Our prolific research teams are at it again. Two articles have recently been accepted for publication in prestigious peer-reviewed journals.
Coward. J, Nightingale. J, Hogg. P,. (2016) A review of incidental findings on low-resolution CT images during SPECT myocardial perfusion imaging: A clinical dilemma. J Nucl Med Technol. Apr 21. pii: jnmt.116.174557. [Epub ahead of print]
(Acknowledgement also goes to Professor Richard Lawson)
Incidental findings are common in medical imaging. There is a particularly high prevalence of incidental findings within the thorax, the most frequent being pulmonary nodules. Whilst pulmonary nodules have the potential to be malignant, the vast majority will be benign, resulting in a high number of false-positive findings. Low-resolution CT images produced during attenuation correction (AC) during single-photon emission tomography (SPECT) are essentially a by-product of the process. The high number of false-positive incidental findings detected on CTAC images causes a reporting dilemma. Early detection of cancer can be beneficial but false-positive findings and over diagnosis can be detrimental to the patient. CTAC images are not diagnostic quality and further diagnostic tests are usually necessary for definitive diagnosis to be reached. Given the high number of false-positive findings, the psychological effects and harms to the patient should be given consideration. This review recommends that caution should be taken when routine reporting of CTAC images occurs.
Tootell. AK, McEntee. MF, Szczepura. K, and Hogg. P,. (2016) Effective dose and Effective risk from post-SPECT imaging of the lumbar spine Journal of Medical Imaging and Radiation Sciences. (In Press)
Planar bone scans play an important role in the staging and monitoring of malignancy and metastases. Metastases in the lumbar spine are associated with significant morbidity, therefore accurate diagnosis is essential. Supplementary imaging after planar bone scans is often, required to characterise lesions, however, this is associated with additional radiation dose. This paper provides information on the comparative effective dose and effective risk from supplementary lumbar spine radiographs, low-dose CT (LDCT) and diagnostic CT (DCT).
Organ dose was measured in a phantom using thermo-luminescent dosimeters. Effective dose and effective risk were calculated for radiographs, LDCT, and DCT imaging of the lumbar spine.
Radiation dose was 0.56mSv for the antero-posterior and lateral lumbar spine radiographs, 0.80mSv for LDCT, and 3.78mSv for DCT. Additional imaging resulted in an increase in effective dose of 12.28%, 17.54% and 82.89%for radiographs, LDCT and DCT respectively. Risk of cancer induction decreased as age increased. The difference in risk between the modalities also decreased. Males had a statistically significant higher risk than female patients (p=0.023) attributed to the sensitive organs being closer to the exposed area.
Effective Dose for LDCT is comparable to radiographs of the lumbar spine. Due to the known benefits image fusion brings it is recommended that LDCT replace radiographs imaging for characterisation of lumbar spine lesions identified on planar bone scan. DCT is associated with significantly higher effective dose than LDCT. Effective risk is also higher and the difference is more marked in younger female patients.
The lead authors of each article, Jo Coward and Andrew Tootell, are both undertaking PhD’s through a published works route. As well as making important contributions to the body of knowledge in their respective fields, these articles will be very important in satisfying their research career ambitions and we wish them well.