Cristina Firetto - Academia.edu (original) (raw)
Papers by Cristina Firetto
Poster: "ECR 2016 / C-2007 / Cystic fibrosis sinus score (CFSS) for the evaluation of the pa... more Poster: "ECR 2016 / C-2007 / Cystic fibrosis sinus score (CFSS) for the evaluation of the paranasal sinuses complications of cystic fibrosis using cone beam CT" by: "M. C. Firetto, M. Di Cicco, D. Di Pasquale, P. Biondetti; Milan/IT"
To retrospectively evaluate the frequency and type of findings that were missed in the original r... more To retrospectively evaluate the frequency and type of findings that were missed in the original reports of multi-detector CT angiography (MDCTA) in patients with suspected acute bowel ischemia. From January 2007 to March 2011, a series of 35 patients who underwent MDCTA of the abdomen and pelvis and had surgery were included. The reports of the initial CT were retrospectively compared with the discharge diagnosis and surgical reports. Discrepant or missing findings were re-evaluated and divided into relevant or not relevant regarding the diagnosis. In 23 of the 35 patients (66 %), all findings were correctly diagnosed in the initial MDCTA report. In the remaining 12 of the 35 patients (34 %), lesions that were not reported were present at surgery. In 10 of the 12 (83 %) patients, the overlooked findings were relevant and subtle: gas in the portal vein (n03), gas in the bowel wall (n03), gas in the portal vein and bowel wall (n02), thrombotic occlusion of the superior mesenteric artery (n01), and thrombotic occlusion of the inferior mesenteric artery (n01). In 2 of the 12 (17 %) patients in whom the MDCTA-overlooked findings were classified as non-relevant, bowel ischemia was found at surgery. With retrospective image interpretation, 83 % of the patients with occlusive mesenteric ischemia at surgery were correctly identified, whereas the remaining 17 % with non-occlusive mesenteric ischemia at surgery showed nonrelevant findings at MDCTA. About 33 % of relevant findings of bowel ischemia were overlooked by the initial MDCTA interpretation, most were subtle findings. However, secondary reading revealed most of these findings and can serve to improve diagnostic performance.
Maria Cristina Firetto1 · Antonella Abbinante2 · Ersilia Barbato3 · Massimo Bellomi4 · Pietro Bio... more Maria Cristina Firetto1 · Antonella Abbinante2 · Ersilia Barbato3 · Massimo Bellomi4 · Pietro Biondetti1 · Andrea Borghesi5 · Maurizio Bossu’3 · Piero Cascone3 · Daniela Corbella6 · Vincenzo Di Candido7 · Paolo Diotallevi8 · Giampiero Farronato9 · Antonio Federici10 · Massimo Gagliani9 · Claudio Granata11 · Mario Guerra12 · Antonio MAGI13 · Maria Cristina Maggio14 · Stefano Mirenghi15 · Michele Nardone10 · Daniela Origgi4 · Luigi Paglia16 · Lorenzo Preda4 · Osvaldo Rampado17 · Luigi Rubino18 · Sergio Salerno14 · Angelo Sodano19 · Alberto Torresin9 · Laura Strohmenger20
To retrospectively evaluate the frequency and type of findings that were missed in the original r... more To retrospectively evaluate the frequency and type of findings that were missed in the original reports of multi-detector CT angiography (MDCTA) in patients with suspected acute bowel ischemia. From January 2007 to March 2011, a series of 35 patients who underwent MDCTA of the abdomen and pelvis and had surgery were included. The reports of the initial CT were retrospectively compared with the discharge diagnosis and surgical reports. Discrepant or missing findings were re-evaluated and divided into relevant or not relevant regarding the diagnosis. In 23 of the 35 patients (66 %), all findings were correctly diagnosed in the initial MDCTA report. In the remaining 12 of the 35 patients (34 %), lesions that were not reported were present at surgery. In 10 of the 12 (83 %) patients, the overlooked findings were relevant and subtle: gas in the portal vein (n = 3), gas in the bowel wall (n = 3), gas in the portal vein and bowel wall (n = 2), thrombotic occlusion of the superior mesenteri...
