomes reviewed were protocol uptake, median LOS in hospital and operative rate. Results were analyzed using the Mann-Whitney U test and the 2-tailed Fisher exact test.
RESULTS
There were 710 patients with ASBO overall. Sixteen of 376 (4.3%) patients received GG before institution of the protocol (period 1), whereas 195 of 334 (58.4%) received GG thereafter (period 2). In period 2, use of GG was limited to between 58% and 69% of all potentially eligible patients per year. Fifty-seven of 710 (8%) patients required surgery. In period 1, there were no significant differences in median LOS in hospital (p=0.29) and operative rate (p=0.65) between patients who received GG and those who were managed without GG. In period 2, patients receiving GG had a greater median LOS in hospital (3 [range 2-5] v. 2 [range 1-5] d, p=0.048) but significantly lower operative rates (5.1% v. 12.9%, p=0.018). Overall, the median LOS decreased over time (period 1: 4 [2-7] d v. period 2: 2 [1-5] d, p=0.010). The operative rate did not vary substantially between periods (7.7% v. 8.4%, p=0.42).
CONCLUSION
The introduction of a protocol has increased the proportion of eligible patients receiving GG. However, protocol nonadherence and factors other than GG usage have influenced LOS in hospital and operative rates. Demonstrated benefits from previously published clinical trials have thus not been replicated within our setting.
Topics: Clinical Protocols; Contrast Media; Diatrizoate Meglumine; Female; Humans; Intestinal Obstruction; Length of Stay; Male; Middle Aged; Retrospective Studies; Tissue Adhesions
PubMed: 21251420
DOI: 10.1503/cjs.024009 -
The Journal of International Medical... 2010This prospective study investigated the value of the hyperosmolar water-soluble contrast medium Urografin(®) in choosing which patients with small-intestine... (Clinical Trial)
Clinical Trial
This prospective study investigated the value of the hyperosmolar water-soluble contrast medium Urografin(®) in choosing which patients with small-intestine obstruction, caused by post-operative adhesions, to treat conservatively. Thirty-seven patients with adhesive intestinal obstruction received Urografin(®) via a nasogastric tube. Direct abdominal radiographs were taken after 2, 4 and 8 h. Twenty-four patients (64.9%) had Urografin(®) in the right colon within 8 h and were considered to have partial obstruction. These patients commenced oral feeding even though abdominal radiographs revealed gas-fluid levels. In the remaining 13 patients (35.1%), Urografin(®) was not observed in the right colon within 8 h: three of the 13 patients (23.1%) were successfully treated conservatively; 10 of the 13 patients (76.9%) developed toxic signs and underwent surgery, with obstruction resulting from adhesive bands being confirmed at operation. Conservative treatment can be recommended for patients in whom contrast medium is observed in the right colon within 8 h following administration, regardless of the presence of obstruction signs. Absence of contrast medium in the right colon within 8 h cannot, however, be considered an indication for surgery.
Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Demography; Diatrizoate Meglumine; Female; Humans; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Osmolar Concentration; Postoperative Complications; Radiography; Solubility; Time Factors; Tissue Adhesions; Water; Young Adult
PubMed: 21227018
DOI: 10.1177/147323001003800628 -
The British Journal of Radiology Apr 2012Minimal preparation CT of the colon (MPCT colon) is used for investigation of suspected colorectal cancer in frail and/or elderly patients who would be expected to...
OBJECTIVES
Minimal preparation CT of the colon (MPCT colon) is used for investigation of suspected colorectal cancer in frail and/or elderly patients who would be expected to tolerate laxative bowel preparation poorly. Although it has good sensitivity for colorectal cancer it has a poor specificity. We wished to investigate whether distension of the colon with carbon dioxide alone would reduce the number of false-positives, but without making the test arduous or excessively uncomfortable.
