Introduction
“The computed tomography (CT) scan is a medical imaging procedure that uses x-rays and digital computer technology to create detailed two or three-dimensional images. Unlike other forms of medical imaging, the CT scan can image every type of body structure at once including bone, blood vessels and soft tissue.” (Better Health Channel definition).
In this analysis, the paper discuses the routine practices for Prince Sultan Hospital in Saudi Arabia and the literature review will recommend some other protocols. The two protocols will be compared to one another in using Siemens somatom sensation 16 protocols. This paper will also discuss whether the protocols in the two cases are optimized in regard to quality of image and radiation dosage.
Prince Sultan Hospital scanning protocols and other protocols recommended by literature review can be seen below in addition to the different operational protocols.
For the head (Brain-Routine) scan, the presented protocols in the literature are different as compared form those for the Prince Sultan Hospital. This difference however occurs in relation to the effective MAS as well as the KVA utilized. The KV employed in Prince is 110 as compared to 120 and the effective mass employed is 380 compared to 400.
Another difference occurs in the slice thickness maintained. The rest of the details are the same. The slice thickness employed at Prince is 4 while that employed for the case in literature is 4.5. Thus, the hospital utilizes lower thickness.
For the thorax (Pulmonary Embolism, chest), all details are similar to those in the literature, except that the effective mass applied and the KV dosage is different. Prince hospital applies 110 KV as compared to that of the literature review. In addition, it employs 120 effective mAss as compared to 130 in the literature. The slice thickness employed in this case is either 1 or 2 mm for the pulmonary Embolism, but for the chest is 5 in both cases. The hospital adopts lower values as compared to the case in literature.
For the abdomen, all the details are observed except differences in the thickness of the slices (Kidney 6 mm for the hospital as compared to 0.75 for all cases; ) KV kidney 110 in hospital as compared to 120 for the case in literature for all the cases and the effective mass is 150 compared to 200 in the literature case. For the splenic lesion, the thicknesses are the same in both cases, while the KV for the hospital is 110 while that of the case 2 is 120. The hospital also implements a lower effective mAss as compared to that of the case in literature. The case of the Pancreatitis is the same, where the hospital implements similar slice thickness compared to that of the case in literature review, while the KV and effective mAss are lower as compared to those in the literature. The same case applies for the liver.
As can be seen, there is usage of lower effective mAss in Prince hospital for all cases, which means there has been compromise to the literature case. Thus, there is higher exposure of radiation in this respect. Thicker slices will lead to problems because blurred lines of radiations strike from the corners. For the
In an attempt to minimize radiation risks, factors that would be important for consideration includes age of the patient, pregnancy height, among others would be considered. Of interest is also the dose adjustment for the patient through the consideration of the health conditions of the patient.
Exposure to low dose results in higher noise in the image, while the resolution is increased in high dosage. In these conditions, it is difficult to control radiation exposure. New technologies have been implemented for handling such conditions to improve the situation. It is possible, using these software technology solutions, to adjust the dose of radiation according to the characteristics of the patient. In addition, these technologies have achieved reduction in the noise realized whenever there is low dosage of radiation.
An alternative to CT is an important consideration if it is available; in regard to the aforementioned problems in CT. it will be considered that a patient would rather undergo safer options than risk with the CT, if these alternatives are available. With the current analytical software, this can be done. This characteristic is combined in the software solutions described above, which tends to achieve reduction in dosage, as well as apply the right amount of dosage according to the characteristics of a person. Of another interest is how the dosage for radiation can be optimized to give the desired results without experiencing the aforementioned difficulties. This idea would be very applicable in case there is no alternative method of treatment rather than the CT. Literature has focused on the idea of optimizing dosage.
It can be argued that the optimization of dosage should only be a second alternative when there is no other to undertake the treatment. Scan need only be performed when it cannot be avoided, because this is the sure way to eliminate exposure.
There idea of optimization of dosage has been focused upon, with protocols being implemented for certain cases. These protocols may help where there has been observed high levels of dosages in hospitals. In this regard, IV contrasts have been applied in optimization of the radiation. This links us to the importance of carrying out surveys as far as these application technologies are concerned. Usage of IV contrast material is important. An example is in Netherlands where some hospitals were examined and noted to be using the IV.
Of importance in the optimization of dosage level are the exposure factors and those which will guide the optimization. Exposure parameters can be utilized in dose reduction, and these parameters include the size of the patient. In the topic regarding dose optimization, collaboration among various radiographers and other practitioners has been found important. With this, a lower dosage level (median effective dose) has been achieved in comparison to the results of dosage levels achieved for protocols on a daily practice (Liedenbaum, et al., 2008).
