Patient exposure and image quality of low-dose pulmonary computed tomography angiography: comparison of 100- and 80-kVp protocols

OBJECTIVE: Measures to reduce radiation exposure and injected iodine mass are becoming more important with the widespread and often repetitive use of pulmonary CT angiography (CTA) in patients with suspected pulmonary embolism. In this retrospective study, we analyzed the capability of 2 low-kilovoltage CTA-protocols to achieve these goals. MATERIALS AND METHODS: Ninety patients weighing less than 100 kg were examined by a pulmonary CTA protocol using either 100 kVp (group A) or 80 kVp (group B). Volume and flow rate of contrast medium were reduced in group B (75 mL at 3 mL/s) compared with group A (100 mL at 4 mL/s). Attenuation was measured in the central and peripheral pulmonary arteries, and the contrast-to-noise ratios (CNR) were calculated. Entrance skin dose was estimated by measuring the surface dose in an ovoid-cylindrical polymethyl methacrylate chest phantom with 2 various dimensions corresponding to the range of chest diameters in our patients. Quantitative image parameters, estimated effective dose, and skin dose in both groups were compared by the t test. Arterial enhancement, noise, and overall quality were independently assessed by 3 radiologists, and results were compared between the groups using nonparametric tests. RESULTS: Mean attenuation in the pulmonary arteries in group B (427.6 +/- 116 HU) was significantly higher than in group A (342.1 +/- 87.7 HU; P < 0.001), whereas CNR showed no difference (group A, 20.6 +/- 7.3 and group B, 22.2 +/- 7.1; P = 0.302). Effective dose was lower by more than 40% with 80 kVp (1.68 +/- 0.23 mSv) compared with 100 kVp (2.87 +/- 0.88 mSv) (P < 0.001). Surface dose was significantly lower at 80 kVp compared with 100 kVp at both phantom dimensions (2.75 vs. 3.22 mGy; P = 0.027 and 2.22 vs. 2.73 mGy; P = 0.005, respectively). Image quality did not differ significantly between the groups (P = 0.151). CONCLUSIONS: Using 80 kVp in pulmonary CTA permits reduced patient exposure by 40% and CM volume by 25% compared with 100 kVp without deterioration of image quality in patients weighing less than 100 kg.

Detection of pulmonary emboli with CT angiography at reduced radiation exposure and contrast material volume: comparison of 80 kVp and 120 kVp protocols in a matched cohort

The detection rate of pulmonary emboli (PE) with computed tomography angiography (CTA) using either a standard or a low-dose protocol, combining reduced radiation exposure and iodine delivery rate, was retrospectively analyzed in a matched cohort of 120 patients.

Thoracoabdominal-aortoiliac multidetector-row CT angiography at 80 and 100 kVp: assessment of image quality and radiation dose

OBJECTIVE: To compare image quality and radiation dose of thoracoabdominal computed tomography (CT) angiography at 80 and 100 kVp and to assess the feasibility of reducing contrast medium volume from 60 to 45 mL at 80 kVp. MATERIALS AND METHODS: This retrospective study had institutional review board approval; informed consent was waived. Seventy-five patients who had undergone thoracoabdominal 64-section multidetector-row CT angiography were divided into 3 groups of 25 patients each. Patients of groups A (tube voltage, 100 kVp) and B (tube voltage, 80 kVp) received 60 mL of contrast medium at 4 mL/s. Patients of group C (tube voltage, 80 kVp) received 45 mL of contrast medium at 3 mL/s. Mean aortoiliac attenuation, image noise, and contrast-to-noise ratio were assessed. The measurement of radiation dose was based on the volume CT dose index. Three independent readers assessed the diagnostic image quality. RESULTS: Mean aortoiliac attenuation for group B (621.1 +/- 90.5 HU) was significantly greater than for groups A and C (485.2 +/- 110.5 HU and 483.1 +/- 119.8 HU; respectively) (P < 0.001). Mean image noise was significantly higher for groups B and C than for group A (P < 0.05). The contrast-to-noise ratio did not significantly differ between the groups (group A, 35.0 +/- 13.8; group B, 31.7 +/- 10.1; group C, 27.3 +/- 11.5; P = 0.08). Mean volume CT dose index in groups B and C (5.2 +/- 0.4 mGy and 4.9 +/- 0.3 mGy, respectively) were reduced by 23.5% and 27.9%, respectively, compared with group A (6.8 +/- 0.8 mGy) (P < 0.001). The average overall diagnostic image quality for the 3 groups was graded as good or better. The score for group A was significantly higher than that for group C (P < 0.01), no difference was seen between group A and B (P = 0.92). CONCLUSIONS: Reduction of tube voltage from 100 to 80 kVp for thoracoabdominal CT angiography significantly reduces radiation dose without compromising image quality. Reduction of contrast medium volume to 45 mL at 80 kVp resulted in lower but still diagnostically acceptable image quality.