METHODS
134 patients were recruited and underwent MPCT colon with gas insufflation and antispasmodics. Results were compared with a cohort of 134 patients undergoing standard protocol MPCT colon. The numbers of false-positives were compared, as was reader confidence. All trial patients were given a questionnaire documenting their experience.
RESULTS
The number of false-positives was 15% in the control group and 5% in the trial group; this difference was statistically significant, (p=0.01). Reader confidence was increased in the trial group. Patient tolerance was good, with 95% saying they would have the test again.
CONCLUSION
Use of gas insufflation and antispasmodics reduces the false-positives from 15% to 5% without adversely affecting patient tolerance.
Topics: Aged; Aged, 80 and over; Colonography, Computed Tomographic; Colorectal Neoplasms; Contrast Media; Diatrizoate Meglumine; False Positive Reactions; Female; Humans; Insufflation; Male; Middle Aged; Surveys and Questionnaires
PubMed: 21224295
DOI: 10.1259/bjr/20678489 -
Abdominal Imaging Oct 2011To determine the rate and associated factors for acquiring a decubitus series at CT colonography (CTC), in addition to the standard supine and prone series.
PURPOSE
To determine the rate and associated factors for acquiring a decubitus series at CT colonography (CTC), in addition to the standard supine and prone series.
MATERIALS AND METHODS
CTC examinations read centrally at one institution but performed at three different centers in 6,380 adults were reviewed to determine the frequency of an additional decubitus series. Results were analyzed according to study indication (primary screening vs. diagnostic for incomplete colonoscopy), practice site (academic vs. community), patient age, gender, body mass index (BMI), and temporal variation. At all sites, the CT technologist determined the need for an additional decubitus series, with infrequent radiologist input in select cases.
RESULTS
The frequency for the CT technologist to obtain a decubitus series at screening was 9.7% (578/5,952), compared with 22.9% (98/428) following failed colonoscopy (P < 0.001). The decubitus rate for screening at the academic center (9.4%, 550/5,871) was significantly lower than the community hospitals (34.6% combined, 28/81) (P < 0.001). The rate progressively increased with age, from 5.0% under age 50 to 28.0% over age 80. No significant difference was seen between men and women (10.3 vs. 9.2%), but a strong correlation existed with increased BMI, rising to >25% for BMI over 40. Marked temporal variation existed at the academic center, with quarterly rates ranging from 0 to 17%.
CONCLUSIONS
The frequency for performing a third series at CTC varies considerably according to indication, practice site, patient age, BMI, and time. These results have important implications for clinical practice, including the need for improved training and feedback for CT technologists.
Topics: Barium Sulfate; Cathartics; Chi-Square Distribution; Citric Acid; Colonography, Computed Tomographic; Colorectal Neoplasms; Contrast Media; Diatrizoate Meglumine; Electrolytes; Female; Humans; Male; Middle Aged; Organometallic Compounds; Patient Positioning; Phosphates; Polyethylene Glycols; Retrospective Studies
PubMed: 21184064
DOI: 10.1007/s00261-010-9666-9 -
Singapore Medical Journal Nov 2010Acute gastric dilatation due to superior mesenteric artery syndrome in healthy individuals is extremely rare. A 17-year-old girl who complained of epigastric pain for...
Acute gastric dilatation due to superior mesenteric artery syndrome in healthy individuals is extremely rare. A 17-year-old girl who complained of epigastric pain for two days following excessive eating was admitted to our hospital. She was nauseated but was unable to vomit. Succussion splash was positive. Bedside ultrasonography revealed a hyperactive duodenum, a distended stomach compressing on the inferior vena cava and a narrowed angle between the superior mesenteric artery (SMA) and the aorta. Abdominal computed tomography imaging confirmed the above findings. The angle between the aorta and SMA was only eight degrees. Gastrograffin follow-through showed complete obstruction of the third part of the duodenum. 3,500 ml of fluid was immediately drained through the nasogastric tube. Another gastrograffin study conducted five days later showed normal results. Bedside ultrasonography thus proved to be useful for both the diagnosis and management of superior mesenteric artery syndrome.