Models for Analyzing the Image
Treatment is achievable or more effective where it is possible to analyze the images from scanning results. Traditional methods of analyzing scan images were manual, but there has been an attempt to diverge from this practice. Just as there have been attempts to improve on dosage reduction using automation techniques, there have been attempts to have automated models for scan analysis. These may become more and more desirable, owing to the advantages they have over manual systems. Manual systems cannot match the automations in terms of viability for application on large-scale users, as well as production of quick and reliable results. These may be more desirable in many places and hospitals to increase speed of delivery of treatments and to improve on treatments. The systems are rather more susceptible to current systems which utilize digital technologies which come with added advantages, such as easier and quicker storage of data. The latter is more desirable because it also helps in long terms plans by governments to carry studies that aid in resolving or combating health problems in the future.
Conventional methods also have problems in terms of larger amount of operator time as compared to automatic methods. This can be enabled by application of motion analysis in MR and CT images. The idea of 3-D segmentation was theorized by Liu et al (2008). This particular method was applied for analysis of joints, and it combines well with computerized biomechanical modeling and analysis. In addition, it can work well with planning for surgery, as well as image-guided joint surgery. Methods including angiography-where it has been possible to remove bones from data sets-and the dual energy CT, which can be applied over a wide range of areas, have also been focused upon. It has also been possible to detect endoleaks by means of a single acquisition, through application of dual energy CT.
The idea of safe applications must linger in mind in regard to the fact that some patients would have excessive exposure when treated severally through some methods. Hence the fact that methods allowing for single acquisition would be very admirable. Cases such as those involving treatment of endovascular aneurysm repair may require a long follow-up, and they would certainly require safe methods because they will undergo several procedures and treatments. However, the competence for application of such methods in prognosis and treatment need to be proved through additional research and studies.
Scans
Head Scan
The studies on treatment of serious and minor injuries of the head are important consideration. In this case, the scan methods as well as the protocols employed are necessary. Patients can be given early routine CT scans if they require examinations for minor head injuries as recommended by Ingebrigtsen & Romner (Ingebrigtsen, and Bertil, 2009) . Application of this alone can save the hospital departments a lot of money in terms of costs, since it can detect minor injuries and discharge would be offered to those with normal parameters and CT findings. The reduction possible in terms of cost and the number of in-patients is about 43%. Other cases would require application of different methods of examination, for example where there has been intravenous thrombolysis, patients must not be treated using CT scans because they may encounter or experience persistent MCA occlusion. This brings us to the focus that some methods are limited to certain applications, and indeed can yield bad results with some other applications. Yet the issue of the factors that can be used guide prediction for admissions of patients has been focused upon or mentioned in literature.
Moreover, Sometimes safer scanning solutions may be required for the treatment of the head injuries and strokes. These include helical CT scanners which will achieve higher speed and carry multi-sectional advantages. Smith et al (2003) posit a method of combining three other methods to carry out scanning of the vascular axis. This would be desirable during treatment of stroke patients. The three methods to be combined in such a methodology include CTA, CT perfusion (Reichenbach et al., 1999) imaging and CT imaging, The case for investigating hemorrhage using CT scans has been presented by Brott et al (1997), who studied the intra-cerebral and early hemorrhage using CT scans. Image protocols were used in carrying out standardized scanning. It was possible in this case, within an hour baseline observation, to observe substantial parenchymal hemorrhage using the standard protocols.
Scanning of the Chest
In this respect, it may be important to ask whether lungs and chest are included. Helical CT scans for the thorax can be carried out with application of bolus saline solution once there is injection of contrast material. This is because the latter would be reduced up to 20% in volume, as has been found by Haage (2000). A double power injector is implemented in the introduction of the bolus solution. Another advantage was the reduction of perivenous artifacts in the above procedure. CT angiography was found to achieve an advantage with more weight involved, when the method was utilized on a Adamkiewicz artery. Other protocols implemented in this case were TBW-total body weight protocol, as well as lean body protocol. The existing hepatic and vascular enhancement variabilities from patient to patient would be reduced through the appliocation of a Low Body Weight protocol (0.92g) among male and female genders, while.
The cause of Lung densities as well as movement of contrast medium could be examined, and it was found that the cause for lung densities can only be explained by atelectasis since the passage of the contrast fluid was not being resisted by increased extravascular fluid-no regions had increased extravascular fluid acting to derail the passage of the fluid.
Debate has focused mainly on the selection of the contrast materials, administration methods for dosage as well as the dose itself, the volume of the dose and application of adjuncts and how they can affect the quality of the image produced. Other topics are regimes of treatment as well as prognosis. There have been reported problems as far as application of contrast mediums is concerned. For instance, it has been indicated that for patients with hypertension, renal artery stenosis cannot be ruled out through the application of magnetic resonance and CT angiographies.
