To optimize examination protocols of 16-row multi-detector CT (MDCT) of pelvis for dose reduction with regard to image quality. MDCT of pelvis was performed on 12 cadaver specimens with stepwise reduction of tube current from 160 mA (113, 80, 56, 40, 28) to 20 mA at 120 kV. Scan parameters were 16 x 1.5 mm collimation. Reconstructions of axial and coronal images were used for evaluation of cortex, trabeculum, image quality, image noise, acetabulum and iliosacral (ISJ) joints. After data were blinded, evaluation of images was done by three radiologists according to 5-point Likert scale. Accuracy of the observers in sorting films according to dose reduction was determined with kappa coefficient. Mean values of image evaluation were determined. Pronounced deterioration of image quality for all criteria was observed between 80 and 28 mA. Adequate image quality was obtained at 40 mA [effective dose (E): 2.2 mSv, CTDI(w): 2.8 mGy] for criterion detailed definition of acetabulum and ISJ and at 80 mA (E: 4.4 mSv, CTDI(w): 5.6 mGy) for remaining criteria. Moderate agreement was observed between the three observers (kappa coefficient: 0.31). All observers were excellent in arranging images according to decreasing dose. Using 16-row MDCT image quality of pelvis is acceptable at 80 mA and 120 kV. This translates into a dose reduction of 33% of average value of the nationwide survey of the German Roentgen Society (1999) for this type of examination.
In recent discussions about potency-enhancing drugs such as sildenafil, health hazards associated with sexual activity have attracted increasing attention (1). In a medicolegal postmortem study performed in the Center of Legal Medicine at the University Hospital in Frank furt/Main over a 33-year period (1972-2004), about 32,000 forensic autopsies revealed 68 (0.22%) natural deaths occurring during sexual activity. Except for 5 women (7.4%; average age 39.8 years), in most cases, men were involved (92.6%; average age 59.1 years). The most frequent cause of death was myocardial infarction (n=28; 41.2%). In three cases, pericardial tamponade accompanied by myomalacia were observed. In 20 patients (29.4%), coronary artery disease (CAD) without signs of acute myocardial infarction (MI) was diagnosed. The medical history of 19 of the deceased indicated previous MI. There were seven cerebral hemorrhages (10.3%). The annual incidence of sudden cardiovascular death during sexual activity is estimated to be 1.9 per 1000 autopsies for men and 0.16 per 1000 autopsies for women (1). It is necessary to inform patients with CAD about prodromes and risk in relation to any form of physical and/or emotional stress.
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