Seminars in Ultrasound, CT and MRI RSS feed: Current Issue. Seminars in Ultrasound, CT and MRI is directed to all physicians involved in the performance and interpretation of ultrasound, computed tomography, and magnetic resonance imaging procedures. It is a timely source for the publication of new concepts and research findings directly applicable to day-to-day clinical practice. Articles compiled by top guest editors describe the performance of various procedures together with the authors' approach to problems of interpretation.http://www.semultrasoundctmri.com/?rss=yesElsevier Inc.en © 2010 Elsevier Inc. All rights reserved. Seminars in Ultrasound, CT and MRI0887-2171311February 2010 © 2010 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semultrasoundctmri.com/article/PIIS0887217109000882/abstract?rss=yesComputed tomography (CT) is one of the landmark advances in medical technology, and has provided radiologists with a useful imaging tool capable of an accurate clinical diagnosis. The improvements in the CT technology in recent years, particularly the rapid scanning made possible by innovations in detector technology, has led to a tremendous increase in the use of CT in medicine. Improved scan times and better resolution indicate a greatly enhanced use in both emergent and non-emergent settings. Apart from increased use for established indications, such as in a trauma patient, evaluation of a patient with acute abdomen, and oncological work up, additional indications have expanded its use in clinical medicine. In patients being evaluated for possible pulmonary embolism, CT has almost completely replaced the VQ scan in most institutions. Use of CT as a screening modality in an asymptomatic patient to aid in the early detection of lung cancer, colon cancer, and coronary artery disease has led to another spurt in its use in recent years. There have been significant concerns raised, and rightly so, because of the increased exposure of the population as a whole to ionizing radiation resulting from this increased use. While this has to be a major concern for the entire population, it is particularly critical in the pediatric population, in utero exposure of the fetus as well as exposure of the breast in younger women undergoing chest CT. There is a clear reason to critically and carefully evaluate the true medical benefits of imaging with ionizing radiation of which CT, by far, delivers the greatest radiation dose. Keeping these factors in mind, we have compiled a series of excellent review articles that discuss the use of CT in various clinical scenarios in the context of radiation risks and methods of dose optimization. The authors emphasize the need for being cognizant of the radiation risk so as to make use of the modality judiciously and only when appropriate. Many of our clinical colleagues may not be aware of the long-term risks of low doses of ionizing radiation and need to be educated on the risks associated with this imaging modality. Caution is needed especially in the case of patients frequently exposed, the very young, exposure in utero, and in the exposure of the breast tissue in a young woman.Letter from the Guest EditorMahesh K. Shetty10.1053/j.sult.2009.10.001Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-712http://www.semultrasoundctmri.com/article/PIIS088721710900081X/abstract?rss=yesThis article reviews the radiation risks to the developing fetus when exposed in utero to diagnostic radiological procedures. The discussion focuses primarily on abdominal computed tomography as this is the examination that delivers the highest radiation dose to the fetus among the diagnostic radiological procedures performed during pregnancy. The review describes the common indications for abdominal computed tomography, the biological risks to the developing fetus, radiation dose, and dose modulation techniques as well as the need for establishing a pregnancy policy to guide performance of radiological investigations in pregnancy.Abdominal Computed Tomography During Pregnancy: A Review of Indications and Fetal Radiation Exposure IssuesMahesh K. Shetty10.1053/j.sult.2009.09.001Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-737http://www.semultrasoundctmri.com/article/PIIS0887217109000821/abstract?rss=yesThe objective of this article is to evaluate the role of computed tomography (CT) in a pregnant patient with right lower quadrant pain in whom there was a clinical suspicion of acute appendicitis. During a 5-year period the clinical records of all pregnant women who underwent imaging examination for clinically suspected appendicitis were reviewed. The imaging findings were correlated with patient management and final outcome. Thirty-nine pregnant patients were referred for imaging, of which 35 underwent initial evaluation with sonography, 23 of these women underwent a computed tomographic examination, and an additional 4 patients were directly imaged with CT without earlier sonographic assessment. Surgery confirmed appendicitis in all 5 patients who were operated on on the basis of findings of appendicitis on a CT scan. Two patients underwent surgery based on an alternate diagnosis suggested preoperatively (tubal torsion = 1, ovarian torsion = 1). All patients with negative findings at CT had an uneventful clinical course. In those patients who were evaluated only with ultrasound, a diagnosis of appendicitis was missed in 5 patients. The sensitivity of CT in the diagnosis of appendicitis in our study group was 100%, compared with a sensitivity of 46.1% for ultrasound. CT provides an accurate diagnosis in patients suspected to have acute appendicitis and is of value in avoiding false negative exploratory laparatomy with its consequent risk of maternal and fetal mortality and morbidity. Although sonography is the preferred initial imaging modality as its lack of ionizing radiation, CT is more accurate in providing a timely diagnosis and its use is justified to reduce maternal mortality and mortality in patients with appendicitis.Abdominal Computed Tomography During Pregnancy for Suspected Appendicitis: 5-Year Experience at a Maternity HospitalMahesh K. Shetty, Nan M. Garrett, Wendy S. Carpenter, Yogesh P. Shah, Candace