Topics: Acute Disease; Adolescent; Diatrizoate Meglumine; Duodenal Diseases; Duodenum; Female; Gastric Dilatation; Humans; Point-of-Care Systems; Risk Factors; Superior Mesenteric Artery Syndrome; Ultrasonography; Vena Cava, Inferior
PubMed: 21140106
DOI: No ID Found -
Obesity Surgery Aug 2011In up to 4% of laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures, anastomotic leaks occur. Early detection of gastrointestinal leakage is important for successful... (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
In up to 4% of laparoscopic Roux-en-Y gastric bypass (LRYGB) procedures, anastomotic leaks occur. Early detection of gastrointestinal leakage is important for successful treatment. Consequently, many centers advocate routine postoperative upper gastrointestinal (UGI) series. The aim of this study was to determine the utility of this practice after LRYGB.
METHODS
Eight hundred four consecutive patients undergoing LRYGB from June 2000 to April 2010 were analyzed prospectively. The first 382 patients received routine UGI series between the third and fifth postoperative days (group A). Thereafter, the test was only performed when clinical findings (tachycardia, fever, and drainage content) were suspicious for a leak of the gastrointestinal anastomosis (group B; n = 422).
RESULTS
Overall, nine of 804 (1.1%) patients suffered from leaks at the gastroenterostomy. In group A, four of 382 (1%) patients had a leak, but only two were detected by the routine UGI series. This corresponds to a sensitivity of 50%. In group B, the sensitivity was higher with 80%. Specificities were comparable with 97% and 91%, respectively. Routine UGI series cost only 1.6% of the overall costs of a non-complicated gastric bypass procedure. With this leak rate and sensitivity, US $86,800 would have to be spent on 200 routine UGI series to find one leak which is not justified.
CONCLUSIONS
This study shows that routine UGI series have a low sensitivity for the detection of anastomotic leaks after LRYGB. In most cases, the diagnosis is initiated by clinical findings. Therefore, routine upper gastrointestinal series are of limited value for the diagnosis of a leak.
Topics: Adult; Anastomotic Leak; Contrast Media; Costs and Cost Analysis; Diatrizoate Meglumine; Female; Fluoroscopy; Gastric Bypass; Hospital Costs; Humans; Laparoscopy; Male; Middle Aged; Obesity, Morbid; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Switzerland; Upper Gastrointestinal Tract
PubMed: 20872254
DOI: 10.1007/s11695-010-0284-y -
European Journal of Radiology Nov 2011To evaluate the influence of CAD for the evaluation of CT colonography (CTC) datasets by inexperienced readers during the attendance of a dedicated hands-on training...
PURPOSE
To evaluate the influence of CAD for the evaluation of CT colonography (CTC) datasets by inexperienced readers during the attendance of a dedicated hands-on training course.
METHOD AND MATERIALS
Twenty-seven radiologists inexperienced in CTC (11 with no CTC training at all, 16 having previously reviewed no more than 10 CTC cases overall) attended a hands-on training course based on direct teaching on fifteen workstations (four Advantage Windows 4.4 with Colon VCAR software, GE; six CADCOLON, Im3D; five ColonScreen (Toshiba/Voxar) with ColonCAD™ API, Medicsight). During the course, readers were instructed to analyze 26 CTC cases including 38 colonic lesions obtained through low-dose MDCT acquisitions, consisting of 12 polyps sized less than 6 mm, 9 polyps sized between 6 and 10 mm, 12 polyps sized between 11 mm and 30 mm, and 5 colonic masses sized>3 cm. CTC images were reviewed by each reader both in 2D and 3D mode, respectively by direct evaluation of native axial images and MPR reconstructions, and virtual endoscopy or dissected views. Each reader had 15 min time for assessing each dataset without CAD, after which results were compared with those provided by CAD software. Global rater sensitivity for each lesion size before and after CAD usage was compared by means of two-tailed Student's t test, while sensitivity of each single reader before and after CAD usage was assessed with the McNemar test.
