Low-dose #CT for the diagnosis of #appendicitis in adolescents and young adults (LOCAT): a pragmatic, multicentre, randomised controlled non-inferiority trial
http://www.thelancet.com/journals/langas/article/PIIS2468-1253(17)30247-9/fulltext
CT radiation is arguably carcinogenic. Results from single-centre studies, mostly retrospective, have advocated lowering the CT radiation dose for the diagnosis of appendicitis. However, adoption of low-dose CT has been slow. We aimed to assess the effectiveness of low-dose CT compared with standard-dose CT in the diagnosis of appendicitis in adolescents and young adults
Between Dec 4, 2013, and Aug 18, 2016, we assigned 1535 patients to the low-dose CT group and 1539 patients to the standard-dose CT group. 22 (3·9%) of 559 patients had a negative appendectomy in the low-dose group versus 16 (2·7%) of 601 patients in the standard-dose group (difference 1·3%, 95% CI −0·8 to 3·3; p=0·0022 for the non-inferiority test). We recorded 43 adverse events in 43 (2·8%) of 1535 patients in the low-dose group and 41 adverse events in 40 (2·6%) of 1539 patients in the standard-dose group. One life-threatening adverse event of anaphylaxis caused by an iodinated contrast material occurred in the low-dose group
Radiation dose of appendiceal CT for adolescents and young adults can be reduced to 2 mSv without impairing clinical outcomes. In view of the vast number of appendiceal CT examinations done worldwide, use of low-dose CT could prevent a sizeable number of radiation-associated cancers in the future
http://www.thelancet.com/journals/langas/article/PIIS2468-1253(17)30247-9/fulltext
CT radiation is arguably carcinogenic. Results from single-centre studies, mostly retrospective, have advocated lowering the CT radiation dose for the diagnosis of appendicitis. However, adoption of low-dose CT has been slow. We aimed to assess the effectiveness of low-dose CT compared with standard-dose CT in the diagnosis of appendicitis in adolescents and young adults
Between Dec 4, 2013, and Aug 18, 2016, we assigned 1535 patients to the low-dose CT group and 1539 patients to the standard-dose CT group. 22 (3·9%) of 559 patients had a negative appendectomy in the low-dose group versus 16 (2·7%) of 601 patients in the standard-dose group (difference 1·3%, 95% CI −0·8 to 3·3; p=0·0022 for the non-inferiority test). We recorded 43 adverse events in 43 (2·8%) of 1535 patients in the low-dose group and 41 adverse events in 40 (2·6%) of 1539 patients in the standard-dose group. One life-threatening adverse event of anaphylaxis caused by an iodinated contrast material occurred in the low-dose group
Radiation dose of appendiceal CT for adolescents and young adults can be reduced to 2 mSv without impairing clinical outcomes. In view of the vast number of appendiceal CT examinations done worldwide, use of low-dose CT could prevent a sizeable number of radiation-associated cancers in the future
Association of Lower Diagnostic Yield With High Users of #CT Pulmonary #Angiogram
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2666795
For each additional 10 studies ordered, the odds of a positive result decreased (odds ratio [OR], 0.76; 95% CI, 0.73-0.79). Increasing patient age was associated with a higher diagnostic yield (OR, 1.02 per year; 95% CI, 1.01-1.03). Physician years of experience (OR, 1.01; 95% CI, 0.99-1.02; P = .39), physician sex (OR, 1.14; 95% CI, 0.79-1.63; P = .49), and studies originating from the emergency department (ER) (OR, 1.11; 95% CI, 0.75-1.65; P = .60) did not show a statistically significant association. When restricting the analysis to those studies performed by ER physicians, 123 of 974 (12.6%) were positive, and the OR for positivity for each additional 10 scans ordered decreased in a similar manner (OR, 0.74; 95% CI, 0.71-0.78).
Discussion
Our institutional yield of positive CTPA was 14.3%, which is similar to prior reported studies.4- 6 However, closer inspection demonstrated that there was substantial interphysician variability, with individual positivity rates ranging between 0% to 33.3%. Our study suggests that individual demographic features, such as specialty and professional experience are not significantly associated with diagnostic yield; however, physicians who ordered a greater volume of scans compared with their peers had a markedly reduced diagnostic yield.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2666795
For each additional 10 studies ordered, the odds of a positive result decreased (odds ratio [OR], 0.76; 95% CI, 0.73-0.79). Increasing patient age was associated with a higher diagnostic yield (OR, 1.02 per year; 95% CI, 1.01-1.03). Physician years of experience (OR, 1.01; 95% CI, 0.99-1.02; P = .39), physician sex (OR, 1.14; 95% CI, 0.79-1.63; P = .49), and studies originating from the emergency department (ER) (OR, 1.11; 95% CI, 0.75-1.65; P = .60) did not show a statistically significant association. When restricting the analysis to those studies performed by ER physicians, 123 of 974 (12.6%) were positive, and the OR for positivity for each additional 10 scans ordered decreased in a similar manner (OR, 0.74; 95% CI, 0.71-0.78).
