CT clinical perspective: Challenges and the impact of future technology developments

Abstract

Computed tomography is not the most frequent radiologic imaging procedure, but is arguably the most important in terms of clinical impact. CT is used extensively for emergencies, cardiovascular, pulmonary, gastrointestinal, endocrine, neurological, orthopedic and other applications -often as the first and only imaging procedure needed for diagnosis. The chances are very high that a patient will have a CT scan in the emergency department, as an outpatient or as an inpatient for a multitude of indications - pain, trauma, suspected infection or malignancy, and frequently to investigate symptoms such as pain, or to answer a question raised by another abnormal test, such as an EKG abnormality or ultrasound finding. Despite the universality of CT in hospitals and clinics as well as free-standing imaging centers, the technology continues to evolve with greater coverage, faster acquisition and multienergy sources or detectors. The most demanding imaging applications are cardiovascular, where complex motion and small morphologic features coexist, so imaging methods that are very satisfactory elsewhere in the body may not be successful. Clinical CT scanning consists of administering toxic materials, e.g., contrast media, often monitoring the EKG and illuminating the body with high brightness x-rays. Larger area detectors and higher acquisition rates are welcome improvements, but don't solve all of the problems encountered with scan variability due to respiratory, random body, and cardiac motion, especially in a spectrum of patients from infant to massively obese adult sizes (< 1 kg to 250 kg or more). The challenges and pitfalls in CT will be delineated and evaluated relative to current and future technology.

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“…26 Furthermore, CT scans may not be as easily accessible in certain regions or healthcare systems as in the United States. 27 …”

Theranostic cancer applications utilized by nanoparticles offering multimodal systems and future insights

“…Nanoparticle-based cancer diagnostics employ various instrumental techniques utilizing optical, magnetic, radioactive and acoustic properties of carrier or contrast agent nanoparticles [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. These particles either have those properties intrinsically (material and shape dependent) or carry those molecules or other nanoparticles that embody them.…”

“…All of these imaging modalities have their own limitations and concerns. For example, there is a concern of radiation dose with CT and its resolution is limited in soft-tissue [18]. MRI provides higher resolution, but its sensitivity is low (in mM levels) [19,20].…”

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“…Even if different imaging modalities are extensively used in clinical practice such as magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), single-photon emission tomography (SPECT), each one presents strong points and limits. Nuclear medicine imaging techniques (PET and SPECT) are highly sensitive (pM range) and quantitative but suffer from poor resolution (mm range) [5,6]; CT is widely available and can detect several pathologies through rapid examinations and easy three-dimensional (3D) reconstructions but radiation dose to the patient is a noticeable concern and it is limited in soft-tissue resolution [7]; MRI gives high resolution, anatomical information, and good soft-tissue contrast but has low sensitivity (mM) [8][9][10]. Table 2 summarizes imaging modalities and related features.…”

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