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Sample records for ct guided lung

  1. Pericardial Tamponade Following CT-Guided Lung Biopsy

    International Nuclear Information System (INIS)

    Mitchell, Michael J.; Montgomery, Mark; Reiter, Charles G.; Culp, William C.

    2008-01-01

    While not free from hazards, CT-guided biopsy of the lung is a safe procedure, with few major complications. Despite its safety record, however, potentially fatal complications do rarely occur. We report a case of pericardial tamponade following CT-guided lung biopsy. Rapid diagnosis and therapy allowed for complete patient recovery. Physicians who perform this procedure should be aware of the known complications and be prepared to treat them appropriately.

  2. Systemic Air Embolism After CT-guided Lung Biopsy

    Science.gov (United States)

    2017-11-27

    Patients Who Underwent Percutaneous Lung Biopsy Under CT Guidance; Patients Who Presented Systemic Air Embolism After Percutaneous Lung Biopsy Under CT Guidance Depicted at the Time of the Procedure on a Whole Thoracic CT

  3. Technical note: CT-guided biopsy of lung masses using an automated guiding apparatus

    International Nuclear Information System (INIS)

    Chellathurai, Amarnath; Kanhirat, Saneej; Chokkappan, Kabilan; Swaminathan, Thiruchendur S; Kulasekaran, Nadhamuni

    2009-01-01

    Automated guiding apparatuses for CT-guided biopsies are now available. We report our experience with an indigenous system to guide lung biopsies. This system gave results similar to those with the manual technique. Automated planning also appears to be technically easier, it requires fewer number of needle passes, consumes less time, and requires fewer number of check scans

  4. CT-guided percutaneous conformal cryoablation for lung carcinoma

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    Yueyong, Xiao; Bin, Wu; Xiao, Zhang; Hongjun, Li; Da, Yu; Jie, Li; Jun, Li [Department of Radiology, PLA General Hospital, Beijing (China)

    2010-02-15

    Objective: To investigate the safety, efficacy and feasibility of CT-guided percutaneous conformal cryoablation for lung cancer. Methods: The inclusion criteria were: (1) Poor respiratory function and aged patients who can not bear the thoracic surgical operation. (2) Peripheral lung cancer involving the pleura and chest wall which can not be resected. (3) Residual tumor after other comprehensive treatment. (4) Focal lung cancer but the patient refused surgical resection. The exclusion criteria were: (1) Multifocal lesions. (2) Lesion close to mediastinum with possible risk of vessel injury. (3) Severe impairment of pulmonary functions, the maximum voluntary ventilation is less than 39%. (4) Repeated cough or dyspnea, can not cooperate with the procedure. (5) Poor systemic conditions, cachexia or bleeding. Totally, 76 lung carcinoma lesions on 66 patients were treated by CT-guided percutaneous conformal cryoablation using 17 G cryoprobes. The maximum diameters of the tumors ranged from 1.5 cm to 1.6 cm. For the tumors with the maximum diameter less than 3.0 cm, they were treated by double-needle clamping cryoablation. For those with the maximum diameter between 3.0 and 5.0 cm, they were treated by multiple-needle conformal cryoablation. For those with the maximum diameter larger than 5.0 cm, they were treated with multiple-needle conformal cyroablation, with the needle distance less than 1.5 cm. All the patients were followed-up 6 to 24 months after the procedure using contrast-enhanced CT to evaluate the tumor size and enhancement. Results: For 18 cases with the maximum diameters less than 3.0 cm, CT scan during the procedure showed that the frozen areas extended beyond the edge of the lesions more than 1.0 cm, the lesion attenuated, narrow-band-like encircled translucency around the lesions and 'target sign' with ground-glass density of the peripheral lung tissue. There was no enhancement during the first 1 st, 3 rd month follow-up, only fibrosis scar in 6 th

  5. CT-guided percutaneous conformal cryoablation for lung carcinoma

    International Nuclear Information System (INIS)

    Xiao Yueyong; Wu Bin; Zhang Xiao; Li Hongjun; Yu Da; Li Jie; Li Jun

    2010-01-01

    Objective: To investigate the safety, efficacy and feasibility of CT-guided percutaneous conformal cryoablation for lung cancer. Methods: The inclusion criteria were: (1) Poor respiratory function and aged patients who can not bear the thoracic surgical operation. (2) Peripheral lung cancer involving the pleura and chest wall which can not be resected. (3) Residual tumor after other comprehensive treatment. (4) Focal lung cancer but the patient refused surgical resection. The exclusion criteria were: (1) Multifocal lesions. (2) Lesion close to mediastinum with possible risk of vessel injury. (3) Severe impairment of pulmonary functions, the maximum voluntary ventilation is less than 39%. (4) Repeated cough or dyspnea, can not cooperate with the procedure. (5) Poor systemic conditions, cachexia or bleeding. Totally, 76 lung carcinoma lesions on 66 patients were treated by CT-guided percutaneous conformal cryoablation using 17 G cryoprobes. The maximum diameters of the tumors ranged from 1.5 cm to 1.6 cm. For the tumors with the maximum diameter less than 3.0 cm, they were treated by double-needle clamping cryoablation. For those with the maximum diameter between 3.0 and 5.0 cm, they were treated by multiple-needle conformal cryoablation. For those with the maximum diameter larger than 5.0 cm, they were treated with multiple-needle conformal cyroablation, with the needle distance less than 1.5 cm. All the patients were followed-up 6 to 24 months after the procedure using contrast-enhanced CT to evaluate the tumor size and enhancement. Results: For 18 cases with the maximum diameters less than 3.0 cm, CT scan during the procedure showed that the frozen areas extended beyond the edge of the lesions more than 1.0 cm, the lesion attenuated, narrow-band-like encircled translucency around the lesions and 'target sign' with ground-glass density of the peripheral lung tissue. There was no enhancement during the first 1 st, 3 rd month follow-up, only fibrosis scar in 6 th

  6. CT fluoroscopy-guided vs. multislice CT biopsy mode-guided lung biopsies: Accuracy, complications and radiation dose

    International Nuclear Information System (INIS)

    Prosch, Helmut; Stadler, Alfred; Schilling, Matthias; Bürklin, Sandra; Eisenhuber, Edith; Schober, Ewald; Mostbeck, Gerhard

    2012-01-01

    Background: The aim of this retrospective study was to compare the diagnostic accuracy, the frequency of complications, the duration of the interventions and the radiation doses of CT fluoroscopy (CTF) guided biopsies of lung lesions with those of multislice CT (MS-CT) biopsy mode-guided biopsies. Methods: Data and images from 124 consecutive patients undergoing CTF-guided lung biopsy (group A) and 132 MS-CT-biopsy mode-guided lung biopsy (group B) were reviewed. CTF-guided biopsies were performed on a Siemens Emotion 6 CT scanner with intermittent or continuous CT-fluoroscopy, MS-CT biopsy mode-guided biopsies were performed on a Siemens Emotion 16 CT scanner. All biopsies were performed with a coaxial needle technique. Results: The two groups (A vs. B) did not differ significantly regarding sensitivity (95.5% vs. 95.9%), specificity (96.7% vs. 95.5%), negative predictive value (87.9% vs. 84%) or positive predictive value (98.8% vs. 98.9%). Pneumothorax was observed in 30.0% and 32.5% of the patients, respectively. Chest tube placement was necessary in 4% (group A) and 13% (group B) of the patients. The duration of the intervention was significantly longer in group A (median 37 min vs. 32 min, p = 0.04). The mean CT dose index (CTDI) was 422 in group A and 36.3 in group B (p < 0.001). Conclusion: Compared to CTF-guided biopsies, chest biopsies using the MS-CT biopsy mode show dramatically lower CTDI levels. Although the diagnostic yield of the procedures do not differ significantly, biopsies using the MS-CT-biopsy mode have a three-fold higher rate of chest tube placement.

  7. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT.

    Science.gov (United States)

    Chami, H A; Faraj, W; Yehia, Z A; Badour, S A; Sawan, P; Rebeiz, K; Safa, R; Saade, C; Ghandour, B; Shamseddine, A; Mukherji, D; Haydar, A A

    2015-12-01

    To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below -950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01-1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  8. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT

    International Nuclear Information System (INIS)

    Chami, H.A.; Faraj, W.; Yehia, Z.A.; Badour, S.A.; Sawan, P.; Rebeiz, K.; Safa, R.; Saade, C.; Ghandour, B.; Shamseddine, A.; Mukherji, D.; Haydar, A.A.

    2015-01-01

    Aim: To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. Materials and methods: One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below −950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. Results: Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01–1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. Conclusion: Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax. - Highlights: • Examine the association between quantitative emphysema measures & post NLB pneumothorax. • The risk of post-NLB pneumothorax increases with every unit increase in percent emphysema. • Percent emphysema is a significant predictor of pneumothorax post transthoracic NLB. • Quantitative analysis of chest CT offers clinicians' objective measures to assess pneumothorax risk.

  9. The contribution of CT-guided transthoracic lung biopsy to the diagnosis of organising pneumonia.

    Science.gov (United States)

    Metzger, F; Pernet, D; Manzoni, P; Ranfaing, E; Dalphin, J-C

    2010-09-01

    Organising pneumonia is a pulmonary disease with variable clinical and radiological features and with many differential diagnoses. Diagnosis is based on histology obtained by either transbronchial or surgical lung biopsy but these techniques have several disadvantages. The aim of this study was to evaluate the diagnostic yield of CT-guided transthoracic lung biopsy in organising pneumonia and to compare it to the usual diagnostic tools. Six cases of organising pneumonia diagnosed with CT-guided lung biopsy are reported and discussed. The role of CT-guided lung biopsy in the diagnosis of organising pneumonia was also reviewed in the literature. CT-guided transthoracic lung biopsies provided a higher rate of adequate samples than transbronchial biopsies (92-100% versus 77-86%). The samples were larger, which reduced the risks of misdiagnosis and increased the diagnostic yield (88-97% versus 26-55% in pulmonary nodules and 42-100% versus 66-75% in diffuse pulmonary disease). Complications were rare and generally not serious. CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organising pneumonia. Surgical lung biopsy remains the gold standard method for diagnosis. Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  10. Analysis of diagnositc accuracy with CT-guided percutaneous transthoracic lung biopsy for pulmonary lesions

    International Nuclear Information System (INIS)

    Wang Haiyan; Zhuang Yiping; Zhang Jin; Feng Yong; Zhang Xiao; Xu Lin

    2007-01-01

    Objective: To evaluate the factors which may affect the diagnostic accmracy of CT-guided percutaneous transthoracic lung biopsy for pulmonary lesions. Methods: CT-guided percutaneous transthoracic lung biopsy was performed in 264 patients, all of which were proved by surgical pathology or clinical follow-up. A logistic regression analysis was used to investigate the relationship between the location and the size of the lesions and insertion depth of biopsy needles and the diagnostic accuracy of CT-guided percutaneous transthomcic lung biopsy. The complication rate including pneumatothorax and bleeding rate were record. Results: The diagnostic accuracy was 87.5%. Both the pneumothorax and the bleeding of lesion were 1.9%. The size of lesion was suggested by Logistic regression analysis had a significant influence on the diagnostic accuracy (Wald=12.891, P=0.00034, OR=0.96). Conclusion: CT-guided pereumneous transthoracic lung biopsy has a high diagnostic accuracy for pulmonary lesions. The size of the lesions had significant effect on the diagnostic accuracy. (authors)

  11. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis

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    Heerink, W.J.; Vliegenthart, R. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Radiology, University of Groningen, Groningen (Netherlands); Bock, G.H. de [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen (Netherlands); Jonge, G.J. de [University Medical Center Groningen, Department of Radiology, University of Groningen, Groningen (Netherlands); Groen, H.J.M. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Pulmonary Medicine, University of Groningen, Groningen (Netherlands); Oudkerk, M. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands)

    2017-01-15

    To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. Four databases were searched from 1/2000 to 8/2015 for studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were pooled and compared between core biopsy and fine needle aspiration (FNA) using the random-effects model. Risk factors for complications in core biopsy and FNA were identified in meta-regression analysis. For core biopsy, 32 articles (8,133 procedures) were included and for FNA, 17 (4,620 procedures). Pooled overall complication rates for core biopsy and FNA were 38.8 % (95 % CI: 34.3-43.5 %) and 24.0 % (95 % CI: 18.2-30.8 %), respectively. Major complication rates were 5.7 % (95 % CI: 4.4-7.4 %) and 4.4 % (95 % CI: 2.7-7.0 %), respectively. Overall complication rate was higher for core biopsy compared to FNA (p < 0.001). For FNA, larger needle diameter was a risk factor for overall complications, and increased traversed lung parenchyma and smaller lesion size were risk factors for major complications. For core biopsy, no significant risk factors were identified. In CT-guided lung biopsy, minor complications were common and occurred more often in core biopsy than FNA. Major complication rate was low. For FNA, smaller nodule diameter, larger needle diameter and increased traversed lung parenchyma were risk factors for complications. (orig.)