La radiologia medica
The bowel and the mesentery represent the third most frequently involved structures in blunt abdo... more The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.
La Radiologia medica, 2015
The bowel and the mesentery represent the third most frequently involved structures in blunt abdo... more The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.
ABSTRACT PURPOSE Patiens who have sustained multiple trauma are often young and the radiation dos... more ABSTRACT PURPOSE Patiens who have sustained multiple trauma are often young and the radiation doses in this range confer a lifetime cancer risk of up to 1/500. It is therefore clear that these scans have to be fully justified either in terms of imaging findings or in potential change in management. Thus, the purpose of our study was to evaluate whether in a selected group of patients, targeted region specific CT (focused CT) can replace Whole-Body CT (WBCT) by using the Injury Severity Score(ISS). METHOD AND MATERIALS A continuous series of 170 patients (mean age 35.2 years ) were included. All patients underwent WBCT ( head to symphysis), with a 64-slice scanner ( Somaton Definition, Siemens, Germany), equipped with an automatic tube current modulation system (Care Dose 4D) In order to evaluate any discrepancy in terms of clinical indications for WBCT, the ISS of each patient was retrospectevely evaluated and compared to the discharge diagnosis. We used an ISS of 15 as a cut-off point because we were interested in evaluating whether below this point a more focussed scan, aimed at specific areas of clinical concern would have been more appropriate.Radiation dose was calculated using a mathematical phantom ( ImPACT CT Patient Dosimetry Calculator, version 0,99x 01/02/2006). RESULTS The Effective dose associated with WBCT is in the region of 16-42 mSv, depending upon how many phases are incorporated. This can be even higher if additional images are required to confirm the diagnosis. The Effective dose for focused CT is in the region of 5-14 mSv, depending upon how extended is the FOV. Forty per cent of the WBCT scans had an ISS <=15 , and revealed no trauma-related pathology.Analysis of our data confirms that many of these negatives scans were clinically indicated , but in a proportion, a more focussed scan , aimed at specific areas of clinical concerns, would have been more appropriate. CONCLUSION The associated radiation dose with WBCT is high and patients should be carefully selected by using the ISS. When the ISS is <= 15, a more targeted region specific CT is recommended. CLINICAL RELEVANCE/APPLICATION According to our results, we have introduced a specific Trauma CT referral request to ensure that all scans are fully justified and meet the National radiation protection guidelines,Istisan 07/26.
The British Journal of Radiology
Objective: The frequency of enostosis incidentally found on CT and CT attenuation value to distin... more Objective: The frequency of enostosis incidentally found on CT and CT attenuation value to distinguish them from untreated osteoblastic metastases (UOM). Methods: Enostosis group: 46 polytrauma patients underwent thoracoabdominal CT. Inclusion criteria: age range 14–35 years. Exclusion criteria: cancer, previous fractures. UOM group: 20 patients with radiological diagnosis of UOM. Analyzed data: number, size, location and density of enostoses and metastases. The density was measured with the broadest possible region of interest at the center of the lesion by two radiologists independently. Receiver operating characteristic analysis to determine the sensitivity and specificity, area under the curve 95% confidence intervals and cutoff values of CT density to differentiate metastases from enostoses. Results: Patients were 28 ± 7 years old (72% males). 41 (89%) patients had 124 enostoses (2–15 mm) with an average density of 1007 ± 122 Hounsfiled unit (HU, observer1) and 1052 ± 107 (obse...