RESULTS
For lesions sized<6 mm, global rater sensitivity was 0.1852±0.1656 (mean±SD) before CAD-assisted reading and 0.2345±0.1761 after CAD (p=0.0018). For lesions sized 6-9 mm, sensitivity was 0.2870±0.1016 before CAD-assisted reading and 0.3117±0.1099 after CAD (p=0.0027). For lesions sized 10-30 mm, sensitivity was 0.5308±0.2120 before CAD-assisted reading and 0.5637±0.2133 after CAD (p=0.0086), while for lesions sized>30 mm, sensitivity before CAD-assisted reading was 0.3556±0.3105 and did not change after CAD usage (p=1). Sensitivity of each single rater did not significantly differ before and after CAD for any lesion size category (McNemar test, p>0.05). Specificity was not significantly different before and after CAD for any lesion size (>96% for all size categories).
CONCLUSION
CAD usage led to increased overall sensitivity of inexperienced readers for all polyps sizes, except for lesions>30 mm, but sensitivity of individual raters was not significantly higher compared with CAD-unassisted reading.
Topics: Colonic Polyps; Colonography, Computed Tomographic; Contrast Media; Diagnosis, Computer-Assisted; Diatrizoate Meglumine; Humans; Radiographic Image Interpretation, Computer-Assisted; Radiology; Retrospective Studies; Sensitivity and Specificity; Software
PubMed: 20832219
DOI: 10.1016/j.ejrad.2010.07.014 -
International Journal of Pharmaceutics May 2010Aerosolized contrast agents may improve the resolution of biomedical imaging modalities and enable more accurate diagnosis of lung diseases. Many iodinated compounds,...
Aerosolized contrast agents may improve the resolution of biomedical imaging modalities and enable more accurate diagnosis of lung diseases. Many iodinated compounds, such as diatrizoic acid, have been shown to be safe and useful for radiographic examination of the airways. Formulations of such compounds must be improved in order to allow imaging of the smallest airways. Here, diatrizoic acid nanoparticle agglomerates were created by assembling nanoparticles into inhalable microparticles that may augment deposition in the lung periphery. Nanoparticle agglomerates were fully characterized and safety was determined in vivo. After dry powder insufflation to rats, no acute alveolar tissue damage was observed 2h post-dose. Diatrizoic acid nanoparticle agglomerates possess the characteristics of an efficient and safe inhalable lung contrast agent.
Topics: Administration, Inhalation; Aerosols; Animals; Chemistry, Pharmaceutical; Contrast Media; Diatrizoate Meglumine; Drug Carriers; Female; Lung; Nanoparticles; Particle Size; Powders; Rats; Rats, Sprague-Dawley; Solubility; Surface Properties
PubMed: 20214960
DOI: 10.1016/j.ijpharm.2010.03.009 -
BMJ Case Reports Sep 2010The case of a boy with cystic fibrosis who presented with an unusual complication of appendicitis is reported. Delayed presentation, with complications of appendicitis...
The case of a boy with cystic fibrosis who presented with an unusual complication of appendicitis is reported. Delayed presentation, with complications of appendicitis such as perforation and abscess formation, is not uncommon in cystic fibrosis; however, this case represents the first report of an isolated appendico-colic fistula following appendicitis in association with cystic fibrosis.
Topics: Adolescent; Anastomosis, Surgical; Appendicitis; Appendix; Colectomy; Colon, Sigmoid; Cystic Fibrosis; Delayed Diagnosis; Diatrizoate Meglumine; Enema; Follow-Up Studies; Humans; Intestinal Fistula; Laparotomy; Male; Risk Assessment; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 22778186
DOI: 10.1136/bcr.02.2010.2714