Roberts10.1053/j.sult.2009.09.002Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-7813http://www.semultrasoundctmri.com/article/PIIS0887217109000833/abstract?rss=yesSince 1972, when the first clinical computed tomography (CT) scanner was installed, amazing advances in CT technology have spurned its rapid growth and increasing utilization. Although CT scans are often performed for clinically valid indications that enable proper medical decision-making, the introduction of some protocols has outpaced the scientific data supporting their appropriateness. Considering the growing volume of CT scans performed and the appurtenant risks of radiation exposure, any exposure of patients to radiation for unnecessary or undocumented indications is worrisome. In this paper, the radiation risks associated with chest CT in 3 specific scenarios are discussed: (1) lung cancer screening, for which scientific data demonstrating a reduction in lung cancer mortality is lacking; (2) CT coronary artery angiography, for which the peer reviewed scientific literature is in evolution as its clinical utility is defined and expanded; and (3) CT pulmonary angiography, which is now widely utilized as the imaging modality of choice in the diagnosis of pulmonary emboli. The risks and benefits of these studies will be reviewed in light of the population radiation burden and the appropriateness of each examination.Radiation Risks from Exposure to Chest Computed TomographyMichael V. Huppmann, William B. Johnson, Marcia C. Javitt10.1053/j.sult.2009.09.003Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-71428http://www.semultrasoundctmri.com/article/PIIS0887217109000845/abstract?rss=yesThe rapid technological developments in computed tomography (CT) have enabled many new clinical applications in the abdominal region. Abdomen CT is considered as a high radiation dose examination due to the large number of radiosensitive organs in the field of view. CT radiation dose has received a lot of attention not only by the medical specialties and researchers, but also by patients and media. This article reviews the situation on radiation dose and risk and provides practical guidelines to effectively manage the radiation dose without losing the benefits and maintaining diagnostic confidence in CT procedures.Radiation Safety in Abdominal Computed TomographyVirginia Tsapaki, Madan Rehani, Sanjay Saini10.1053/j.sult.2009.09.004Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-72938http://www.semultrasoundctmri.com/article/PIIS0887217109000857/abstract?rss=yesCombined positron emission tomography and computed tomography (PET/CT) has proven clinical utility, particularly in the diagnosis, staging, and management of cancer. The use of PET/CT has grown substantially in the past few years, with an increasing number of hospitals and imaging centers installing PET/CT systems each year. The combination of 2 procedures, which each imparting a radiation dose and hence the potential for deleterious health effects, creates unique radiation safety issues. This article addresses the radiation safety issues posed by PET/CT with regard to the protection and safety of PET/CT personnel, the public, and adult and pediatric patients.Radiation Safety With Positron Emission Tomography and Computed TomographyCatherine E. Devine, Osama Mawlawi10.1053/j.sult.2009.09.005Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-73945http://www.semultrasoundctmri.com/article/PIIS0887217109000869/abstract?rss=yesPractical methods are described in this review for the practicing radiologist to minimize radiation dose to patients particularly with reference to multidetector helical computed tomography. Technical, educational, and management methods are outlined in detail as well as their rationale. Preliminary results of this comprehensive program are also outlined after the first year of its institution.Radiation Protection in the Era of Helical CT: Practical Patient Based Programs for Decreasing Patient ExposureSteven Birnbaum10.1053/j.sult.2009.09.006Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-74652http://www.semultrasoundctmri.com/article/PIIS0887217109000973/abstract?rss=yesComputed tomography (CT) seems to be a favorable method in diagnostic workup of patients. Multidetector (MD) CT technology has allowed joining of a rapid time examination to dynamic study after intravenous contrast medium administration; wide information regarding the status of the vessels as well as of the parenchymal organs could be received from the image analysis. Is the destiny of the MDCT same as that of conventional plain radiograph in the past: a relatively “simple and rapid” method to make diagnosis? This review will focus on the use of MDCT considering questions related to radiation dose and diagnostic gain.Utilization Patterns of Multidetector Computed Tomography in Elective and Emergency Conditions: Indications, Exposure Risk, and Diagnostic GainStefania Romano, Luigia Romano10.1053/j.sult.2009.10.002Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-75356http://www.semultrasoundctmri.com/article/PIIS0887217109000870/abstract?rss=yesThe Alliance for Radiation Safety in Pediatric Imaging is an organization of over 45 international professional societies and agencies with the goal of promoting radiation safety for children. The Alliance, through the Image Gently campaign, uses social marketing techniques and critical partnerships with vendors, government agencies, and not-for-profit organizations, to advocate best practices in radiation use and safety. Advocacies include improving education regarding radiation risk to patients from medical imaging for radiologists, technologists, and referring physicians; promoting standardization of dose measurements and display across vendor equipment; and improving medical literacy for parents.Image Gently: Providing Practical Educational Tools and Advocacy to Accelerate Radiation Protection for Children WorldwideMarilyn J. Goske, Kimberly E. Applegate, Coreen Bell, Jennifer Boylan, Dorothy Bulas, Penny Butler, Michael J. Callahan, Brian D. Coley, Shawn Farley, Donald P. Frush, Ceela McElveny, Marta Hernanz-Schulman, Neil D. Johnson, Sue C. Kaste, Gregory Morrison, Keith J. Strauss10.1053/j.sult.2009.09.007Seminars in Ultrasound, CT and MRI 31, 1 (2010)2010-02-01Seminars in Ultrasound, CT and MRI2010-02-01311S0887-2171(09)X0007-75763