La radiologia medica
Introduction Work Group Bibliographical Research Current regulations Considerations on radiologic... more Introduction Work Group Bibliographical Research Current regulations Considerations on radiological risks and containment strategies in x-ray examinations Diagnostic imaging for caries and periodontal disease Diagnostic imaging in orthodontics and gnathology Diagnostic imaging in cranio-maxillofacial malformations Ministry of Health Secretariat General Office 2 National Guidelines for Dental Diagnostic Imaging in the Developmental Age Diagnostic imaging in dental anomalies Diagnostic imaging in dental traumatology Table of Recommendations Glossary This document aims to support the dental professional in choosing the adequate diagnostic technique, minimising the radiation dose in observance of the As Low As Reasonably Achievable (ALARA) principle (7). This principle states that the biological cost can only be justified when the benefit, that is, the diagnosis, outweighs the risk related to radiation exposure. In this guideline paper, we report recommendations for radiologists, medical physicists, paediatrician, dentists and maxillofacial surgeons, with reference to the specific fields. The diagnostic techniques considered in this paper are intraoral X-ray, orthopantomography (OPT), cephalometric (Ceph) x-ray and cone beam computed tomography (CBCT). This work considers the Methodological Manual for National Guidelines System (2011), titled "How to produce, spread, and update Public Health Guidelines". Bibliographical research A systematic analysis of existing literature was carried out using PubMed, Embase and The Cochrane Library databases, with the following restrictions:
Emergency radiology, Jan 27, 2018
Bowel and/or mesentery injuries represent the third most common injury among patients with blunt ... more Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinica...
To evaluate whether the elimination of unenhanced imaging acquisition series from dual-phase ches... more To evaluate whether the elimination of unenhanced imaging acquisition series from dual-phase chest pain CT angiography protocol may affect diagnostic accuracy in the detection of Intramural Hematoma (IMH), and justify the reduced radiation dose. METHOD AND MATERIALS From October 2006 to February 2011, 37 patients (20 males, 17 females ; mean age 65.0 years) with acute chest pain underwent emergency multi-detector CT angiography (MDCTA) and subsequent Transesophageal Echocardiography (TEE) and/or surgery for IMH. All patients underwent MDCTA with a 64-slice scanner (Somaton Definition, Siemens, Germany).Two experienced Emergency Radiologists blind-tested with regard to the diagnosis, assessed the images in two different sessions in which enhanced (single-phase MDCTA) , and combined unenhanced and enhanced (dual-phase MDCTA) findings were separately evaluated.Sensitivity, specificity and accuracy of both modalities, along with 95%CIs, were calculated by using TEE and surgical confirmation as reference standards. RESULTS Single-phase MDCTA showed a higher number of false negative, and false positive results than did dual-phase MDCTA. For the detection of aortic IMH, the sensitivity, specificity and accuracy, respectively, were 85%, 93% and 92% for combined dual-phase MDCTA , and 51%, 77%,and 69% for single-phase MDCTA. CONCLUSION The acquisition of unenhanced images during dual-phase chest pain MDCTA protocol provides additional benefit in terms of diagnostic accuracy over single-phase CT , and warrants the increased radiation dose. CLINICAL RELEVANCE/APPLICATION Our results suggest that unenhanced phase should not be eliminated from dual-phase chest pain MDCTA protocol.
PURPOSE/AIM To review the indications, strategies to optimize image quality, and radiation dose o... more PURPOSE/AIM To review the indications, strategies to optimize image quality, and radiation dose of Whole Body CT (WBCT) for trauma. CONTENT ORGANIZATION A. Indications according to the Injury Severity Score B.Patient positioning C. Technical aspects (intravenous injection of contrast material, Bolus Tracking versus empirical delay, FOV extension). D.Strategies to reduce artifacts and radiation dose F. Standard phase G.Additional phases H. Outcomes ( simultaneous evaluation of vascular and solid organ structures) SUMMARY The usefulness and challanges of WBCT protocol for trauma are presented. This exhbit will review: a. the various techniques to acquire Whole-Body CT b. the indications according with the Injury Severity Score c.Considerations of radiation doses and indications to a targeted CT in cases of region specific injury. d.Optimization of vascular and solid organ phase.
PURPOSE Patiens who have sustained multiple trauma are often young and the radiation doses in thi... more PURPOSE Patiens who have sustained multiple trauma are often young and the radiation doses in this range confer a lifetime cancer risk of up to 1/500. It is therefore clear that these scans have to be fully justified either in terms of imaging findings or in potential change in management. Thus, the purpose of our study was to evaluate whether in a selected group of patients, targeted region specific CT (focused CT) can replace Whole-Body CT (WBCT) by using the Injury Severity Score(ISS). METHOD AND MATERIALS A continuous series of 170 patients (mean age 35.2 years ) were included. All patients underwent WBCT ( head to symphysis), with a 64-slice scanner ( Somaton Definition, Siemens, Germany), equipped with an automatic tube current modulation system (Care Dose 4D) In order to evaluate any discrepancy in terms of clinical indications for WBCT, the ISS of each patient was retrospectevely evaluated and compared to the discharge diagnosis. We used an ISS of 15 as a cut-off point becau...
