■胸部超低剂量CT(ULDCT)检查仅是胸部X射线(CXR)辐射剂量的两倍,现在为CXR提供了一种有价值的成像替代方案。该试验前瞻性比较了ULDCT和CXR在非创伤性急诊科患者的低患病率队列中的诊断检出率及其临床相关性。
■在这项前瞻性交叉队列试验中,在2019年5月2日至11月26日期间,纳入了294例非创伤性急诊科患者,临床上有CXR(www.临床试验:NCT03922516)。所有参与者都接受了CXR和ULDCT,并以反向报告顺序随机分为两组。CXR的检出率从\'armCXR\'计算(n=147;CXR首先),和来自\'臂ULDCT\'的ULDCT(n=147;ULDCT首先)。记录了每个手臂的第二次检查报告的其他信息。从所有可用的临床和影像学数据来看,放射科专家和急诊医师建立了复合参考标准,包括放射学无法检测的诊断,并将每个发现分配给相应患者的五个临床相关类别之一。
■CXR和ULDCT(平均有效剂量:0.22mSv)对主要诊断的检出率为9.1%(CI[5.2,15.5];11/121)和20.1%(CI[14.2,27.7];27/134;P=0.016),分别。作为一种额外的成像模式,ULDCT将9.1%(CI[5.2,15.5];11/121)的主要诊断添加到先前的CXR,而CXR没有增加单一的主要诊断(0/134;P<0.001)。值得注意的是,对于所有其他临床相关类别,ULDCT还提供了比CXR更高的检测率,包括与相应急诊科就诊临床无关的发现,78.5%(CI[74.0,82.5];278/354)与16.2%(CI[12.7,20.3];58/359)作为主要模式,68.2%(CI[63.3,72.8];245/359)与2.5%(CI[1.3,4.7];9/354)作为额外的成像模式。
■在非创伤性急诊科患者中,与CXR相比,胸部的ULDCT为主要诊断提供了两倍以上的检测率。
■维也纳医科大学生物医学成像和图像引导治疗系获得了西门子Healthineers(Erlangen,德国)雇用两名研究助理,为期一年。
UNASSIGNED: Ultra-low-dose CT (ULDCT) examinations of the chest at only twice the radiation dose of a chest X-ray (CXR) now offer a valuable imaging alternative to CXR. This trial prospectively compares ULDCT and CXR for the detection rate of diagnoses and their clinical relevance in a low-prevalence cohort of non-traumatic emergency department patients.
UNASSIGNED: In this prospective crossover cohort trial, 294 non-traumatic emergency department patients with a clinically indicated CXR were included between May 2nd and November 26th of 2019 (www.clinicaltrials.gov: NCT03922516). All participants received both CXR and ULDCT, and were randomized into two arms with inverse reporting order. The detection rate of CXR was calculated from \'arm CXR\' (n = 147; CXR first), and of ULDCT from \'arm ULDCT\' (n = 147; ULDCT first). Additional information reported by the second exam in each arm was documented. From all available clinical and imaging data, expert radiologists and emergency physicians built a compound reference standard, including radiologically undetectable diagnoses, and assigned each finding to one of five clinical relevance categories for the respective patient.
UNASSIGNED: Detection rates for main diagnoses by CXR and ULDCT (mean effective dose: 0.22 mSv) were 9.1% (CI [5.2, 15.5]; 11/121) and 20.1% (CI [14.2, 27.7]; 27/134; P = 0.016), respectively. As an additional imaging modality, ULDCT added 9.1% (CI [5.2, 15.5]; 11/121) of main diagnoses to prior CXRs, whereas CXRs did not add a single main diagnosis (0/134; P < 0.001). Notably, ULDCT also offered higher detection rates than CXR for all other clinical relevance categories, including findings clinically irrelevant for the respective emergency department visit with 78.5% (CI [74.0, 82.5]; 278/354) vs. 16.2% (CI [12.7, 20.3]; 58/359) as a primary modality and 68.2% (CI [63.3, 72.8]; 245/359) vs. 2.5% (CI [1.3, 4.7]; 9/354) as an additional imaging modality.
UNASSIGNED: In non-traumatic emergency department patients, ULDCT of the chest offered more than twice the detection rate for main diagnoses compared to CXR.
UNASSIGNED: The Department of Biomedical Imaging and Image-guided Therapy of Medical University of Vienna received funding from Siemens Healthineers (Erlangen, Germany) to employ two research assistants for one year.