  12. The clinical application of percutaneous auto-biopsy of small lung nodular under CT-Guided

    International Nuclear Information System (INIS)

    Zhou Yuanmin; Ye Genxin; Zhang Chenghui; Wang Yu; Chen Wei

    2008-01-01

    Objective: To evaluated the clinical value of technology of petcutaneous auto-biopsy of small lung nodular under CT- Guide. Methods: 44 cases of small single lung nodular were underwent biopsy with 20G auto-biopsy needle under CT guidance. All cases underwent pathological diagnosis. Results: All 44 cases were punctured successfully. 41 cases were succeeded in first puncturation. The success ratio was 93.02%. Other 3 cases needed second puncturation. 39 of 44 cases pathological diagnosis were malignant. Only 1 case could not be diagnosed. 6 patients had lightly pneumatothorax after biopsy. 10 cases had mild pneumonorrhagia after biopsy. 2 of them had haemptysis. All cases had no complication such as infection, needle track implantation. Conclusion: The technology of CT Guidance auto-biopsy of small lung nodular is safe and effective; it has extreme diagnostic ratio and less complication. (authors)

  13. Usefulness of normal saline for sealing the needle track after CT-guided lung biopsy

    International Nuclear Information System (INIS)

    Li, Y.; Du, Y.; Luo, T.Y.; Yang, H.F.; Yu, J.H.; Xu, X.X.; Zheng, H.J.; Li, B.

    2015-01-01

    Aim: To determine whether the use of normal saline for sealing the needle track can reduce the incidence of pneumothorax and chest tube placement after computed tomography (CT)-guided lung biopsy. Materials and methods: A prospective, randomised, controlled trial enrolling 322 patients was conducted. All patients were randomly assigned to one of two groups: those in whom the needle track was not sealed with normal saline (n=161, Group A) and those who did receive normal saline (n=161, Group B). CT-guided biopsy was performed with coaxial technique. Normal saline, which ranged from 1–3 ml, was injected while the trocar needle was being withdrawn. Patient characteristics, lesion, and procedure variables were analysed as potential risk variables for occurrence of pneumothorax and chest tube placement. Results: The incidence of pneumothorax was 26.1% in Group A and 6.2% in Group B (p<0.001). Nine patients in Group A and one patient in Group B required chest tube placement (p=0.010). Using multiple logistic regression analysis, smaller lesion size, greater needle–pleural angle, longer lesion–pleural distance, presence of emphysema, and no sealing the needle track with normal saline were significantly associated with an increased risk of pneumothorax, and that the latter three factors were also associated with an increased risk of pneumothorax requiring chest tube placement. Conlusion: Normal saline for sealing the needle track significantly reduces the incidence of pneumothorax and prevents subsequent chest tube placement after CT-guided lung biopsy. - Highlights: • Normal saline is an effective sealant for use in lung biopsy. • This technique reduced the incidence of pneumothorax and chest tube placement. • This technique should be recommended for CT-guided lung biopsy.

  14. Dynamic telecytologic evaluation of imprint cytology samples from CT-guided lung biopsies: A feasibility study

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    Prosch, Helmut [Otto Wagner Hospital, Department of Radiology, Vienna (Austria); Medical University of Vienna, Department of Radiology, Vienna (Austria); Medical University of Vienna, Vienna General Hospital, Department of Radiology, Vienna (Austria); Hoffmann, Elisabeth; Schober, Ewald; Mostbeck, Gerhard [Otto Wagner Hospital, Department of Radiology, Vienna (Austria); Bernhardt, Klaus; Schalleschak, Johann [Otto Wagner Hospital, Department of Laboratory Medicine, Vienna (Austria); Rowhani, Marcel [Otto Wagner Hospital, Department of Respiratory and Critical Care Medicine, Vienna (Austria); Weber, Michael [Medical University of Vienna, Department of Radiology, Vienna (Austria)

    2011-09-15

    This study assessed the feasibility of telecytological evaluation of samples from CT-guided lung biopsies using a dynamic telecytological system in which the microscope was operated by personnel from the radiology department at the site of the biopsy and a cytologist off-site diagnosed the biopsy sample. 45 imprint samples from CT-guided biopsies of lung lesions were reviewed by two cytologists using a telecytological microscope (Olympus BX51, Tokyo, Japan). The telecytological microscope was operated by one radiologist and one radiology technician. The cytological samples were classified by a cytologist into four categories: benign, malignant, atypical cells of undetermined significance, and non-diagnostic. The results were compared with those of a previous consensus reading of two independent cytologists (gold standard). When the radiologist was operating the microscope, the diagnostic accuracy was 100% as both cytologists came to the correct diagnosis in all samples. When the technician operated the microscope, two diagnoses of cyotologist 1 differed from the gold standard. Thus, the accuracy for the technician was 95.56%. Telecytological evaluation of imprint samples from CT-guided lung biopsies is feasible because it can be performed with high diagnostic accuracy if personnel from the radiology department operate the microscope. (orig.)

  15. CT-guided intratumoral gene therapy in non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Kauczor, H.U.; Heussel, C.P.; Thelen, M.; Schuler, M.; Huber, C.; Weymarn, A. von; Bongartz, G.; Rochlitz, C.

    1999-01-01

    The objective of this study was to prove the principle of CT-guided gene therapy by intratumoral injection of a tumor suppressor gene as an alternative treatment approach of incurable non-small-cell lung cancer. In a prospective clinical phase I trial six patients with non-small-cell lung cancer and a mutation of the tumor suppressor gene p53 were treated by CT-guided intratumoral gene therapy. Ten milliliters of a vector solution (replication-defective adenovirus with complete wild-type p53 cDNA) were injected under CT guidance. In four cases the vector solution was completely applied to the tumor center, whereas in two cases 2 ml aliquots were injected into different tumor areas. For the procedure the scan room had been approved as a biosafety cabinet. Gene transfer was assessed by reverse transcription and polymerase chain reaction in biopsy specimens obtained under CT guidance 24-48 h after therapy. Potential therapeutic efficacy was evaluated on day 28 after treatment using spiral CT. The CT-guided gene therapy was easily performed in all six patients without intervention-related complications. Besides flu-like symptoms, no significant adverse effects of gene therapy were noted. Three of the four patients with central injection exhibited gene transfer in the posttreatment biopsy. Gene transfer could not be proven in the two patients with multiple 2 ml injections. After 28 days, four of the six patients showed stable disease at the treated tumor site, whereas other tumor manifestations progressed. Computed tomography-guided injections are an adequate and easy-to-perform procedure for intratumoral gene therapy. (orig.)

  16. Separation of left and right lungs using 3D information of sequential CT images and a guided dynamic programming algorithm

    Science.gov (United States)

    Park, Sang Cheol; Leader, Joseph Ken; Tan, Jun; Lee, Guee Sang; Kim, Soo Hyung; Na, In Seop; Zheng, Bin

    2011-01-01

    Objective this article presents a new computerized scheme that aims to accurately and robustly separate left and right lungs on CT examinations. Methods we developed and tested a method to separate the left and right lungs using sequential CT information and a guided dynamic programming algorithm using adaptively and automatically selected start point and end point with especially severe and multiple connections. Results the scheme successfully identified and separated all 827 connections on the total 4034 CT images in an independent testing dataset of CT examinations. The proposed scheme separated multiple connections regardless of their locations, and the guided dynamic programming algorithm reduced the computation time to approximately 4.6% in comparison with the traditional dynamic programming and avoided the permeation of the separation boundary into normal lung tissue. Conclusions The proposed method is able to robustly and accurately disconnect all connections between left and right lungs and the guided dynamic programming algorithm is able to remove redundant processing. PMID:21412104

  17. CT Fluoroscopy-Guided Lung Biopsy with Novel Steerable Biopsy Canula: Ex-Vivo Evaluation in Ventilated Porcine Lung Explants

    International Nuclear Information System (INIS)

    Schaefer, Philipp J.; Fabel, Michael; Bolte, Hendrik; Schaefer, Fritz K. W.; Jahnke, Thomas; Heller, Martin; Lammer, Johannes; Biederer, Juergen

    2010-01-01

    The purpose was to evaluate ex-vivo a prototype of a novel biopsy canula under CT fluoroscopy-guidance in ventilated porcine lung explants in respiratory motion simulations. Using an established chest phantom for porcine lung explants, n = 24 artificial lesions consisting of a fat-wax-Lipiodol mixture (approx. 70HU) were placed adjacent to sensible structures such as aorta, pericardium, diaphragm, bronchus and pulmonary artery. A piston pump connected to a reservoir beneath a flexible silicone reconstruction of a diaphragm simulated respiratory motion by rhythmic inflation and deflation of 1.5 L water. As biopsy device an 18-gauge prototype biopsy canula with a lancet-like, helically bended cutting edge was used. The artificial lesions were punctured under CT fluoroscopy-guidance (SOMATOM Sensation 64, Siemens, Erlangen, Germany; 30mAs/120 kV/5 mm slice thickness) implementing a dedicated protocol for CT fluoroscopy-guided lung biopsy. The mean-diameter of the artificial lesions was 8.3 ± 2.6 mm, and the mean-distance of the phantom wall to the lesions was 54.1 ± 13.5 mm. The mean-displacement of the lesions by respiratory motion was 14.1 ± 4.0 mm. The mean-duration of CT fluoroscopy was 9.6 ± 5.1 s. On a 4-point scale (1 = central; 2 = peripheral; 3 = marginal; 4 = off target), the mean-targeted precision was 1.9 ± 0.9. No misplacement of the biopsy canula affecting adjacent structures could be detected. The novel steerable biopsy canula proved to be efficient in the ex-vivo set-up. The chest phantom enabling respiratory motion and the steerable biopsy canula offer a feasible ex-vivo system for evaluating and training CT fluoroscopy-guided lung biopsy adapted to respiratory motion.

  18. BEM-based simulation of lung respiratory deformation for CT-guided biopsy.

    Science.gov (United States)

    Chen, Dong; Chen, Weisheng; Huang, Lipeng; Feng, Xuegang; Peters, Terry; Gu, Lixu

    2017-09-01

    Accurate and real-time prediction of the lung and lung tumor deformation during respiration are important considerations when performing a peripheral biopsy procedure. However, most existing work focused on offline whole lung simulation using 4D image data, which is not applicable in real-time image-guided biopsy with limited image resources. In this paper, we propose a patient-specific biomechanical model based on the boundary element method (BEM) computed from CT images to estimate the respiration motion of local target lesion region, vessel tree and lung surface for the real-time biopsy guidance. This approach applies pre-computation of various BEM parameters to facilitate the requirement for real-time lung motion simulation. The resulting boundary condition at end inspiratory phase is obtained using a nonparametric discrete registration with convex optimization, and the simulation of the internal tissue is achieved by applying a tetrahedron-based interpolation method depend on expert-determined feature points on the vessel tree model. A reference needle is tracked to update the simulated lung motion during biopsy guidance. We evaluate the model by applying it for respiratory motion estimations of ten patients. The average symmetric surface distance (ASSD) and the mean target registration error (TRE) are employed to evaluate the proposed model. Results reveal that it is possible to predict the lung motion with ASSD of [Formula: see text] mm and a mean TRE of [Formula: see text] mm at largest over the entire respiratory cycle. In the CT-/electromagnetic-guided biopsy experiment, the whole process was assisted by our BEM model and final puncture errors in two studies were 3.1 and 2.0 mm, respectively. The experiment results reveal that both the accuracy of simulation and real-time performance meet the demands of clinical biopsy guidance.

  19. CT-guided percutaneous transthoracic aspiration biopsy of lung lesions: factors influencing the diagnostic accuracy

    International Nuclear Information System (INIS)

    Huang Zhenguo; Zhang Xuezhe; Wang Wu

    2006-01-01

    Objective: To investigate the factors influencing the diagnostic accuracy in CT-guided percutaneous transthoracic aspiration biopsy of lung lesions. Methods: CT-guided percutaneous transthoracic biopsy was performed in 435 patients with surgical pathologic confirmation or clinical follow-up. Univariant statistical analysis and multivariant stepwise Logistic regression analysis were used to study the influence of lesion-related factors (benignancy or malignancy, size, location, depth, presence of cavity), procedure factors (laser-guidance, position of patient) and patient-related factors (sex, age, presence of emphysema); with the accuracy of the diagnosis. Results: 1)289 lesions were diagnosed as malignant ones and 146 as benign ones. The accuracy of CT-guided biopsy was 83.4%(363/435). Univariant analysis showed that the diagnostic accuracies for malignant and benign lesions were 88.9%(257/289) and 72.6%(106/146), respectively (χ 2 =18.71, P=0.00002). Laser-group was superior to non-laser group (88.4% versus 80.9%, respectively, χ 2 =4.00, P=0.0456). Mean diameters of lesions in correct diagnostic group and non-correct diagnostic group were 3.78±1.64 cm and 3.02±1.26 cm, respectively (F=13.79, P=0.0002). 2)Multivariant stepwise Logistic regression analysis showed that among the various factors influencing the final benign or malignant diagnoses (Wald χ 2 =14.01, P=0.0002) and using laser-guidance(Wald χ 2 =3.92, P=0.0477) were significantly associated with the diagnostic accuracy. Conclusions: Final correct diagnoses (benign, malignant) are closely related to the application of laser-guidance for determining the diagnostic accuracy in CT-guided transcutaneous thoracic needle aspiration biopsy. (authors)

  20. Design and validation of a CT-guided robotic system for lung cancer brachytherapy.

    Science.gov (United States)