Emergency Radiology, 2012
To retrospectively evaluate the frequency and type of findings that were missed in the original r... more To retrospectively evaluate the frequency and type of findings that were missed in the original reports of multi-detector CT angiography (MDCTA) in patients with suspected acute bowel ischemia. From January 2007 to March 2011, a series of 35 patients who underwent MDCTA of the abdomen and pelvis and had surgery were included. The reports of the initial CT were retrospectively compared with the discharge diagnosis and surgical reports. Discrepant or missing findings were re-evaluated and divided into relevant or not relevant regarding the diagnosis. In 23 of the 35 patients (66 %), all findings were correctly diagnosed in the initial MDCTA report. In the remaining 12 of the 35 patients (34 %), lesions that were not reported were present at surgery. In 10 of the 12 (83 %) patients, the overlooked findings were relevant and subtle: gas in the portal vein (n03), gas in the bowel wall (n03), gas in the portal vein and bowel wall (n02), thrombotic occlusion of the superior mesenteric artery (n01), and thrombotic occlusion of the inferior mesenteric artery (n01). In 2 of the 12 (17 %) patients in whom the MDCTA-overlooked findings were classified as non-relevant, bowel ischemia was found at surgery. With retrospective image interpretation, 83 % of the patients with occlusive mesenteric ischemia at surgery were correctly identified, whereas the remaining 17 % with non-occlusive mesenteric ischemia at surgery showed nonrelevant findings at MDCTA. About 33 % of relevant findings of bowel ischemia were overlooked by the initial MDCTA interpretation, most were subtle findings. However, secondary reading revealed most of these findings and can serve to improve diagnostic performance.
La radiologia medica, 2015
Poster: "ECR 2016 / C-2007 / Cystic fibrosis sinus score (CFSS) for the evaluation of the pa... more Poster: "ECR 2016 / C-2007 / Cystic fibrosis sinus score (CFSS) for the evaluation of the paranasal sinuses complications of cystic fibrosis using cone beam CT" by: "M. C. Firetto, M. Di Cicco, D. Di Pasquale, P. Biondetti; Milan/IT"
To retrospectively evaluate the frequency and type of findings that were missed in the original r... more To retrospectively evaluate the frequency and type of findings that were missed in the original reports of multi-detector CT angiography (MDCTA) in patients with suspected acute bowel ischemia. From January 2007 to March 2011, a series of 35 patients who underwent MDCTA of the abdomen and pelvis and had surgery were included. The reports of the initial CT were retrospectively compared with the discharge diagnosis and surgical reports. Discrepant or missing findings were re-evaluated and divided into relevant or not relevant regarding the diagnosis. In 23 of the 35 patients (66 %), all findings were correctly diagnosed in the initial MDCTA report. In the remaining 12 of the 35 patients (34 %), lesions that were not reported were present at surgery. In 10 of the 12 (83 %) patients, the overlooked findings were relevant and subtle: gas in the portal vein (n03), gas in the bowel wall (n03), gas in the portal vein and bowel wall (n02), thrombotic occlusion of the superior mesenteric artery (n01), and thrombotic occlusion of the inferior mesenteric artery (n01). In 2 of the 12 (17 %) patients in whom the MDCTA-overlooked findings were classified as non-relevant, bowel ischemia was found at surgery. With retrospective image interpretation, 83 % of the patients with occlusive mesenteric ischemia at surgery were correctly identified, whereas the remaining 17 % with non-occlusive mesenteric ischemia at surgery showed nonrelevant findings at MDCTA. About 33 % of relevant findings of bowel ischemia were overlooked by the initial MDCTA interpretation, most were subtle findings. However, secondary reading revealed most of these findings and can serve to improve diagnostic performance.