Discussion
Our institutional yield of positive CTPA was 14.3%, which is similar to prior reported studies.4- 6 However, closer inspection demonstrated that there was substantial interphysician variability, with individual positivity rates ranging between 0% to 33.3%. Our study suggests that individual demographic features, such as specialty and professional experience are not significantly associated with diagnostic yield; however, physicians who ordered a greater volume of scans compared with their peers had a markedly reduced diagnostic yield.
Future Osteoporotic #Fracture Risk Related to Lumbar Vertebral Trabecular Attenuation Measured at Routine Body #CT
http://onlinelibrary.wiley.com/doi/10.1002/jbmr.3383/abstract
The median post-CT follow-up interval was 5.8 years (interquartile range 2.1–11.0 years). Univariate analysis showed that L1 attenuation values ≤90 Hounsfield units (HU) are significantly associated with decreased fracture-free survival (p < 0.001 by log-rank test). After adjusting for age, sex, prior fracture, glucocorticoid use, bisphosphonate use, chronic kidney disease, tobacco use, ethanol abuse, cancer history, and rheumatoid arthritis history, multivariate analysis demonstrated a persistent modest effect of L1 attenuation on fracture-free survival (hazard ratio HR = 0.63 per 10-unit increase; 95% confidence interval CI 0.47–0.85). The model concordance index was 0.700. Ten-year probabilities for major osteoporosis-related fractures straddled the treatment threshold for most subcohorts over the observed L1 HU range. In conclusion, for patients undergoing body CT scanning for any indication, L1 vertebral trabecular attenuation is a simple measure that, when ≤90 HU, identifies patients with a significant decrease in fracture-free survival
http://onlinelibrary.wiley.com/doi/10.1002/jbmr.3383/abstract
The median post-CT follow-up interval was 5.8 years (interquartile range 2.1–11.0 years). Univariate analysis showed that L1 attenuation values ≤90 Hounsfield units (HU) are significantly associated with decreased fracture-free survival (p < 0.001 by log-rank test). After adjusting for age, sex, prior fracture, glucocorticoid use, bisphosphonate use, chronic kidney disease, tobacco use, ethanol abuse, cancer history, and rheumatoid arthritis history, multivariate analysis demonstrated a persistent modest effect of L1 attenuation on fracture-free survival (hazard ratio HR = 0.63 per 10-unit increase; 95% confidence interval CI 0.47–0.85). The model concordance index was 0.700. Ten-year probabilities for major osteoporosis-related fractures straddled the treatment threshold for most subcohorts over the observed L1 HU range. In conclusion, for patients undergoing body CT scanning for any indication, L1 vertebral trabecular attenuation is a simple measure that, when ≤90 HU, identifies patients with a significant decrease in fracture-free survival
Predictive Value of Initial #CT scan for Various Adverse Outcomes in Patients with #COVID-19 #Pneumonia
https://2medical.news/2020/10/16/predictive-value-of-initial-ct-scan-for-various-adverse-outcomes-in-patients-with-covid-19-pneumonia/
..This study investigates the predictive value of CT severity score (CSS) for length-of-stay (LOS) in hospital, initial disease severity, ICU admission, intubation, and mortality ..Total of 121 patients (60±16 years), including 54 women and 67 men, with positive RT-PCR tests were enrolled. We found a significant but weak correlation between CSS and qSOFA, as a measure of disease severity (r: 0.261, p= 0.003). No significant …
https://2medical.news/2020/10/16/predictive-value-of-initial-ct-scan-for-various-adverse-outcomes-in-patients-with-covid-19-pneumonia/
..This study investigates the predictive value of CT severity score (CSS) for length-of-stay (LOS) in hospital, initial disease severity, ICU admission, intubation, and mortality ..Total of 121 patients (60±16 years), including 54 women and 67 men, with positive RT-PCR tests were enrolled. We found a significant but weak correlation between CSS and qSOFA, as a measure of disease severity (r: 0.261, p= 0.003). No significant …
Automated quantitative thin slice volumetric low dose #CT analysis predicts disease severity in #COVID-19 patients
http://2medical.news/2021/04/30/automated-quantitative-thin-slice-volumetric-low-dose-ct-analysis-predicts-disease-severity-in-covid-19-patients/
http://2medical.news/2021/04/30/automated-quantitative-thin-slice-volumetric-low-dose-ct-analysis-predicts-disease-severity-in-covid-19-patients/
2Medical.News
Automated quantitative thin slice volumetric low dose #CT analysis predicts disease severity in #COVID-19 patients
This study aimed to identify predictive (bio-)markers for COVID-19 severity derived from automated quantitative thin slice low dose volumetric CT analysis, clinical chemistry and lung function test…