    Dou, Huaisu; Jiang, Shan; Yang, Zhiyong; Sun, Luqing; Ma, Xiaodong; Huo, Bin

    2017-09-01

    Currently, lung brachytherapy in clinical setting is a complex procedure. Operation accuracy depends on accurate positioning of the template; however, it is difficult to guarantee the positioning accuracy manually. Application of robotic-assisted systems can simplify the procedure and improve the manual positioning accuracy. Therefore, a novel CT-guided robotic system was developed to assist the lung cancer brachytherapy. A four degree-of-freedom (DOF) robot, controlled by a lung brachytherapy treatment planning system (TPS) software, was designed and manufactured to assist the template positioning. Target position of the template can be obtained from the treatment plan, thus the robot is driven to the target position automatically. The robotic system was validated in both the laboratory and the CT environment. In laboratory environment, a 3D laser tracker and an inertial measurement unit (IMU) were used to measure the mechanical accuracy in air, which includes positioning accuracy and position repeatability. Working reliability was also validated in this procedure by observing the response reliability and calculating the position repeatability. Imaging artifacts and accuracy of the robot registration were validated in the CT environment by using an artificial phantom with fiducial markers. CT images were obtained and used to test the image artifact and calculate the registration accuracy. Phantom experiments were conducted to test the accuracy of needle insertion by using a transparent hydrogel phantom with a high imitation artificial phantom. Also, the efficiency was validated in this procedure by comparing time costs in manual positioning with robotic positioning under the same experimental conditions. The robotic system achieved the positioning accuracy of 0.28 ± 0.25 mm and the position repeatability of 0.09 ± 0.11 mm. Experimental results showed that the robot was CT-compatible and responded reliably to the control commands. The mean registration accuracy

  1. Efficacy of an opposite position aspiration on resolution of pneumothorax following CT-guided lung biopsy

    Science.gov (United States)

    Zeng, L-C; Du, Y; Yang, H-F; Xie, M-G; Liao, H-Q; Zhang, Y-D; Li, L; Wang, Q; Hu, L

    2015-01-01

    Objective: To evaluate the efficacy of aspiration in an opposite position to deal with pneumothorax after CT-guided lung biopsy. Methods: A retrospective study was developed involving 210 patients with pneumothorax who had undergone CT-guided percutaneous core biopsies from January 2012 to March 2014 for various pulmonary lesions. Asymptomatic patients with minimal pneumothorax were treated conservatively. Simple manual aspiration was performed for symptomatic patients with minimal pneumothorax and for all patients with moderate to large pneumothorax. An opposite position aspiration was performed when simple manual aspiration failed. The efficacy of simple manual aspiration and the opposite position aspiration was observed. Results: Among 210 patients with pneumothorax, 128 (61.0%) asymptomatic patients with minimal pneumothorax were treated conservatively. The remaining 82 were treated with attempted simple manual aspiration. Out of these 82 patients, simple manual aspiration was successful in 58 (70.7%, 58/82) cases. The complete and partial regression rates were 17.2% (10/58) and 82.8% (48/58), respectively. In the other 24 patients (29.3%, 24/82), simple aspiration technique was ineffective. An opposite position (from prone to supine or vice versa) was applied, and a new biopsy puncture site was chosen for reaspiration. This procedure was successful in 22 patients but not in 2 patients who had to have a chest tube insertion. The complete and partial regression rates were 25.0% (6/24) and 66.7% (16/24), respectively. Applying the new method, the total effective rate of aspiration improved significantly from 70.7% (58/82) to 97.6% (80/82). Conclusion: The opposite position aspiration can be safe, effective and minimally invasive treatment for CT-guided lung biopsy-induced pneumothorax thus reducing the use of chest tube significantly. Advances in knowledge: (1) Opposite position aspiration can elevate the success rate of aspiration significantly (from 70.7% to 97

  2. Implementation of single-breath-hold cone beam CT guided hypofraction radiotherapy for lung cancer

    International Nuclear Information System (INIS)

    Zhong, Renming; Lu, You; Wang, Jin; Zhou, Lin; Xu, Feng; Liu, Li; Zhou, Jidan; Jiang, Xiaoqin; Chen, Nianyong; Bai, Sen

    2014-01-01

    To analyze the feasibility of active breath control (ABC), the lung tumor reproducibility and the rationale for single-breath-hold cone beam CT (CBCT)-guided hypofraction radiotherapy. Single-breath-hold CBCT images were acquired using ABC in a cohort of 83 lung cancer patients (95 tumors) treated with hypofraction radiotherapy. For all alignments between the reference CT and CBCT images (including the pre-correction, post-correction and post-treatment CBCT images), the tumor reproducibility was evaluated via online manual alignment of the tumors, and the vertebral bone uncertainties were evaluated via offline manual alignment of the vertebral bones. The difference between the tumor reproducibility and the vertebral bone uncertainty represents the change in the tumor position relative to the vertebral bone. The relative tumor positions along the coronal, sagittal and transverse axes were measured based on the reference CT image. The correlations between the vertebral bone uncertainty, the relative tumor position, the total treatment time and the tumor reproducibility were evaluated using the Pearson correlations. Pre-correction, the systematic/random errors of tumor reproducibility were 4.5/2.6 (medial-lateral, ML), 5.1/4.8 (cranial-caudal, CC) and 4.0/3.6 mm (anterior-posterior, AP). These errors were significantly decreased to within 3 mm, both post-correction and post-treatment. The corresponding PTV margins were 4.7 (ML), 7.4 (CC) and 5.4 (AP) mm. The changes in the tumor position relative to the vertebral bone displayed systematic/random errors of 2.2/2.0 (ML), 4.1/4.4 (CC) and 3.1/3.3 (AP) mm. The uncertainty of the vertebral bone significantly correlated to the reproducibility of the tumor position (P < 0.05), except in the CC direction post-treatment. However, no significant correlation was detected between the relative tumor position, the total treatment time and the tumor reproducibility (P > 0.05). Using ABC for single-breath-hold CBCT guidance is an

  3. Evaluation of chronic infectious interstitial pulmonary disease in children by low-dose CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Heyer, Christoph M.; Lemburg, Stefan P.; Kagel, Thomas; Nicolas, Volkmar [Ruhr-University of Bochum, Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, BG Clinics Bergmannsheil, Bochum (Germany); Mueller, Klaus-Michael [Ruhr-University of Bochum, Institute of Pathology, BG Clinics Bergmannsheil, Bochum (Germany); Nuesslein, Thomas G.; Rieger, Christian H.L. [Ruhr-University of Bochum, Pediatric Hospital, Bochum (Germany)

    2005-07-01

    Children with chronic infectious interstitial lung disease often have to undergo open lung biopsy to establish a final diagnosis. Open lung biopsy is an invasive procedure with major potential complications. Transthoracic lung biopsy (TLB) guided by computed tomography (CT) is a less-invasive well-established procedure in adults. Detailing the role of low-dose CT-guided TLB in the enhanced diagnosis of chronic lung diseases related to infection in children. A group of 11 children (age 8 months to 16 years) underwent CT-guided TLB with a 20-gauge biopsy device. All investigations were done under general anaesthesia on a multidetector CT scanner (SOMATOM Volume Zoom, Siemens, Erlangen, Germany) using a low-dose protocol (single slices, 120 kV, 20 mAs). Specimens were processed by histopathological, bacteriological, and virological techniques. All biopsies were performed without major complications; one child developed a small pneumothorax that resolved spontaneously. A diagnosis could be obtained in 10 of the 11 patients. Biopsy specimens revealed chronic interstitial alveolitis in ten patients. In five patients Chlamydia pneumoniae PCR was positive, in three Mycoplasma pneumoniae PCR was positive, and in two Cytomegalovirus PCR was positive. The average effective dose was 0.83 mSv. Low-dose CT-guided TLB can be a helpful tool in investigating chronic infectious inflammatory processes in children with minimal radiation exposure. It should be considered prior to any open surgical procedure performed for biopsy alone. In our patient group no significant complication occurred. A disadvantage of the method is that it does not allow smaller airways and vessels to be assessed. (orig.)

  4. Effects of a Multidisciplinary Approach to Improve Volume of Diagnostic Material in CT-Guided Lung Biopsies.

    Science.gov (United States)

    Ferguson, Philip E; Sales, Catherine M; Hodges, Dalton C; Sales, Elizabeth W

    2015-01-01

    Recent publications have emphasized the importance of a multidisciplinary strategy for maximum conservation and utilization of lung biopsy material for advanced testing, which may determine therapy. This paper quantifies the effect of a multidisciplinary strategy implemented to optimize and increase tissue volume in CT-guided transthoracic needle core lung biopsies. The strategy was three-pronged: (1) once there was confidence diagnostic tissue had been obtained and if safe for the patient, additional biopsy passes were performed to further increase volume of biopsy material, (2) biopsy material was placed in multiple cassettes for processing, and (3) all tissue ribbons were conserved when cutting blocks in the histology laboratory. This study quantifies the effects of strategies #1 and #2. This retrospective analysis comparing CT-guided lung biopsies from 2007 and 2012 (before and after multidisciplinary approach implementation) was performed at a single institution. Patient medical records were reviewed and main variables analyzed include biopsy sample size, radiologist, number of blocks submitted, diagnosis, and complications. The biopsy sample size measured was considered to be directly proportional to tissue volume in the block. Biopsy sample size increased 2.5 fold with the average total biopsy sample size increasing from 1.0 cm (0.9-1.1 cm) in 2007 to 2.5 cm (2.3-2.8 cm) in 2012 (Pstrategy to CT-guided lung biopsies was effective in significantly increasing tissue volume and number of blocks available for advanced diagnostic testing.

  5. CT-guided puncture

    International Nuclear Information System (INIS)

    Noeldge, G.; Richter, G.M.; Grenacher, L.; Brado, M.; Kauffmann, G.W.

    1996-01-01

    Sonographic and CT-guided punctures allow the evaluation of suspected lesions in the head, thorax, abdomen, retroperitoneum and skeletal system. The size of the lesion to be evaluated determines the size and the diameter of the puncture needle. The quantity of the material obtained will be defined by the diameter of the needle, i.e. fine-needle biopsy is more adequate for cytological than for histological evaluation. Strict adherence to the indications and contraindications for puncture and painstaking performance of the procedure go a long why towards minimizing the complications. The advantage of CT-guided puncture, in contrast to an ultrasound-guided procedure, is visualization during the puncture procedure free from overshadowing. This permits punctures of lesions located deep in the thorax or the abdomen which are overshadowed by the lungs, by air in the small or large bowel or by bone structures. Moreover, this technique yields much more information about the tissues and organs surrounding the suspected lesion. This information is much more investigator-related with ultrasoundguided puncture. Therefore, the CT-guided puncture has become mandatory in the evaluation of suspected lesions. Moreover, using the same technique, percutaneous drainage of fluids in the interpleural space, abscesses in organs, hematomas, lymphoceles and urinomas; ablation of metastases; and sympathicolysis can be carried out. CT-guided puncture thus changes from a minimally invasive diagnostic procedure to a minimally invasive therapy. (orig./MG) [de

  6. CT-guided core biopsy of malignant lung lesions: how many needle passes are needed?

    International Nuclear Information System (INIS)

    Lim, Chaehun; Han, Dae Hee; Lee, Kyo Young; Kim, Young Kyoon; Ko, Jeong Min

    2013-01-01

    The study aims to determine the number of needle pass in the CT-guided core needle biopsy (CNB) in making a diagnosis of pulmonary malignancy. A total of 434 CNB records were retrospectively reviewed. The specimen obtained from each needle pass was put in a formalin container and then labelled for separate histopathological reporting. The patients were divided into five groups according to the total number of needle passes (n=1, n=2, n=3, n=4 and n≥5). In each of the groups 2–4, it was analysed how many needle passes are required before a plateau in diagnostic yield is achieved. CNB produced 283 true-positive and 23 false-negative diagnosis of malignancy. Cumulative sensitivity significantly (P<0.05) increased between the first and second as well as the second and the third (if done) needle passes, but not between the third and fourth ones. Three coaxial needle passes might be optimal in the diagnosis of lung malignancy.

  7. Percutaneous CT-guided lung biopsy: sequential versus spiral scanning. A randomized prospective study

    International Nuclear Information System (INIS)

    Ghaye, B.; Dondelinger, R.F.; Dewe, W.

    1999-01-01

    The aim of this study was to evaluate in a prospective and randomized study spiral versus sequential scanning in the guidance of percutaneous lung biopsy. Fifty thoracic lesions occurring in 48 patients were biopsied by a senior and a junior operator. Six different time segments of the procedure were measured. Scanning mode versus length of procedure, pathological results, irradiation and complications were evaluated. Total duration of the procedure and of the first sampling was significantly longer with spiral CT for the senior operator (p < 0.004). No significant time difference was observed for the junior operator. Diameter of the lesion, depth of location, position of the patient and needle entry site did not influence the results. The sensitivity was 90.9, specificity 100, positive predictive value 100 and negative predictive value 60 % for spiral CT, and 94.7, 100, 100 and 85.7 % for sequential CT, respectively. Eleven pneumothoraces and ten perinodular hemorrhages were seen with spiral CT and six and ten, respectively, with sequential CT. The mean dose of irradiation was 4027 mAs for spiral CT and 2358 mAs for conventional CT. Spiral CT does neither reduce procedure time nor the rate of complications. Pathological results do not differ compared with sequential CT, and total dose of irradiation is higher with spiral scanning. (orig.)

