Background: Digital chest X-ray radiography (CXR) is the imaging modality of first choice for detecting chest pathology. The average effective dose for CXR (posteroanterior and lateral projection) is 0.10 mSv (range: 0.01 to 0.26 mSv). CT examinations using ultra-low-dose CT (ULDCT) with doses equivalent to CXR examinations allow for detecting chest pathologies and pulmonary nodules with comparable sensitivity to previous standard or low-dose CT techniques. The ULDCT may improve the detection of pulmonary nodules and diagnose a broader range of pathologies. Objectives: This study aims to show the possibility of recognizing and defining a variety of chest pathology using ultralow-dose CT of the chest below 1mSv. Methods: For all patients, after initial CXR, chest ultra-low (ULDCT) and standard-dose CT were performed. The ultra-low dose was achieved by fixing the tube voltage, lowering the tube current, or reducing the scan length. The field size was adapted individually for each patient. In order to reduce radiation exposure, sonograms were not obtained throughout this study. Instead, a conventional laser beam was used to manually set up the start of the scan range (from the lung apex to the whole diaphragm) at the gantry. The CT scan was taken while holding a breath during inspiration with the following parameters: helical scan, 80 kV, 30 mA, 80 0.5 mm collimation, and 0.3 seconds rotation time. No iodinated contrast material was used. Results: We compare the imaging properties of low voltage (80 kV -dosages equal to CXR) CT to a standard voltage (120 kV) CT and CXR in different chest pathologies and lung nodules with diameters from 4 to 30 mm. The sensitivity of ULDCT was 100% compared to CXR. CXR was considered diagnostic in 98% and ULDCT in 100%. The mean perceived confidence for diagnosis was 88±12% with CXR and 98±2% with ULDCT. Ultra-low-dose CT offered higher sensitivity for lesions like consolidation (97%), pleural effusion (95%), fibrosis (92%), and solid pulmonary nodules (91%). Conclusions: ULDCT is a safe and effective method for evaluating lung nodules of different sizes or densities. Keywords: Chest X-ray radiography (CXR); low-dose computer tomography (LDCT); scanogram; ultra-low-dose computer tomography (ULDCT).
Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.
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