Is body weight the most appropriate criterion to select patients eligible for low-dose pulmonary CT angiography? Analysis of objective and subjective image quality at 80 kVp in 100 patients

The objective of this retrospective study was to assess image quality with pulmonary CT angiography (CTA) using 80 kVp and to find anthropomorphic parameters other than body weight (BW) to serve as selection criteria for low-dose CTA. Attenuation in the pulmonary arteries, anteroposterior and lateral diameters, cross-sectional area and soft-tissue thickness of the chest were measured in 100 consecutive patients weighing less than 100 kg with 80 kVp pulmonary CTA. Body surface area (BSA) and contrast-to-noise ratios (CNR) were calculated. Three radiologists analyzed arterial enhancement, noise, and image quality. Image parameters between patients grouped by BW (group 1: 0-50 kg; groups 2-6: 51-100 kg, decadally increasing) were compared. CNR was higher in patients weighing less than 60 kg than in the BW groups 71-99 kg (P between 0.025 and <0.001). Subjective ranking of enhancement (P = 0.165-0.605), noise (P = 0.063), and image quality (P = 0.079) did not differ significantly across all patient groups. CNR correlated moderately strongly with weight (R = -0.585), BSA (R = -0.582), cross-sectional area (R = -0.544), and anteroposterior diameter of the chest (R = -0.457; P < 0.001 all parameters). We conclude that 80 kVp pulmonary CTA permits diagnostic image quality in patients weighing up to 100 kg. Body weight is a suitable criterion to select patients for low-dose pulmonary CTA.

Tradition mit Weitsicht. Festschrift für Eugen Bucher zum 80. Geburtstag

Am 1. Juni 2009 feiert Prof. Dr. Eugen Bucher seinen 80. Geburtstag. Mit dieser Festschrift ehren Herausgeber und Autoren einen aussergewöhnlichen Menschen und einen herausragenden Juristen. Eugen Bucher hat in der zweiten Hälfte des 20. Jahrhunderts die Entwicklung des schweizerischen Privatrechts massgeblich beeinflusst. In vielen Bereichen hat er neue Denkansätze gewählt und daraus resultierende Konzepte mit Überzeugungskraft und Beharrlichkeit durchgesetzt. Die 45 Beiträge sind Ausdruck der grossen Anerkennung, die der Jubilar national und international geniesst.

Introduction: A brief journey through the 80 year history of the International Association of Schools of Social Work

The leaders of the International Association of Schools of Social Work (IASSW) have played major roles in shaping the organization over its 80 year history. This brief introduction will put their roles in the context of the organization’s history. While influenced by its presidents in significant ways, the organization’s trajectory has also been affected by the political, economic and social developments of the 20th century and the beginning of the 21st. Significant changes have occurred in the organization and in social work education, yet, as Feustel (2006) observed, “the history of the IASSW demonstrates lines of continuity that are even more remarkable for the fact that it was caught up in the great historical ruptures of the 20th century” (p. 3).

Congenitally corrected transposition of the great arteries in an 80 year old woman

Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease characterised by atrioventricular as well as ventriculoarterial discordance. It is usually associated with a variety of severe intracardiac defects. Few patients with this abnormality survive past 50 years. An 80 year old woman was admitted to the hospital because of mild congestive heart failure. Cardiac examination revealed a 4/6 holosystolic and a 2/6 decrescendo diastolic murmur at the left sternal border. Radiography, echocardiography, and computed tomography confirmed newly diagnosed CCTGA without associated intracardiac defects.