  8. Percutaneous CT-guided high-dose brachytherapy (CT-HDRBT) ablation of primary and metastatic lung tumors in nonsurgical candidates; Perkutane CT-gesteuerte Hochdosis-Brachytherapie (CT-HDRBT) von primaeren und metastatischen Lungentumoren in nicht chirurgischen Kandidaten

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, F.; Schnapauff, D.; Poellinger, A.; Denecke, T.; Banzer, J.; Golenia, M.J.; Gebauer, B. [Charite - Universitatesmedizin Berlin (Germany). Inst. fuer Radiologie; Wust, P. [Charite - Universitatesmedizin Berlin (Germany). Klinik fuer Strahlentherapie

    2012-04-15

    To evaluate the safety and efficacy of CT-guided high-dose brachytherapy (CT-HDRBT) ablation of primary and metastatic lung tumors. Between November 2007 and May 2010, all consecutive patients with primary or metastatic lung tumors, unsuitable for surgery, were treated with CT-HDRBT. Imaging follow-up after treatment was performed with contrast-enhanced CT at 6 weeks, 3 months and every 6 months after the procedure. The endpoints of the study were local tumor control and time to progression. The Kaplan-Meier method was used to estimate survival functions and local tumor progression rates. 34 procedures were carried out on 33 lesions in 22 patients. The mean diameter of the tumors was 33.3 mm (SD = 20.4). The first contrast-enhanced CT showed that complete ablation was achieved in all lesions. The mean minimal tumor enclosing dose was 18.9 Gy (SD = 2). Three patients developed a pneumothorax after the procedure. The mean follow-up time was 13.7 (3 - 29) months. 2 of 32 lesions (6.25 %) developed a local tumor progression. 8 patients (36.3 %) developed a distant tumor progression. After 17.7 months, 13 patients were alive and 9 patients had died. CT-HDRBT ablation is a safe and attractive treatment option for patients with lung malignancies and allows targeted destruction of tumor tissue with simultaneous preservation of important lung structures. Furthermore, CT-HDRBT is independent of the size of the lesion and its location within the lung parenchyma. (orig.)

  9. CT-guided lung biopsy: incidence of pneumothorax after instillation of NaCl into the biopsy track

    Energy Technology Data Exchange (ETDEWEB)

    Billich, Christian; Brenner, Gerhard; Schmidt, Stefan A.; Brambs, Hans-Juergen; Pauls, Sandra [University of Ulm, Department of Diagnostic and Interventional Radiology, Ulm (Germany); Muche, Rainer [University of Ulm, Institute of Biometrics, Ulm (Germany); Krueger, Stefan [University of Ulm, Department of Internal Medicine, Ulm (Germany)

    2008-06-15

    This study was conducted to evaluate whether instillation of NaCl 0.9% solution into the biopsy track reduces the incidence of pneumothoraces after CT-guided lung biopsy. A total of 140 consecutive patients with pulmonary lesions were included in this prospective study. All patients were alternatingly assigned to one of two groups: group A in whom the puncture access was sealed by instillation of NaCl 0.9% solution during extraction of the guide needle (n = 70) or group B for whom no sealing was performed (n = 70). CT-guided biopsy was performed with a 18-G coaxial system. Localization of lesion (pleural, peripheral, central), lesion size, needle-pleural angle, rate of pneumothorax and alveolar hemorrhage were evaluated. In group A, the incidence of pneumothorax was lower compared to group B (8%, 6/70 patients vs. 34%, 24/70 patients; P < 0.001). All pneumothoraces occurred directly post punctionem after extraction of the guide needle. One patient in group A and eight patients in group B developed large pneumothoraces requiring chest tube placement (P = 0.01). The frequency of pneumothorax was independent of other variables. After CT-guided biopsy, instillation of NaCl 0.9% solution into the puncture access during extraction of the needle significantly reduces the incidence of pneumothorax. (orig.)

  10. CT-guided lung biopsy: incidence of pneumothorax after instillation of NaCl into the biopsy track

    International Nuclear Information System (INIS)

    Billich, Christian; Brenner, Gerhard; Schmidt, Stefan A.; Brambs, Hans-Juergen; Pauls, Sandra; Muche, Rainer; Krueger, Stefan

    2008-01-01

    This study was conducted to evaluate whether instillation of NaCl 0.9% solution into the biopsy track reduces the incidence of pneumothoraces after CT-guided lung biopsy. A total of 140 consecutive patients with pulmonary lesions were included in this prospective study. All patients were alternatingly assigned to one of two groups: group A in whom the puncture access was sealed by instillation of NaCl 0.9% solution during extraction of the guide needle (n 70) or group B for whom no sealing was performed (n = 70). CT-guided biopsy was performed with a 18-G coaxial system. Localization of lesion (pleural, peripheral, central), lesion size, needle-pleural angle, rate of pneumothorax and alveolar hemorrhage were evaluated. In group A, the incidence of pneumothorax was lower compared to group B (8%, 6/70 patients vs. 34%, 24/70 patients; P < 0.001). All pneumothoraces occurred directly post punctionem after extraction of the guide needle. One patient in group A and eight patients in group B developed large pneumothoraces requiring chest tube placement (P 0.01). The frequency of pneumothorax was independent of other variables. After CT-guided biopsy, instillation of NaCl 0.9% solution into the puncture access during extraction of the needle significantly reduces the incidence of pneumothorax. (orig.)

  11. CT-guided thin needles percutaneous cryoablation (PCA) in patients with primary and secondary lung tumors: A preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Division of Interventional Radiology, Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncologic Diseases, Cagliari, Zip code 09100 (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy)

    2013-05-15

    Purpose: To report the data of our initial experience with CT-guided thin cryoprobes for percutaneous cryoablation (PCA) in patients with primary and secondary pulmonary tumors. Material and methods: CT-guided thin needles PCA was performed on 34 lung masses (11 NSCLC = 32%; 23 secondary lung malignancies = 68%) in 32 consecutive patients (24 men and 8 women; mean age 67 ± 10 years) not suitable for surgical resection. Lung masses were treated using two types of cryoprobes: IceRod and IceSeed able to obtain different size of iceball. The number of probes used ranged from 1 to 5 depending on the size of the tumor. After insertion of the cryoprobes into the lesion, the PCA were performed with two 2 (91%) or 3 (9%) cycles each of 12 min of freezing followed by a 4 min active thawing phase and a 4 min passive thawing phase for each one for all treatments. Results: All cryoablation sessions were successfully completed. All primary and metastatic lung tumors were ablated. No procedure-related deaths occurred. Morbidity consisted of 21% (7 of 34) pneumothorax and 3% (1 of 34) cases asymptomatic small pulmonary hemorrhage, respectively, all of CTCAE grade 1 (Common Terminology Criteria for Adverse Events). Low density of entire lesion, central necrosis and solid mass appearance were identify in 21 (62%), 7 (21%) and 6 (17%) of cryoablated tumors, respectively. No lymphadenopathy developed in the region of treated lesions. Technical success (complete lack of enhancement) was achieved in 82%, 97% and 91% of treated lesions at 1-, 3- and 6-months CT follow-up scan, respectively (p < .000). Comparing the tumor longest diameter between the baseline and at 6 month CT images, technical success was revealed in 92% cases (p < .000). Conclusion: Our preliminary experience suggests that PCA is a feasible treatment option. Well-designed clinical trials with a larger patient population are necessary to further investigate the long-term results and prognostic factors.

  12. CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan

    International Nuclear Information System (INIS)

    Tomiyama, Noriyuki; Yasuhara, Yoshifumi; Nakajima, Yasuo; Adachi, Shuji; Arai, Yasuaki; Kusumoto, Masahiko; Eguchi, Kenji; Kuriyama, Keiko; Sakai, Fumikazu; Noguchi, Masayuki; Murata, Kiyoshi; Murayama, Sadayuki; Mochizuki, Teruhito; Mori, Kiyoshi; Yamada, Kozo

    2006-01-01

    Purpose: The aim of our study was to update the rate of severe complications following CT-guided needle biopsy in Japan via a mailed survey. Materials and methods: Postal questionnaires regarding CT-guided needle biopsy were sent out to multiple hospitals in Japan. The questions regarded: the total number and duration of CT-guided lung biopsies performed at each hospital, and the complication rates and numbers of pneumothorax, hemothorax, air embolism, tumor seeding, tension pneumothorax and other rare complications. Each severe complication was followed with additional questions. Results: Data from 9783 biopsies was collected from 124 centers. Pneumothorax was the most common complication, and occurred in 2412 (35%) of 6881 cases. A total of 39 (35%) hospitals reported 74 (0.75%) cases with severe complications. There were six cases (0.061%) with air embolism, six cases (0.061%) with tumor seeding at the site of the biopsy route, 10 cases (0.10%) with tension pneumothorax, six cases (0.061%) with severe pulmonary hemorrhage or hemoptysis, nine cases (0.092%) with hemothorax, and 27 cases (0.26%) with others, including heart arrest, shock, and respiratory arrest. From a total of 62 patients with severe complications, 54 patients (0.55%) recovered without sequela, however one patient (0.01%) recovered with hemiplegia due to cerebral infarction, and the remaining seven patients (0.07%) died. Conclusions: This is the first national study documenting severe complications with respect to CT-guided needle biopsy in Japan. The complication rate in Japan is comparable to internationally published figures. We believe this data will improve both clinicians as well as patients understanding of the risk versus benefit of CT-guided needle biopsy, resulting better decisions

  13. CT-guided percutaneous lung biopsy: Comparison of conventional CT fluoroscopy to CT fluoroscopy with electromagnetic navigation system in 60 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Grand, David Justin, E-mail: dgrand@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Atalay, Michael A., E-mail: matalay@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Cronan, John J., E-mail: cronan@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Mayo-Smith, William W., E-mail: wmayo-smith@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Dupuy, Damian E., E-mail: ddupuy@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States)

    2011-08-15

    Purpose: To determine if use of an electromagnetic navigation system (EMN) decreases radiation dose and procedure time of CT fluoroscopy guided lung biopsy in lesions smaller than 2.5 cm. Materials/methods: 86 consecutive patients with small lung masses (<2.5 cm) were approached. 60 consented and were randomized to undergo biopsy with CT fluoroscopy (CTF) (34 patients) or EMN (26 patients). Technical failure required conversion to CTF in 8/26 EMN patients; 18 patients completed biopsy with EMN. Numerous biopsy parameters were compared as described below. Results: Average fluoroscopy time using CTF was 28.2 s compared to 35.0 s for EMN (p = 0.1). Average radiation dose was 117 mGy using CTF and 123 mGy for EMN (p = 0.7). Average number of needle repositions was 3.7 for CTF and 4.4 for EMN (p = 0.4). Average procedure time was 15 min for CTF and 20 min for EMN (p = 0.01). There were 7 pneumothoracesin the CTF group and 6 pneumothoraces in the EMN group (p = 0.7). One pneumothorax in the CTF group and 3 pneumothoraces in the EMN group required chest tube placement (p = 0.1). One pneumothorax patient in each group required hospital admission. Diagnostic specimens were obtained in 31/34 patients in the CTF group and 22/26 patients in the EMN group (p = 0.4). Conclusions: EMN was not statistically different than CTF for fluoroscopy time, radiation dose, number of needle repositions, incidence of pneumothorax, need for chest tube, or diagnostic yield. Procedure time was increased with EMN.

  14. Percutaneous CT-guided biopsy for lung lesions 1 cm or smaller: the technique, results and complication

    International Nuclear Information System (INIS)

    Song, Chi Sung

    2006-01-01

    The author wanted to assess the diagnostic accuracy and safety of percutaneous biopsy for lung lesions 1 cm or smaller; the biopsies were performed on the basis of the modified coaxial technique under CT guidance. Thirty-five patients (22 men and 13 women) 23-76 years old (average age: 56.8 years) with lung lesions 1 cm or smaller underwent CT-guided percutaneous biopsy. Fifteen patients had underlying primary malignancies. After an 18 G guiding cannula was introduced to the border of the small lung lesion via the modified coaxial technique, fine-needle aspiration biopsy with 21 G needle and core tissue biopsies with 19.5 G or 20 G biopsy guns were performed through the lumen of the guiding cannula. The core tissue biopsies were finished after 6 macroscopic core tissue specimens were obtained. When the needle hit the eccentric portion of the small lung lesion, a 'fanning-out' technique with using the guiding cannula was applied to get multiple core tissue specimens from the small lung lesion. The diagnostic accuracy of this method was evaluated and the complications were reviewed. Both the cytopathologic and histopathologic specimens were obtained in all 35 cases. The fanning-out technique was necessary in 15 cases (43%) for obtaining six core tissue specimens from small lesions. The final diagnoses were 17 malignant lesions and 18 benign lesions. Sixteen lesions were true-positive, eighteen were true-negative, none was false-positive and one was false-negative. The overall diagnostic accuracy was 97%. The sensitivity for detecting malignancy and the specificity for benign lesion were 94% and 100%, respectively. The positive and negative predictive values were 100% and 95%, respectively. The diagnostic ability to characterize the specific cell type of the malignant lesion was 94% (16 of 17), that for the benign lesions was 83% (15 of 18), and overall diagnostic ability was 89% (31 of 35). Five patients (14%) developed a pneumopthorax, and one of them (3%) received

  15. CT guided biopsies as a part of the investigations in findings in the lung and thorax wall

    DEFF Research Database (Denmark)

    Vagn-Hansen, Chris Aksel; Pedersen, Malene Roland Vils; Rafaelsen, Søren Rafael

    was performed. Results: In 86 % of the biopsies, the tissue material was found sufficient. In 32 % of the biopsies there was a complication, mostly pneumothorax (30%), but in only 15 % of the 520 cases chest drainage was needed. There was one death in a known cancer patient with severe reduced lung and cardiac...... function. Patients with more than 10 cigarette pack years had a complication risk twice as high compared to patients with less pack years. We found that the risk of pneumothorax rises the further the lesion is from the skin surface, the smaller the lesions are and when the patient is biopsied in a lateral...... position. We found a higher risk of complications in females. Conclusion: CT guided biopsy is an excellent tool in the analysis of lesions in the lungs. This study clearly shows that the risk of developing a pneumothorax is significantly higher among smokers and former smokers with more than 10 pack years....