Maria Cristina Firetto1 · Antonella Abbinante2 · Ersilia Barbato3 · Massimo Bellomi4 · Pietro Bio... more Maria Cristina Firetto1 · Antonella Abbinante2 · Ersilia Barbato3 · Massimo Bellomi4 · Pietro Biondetti1 · Andrea Borghesi5 · Maurizio Bossu’3 · Piero Cascone3 · Daniela Corbella6 · Vincenzo Di Candido7 · Paolo Diotallevi8 · Giampiero Farronato9 · Antonio Federici10 · Massimo Gagliani9 · Claudio Granata11 · Mario Guerra12 · Antonio MAGI13 · Maria Cristina Maggio14 · Stefano Mirenghi15 · Michele Nardone10 · Daniela Origgi4 · Luigi Paglia16 · Lorenzo Preda4 · Osvaldo Rampado17 · Luigi Rubino18 · Sergio Salerno14 · Angelo Sodano19 · Alberto Torresin9 · Laura Strohmenger20
To retrospectively evaluate the frequency and type of findings that were missed in the original r... more To retrospectively evaluate the frequency and type of findings that were missed in the original reports of multi-detector CT angiography (MDCTA) in patients with suspected acute bowel ischemia. From January 2007 to March 2011, a series of 35 patients who underwent MDCTA of the abdomen and pelvis and had surgery were included. The reports of the initial CT were retrospectively compared with the discharge diagnosis and surgical reports. Discrepant or missing findings were re-evaluated and divided into relevant or not relevant regarding the diagnosis. In 23 of the 35 patients (66 %), all findings were correctly diagnosed in the initial MDCTA report. In the remaining 12 of the 35 patients (34 %), lesions that were not reported were present at surgery. In 10 of the 12 (83 %) patients, the overlooked findings were relevant and subtle: gas in the portal vein (n = 3), gas in the bowel wall (n = 3), gas in the portal vein and bowel wall (n = 2), thrombotic occlusion of the superior mesenteri...
La radiologia medica
The bowel and the mesentery represent the third most frequently involved structures in blunt abdo... more The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.
La Radiologia medica, 2015
The bowel and the mesentery represent the third most frequently involved structures in blunt abdo... more The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.
ABSTRACT PURPOSE Patiens who have sustained multiple trauma are often young and the radiation dos... more ABSTRACT PURPOSE Patiens who have sustained multiple trauma are often young and the radiation doses in this range confer a lifetime cancer risk of up to 1/500. It is therefore clear that these scans have to be fully justified either in terms of imaging findings or in potential change in management. Thus, the purpose of our study was to evaluate whether in a selected group of patients, targeted region specific CT (focused CT) can replace Whole-Body CT (WBCT) by using the Injury Severity Score(ISS). METHOD AND MATERIALS A continuous series of 170 patients (mean age 35.2 years ) were included. All patients underwent WBCT ( head to symphysis), with a 64-slice scanner ( Somaton Definition, Siemens, Germany), equipped with an automatic tube current modulation system (Care Dose 4D) In order to evaluate any discrepancy in terms of clinical indications for WBCT, the ISS of each patient was retrospectevely evaluated and compared to the discharge diagnosis. We used an ISS of 15 as a cut-off point because we were interested in evaluating whether below this point a more focussed scan, aimed at specific areas of clinical concern would have been more appropriate.Radiation dose was calculated using a mathematical phantom ( ImPACT CT Patient Dosimetry Calculator, version 0,99x 01/02/2006). RESULTS The Effective dose associated with WBCT is in the region of 16-42 mSv, depending upon how many phases are incorporated. This can be even higher if additional images are required to confirm the diagnosis. The Effective dose for focused CT is in the region of 5-14 mSv, depending upon how extended is the FOV. Forty per cent of the WBCT scans had an ISS <=15 , and revealed no trauma-related pathology.Analysis of our data confirms that many of these negatives scans were clinically indicated , but in a proportion, a more focussed scan , aimed at specific areas of clinical concerns, would have been more appropriate. CONCLUSION The associated radiation dose with WBCT is high and patients should be carefully selected by using the ISS. When the ISS is <= 15, a more targeted region specific CT is recommended. CLINICAL RELEVANCE/APPLICATION According to our results, we have introduced a specific Trauma CT referral request to ensure that all scans are fully justified and meet the National radiation protection guidelines,Istisan 07/26.
