Studies suggest that screening with spiral computed tomography can detect lung cancers at a smaller size and earlier stage than chest radiography can. To evaluate low-radiation-dose spiral computed tomography and sputum cytology in screening for lung cancer, we enrolled 1,520 individuals aged 50 yr or older who had smoked 20 pack-years or more in a prospective cohort study. One year after baseline scanning, 2,244 uncalcified lung nodules were identified in 1,000 participants (66%). Twenty-five cases of lung cancer were diagnosed (22 prevalence, 3 incidence). Computed tomography alone detected 23 cases; sputum cytology alone detected 2 cases. Cell types were: squamous cell, 6; adenocarcinoma or bronchioalveolar, 15; large cell, 1; small cell, 3. Twenty-two patients underwent curative surgical resection. Seven benign nodules were resected. The mean size of the non-small cell cancers detected by computed tomography was 17 mm (median, 13 mm). The postsurgical stage was IA, 13; IB, 1; IIA, 5; IIB, 1; IIIA, 2; limited, 3. Twelve (57%) of the 21 non-small cell cancers detected by computed tomography were stage IA at diagnosis. Computed tomography can detect early-stage lung cancers. The rate of benign nodule detection is high.

Our purpose in this study was to characterize the performance of a recently introduced multi-slice CT scanner (LightSpeed QX/i, Version 1.0, General Electric Medical Systems) in comparison to a single-slice scanner from the same manufacturer (HiSpeed CT/i, Version 4.0). To facilitate this comparison, a refined definition of pitch is introduced which accommodates multi-slice CT systems, yet maintains the existing relationships between pitch, patient dose, and image quality. The following performance parameters were assessed: radiation and slice sensitivity profiles, low-contrast and limiting spatial resolution, image uniformity and noise, CT number and geometric accuracy, and dose. The multi-slice system was tested in axial (1, 2, or 4 images per gantry rotation) and HQ (Pitch = 0.75) and HS (Pitch = 1.5) helical modes. Axial and helical acquisition speed and limiting spatial resolution (0.8-s exposure) were improved on the multi-slice system. Slice sensitivity profiles, image noise, CT number accuracy and uniformity, and low-contrast resolution were similar. In some HS-helical modes, helical artifacts and geometric distortion were more pronounced with a different appearance. Radiation slice profiles and doses were larger on the multi-slice system at all scan widths. For a typical abdomen and pelvis exam, the central and surface body doses for 5-mm helical scans were higher on the multi-slice system by approximately 50%. The increase in surface CTDI values (with respect to the single-slice system) was greatest for the 4 x 1.25-mm detector configuration (190% for head, 240% for body) and least for the 4 x 5-mm configuration (53% for head, 76% for body). Preliminary testing of version 1.1 software demonstrated reduced doses on the multi-slice scanner, where the increase in body surface CTDI values (with respect to the single-slice system) was 105% for the 4 x 1.25-mm detector configuration and 10% for the 4 x 5-mm configuration. In summary, the axial and HQ-helical modes of the multi-slice system provided excellent image quality and a substantial reduction in exam time and tube loading, although at varying degrees of increased dose relative to the single-slice scanner.

As implemented at the authors' institution, use of CT fluoroscopy for the guidance of interventional radiologic procedures markedly decreased patient radiation dose and total procedure time compared with use of conventional CT guidance.

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Artefacts on radiographic images are distracting and may compromise accurate diagnosis. Although most artefacts that occur in conventional radiography have become familiar, computed radiography (CR) systems produce artefacts that differ from those found in conventional radiography. We have encountered a variety of artefacts in CR images that were produced from four different models plate reader. These artefacts have been identified and traced to the imaging plate, plate reader, image processing software or laser printer or to operator error. Understanding the potential sources of CR artefacts will aid in identifying and resolving problems quickly and help prevent future occurrences.