  16. Study of different registration methods for on-line kilovoltage cone-beam CT guided lung cancer radiation

    International Nuclear Information System (INIS)

    Wang Yanyang; Fu Xiaolong; Xia Bing; Wu Zhengqin; Fan Min; Yang Huanjun; Xu Zhiyong; Jiang Guoliang

    2009-01-01

    Objective: To select the optimal registration method for on-line kilovoltage cone-beam CT (KVCBCT) guided lung cancer radiation and evaluate the reproducibility of the selected method. Methods: Sixteen patients with non-small cell lung cancer were enrolled into this study. A total of 96 pretreatment KVCBCT images from the 16 patients were available for the analysis. Image registration methods were bone-based automatic registration, gray-based automatic registration, manual registration and semi-automatic registration. All registrations were accomplished by one physician. Another physician blindly evaluated the results of each registration, then selected the optimal registration method and evaluated its reproducibility. Results: The average score of the bone-based automatic registration, gray-based automatic registration, manual registration and semi-automatic registration methods was 2.4, 2.7, 3.0 and 3.7, respectively. The score of the four different groups had statistics significant difference (F=42.20, P<0.001). Using the semi-automatic registration method, the probability of the difference between two registration results more than 3 mm in the left-right, superior-inferior, and anterior-posterior directions was 0, 3% and 6% by the same physician, 0, 14% and 0 by different physicians, and 8%, 14% and 8% by physician and radiation therapist. Conclusions: Semi-automatic registration method, possessing the highest score and accepted reproducibility, is appropriate for KVCBCT guided lung cancer radiation. (authors)

  17. Use of CT-guided fine needle aspiration biopsy in epidermal growth factor receptor mutation analysis in patients with advanced lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Yi-Ping; Wang, Hai-Yan; Zhang, Jin; Feng, Yong (Dept. of Radiology, Jiangsu Cancer Inst. and Hospital, Nanjing, Jiangsu (China)), email: yipingzhuang2010@sina.com; Shi, Mei-Qi (Dept. of Chemotherapy, Jiangsu Cancer Inst. and Hospital, Nanjing, Jiangsu (China))

    2011-12-15

    Background. The safety of using a cutting needle when performing a core-needle biopsy is of major concern, in particular for small lung tumors or tumors near the hilum. Purpose. To investigate the usefulness of CT-guided fine needle aspiration biopsy (FNAB) of the lung in obtaining tumor tissue for epidermal growth factor receptor (EGFR) mutation analysis in advanced lung cancer patients. Material and Methods. Forty-three patients with stage IIIB-IV lung cancer were enrolled. In all patients, CT-guided FNAB was performed using an 18-gauge or 20-gauge Chiba aspiration needle for histology diagnosis and EGFR mutation analysis. Complications associated with CT-guided FNAB were observed, and the specimen mutational assessments were recorded. Results. The obtained tumor samples ranged from 0.5-1.5 cm in length and were adequate for histological and DNA analyses in all patients. No patient had a pneumothorax or hemoptysis. Minor needle tract bleeding appeared in eight patients. Mutation analysis was satisfactorily demonstrated in 23 mutations and 20 non-mutations. Ten and 13 mutations were identified by 18-gauge and 20-gauge needle biopsies, respectively. EFGR mutations, including 12 cases of EGFR exon 19 deletion and 11 cases of exon 21 point mutation, were present in 21 patients with adenocarcinomas, one with squamous cell carcinoma, and one with undifferentiated carcinoma. Conclusion. CT-guided FNAB is a feasible and safe technique for obtaining lung tumor tissues for EGFR gene mutation analysis

  18. Feasibility study of image guided radiotherapy for lung tumor using online and offline cone-beam CT setup verification

    International Nuclear Information System (INIS)

    Li Hongsheng; Li Baosheng; Lu Jie; Yin Yong; Yu Ningsha; Chen Yiru

    2009-01-01

    Objective: To investigate the feasibility of online and offline cone-beam CT(CBCT) guided radiotherapy for lung cancer. Methods: Fourteen patients with lung tumor treated by three-dimensional conformal radiotherapy were investigated. Online kV CBCT scan, image registration and setup correction were performed before and immediately after radiotherapy. CBCT online-guided correction data were used to calculate the population-based CTV-PTV margins under the condition of non-correction and correction in every fraction respectively. The numbers of initial images and the population-based CTV-PTV margins after the offline compensation of the system setup error were evaluated with the permission of 0.5 mm and 1.5 mm maximal residue error, respectively. Results: Under the condition of non-correction, the required margins for total error were 5.7 mm, 8.0 mm and 7.8 mm in the left-right (x axis), cranio-caudal (y axis) and anterior-posterior(z axis) directions, respectively. When the tumor was corrected in every fraction, the required margins for intra-fraction error were 2.4 mm, 2.4 mm and 2.3 mm in x,y and z axes, respectively. To correct the systematic setup error, 9 sets of CBCT images for 3.3 mm, 3.7 mm and 3.6 mm PTV margins, and 7 sets of CBCT images for 3.9 mm, 4.3 mm and 4.3 mm PTV margins in x,y and z axes were necessary when 0.5 mm and 1.5 mm maximal residue error were permitted respectively. Conclusions: Both of the online CBCT correction and the offline adaptive correction can markedly reduce the impact of setup error and reduce the required PTV margins accordingly. It is feasible to deliver the online and offline image guided radiation for patients with lung tumor. (authors)

  19. Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method.

    Science.gov (United States)

    Kakizawa, Hideaki; Toyota, Naoyuki; Hieda, Masashi; Hirai, Nobuhiko; Tachikake, Toshihiro; Matsuura, Noriaki; Oda, Miyo; Ito, Katsuhide

    2010-09-01

    The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: "none", "mild", "moderate" and "severe". The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p < 0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax.

  20. Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method

    International Nuclear Information System (INIS)

    Kakizawa, Hideaki; Hieda, Masashi; Oda, Miyo; Toyota, Naoyuki; Hirai, Nobuhiko; Tachikake, Toshihiro; Matsuura, Noriaki; Ito, Katsuhide

    2010-01-01

    The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: 'none', 'mild', 'moderate' and 'severe'. The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p<0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax. (author)

  1. Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique

    International Nuclear Information System (INIS)

    Anzidei, Michele; Argiro, Renato; Porfiri, Andrea; Boni, Fabrizio; Zaccagna, Fulvio; Napoli, Alessandro; Leonardi, Andrea; Bezzi, Mario; Catalano, Carlo; Anile, Marco; Venuta, Federico; Vitolo, Domenico; Saba, Luca; Longo, Flavia

    2015-01-01

    Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique. One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A (robot-assisted procedure) or group B (conventional procedure). Size, distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups. Procedure duration, dose length product (DLP), precision of needle positioning, diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique. All biopsies were successfully performed. The size (p = 0.41), distance from entry point (p = 0.86) and position in lung (p = 0.32) of target lesions were similar in both groups (p = 0.05). Procedure duration and radiation dose were significantly reduced in group A as compared to group B (p = 0.001). Precision of needle positioning, diagnostic performance of the biopsy and rate of complications were similar in both groups (p = 0.05). Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy, reducing procedure duration and radiation dose in comparison to the conventional manual technique. (orig.)

  2. Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique

    Energy Technology Data Exchange (ETDEWEB)

    Anzidei, Michele; Argiro, Renato; Porfiri, Andrea; Boni, Fabrizio; Zaccagna, Fulvio; Napoli, Alessandro; Leonardi, Andrea; Bezzi, Mario; Catalano, Carlo [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Radiology - Sapienza, Rome (Italy); Anile, Marco; Venuta, Federico [University of Rome, Department of Thoracic Surgery - Sapienza, Rome (Italy); Vitolo, Domenico [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Pathology - Sapienza, Rome (Italy); Saba, Luca [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Monserrato (Italy); Longo, Flavia [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Oncology - Sapienza, Rome (Italy)

    2015-05-01

    Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique. One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A (robot-assisted procedure) or group B (conventional procedure). Size, distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups. Procedure duration, dose length product (DLP), precision of needle positioning, diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique. All biopsies were successfully performed. The size (p = 0.41), distance from entry point (p = 0.86) and position in lung (p = 0.32) of target lesions were similar in both groups (p = 0.05). Procedure duration and radiation dose were significantly reduced in group A as compared to group B (p = 0.001). Precision of needle positioning, diagnostic performance of the biopsy and rate of complications were similar in both groups (p = 0.05). Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy, reducing procedure duration and radiation dose in comparison to the conventional manual technique. (orig.)

  3. Cone-beam CT-guided radiotherapy in the management of lung cancer. Diagnostic and therapeutic value

    Energy Technology Data Exchange (ETDEWEB)

    Elsayad, Khaled; Kriz, Jan; Reinartz, Gabriele; Scobioala, Sergiu; Ernst, Iris; Haverkamp, Uwe; Eich, Hans Theodor [University Hospital of Muenster, Department of Radiation Oncology, Muenster (Germany)

    2016-02-15

    Recent studies have demonstrated an increase in the necessity of adaptive planning over the course of lung cancer radiation therapy (RT) treatment. In this study, we evaluated intrathoracic changes detected by cone-beam CT (CBCT) in lung cancer patients during RT. A total of 71 lung cancer patients treated with fractionated CBCT-guided RT were evaluated. Intrathoracic changes and plan adaptation priority (AP) scores were compared between small cell lung cancer (SCLC, n = 13) and non-small cell lung cancer (NSCLC, n = 58) patients. The median cumulative radiation dose administered was 54 Gy (range 30-72 Gy) and the median fraction dose was 1.8 Gy (range 1.8-3.0 Gy). All patients were subjected to a CBCT scan at least weekly (range 1-5/week). We observed intrathoracic changes in 83 % of the patients over the course of RT [58 % (41/71) regression, 17 % (12/71) progression, 20 % (14/71) atelectasis, 25 % (18/71) pleural effusion, 13 % (9/71) infiltrative changes, and 10 % (7/71) anatomical shift]. Nearly half, 45 % (32/71), of the patients had one intrathoracic soft tissue change, 22.5 % (16/71) had two, and three or more changes were observed in 15.5 % (11/71) of the patients. Plan modifications were performed in 60 % (43/71) of the patients. Visual volume reduction did correlate with the number of CBCT scans acquired (r = 0.313, p = 0.046) and with the timing of chemotherapy administration (r = 0.385, p = 0.013). Weekly CBCT monitoring provides an adaptation advantage in patients with lung cancer. In this study, the monitoring allowed for plan adaptations due to tumor volume changes and to other anatomical changes. (orig.) [German] Neuere Studien haben eine zunehmende Notwendigkeit der adaptiven Bestrahlungsplanung im Verlauf der Bestrahlungsserie bei Patienten mit Lungenkrebs nachgewiesen. In der vorliegenden Studie haben wir intrathorakale Aenderungen mittels Cone-beam-CT (CBCT) bei Lungenkrebspatienten waehrend der Radiotherapie (RT) analysiert. Analysiert wurden

  4. Diagnostic feasibility and safety of CT-guided core biopsy for lung nodules less than or equal to 8 mm. A single-institution experience

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ying-Yueh [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); Chen, Chun-Ku [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); National Yang-Ming University, School of Medicine, Taipei (China); National Yang-Ming University, Institute of Clinical Medicine, Taipei (China); Yeh, Yi-Chen [National Yang-Ming University, School of Medicine, Taipei (China); Taipei Veterans General Hospital, Department of Pathology and Laboratory Medicine, Taipei (China); Wu, Mei-Han [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); National Yang-Ming University, School of Medicine, Taipei (China)

    2018-02-15

    This retrospective study evaluated the diagnostic yield and safety of CT-guided core biopsy of pulmonary nodules ≤8 mm. We determined the diagnostic yield and safety profile of CT-guided lung biopsies for 125 pulmonary nodules ≤8 mm. Pathological diagnoses were made by a combination of histopathological examination and imprint cytology. Results were compared with biopsy results for 134 pulmonary nodules >8 and ≤10 mm. Final diagnoses were established in 94 nodules ≤8 mm. The sensitivity, specificity and diagnostic accuracy of CT-guided core biopsy for nodules ≤8 mm were 87.1 % (61/70 nodules), 100 % (24/24) and 90.4 % (85/94), respectively. Diagnostic failure rates were comparable for nodules ≤8 mm and nodules >8 mm and ≤10 mm (9/94, 9.6 % and 7/111, 6.3 %, respectively, P=0.385). The rate of tube thoracostomy for nodules ≤8 mm was comparable to that for nodules >8 and ≤10 mm (1.6 % vs. 0.7 %, P=0.611). Nodules ≤6 mm had a higher non-diagnostic result rate of 15.4 % (6/39) than did nodules >8 and ≤10 mm (3.7 %, 5/134, P=0.017). CT-guided pulmonary biopsy is feasible for lung nodules ≤8 mm, especially those >6 mm, and has an acceptable diagnostic yield and safety profile. (orig.)