The British Journal of Radiology
Objective: The frequency of enostosis incidentally found on CT and CT attenuation value to distin... more Objective: The frequency of enostosis incidentally found on CT and CT attenuation value to distinguish them from untreated osteoblastic metastases (UOM). Methods: Enostosis group: 46 polytrauma patients underwent thoracoabdominal CT. Inclusion criteria: age range 14–35 years. Exclusion criteria: cancer, previous fractures. UOM group: 20 patients with radiological diagnosis of UOM. Analyzed data: number, size, location and density of enostoses and metastases. The density was measured with the broadest possible region of interest at the center of the lesion by two radiologists independently. Receiver operating characteristic analysis to determine the sensitivity and specificity, area under the curve 95% confidence intervals and cutoff values of CT density to differentiate metastases from enostoses. Results: Patients were 28 ± 7 years old (72% males). 41 (89%) patients had 124 enostoses (2–15 mm) with an average density of 1007 ± 122 Hounsfiled unit (HU, observer1) and 1052 ± 107 (obse...
La radiologia medica
Introduction Work Group Bibliographical Research Current regulations Considerations on radiologic... more Introduction Work Group Bibliographical Research Current regulations Considerations on radiological risks and containment strategies in x-ray examinations Diagnostic imaging for caries and periodontal disease Diagnostic imaging in orthodontics and gnathology Diagnostic imaging in cranio-maxillofacial malformations Ministry of Health Secretariat General Office 2 National Guidelines for Dental Diagnostic Imaging in the Developmental Age Diagnostic imaging in dental anomalies Diagnostic imaging in dental traumatology Table of Recommendations Glossary This document aims to support the dental professional in choosing the adequate diagnostic technique, minimising the radiation dose in observance of the As Low As Reasonably Achievable (ALARA) principle (7). This principle states that the biological cost can only be justified when the benefit, that is, the diagnosis, outweighs the risk related to radiation exposure. In this guideline paper, we report recommendations for radiologists, medical physicists, paediatrician, dentists and maxillofacial surgeons, with reference to the specific fields. The diagnostic techniques considered in this paper are intraoral X-ray, orthopantomography (OPT), cephalometric (Ceph) x-ray and cone beam computed tomography (CBCT). This work considers the Methodological Manual for National Guidelines System (2011), titled "How to produce, spread, and update Public Health Guidelines". Bibliographical research A systematic analysis of existing literature was carried out using PubMed, Embase and The Cochrane Library databases, with the following restrictions:
Emergency radiology, Jan 27, 2018
Bowel and/or mesentery injuries represent the third most common injury among patients with blunt ... more Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair. Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as "minor CT findings." The presence of abdominal guarding and/or abdominal pain was considered as "clinical signs." Reference standards included surgically proven BBMI and clinica...
To evaluate whether the elimination of unenhanced imaging acquisition series from dual-phase ches... more To evaluate whether the elimination of unenhanced imaging acquisition series from dual-phase chest pain CT angiography protocol may affect diagnostic accuracy in the detection of Intramural Hematoma (IMH), and justify the reduced radiation dose. METHOD AND MATERIALS From October 2006 to February 2011, 37 patients (20 males, 17 females ; mean age 65.0 years) with acute chest pain underwent emergency multi-detector CT angiography (MDCTA) and subsequent Transesophageal Echocardiography (TEE) and/or surgery for IMH. All patients underwent MDCTA with a 64-slice scanner (Somaton Definition, Siemens, Germany).Two experienced Emergency Radiologists blind-tested with regard to the diagnosis, assessed the images in two different sessions in which enhanced (single-phase MDCTA) , and combined unenhanced and enhanced (dual-phase MDCTA) findings were separately evaluated.Sensitivity, specificity and accuracy of both modalities, along with 95%CIs, were calculated by using TEE and surgical confirmation as reference standards. RESULTS Single-phase MDCTA showed a higher number of false negative, and false positive results than did dual-phase MDCTA. For the detection of aortic IMH, the sensitivity, specificity and accuracy, respectively, were 85%, 93% and 92% for combined dual-phase MDCTA , and 51%, 77%,and 69% for single-phase MDCTA. CONCLUSION The acquisition of unenhanced images during dual-phase chest pain MDCTA protocol provides additional benefit in terms of diagnostic accuracy over single-phase CT , and warrants the increased radiation dose. CLINICAL RELEVANCE/APPLICATION Our results suggest that unenhanced phase should not be eliminated from dual-phase chest pain MDCTA protocol.