This was posited by Vasbinder et al (2004). This was found through studies that they carried out. In addition, it is possible to allow pre-emptive surgery since the risk of pneumothorax would be predictable through application of CT scanning. Nieman et al (2001) on the other side, has recommended the application of slide CT scanners which can achieve complete coverage of coronary. In addition, those problems occurring in the 4D radiotherapy (respiratory correlated artefacts) could be overcome through the application of CT scanners as employed by Sonke et al (2005) in the analysis of image guided radiotherapy and Nieman et al as earlier on described. It has been possible to detect pulmonary diseases through the application of CT scanning protocols as done by Zhu et al (2004).
Arising needs have led to introduction of new technological solutions. However, although these solutions are implemented to solve more advanced problems or existing problems with quicker speeds, there has been an attempt to investigate their suitability. These new methods have aided in the treatment of cancers, such as advanced lung cancer by application of platinum-based chemotherapy. However, these solutions may not be free of side effects, because there has been observed such reactions as diarrhea, acne, among others (Zhu et al., 2004) with use of drugs.
Abdomen Scans
There was an examination for application of Triple bolus protocol, and it was found that it was dose-efficient protocol when applied with CT Urography. This method resulted also to other advantages such as good quality of image and had superior enhancement phases. Results for abdominal CT imaging have given evidence that corn oil could be used as a contrast medium in these scans to replace ionated solution. Yet this point to another important thing in the literature, as far as getting solutions that apply commonly found materials. For instance, it is possible to buy corn oil from anywhere and that means it could be applied more regularly.
Of course the issues of costs would feature for any treatment methods, but that purification and sterilization for the corn oil emulsion to be suitable for medical applications. Because of the capability to achieve peri-pancreatic vascular enhancement, providing “maximum pancreatic” and “parenchymal” vascular enhancement, it would be sufficient to utilize a method that combines both the “pancreatic parenchyma phase” and “PVP imaging” (McNulty, et al., 2001) Patients having CT angiography can be treated specifically with arterial phase imaging. This was applied in detecting and staging on pancreatic tumor, where it acted as a modification of the CT scan protocol formerly employed for this practice. Where more sensitive conventional film radiography has been implemented, it may be possible to save time, cost and the risk of exposure by the use of helical CT to reformat visceral protocol. Several authors have dealt with the idea of imaging protocols, including effects of contrast enhancement on images, as well as media and dosage among others.
Findings have ruled out the possibilities of encountering adverse effects on kidney functions with iso-osmolality and low-osmolalityiopromide as implemented by (Nguyen, et al., 2008) who applied them to investigate the effects to kidney functions. These were used for IV contrast-enhanced CT.
Comparison between the Protocols (Medical 2 and Prince Sultan Hospital)
Comparisons were carried out for the two cases mentioned in this paper. Case 2 Hospital may tend to maintain the protocols to gain a name and correct protocols to defend its name. In addition, where many experts are already using the hospital services, the trend of defending protocols may suffice. As can be seen Prince Sultan Hospital use lower Kvp and MAs than the Literature review, which is more safety for the patients.
Literature Review Summary
CT may have some advantages over traditional models. These advantages include the fact that there are no superimposed images in the area of no interest. Because it can recognize differences in densities, it can be possible to differentiate between tissues in an operation. The technology can be employed in single imaging because of multi-planar reformat imaging available with the CT. These can be viewed through sagittal, coronal or axial plane. It has achieved better accuracy and efficiency, thus, can replace many conventional systems. It can be employed in regime treatment and monitoring, as well as for prognosis. This applies also to its related technologies.
Summary
There are many protocols posited in the discussion for literature review. In addition, there are those protocols for optimizing on contrast medium as well as prognosis and treatment. There has been interest to analyze issues related to radiation safety, because it is an important aspect of health. There is need for all the attention to be focused in the offering of and finding the related solution. Other issues that were of great concern included reliability and accuracy of the CT scan technologies. There are some things which may tend to reduce the accuracy of the CT scan.
Bibliography
Brott Thomas, Broderick Joseph, Kothari Rashmi, Barsan William, Tomsick Thomas, Sauerbeck Laura, Spilker Judith, Duldner John, and Khoury Jane. “Early Hemorrhage Growth in Patients with Intracerebral Hemorrhage”. Stroke 28, no. 1 (1997): 1-5.
Haage Patrick, Schmitz-Rode Thomas, Hubner Dolores, Piroth Werner, and Gunther Rolf. “Reduction of Contrast Material Dose and Artifacts by a Saline Flush Using a Double Power Injector in Helical Ct of the Thorax”. American Journal of Roentgenology 174, no. 4 (2000): 1049-53.