  5. CT-guided needle biopsy in the diagnosis of lung adenocarcinoma accompanied by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue: a rare combination.

    Science.gov (United States)

    Tian, Panwen; Wang, Ye; Wan, Chun; Shen, Yongchun; Wen, Fuqiang

    2015-01-01

    We represent a rare case of lung adenocarcinoma accompanied by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). The patient was a 66-year-old male presented with 1 month history of recurrent cough and hemoptysis. Chest CT showed solitary ground-glass opacity (GGO) in the upper lobe of the right lung and mediastinal lymph node enlargement in station 3p. A CT-guided transthoracic needle biopsy was performed. Tissue specimens of the GGO revealed a typical adenocarcinoma. Histopathologic diagnosis of mediastinal lymph node was extranodal marginal zone lymphoma of MALT. Because of its rarity, extranodal marginal zone lymphoma of MALT should be considered in the differential diagnosis when we encounter mediastinal lymphadenopathy in patients with lung adenocarcinoma.

  6. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Min, Lingfeng; Xu, Xingxiang [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Song, Yong [Jinling Hospital, Nanjing University School of Medical, Nanjing 210002, Jiangsu (China); Issahar, Ben-Dov [Pulmonary Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel); Wu, Jingtao; Zhang, Le; Huang, Qian [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Chen, Mingxiang, E-mail: chenmx1129@126.com [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China)

    2013-01-15

    Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. Materials and methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique. Results: A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver. Conclusion: Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.

  7. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

    International Nuclear Information System (INIS)

    Min, Lingfeng; Xu, Xingxiang; Song, Yong; Issahar, Ben-Dov; Wu, Jingtao; Zhang, Le; Huang, Qian; Chen, Mingxiang

    2013-01-01

    Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. Materials and methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique. Results: A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver. Conclusion: Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study

  8. Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ia non-small cell lung cancer: A retrospective cohort study.

    Science.gov (United States)

    Huang, Bing-Yang; Li, Xin-Min; Song, Xiao-Yong; Zhou, Jun-Jun; Shao, Zhuang; Yu, Zhi-Qi; Lin, Yi; Guo, Xin-Yu; Liu, Da-Jiang; Li, Lu

    2018-05-01

    This study was performed to retrospectively evaluate the 10-year overall survival (OS), progression-free survival (PFS), and local control rates of patients with inoperable stage Ia non-small cell lung cancer (NSCLC) who underwent computed tomography (CT)-guided radiofrequency ablation (RFA) in a single center. Fifty patients with inoperable NSCLC underwent RFA between 2004 and 2016. Thoracic surgeons evaluated the patients and performed RFA under CT guidance. Follow-up CT and positron emission tomography/CT scans were obtained. Local control rates and recurrence patterns were analyzed. Seventy-three lesions in 50 patients (M:F = 22:28; median age: 73 years; range: 52-82 years) were treated with CT-guided RFA. The mean lesion size was 2.2 cm (range: 1-3 cm). No procedure-related deaths occurred. Low-grade fever was the most common post-ablation complication, with an incidence rate of 36%. The 1-, 2-, 3-, 5-, and 10-year OS rates of patients with Ia NSCLC were 96.0%, 86.5%, 67.1%, 36.3%, and 1%, respectively, and the 1-, 2-, 3-, and 5-year PFS rates were 94.0%, 77.5%, 43.5%, and 10.8%, respectively. The most common pattern of recurrence was local, and 15 patients with recurrence were treated with repeat RFA. Tumor size Ia NSCLC. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Influence able and Avoidable Risk Factors for Systemic Air Embolism due to Percutaneous CT-Guided Lung Biopsy: Patient Positioning and Coaxial Biopsy Technique-Case Report, Systematic Literature Review, and a Technical Note

    International Nuclear Information System (INIS)

    Rott, G.; Boecker, F.

    2014-01-01

    Following the first case of a systemic air embolism due to percutaneous CT-guided lung biopsy in our clinic we analysed the literature regarding this matter in view of influence able or avoidable risk factors. A systematic review of literature reporting cases of systemic air embolism due to CT-guided lung biopsy was performed to find out whether prone positioning might be a risk factor regarding this issue. In addition, a technical note concerning coaxial biopsy practice is presented. Prone position seems to have relevance for the development and/or clinical manifestation of air embolism due to CT-guided lung biopsy and should be considered a risk factor, at least as far as lesions in the lower parts of the lung are concerned. Biopsies of small or cavitary lesions in coaxial technique should be performed using a hemo static valve.

  10. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions.

    Science.gov (United States)

    Mills, M; Choi, J; El-Haddad, G; Sweeney, J; Biebel, B; Robinson, L; Antonia, S; Kumar, A; Kis, B

    2017-12-01

    To investigate the technical success rate and procedure-related complications of computed tomography (CT)-guided needle biopsy of lung lesions and to identify the factors that are correlated with the occurrence of procedure-related complications. This was a single- institution retrospective study of 867 consecutive CT-guided needle biopsies of lung lesions performed on 772 patients in a tertiary cancer centre. The technical success rate and complications were correlated with patient, lung lesion, and procedure-related variables. The technical success rate was 87.2% and the mortality rate was 0.12%. Of the 867 total biopsies 25.7% were associated with pneumothorax, and 6.5% required chest tube drainage. The haemothorax rate was 1.8%. There was positive correlation between the development of pneumothorax and smaller lesion diameter (ptechnical success and a low rate of major complications. The present study has revealed several variables that can be used to identify high-risk procedures. A post-procedural chest X-ray within hours after the procedure is highly recommended to identify high-risk patients who require chest tube placement. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  11. Radiation exposure in CT-guided interventions

    Energy Technology Data Exchange (ETDEWEB)

    Kloeckner, Roman, E-mail: Roman.Kloeckner@unimedizin-mainz.de [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany); Santos, Daniel Pinto dos; Schneider, Jens [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany); Kara, Levent [Department of Radiology, Inselspital Bern, Freiburgstraße 18, 3010 Bern (Switzerland); Dueber, Christoph; Pitton, Michael B. [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany)

    2013-12-01

    Purpose: To investigate radiation exposure in computed tomography (CT)-guided interventions, to establish reference levels for exposure, and to discuss strategies for dose reduction. Materials and methods: We analyzed 1576 consecutive CT-guided procedures in 1284 patients performed over 4.5 years, including drainage placements; biopsies of different organs; radiofrequency and microwave ablations (RFA/MWA) of liver, bone, and lung tumors; pain blockages, and vertebroplasties. Data were analyzed with respect to scanner settings, overall radiation doses, and individual doses of planning CT series, CT intervention, and control CT series. Results: Eighy-five percent of the total radiation dose was applied during the pre- and post-interventional CT series, leaving only 15% applied by the CT-guided intervention itself. Single slice acquisition was associated with lower doses than continuous CT-fluoroscopy (37 mGy cm vs. 153 mGy cm, p < 0.001). The third quartile of radiation doses varied considerably for different interventions. The highest doses were observed in complex interventions like RFA/MWA of the liver, followed by vertebroplasty and RFA/MWA of the lung. Conclusions: This paper suggests preliminary reference levels for various intervention types and discusses strategies for dose reduction. A multicenter registry of radiation exposure including a broader spectrum of scanners and intervention types is needed to develop definitive reference levels.

  12. PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Wei; Hao, Bing; Chen, Hao-jun; Zhao, Long; Luo, Zuo-ming; Wu, Hua; Sun, Long [The First Affiliated Hospital of Xiamen University, Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, Xiamen (China)

    2017-01-15

    {sup 18}F-FDG PET/CT should be performed before a diagnostic biopsy site is chosen in patients with a high clinical suspicion of aggressive, advanced tumour. The aim of this study was to evaluate the safety and efficacy of {sup 18}F-FDG PET/CT in guiding biopsy of bone metastases in patients with advanced lung cancer. PET/CT-guided percutaneous core biopsies were performed in 51 consecutive patients with suspected lung cancer and {sup 18}F-FDG-avid bone lesions after whole-body {sup 18}F-FDG PET/CT scans. Generally, one tissue sample was obtained from each patient. The final diagnoses were established on the basis of the histology results. The histopathological and molecular testing results were systematically evaluated. A total of 53 samples were obtained for histological examination or molecular testing as a second biopsy was required in two patients in whom the pathological diagnosis was unclear following the first biopsy. The pathological diagnosis and lung cancer classification were confirmed in 48 patients. The epidermal growth factor receptor mutation status was determined in 23 biopsies, and the mutation rate was 30.4 % (7/23). The anaplastic lymphoma kinase mutation status was determined in 19 biopsies, and the mutation rate was 31.6 % (6/19). Two of the 51 biopsies were positive for non-Hodgkin's lymphoma and one was positive for metastatic renal cell carcinoma. The first-time diagnostic success rate of biopsy was 96.1 % (49/51) and the overall diagnostic success rate and sensitivity were 100 %. All 51 patients were eventually confirmed as having stage IV disease. No serious complications were encountered and the average biopsy time was 30 min. PET/CT-guided percutaneous biopsy of {sup 18}F-FDG-avid bone metastases is an effective and safe method that yields a high diagnostic success rate in the evaluation of hypermetabolic bone lesions in patients with suspected advanced lung cancer. (orig.)

  13. Image-Guided Radiotherapy via Daily Online Cone-Beam CT Substantially Reduces Margin Requirements for Stereotactic Lung Radiotherapy

    International Nuclear Information System (INIS)

    Grills, Inga S.; Hugo, Geoffrey; Kestin, Larry L.; Galerani, Ana Paula; Chao, K. Kenneth; Wloch, Jennifer; Yan Di

    2008-01-01

    Purpose: To determine treatment accuracy and margins for stereotactic lung radiotherapy with and without cone-beam CT (CBCT) image guidance. Methods and Materials: Acquired for the study were 308 CBCT of 24 patients with solitary peripheral lung tumors treated with stereotactic radiotherapy. Patients were immobilized in a stereotactic body frame (SBF) or alpha-cradle and treated with image guidance using daily CBCT. Four (T1) or five (T2/metastatic) 12-Gy fractions were prescribed to the planning target volume (PTV) edge. The PTV margin was ≥5 mm depending on a pretreatment estimate of tumor excursion. Initial daily setup was according to SBF coordinates or tattoos for alpha-cradle cases. A CBCT was performed and registered to the planning CT using soft tissue registration of the target. The initial setup error/precorrection position, was recorded for the superior-inferior, anterior-posterior, and medial-lateral directions. The couch was adjusted to correct the tumor positional error. A second CBCT verified tumor position after correction. Patients were treated in the corrected position after the residual errors were ≤2 mm. A final CBCT after treatment assessed intrafraction tumor displacement. Results: The precorrection systematic (Σ) and random errors (σ) for the population ranged from 2-3 mm for SBF and 2-6 mm for alpha-cradle patients; postcorrection errors ranged from 0.4-1.0 mm. Calculated population margins were 9 to 13 mm (SBF) and 10-14 mm (cradle) precorrection, 1-2 mm (SBF), and 2-3 mm (cradle) postcorrection, and 2-4 mm (SBF) and 2-5 mm (cradle) posttreatment. Conclusions: Setup for stereotactic lung radiotherapy using a SBF or alpha-cradle alone is suboptimal. CBCT image guidance significantly improves target positioning and substantially reduces required target margins and normal tissue irradiation

  14. Study of percutaneous 125I seeds implantation guided by CT in elderly patients of stage I peripheral non-small cell lung cancer

    International Nuclear Information System (INIS)

    Ke Mingyao; Yong Yazhi; Luo Bingqing; Wu Xuemei; Chen Lingling; Xie Hongqi

    2011-01-01

    Objective: To evaluate the efficacy, feasibility and safety of CT guided percutaneous 125 I seeds implantation in elderly patients of stage I peripheral non-small cell lung cancer (NSCLC). Methods: Clinical data of 16 elderly peripheral stage I NSCLC patients (10 squamous carcinoma and 6 adenocarcinoma; 13 stage I A and 3 stage I B ) who received radioactive 125 I seeds implantation because of refusal or being unsuited to operation or external radiotherapy were retrospectively analyzed. Prescribed dose was 140 - 160 Gy. Under CT guidance, 125 I seeds were implanted percutaneously into tumors for interstitial radiotherapy according to treatment plan system. Results: Mean number of 125 I seeds each patient received was 21.1. 12 complete response (CR) and 4 partial response (PR) were achieved. Total response rate (CR + PR) was 100%. 100% patients completed 10 to 56 months of follow-up, 15, 13, 8 and 6 patients completed 1-, 2-, 3-and 4-years' follow-up, respectively. The median local progression free time was 14 months. The 1-, 2-, 3-and 4-year overall survival rate were 60%, 54%, 50% and 33%, respectively (median : 14 months). 7 cases died of non-tumor disease and 5 died of metastasis. No severe complications were observed. Conclusions: CT guided 125 I seeds implantation is a safe, reliable and effective radical treatment method for elderly stage I peripheral NSCLC patients, who refuse to or are unsuitable to operation or external radiotherapy. (authors)