Gedanken zur Gerechtigkeit, Festschrift für Hans Giger zum 80. Geburtstag

Ein hochaktueller Band ist zum 80. Geburtstag des international anerkannten Gelehrten Hans Giger aus der Taufe gehoben worden. Wissenschafter in- und ausländischer Universitäten, des Max-Planck-Institutes in Hamburg, a. Bundespräsident der Schweiz, Bundesrichter, Kassationsgerichtspräsident sowie Vertreter von Wirtschaft, Politik, Verwaltung und Medien veranschaulichen ihre Gedanken zur Gerechtigkeit. Beleuchtet werden etwa Themen wie Lohngerechtigkeit und Wirtschaftsethik, Zuteilung von Spenderorganen, Gerechtigkeit in der Strafjustiz, Chancengleichheit in der Bildung, Sport als Weg zu mehr Gerechtigkeit, Biowissenschaften als ethische Provokation, der Preis der sozialen Gerechtigkeit, Sachgerechtigkeit und Regelungsflut, Ungerechtigkeit durch Mainstream-Denken, Quellen des Rechtsbewusstseins u.a.m. Mit 23 fesselnden Beiträgen und einem Geleitwort von Bundesrätin Doris Leuthard liegt ein Werk vor, das in eindrücklicher Weise das zeitgenössische Gerechtigkeitsempfinden reflektiert.

Human TNF receptor p75/80 gene structure and promoter characterization

Tumor necrosis factor receptor p75/80 ((TNF-R p75/80) is a 75 kDa type 1 transmembrane protein expressed predominately on cells of hematopoietic lineage. TNF-R p75/80 belongs to the TNF receptor superfamily characterized by cysteine-rich extracellular regions composed of three to six disulfide-linked domains. In the present report, we have characterized, for the first time, the complete gene structure for human TNF-R p75/80 which spans approximately 43 kbp. The gene consists of 10 exons (ranging from 34 bp to 2.5 kbp) and 9 introns (343 bp to 19 kbp). Consensus elements for transcription factors involved in T cell development and activation were noted in the 5$\sp\prime$ flanking region including TCF-1, Ikaros, AP-1, CK-2, IL-6RE, ISRE, GAS, NF-$\kappa$B and SP1, as well as an unusually high GC content and CpG frequency that appears characteristic of some TNF-R family members. The unusual (GATA)$\sb{\rm n}$ and (GAA)(GGA) repeats found within intron 1 may prove useful for further genome analysis within the 1p36 chromosomal locus. The human TNF-R p75/80 gene structure will permit further assessment of its involvement in normal hematopoietic cell development and function, autoimmune disease, and non-random translocations in hematopoietic malignancies. The region 1.8 kb 5$\sp\prime$ of the ATG was able to drive luciferase expression when transfected into cell lines expressing TNF-R p75/80. Further characterization of the 5$\sp\prime$-regulatory region will aid in determining factors and signal transduction pathways involved in regulating TNF-R p75/80 expression. ^

Preliminary Results from the Chemical Records of an 80.4 M Ice Core Recovered from East Rongbuk Glacier, Qomolangma (Mount Everest), Himalaya

High-resolution chemical records from an 80.4 m ice core from the central Himalaya demonstrate climatic and environmental changes since 1844. The chronological net accumulation series shows a sharp decrease from the mid-1950s, which is coincident with the widely observed glacier retreat. A negative correlation is found between the ice-core delta(18)O record and the monsoon precipitation for Indian region 7. The temporal variation of the terrestrial ions (Ca2+ and Mg2+) is controlled by both the monsoon precipitation for Indian regions 3,7 and 8, located directly south and west of the Himalaya, and the dust-storm duration and frequency in the northern arid regions, such as the Taklimakan desert, China. The NH4+ profile is fairly flat until the 1940s, then substantially increases until the end of the 1980s, with a slight decrease during the 1990s which may reflect new agricultural practices. The SO42- and NO3- profiles show an apparent increasing trend, especially during the period 1940s-80s. Moreover, SO42- concentrations for the East Rongbuk Glacier core are roughly double that of the nearby Dasuopu core at Xixabangma, Himalaya, due to local human activity including that of climbing teams who use gasoline for cooking, energy and transport.