PURPOSE/AIM To review the indications, strategies to optimize image quality, and radiation dose o... more PURPOSE/AIM To review the indications, strategies to optimize image quality, and radiation dose of Whole Body CT (WBCT) for trauma. CONTENT ORGANIZATION A. Indications according to the Injury Severity Score B.Patient positioning C. Technical aspects (intravenous injection of contrast material, Bolus Tracking versus empirical delay, FOV extension). D.Strategies to reduce artifacts and radiation dose F. Standard phase G.Additional phases H. Outcomes ( simultaneous evaluation of vascular and solid organ structures) SUMMARY The usefulness and challanges of WBCT protocol for trauma are presented. This exhbit will review: a. the various techniques to acquire Whole-Body CT b. the indications according with the Injury Severity Score c.Considerations of radiation doses and indications to a targeted CT in cases of region specific injury. d.Optimization of vascular and solid organ phase.
PURPOSE Patiens who have sustained multiple trauma are often young and the radiation doses in thi... more PURPOSE Patiens who have sustained multiple trauma are often young and the radiation doses in this range confer a lifetime cancer risk of up to 1/500. It is therefore clear that these scans have to be fully justified either in terms of imaging findings or in potential change in management. Thus, the purpose of our study was to evaluate whether in a selected group of patients, targeted region specific CT (focused CT) can replace Whole-Body CT (WBCT) by using the Injury Severity Score(ISS). METHOD AND MATERIALS A continuous series of 170 patients (mean age 35.2 years ) were included. All patients underwent WBCT ( head to symphysis), with a 64-slice scanner ( Somaton Definition, Siemens, Germany), equipped with an automatic tube current modulation system (Care Dose 4D) In order to evaluate any discrepancy in terms of clinical indications for WBCT, the ISS of each patient was retrospectevely evaluated and compared to the discharge diagnosis. We used an ISS of 15 as a cut-off point becau...
Emergency Radiology, 2012
To retrospectively evaluate the frequency and type of findings that were missed in the original r... more To retrospectively evaluate the frequency and type of findings that were missed in the original reports of multi-detector CT angiography (MDCTA) in patients with suspected acute bowel ischemia. From January 2007 to March 2011, a series of 35 patients who underwent MDCTA of the abdomen and pelvis and had surgery were included. The reports of the initial CT were retrospectively compared with the discharge diagnosis and surgical reports. Discrepant or missing findings were re-evaluated and divided into relevant or not relevant regarding the diagnosis. In 23 of the 35 patients (66 %), all findings were correctly diagnosed in the initial MDCTA report. In the remaining 12 of the 35 patients (34 %), lesions that were not reported were present at surgery. In 10 of the 12 (83 %) patients, the overlooked findings were relevant and subtle: gas in the portal vein (n03), gas in the bowel wall (n03), gas in the portal vein and bowel wall (n02), thrombotic occlusion of the superior mesenteric artery (n01), and thrombotic occlusion of the inferior mesenteric artery (n01). In 2 of the 12 (17 %) patients in whom the MDCTA-overlooked findings were classified as non-relevant, bowel ischemia was found at surgery. With retrospective image interpretation, 83 % of the patients with occlusive mesenteric ischemia at surgery were correctly identified, whereas the remaining 17 % with non-occlusive mesenteric ischemia at surgery showed nonrelevant findings at MDCTA. About 33 % of relevant findings of bowel ischemia were overlooked by the initial MDCTA interpretation, most were subtle findings. However, secondary reading revealed most of these findings and can serve to improve diagnostic performance.
La radiologia medica, 2015