  15. Fast kilovoltage/megavoltage (kVMV) breathhold cone-beam CT for image-guided radiotherapy of lung cancer

    International Nuclear Information System (INIS)

    Wertz, Hansjoerg; Stsepankou, Dzmitry; Blessing, Manuel; Boda-Heggemann, Judit; Hesser, Juergen; Lohr, Frank; Wenz, Frederik; Rossi, Michael; Gros, Uwe; Knox, Chris; Brown, Kevin; Walter, Cornelia

    2010-01-01

    Long image acquisition times of 60-120 s for cone-beam CT (CBCT) limit the number of patients with lung cancer who can undergo volume image guidance under breathhold. We developed a low-dose dual-energy kilovoltage-megavoltage-cone-beam CT (kVMV-CBCT) based on a clinical treatment unit reducing imaging time to ≤15 s. Simultaneous kVMV-imaging was achieved by dedicated synchronization hardware controlling the output of the linear accelerator (linac) based on detector panel readout signals, preventing imaging artifacts from interference of the linac's MV-irradiation and panel readouts. Optimization was performed to minimize the imaging dose. Single MV-projections, reconstructed MV-CBCT images and images of simultaneous 90 0 kV- and 90 0 MV-CBCT (180 0 kVMV-CBCT) were acquired with different parameters. Image quality and imaging dose were evaluated and compared to kV-imaging. Hardware-based kVMV synchronization resulted in artifact-free projections. A combined 180 0 kVMV-CBCT scan with a total MV-dose of 5 monitor units was acquired in 15 s and with sufficient image quality. The resolution was 5-6 line pairs cm -1 (Catphan phantom). The combined kVMV-scan dose was equivalent to a kV-radiation scan dose of ∼33 mGy. kVMV-CBCT based on a standard linac is promising and can provide ultra-fast online volume image guidance with low imaging dose and sufficient image quality for fast and accurate patient positioning for patients with lung cancer under breathhold.

  16. Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients

    Energy Technology Data Exchange (ETDEWEB)

    Nour-Eldin, Nour-Eldin A., E-mail: nour410@hotmail.com [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Diagnostic and Interventional Radiology Department, Cairo University Hospital, Cairo (Egypt); Alsubhi, Mohammed [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Naguib, Nagy N. [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Diagnostic and Interventional Radiology Department, Alexandria University Hospital, Alexandria (Egypt); Lehnert, Thomas; Emam, Ahmed; Beeres, Martin; Bodelle, Boris; Koitka, Karen; Vogl, Thomas J.; Jacobi, Volkmar [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany)

    2014-10-15

    Purpose: To evaluate the risk factors involved in the development of pulmonary hemorrhage complicating CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques. Materials and methods: Retrospective study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD: 5.2) from November 2008 to June 2013. Patients were classified according to lung biopsy technique in coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were: lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension or refusal of the procedure. Risk factors for pulmonary hemorrhage complicating lung biopsy were classified into: (a) patient's related risk factors, (b) lesion's related risk factors and (d) technical risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher's exact tests for statistical analysis. p values <0.05 were considered statistically significant. Results: Incidence of pulmonary hemorrhage was 19.6% (65/332) in non-coaxial group and 22.3% (71/318) in coaxial group. The difference in incidence between both groups was statistically insignificant (p = 0.27). Hemoptysis developed in 5.4% (18/332) and in 6.3% (20/318) in the non-coaxial and coaxial groups respectively. Traversing pulmonary vessels in the needle biopsy track was a significant risk factor of the development pulmonary hemorrhage (incidence: 55.4% (36/65, p = 0.0003) in the non-coaxial group and 57.7% (41/71, p = 0.0013) in coaxial group). Other significant risk factors included: lesions of less than 2 cm (p value of 0.01 and 0.02 in non-coaxial and coaxial groups respectively), basal and middle zonal lesions in comparison to upper zonal lung lesions (p = 0.002 and 0.03 in non-coaxial and coaxial groups respectively), increased lesion

  17. Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients

    International Nuclear Information System (INIS)

    Nour-Eldin, Nour-Eldin A.; Alsubhi, Mohammed; Naguib, Nagy N.; Lehnert, Thomas; Emam, Ahmed; Beeres, Martin; Bodelle, Boris; Koitka, Karen; Vogl, Thomas J.; Jacobi, Volkmar

    2014-01-01

    Purpose: To evaluate the risk factors involved in the development of pulmonary hemorrhage complicating CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques. Materials and methods: Retrospective study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD: 5.2) from November 2008 to June 2013. Patients were classified according to lung biopsy technique in coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were: lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension or refusal of the procedure. Risk factors for pulmonary hemorrhage complicating lung biopsy were classified into: (a) patient's related risk factors, (b) lesion's related risk factors and (d) technical risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher's exact tests for statistical analysis. p values <0.05 were considered statistically significant. Results: Incidence of pulmonary hemorrhage was 19.6% (65/332) in non-coaxial group and 22.3% (71/318) in coaxial group. The difference in incidence between both groups was statistically insignificant (p = 0.27). Hemoptysis developed in 5.4% (18/332) and in 6.3% (20/318) in the non-coaxial and coaxial groups respectively. Traversing pulmonary vessels in the needle biopsy track was a significant risk factor of the development pulmonary hemorrhage (incidence: 55.4% (36/65, p = 0.0003) in the non-coaxial group and 57.7% (41/71, p = 0.0013) in coaxial group). Other significant risk factors included: lesions of less than 2 cm (p value of 0.01 and 0.02 in non-coaxial and coaxial groups respectively), basal and middle zonal lesions in comparison to upper zonal lung lesions (p = 0.002 and 0.03 in non-coaxial and coaxial groups respectively), increased lesion

  18. Inter- and intrafractional localisation errors in cone-beam CT guided stereotactic radiation therapy of tumours in the liver and lung

    International Nuclear Information System (INIS)

    Worm, Esben S.; Hansen, Anders T.; Petersen, Joergen B.; Muren, Ludvig P.; Praestegaard, Lars H.; Hoeyer, Morten

    2010-01-01

    Background. Localisation errors in cone-beam CT (CBCT) guided stereotactic body radiation therapy (SBRT) were evaluated and compared to positioning using the external coordinates of a stereotactic body frame (SBF) alone. Possible correlations to patient- or treatment-specific factors such as body mass index (BMI), planning time, treatment delivery time, and distance between tumour and spinal cord were explored to determine whether they influenced on the benefit of image-guidance. Material and methods. A total of 34 patients received SBRT (3 fractions) for tumours in the liver (15 patients) or the lung (19 patients). Immobilisation and positioning was obtained with a SBF. Pre- and post-treatment CBCT scans were registered with the bony anatomy of the planning CT to find inter- and intrafractional patient positioning errors (PPE). For lung tumour patients, matching was also performed on the tumours to find the tumour positioning errors (TPE) and baseline shifts relative to bony anatomy. Results. The mean inter- and intrafractional 3D vector PPE was 4.5 ± 2.7 mm (average ± SD) and 1.5 ± 0.6 mm, respectively, for the combined group of patients. For lung tumours, the interfractional misalignment was 5.6 ± 1.8 mm. The baseline shift was 3.9 ± 2.0 mm. Intrafractional TPE and baseline shifts were 2.1 ± 0.7 mm and 1.9 ± 0.6 mm, respectively. The magnitude of interfractional baseline shift was closely correlated with the distance between the tumour and the spinal cord. Intrafractional errors were independent of patient BMI, age or gender. Conclusion. Image-guidance reduced setup errors considerably. The study demonstrated the benefit of CBCT-guidance regardless of patient specific factors such as BMI, age or gender. Protection of the spinal cord was facilitated by the correlation between the tumour position relative to the spinal cord and the magnitude of baseline shift.

  19. Radiation protective nursing intervene of 125I seed implantation in non-small cell lung carcinoma guided by CT

    International Nuclear Information System (INIS)

    Fu Li; Zhang Zuncheng; Yu Zhaochen; Zheng Guangjun; Tian Meirong

    2009-01-01

    Objective: To research radiation protective nursing intervene and important notice of 125 I seeds minimally invasive implantation in non-small cell lung carcinoma (NSCLC) by CT. Methods: Under the system of therapy planning system (TPS) and posologic validation, 125 I seeds were implanted in 89 cases of NSCLC patients. The consistent radiation protective nursing intervene was used in perioperative period management. The operative successful rate, therapeutic effect and complication rate, therapeutic effect and complication rate was observed. Results: The scientific radiation protective nursing intervene can ensure that the radioactive dose distribution of 125 I seed implantation brachytherapy is consistent with the principles of effective and minimally invasive. The operative successful rate was 100%. The local control rate and 1 year survival rate respectively was 97.4% and 92.2%. But the early and later incidence rate of radioactive damaging effect was 14.6% and 1.1% respectively. Leakage of radioactive contamination has not occurred. Conclusion: The consistent TPS and posologic validation 125 I seeds implantation integrated scientific radiation protective nursing intervene. It is very important to improve the therapeutic effect of NSCLC and reduce the incidence of complications. (authors)

  20. CT-guided marking of pulmonary nodules with a special lung marking wire before video-assisted thoracoscopic surgery. Review of 184 cases; CT-gestuetzte Drahtmarkierung vor videoassistierter thorakoskopischer OP von pulmonalen Rundherden. Eine Auswertung von 184 Faellen

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, M.K.; Eichfeld, U.; Kahn, T.; Stumpp, P. [Universitaetsklinikum Leipzig AoeR (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie

    2012-06-15

    Purpose: Minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) are currently the method of choice for the resection of small pulmonary nodules, when they are located in the periphery of the lungs. To guarantee quick and safe intraoperative identification of the nodule, preoperative marking is necessary and sensible. We report about our experiences in 184 markings with a special lung marking wire, which is placed in or around the pulmonary nodule using CT guidance. Materials and Methods: In 184 patients (97 m, 87f, mean age: 58.1 {+-} 13.7 years) with pulmonary nodules, scheduled for resection with VATS, a special lung marking wire was placed preoperatively under CT guidance. We evaluated the technical success, safety, necessity of conversion to thoracotomy and histology in all patients. Results: The marking wire could be positioned successfully in 181 cases (98.4 %). There was one major complication (uncontrollable pneumothorax). Minor adverse events like small pneumothorax (53.3 %) or a perifocal bleeding (30.4 %) did not necessitate treatment. Complete resection of the marked nodule was successful in 98.4 % of the patients. Conversion to thoracotomy was necessary in 29 patients (15.9 %) due to bleeding, adhesions, malignancy or wire dislocation. Histology revealed a benign nodule in 96 cases (54.4 %) and a malignant lesion in 78 cases (45.6 %), of which only 21 nodules (11.5 %) turned out to present a primary pulmonary carcinoma. Conclusion: CT-guided marking of pulmonary nodules using a special marking wire followed by thoracoscopic resection is an efficient and safe method for diagnosing suspicious nodules in the periphery of the lung. (orig.)

  1. CT-guided stereotactic neurosurgery

    International Nuclear Information System (INIS)

    Takizawa, Takaaki; Sato, Shoju; Matsumoto, Akira; Sano, Akira; Takahashi, Kazunori; Murakami, Yuji; Ohta, Kosuke

    1985-01-01

    Brown-Roberts-Wells stereotactic instruments were used for CT guided stereotactic surgery in 54 cases (65 operations). Stereotactic biopsy was done in 9 cases and successive regional chemotherapy was done in 3 cases. Stereotactic drainage was done in 2 cases of bacterial abcess, 3 cases of cystic neoplasm and 33 cases (43 operations) of intracerebral hematoma. CT guided stereotactic procedure was valuable for the correct cannulation to the center of the cavity. We tried to utilize CT image for the selection of targets for stereotactic functional neurosurgical procedures in 6 cases. In the cases of thalamotomy, the information derived from CT made the operation safer than that by contrast ventriculography alone. In all cases of electrode implantation for deep brain stimulation, accurate and precise electrode placement was achieved from CT images alone. This rapid and easy surgical technique was useful also for poor risk patients. (author)

  2. Mass preserving image registration for lung CT

    DEFF Research Database (Denmark)

    Gorbunova, Vladlena; Sporring, Jon; Lo, Pechin Chien Pau

    2012-01-01

    This paper presents a mass preserving image registration algorithm for lung CT images. To account for the local change in lung tissue intensity during the breathing cycle, a tissue appearance model based on the principle of preservation of total lung mass is proposed. This model is incorporated...... on four groups of data: 44 pairs of longitudinal inspiratory chest CT scans with small difference in lung volume; 44 pairs of longitudinal inspiratory chest CT scans with large difference in lung volume; 16 pairs of expiratory and inspiratory CT scans; and 5 pairs of images extracted at end exhale and end...