Ingebrigtsen Tor, and Romner Bertil. “Routine Early Ct-Scan Is Cost Saving after Minor Head Injury”. Acta Neurologica Scandinavica 93, no. 2-3 (2009): 207-10.
Kartik Jhaveril1, Sanjay Saini, Leonard Levine, David Piazzo, Ronald Doncaster, Elkan Halpern, Patrick Jordan, and James Thrall. “Effect of Multislice CT Technology on Scanner Productivity”. AJR 177 (2001): 769-772.
Klingenbeck-Regn Klaus, Schaller Stefan, Flohr Thomas, Ohnesorge Bernd, Kopp Andreas, Baum Ullrich. “Subsecond multislice computed tomography: basics and applications”. Eur J Radiol 31 (1999): 110 -124.
Liedenbaum Marjolein, Venema Henk, and Stoker Jaap. “Radiation Dose in Ct Colonography–Trends in Time and Differences between Daily Practice and Screening Protocols”. European Radiology 18 (2008): 2222-30.
Liu Jiamin, Udupa Jayaram, Saha Punam, Odhner Dewey, Hirsch Bruce, Siegler Sorin, Simon, Scott, and Winkelstein Beth. 2008 “Rigid Model-Based 3d Segmentation of the Bones of Joints in Mr and Ct Images for Motion Analysis.” Medical Physics 35, no. 8 (2008): 3637-49.
McNulty Nancy, Francis Isaac, Platt Joel, Cohan Richard, Korobkin Melvyn, and Gebremariam Achamyeleh. “Multi–Detector Row Helical Ct of the Pancreas: Effect of Contrast-Enhanced Multiphasic Imaging on Enhancement of the Pancreas, Peripancreatic Vasculature, and Pancreatic Adenocarcinoma1”. Radiology 220, no. 1 (2001): 97-102.
Nguyen Shaun, Suranyi Paul, Ravenel James, Randall Patrick, Romano Peter, Strom Kimberly, Costello Phillip, and Schoepf, Joseph. “Iso-Osmolality Versus Low-Osmolality Iodinated Contrast Medium at Intravenous Contrast-Enhanced Ct: Effect on Kidney Function1.” Radiology 248, no. 1 (2008): 97-105.
Nieman Koen, Oudkerk Mathijs, Rensing Benno., Ooijen Peter, Munne Arie, Geuns Robert, and Feyter Pim. “Coronary Angiography with Multi-Slice Computed Tomography”. The Lancet 357 (2001): 599-603.
Pirker Robert, Pereira Jose, Szczesna Aleksandra, Pawel Joachim, Krzakowski Maciej, Ramlau Rodryg, Vynnychenko Ihor, Park Keunchil, Chih-Teng Yu, and Valentyn Ganul. “Cetuximab Plus Chemotherapy in Patients with Advanced Non-Small-Cell Lung Cancer (Flex): An Open-Label Randomised Phase Iii Trial.” The Lancet 373 (2009): 1525-31.
Reichenbach Jurgen, Joachim Rother, Lars Jonetz-Mentzel, Michael Herzau, Anke Fiala, Cornelius Weiller and Werner Kaiser. “Acte stroke evaluated by time-to-peak mapping during initial and early follw-up perfusion CT studies”. American Journal of Neuroradiology 20 (1999) 1842-1850
Rigauts Hans. “One year experience with the multislice helical CT”. JBR-BTR 82 (1999): 273 -276.
Siemens Somatom Sensation 16 Protocols,2003. Web.
Smith Wade, Roberts Herdi, Chuang Nathael, Ong Kenneth, Lee Theodore, Johnston Claiborne, and Dillon William. “Safety and Feasibility of a Ct Protocol for Acute Stroke: Combined Ct, Ct Angiography, and Ct Perfusion Imaging in 53 Consecutive Patients”. American Journal of Neuroradiology 24, no. 4 (2003): 688-90.
Sonke Jan-Jacob, Zijp Lambert, Remeijer Peter, and Herk Marcel. “Respiratory Correlated Cone Beam Ct”. Medical Physics 32, no. 4 (2005): 1176-86.
Vasbinder Boudewijn, Nelemans Patricia, Kessels Alfons, Kroon Abraham, Maki Jeffrey, Leiner Tim, Beek Frederik, Korst Michael, Flobbe Karin, and Haan Michiel. “Accuracy of Computed Tomographic Angiography and Magnetic Resonance Angiography for Diagnosing Renal Artery Stenosis”. Annals of internal medicine 141, no. 9 (2004): 674-82.
Zhu Xiaohua, Yu Jianqun, and Huang Zeng. “The Optimization of Ct Scan Protocol for Patient Radiation Protection: Chest Ct Scan with a Low Tube Current Setting”. Journal of X-Ray Science and Technology 12, no. 1 (2004): 27-33.