  3. Major complications of high-energy microwave ablation for percutaneous CT-guided treatment of lung malignancies: single-centre experience after 4 years

    International Nuclear Information System (INIS)

    Splatt, Alexander M.; Steinke, Karin

    2015-01-01

    To evaluate the rate of major complications related to percutaneous computed tomography (CT)-guided microwave ablation (MWA) of primary and secondary lung malignancies performed at our institution over a 4-year period. From May 2010 to September 2014, 70 MWAs were performed on 51 patients. All major intra- and post-procedural complications (as defined by the classification proposed by the Society of Interventional Radiology) were retrospectively analysed. The results were correlated with a systematic review of the available literature on MWA in the lung. Major complications were encountered in 14 out of 70 ablations (20%). Twenty-one separate major complications were encountered (some ablations lead to more than one major complication). One death occurred within 30 days of ablation, though the relationship to the procedure remains uncertain. Other major complications included: nine pneumothoraces requiring drain insertion (12.9%), four cases of large effusion requiring drainage (5.7%), two cases of significant pulmonary haemorrhage altering clinical management (2.9%), two infections (2.9%), one case of mechanical failure (1.4%), one chest wall burn (1.4%) and one case of pleural seeding (1.4%). Major complications were much more likely to occur if the nodule was located within 7 mm from the pleura. MWA of pulmonary tumours carries moderate risk; nevertheless, the usually manageable complications should not deter from undertaking a potentially curative therapy for poor surgical candidates.

  4. Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Im [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Park, Chang Min; Goo, Jin Mo [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of); Seoul National University, Cancer Research Institute, Seoul (Korea, Republic of); Lee, Sang Min [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of)

    2015-07-15

    To investigate the effect of rapid needle-out patient-rollover approach on the incidence of pneumothorax and drainage catheter placement due to pneumothorax in C-arm Cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions. From May 2011 to December 2012, 1227 PTNBs were performed in 1191 patients with a 17-gauge coaxial needle. 617 biopsies were performed without (conventional-group) and 610 with rapid-rollover approach (rapid-rollover-group). Overall pneumothorax rates and incidences of pneumothorax requiring drainage catheter placement were compared between two groups. There were no significant differences in overall pneumothorax rates between conventional and rapid-rollover groups (19.8 % vs. 23.1 %, p = 0.164). However, pneumothorax rate requiring drainage catheter placement was significantly lower in rapid-rollover-group (1.6 %) than conventional-group (4.2 %) (p = 0.010). Multivariate analysis revealed male, age > 60, bulla crossed, fissure crossed, pleura to target distance > 1.3 cm, emphysema along needle tract, and pleural punctures ≥ 2 were significant risk factors of pneumothorax (p < 0.05). Regarding pneumothorax requiring drainage catheter placement, fissure crossed, bulla crossed, and emphysema along needle tract were significant risk factors (p < 0.05), whereas rapid-rollover approach was an independent protective factor (p = 0.002). The rapid needle-out patient-rollover approach significantly reduced the rate of pneumothorax requiring drainage catheter placement after CBCT-guided PTNB. (orig.)

  5. CT guided diagnostic foot injections

    International Nuclear Information System (INIS)

    Saifuddin, A.; Abdus-Samee, M.; Mann, C.; Singh, D.; Angel, J.C.

    2005-01-01

    AIM: To describe a CT technique for guiding diagnostic and therapeutic injections in the hind- and mid-foot. MATERIALS AND METHODS: Over a period of 50 months, 28 individuals were referred for diagnostic and therapeutic hind- and mid-foot injections before possible arthrodesis. A CT technique was developed that allowed entry into the various joints using a vertical approach. Numbers of joints injected were as follows: posterior subtalar, 21; talonavicular, 4; calcaneonavicular, calcaneocuboid, navicular-cuneiform and 5th metatarsocuboid joints, 1 each. RESULTS: All injections but one were technically successful. Significant relief of symptoms was noted by 16 participants, whereas for 9 there was no improvement and for 3 a partial response was achieved. CONCLUSION: CT is a simple and safe alternative to fluoroscopy for guiding diagnostic and therapeutic foot injections, and may be the technique of choice in cases of disordered anatomy

  6. Lung cancer mimicking lung abscess formation on CT images.

    Science.gov (United States)

    Taira, Naohiro; Kawabata, Tsutomu; Gabe, Atsushi; Ichi, Takaharu; Kushi, Kazuaki; Yohena, Tomofumi; Kawasaki, Hidenori; Yamashiro, Toshimitsu; Ishikawa, Kiyoshi

    2014-01-01

    Male, 64 FINAL DIAGNOSIS: Lung pleomorphic carcinoma Symptoms: Cough • fever - Clinical Procedure: - Specialty: Oncology. Unusual clinical course. The diagnosis of lung cancer is often made based on computed tomography (CT) image findings if it cannot be confirmed on pathological examinations, such as bronchoscopy. However, the CT image findings of cancerous lesions are similar to those of abscesses.We herein report a case of lung cancer that resembled a lung abscess on CT. We herein describe the case of 64-year-old male who was diagnosed with lung cancer using surgery. In this case, it was quite difficult to distinguish between the lung cancer and a lung abscess on CT images, and a lung abscess was initially suspected due to symptoms, such as fever and coughing, contrast-enhanced CT image findings showing a ring-enhancing mass in the right upper lobe and the patient's laboratory test results. However, a pathological diagnosis of lung cancer was confirmed according to the results of a rapid frozen section biopsy of the lesion. This case suggests that physicians should not suspect both a lung abscesses and malignancy in cases involving masses presenting as ring-enhancing lesions on contrast-enhanced CT.

  7. CT evaluation of complications of cryoablation treatment in lung cancer

    International Nuclear Information System (INIS)

    Zhu Caiqiao; Chen Yao; Zhang Zhitian; Su Jinzhan; Huang Zhen; Bao Kaikai

    2011-01-01

    Objective: To assess the complications of percutaneous targeted Argon-Helium cryoablation treatment in patients with lung cancer on CT. Methods: Ten patients with unresectable lung cancer were treated by cryotherapy under CT guidance with Argon-Helium cryoablation system. Dynamic contrast-enhanced CT was performed to assess changes before and after treatment, complications and treatment response. Results: Ice ball coverage immediately after surgery was satisfactory in all patients. There were a few complications including worsening hoarseness (1), small pneumothorax (1), and small amount of bleeding at the site of probe puncture (1). Conclusion: Percutaneous targeted Argon-Helium cryoablation guided by CT is an effective treatment for lung cancer without severe complications. (authors)

  8. Lung cancer mimicking lung abscess formation on CT images

    OpenAIRE

    Taira, Naohiro; Kawabata, Tsutomu; Gabe, Atsushi; Ichi, Takaharu; Kushi, Kazuaki; Yohena, Tomofumi; Kawasaki, Hidenori; Yamashiro, Toshimitsu; Ishikawa, Kiyoshi

    2014-01-01

    Patient: Male, 64 Final Diagnosis: Lung pleomorphic carcinoma Symptoms: Cough • fever Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual clinical course Background: The diagnosis of lung cancer is often made based on computed tomography (CT) image findings if it cannot be confirmed on pathological examinations, such as bronchoscopy. However, the CT image findings of cancerous lesions are similar to those of abscesses.We herein report a case of lung cancer that resemble...

  9. High resolution CT in diffuse lung disease

    International Nuclear Information System (INIS)

    Webb, W.R.

    1995-01-01

    High resolution CT (computerized tomography) was discussed in detail. The conclusions were HRCT is able to define lung anatomy at the secondary lobular level and define a variety of abnormalities in patients with diffuse lung diseases. Evidence from numerous studies indicates that HRCT can play a major role in the assessment of diffuse infiltrative lung disease and is indicate clinically (95 refs.)

  10. High resolution CT in diffuse lung disease

    Energy Technology Data Exchange (ETDEWEB)

    Webb, W R [California Univ., San Francisco, CA (United States). Dept. of Radiology

    1996-12-31

    High resolution CT (computerized tomography) was discussed in detail. The conclusions were HRCT is able to define lung anatomy at the secondary lobular level and define a variety of abnormalities in patients with diffuse lung diseases. Evidence from numerous studies indicates that HRCT can play a major role in the assessment of diffuse infiltrative lung disease and is indicate clinically (95 refs.).

  11. CT findings of inoperable lung carcinoma

    International Nuclear Information System (INIS)

    Gay, S.B.; Black, W.C.

    1987-01-01

    CT is useful in the evaluation of patients with newly diagnosed or highly suspected lung cancer. The principal role of CT is to screen those patients with metastatic disease beyond the hili from an attempt at curative thoracotomy. While CT is regarded as very sensitive, it is not considered highly specific, and thus a surgical procedure is usually recommended for definitive diagnosis of most ''positive'' CT findings. However, the authors demonstrate a few characteristic CT findings that are highly predictive of unresectable metastatic disease. These CT findings include massive mediastinal lymphadenopathy, diffuse mediastinal infiltration, pericardial involvement, vascular encasement, and advanced chest wall invasion

  12. Computer tomography guided lung biopsy using interactive breath-hold control

    DEFF Research Database (Denmark)

    Ashraf, Haseem; Krag-Andersen, Shella; Naqibullah, Matiullah

    2017-01-01

    Background: Interactive breath-hold control (IBC) may improve the accuracy and decrease the complication rate of computed tomography (CT)-guided lung biopsy, but this presumption has not been proven in a randomized study. Methods: Patients admitted for CT-guided lung biopsy were randomized...

  13. Segmentation of Lung Structures in CT

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau

    This thesis proposes and evaluates new algorithms for segmenting various lung structures in computed tomography (CT) images, namely the lungs, airway trees and vessel trees. The main objective of these algorithms is to facilitate a better platform for studying Chronic Obstructive Pulmonary Disease......, 200 randomly selected CT scans were manually evaluated by medical experts, and only negligible or minor errors were found in nine scans. The proposed algorithm has been used to study how changes in smoking behavior affect CT based emphysema quantification. The algorithms for segmenting the airway...

  14. Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients.

    Science.gov (United States)

    Nour-Eldin, Nour-Eldin A; Alsubhi, Mohammed; Emam, Ahmed; Lehnert, Thomas; Beeres, Martin; Jacobi, Volkmar; Gruber-Rouh, Tatjana; Scholtz, Jan-Erik; Vogl, Thomas J; Naguib, Nagy N

    2016-02-01

    To assess the scope and determining risk factors related to the development of pneumothorax throughout CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques and the outcome of its management. The study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD 5.2) from November 2008 to June 2013 in a retrospective design. Patients were classified according to lung biopsy technique into coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were lesions pneumothorax were classified into: (a) Technical risk factors, (b) patient-related risk factors, and (c) lesion-associated risk factors. Radiological assessments were performed by two radiologists in consensus. Mann-Whitney U test and Fisher's exact tests were used for statistical analysis. p values pneumothorax complicating CT-guided lung biopsy was less in the non-coaxial group (23.2 %, 77 out of 332) than the coaxial group (27 %, 86 out of 318). However, the difference in incidence between both groups was statistically insignificant (p = 0.14). Significant risk factors for the development of pneumothorax in both groups were emphysema (p pneumothorax in the non-coaxial group was significantly correlated to the number of specimens obtained (p = 0.006). This factor was statistically insignificant in the coaxial group (p = 0.45). The biopsy yield was more diagnostic and conclusive in the coaxial group in comparison to the non-coaxial group (p = 0.008). Simultaneous incidence of pneumothorax and pulmonary hemorrhage was 27.3 % (21/77) in non-coaxial group and in 30.2 % (26/86) in coaxial group. Conservative management was sufficient for treatment of 91 out of 101 patients of pneumothorax in both groups (90.1 %). Manual evacuation of pneumothorax was efficient in 44/51 patients (86.3 %) in both groups and intercostal chest tube was applied after failure of manual evacuation (7

  15. CT guided transthoracic catheter drainage of intrapulmonary abscess.

    Science.gov (United States)

    Yunus, Mahira

    2009-10-01

    To determine the efficacy of CT- guided transthoracic catheter drainage of intrapulmonary abscess considering success rate versus complications. This prospective study was carried out at radiology department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from 1.1.2003 to 31.12.2005. Nineteen patients were selected for CT guided percutaneous drainage. Under CT guidance catheter placement was carried out using Seldinger technique. Nineteen patients with lung abscess were selected for the percutaneous CT guided drainage. Eight (42.105%) patients encountered no complications and lung abscess completely resolved with no residual cavity. Five (26.31%) patients developed pneumothorax, which was the most common complication of this study. These patients were kept under observation and followed-up by chest X-rays. Three (15.78%) had mild pneumothorax, which resolved and needed no further management, while two (10.52%) patients developed moderate pneumothorax and chest tube was inserted. Two (10.52%) patients developed mild haemoptysis which resolved within two hours, hence, no further management was required. Two (10.52%) patients had residual cavity and surgery was performed. Congenital cystic adenomatoid malformation (CCAM) was found in both cases. Two patients out of nineteen patients (10.52%) developed bronchopleural fistula and were operated. No mortality occurred during or after the procedure. CT allows optimal placement of catheter and hence enables safe and effective percutaneous evacuation of lung abscess. The morbidity and mortality of patients with percutaneous catheter drainage is lower than with surgical resection. Hence, CT guided drainage should be considered the first therapeutic choice in most patients of lung abscess who do not respond to medical therapy.

  16. CT diagnosis of the primary lung cancer and usefulness of biopsy under CT

    International Nuclear Information System (INIS)

    Fujisawa, Hidefumi; Kushihashi, Tamio

    2011-01-01

    CT especially plays an important role in imaging diagnosis of lung cancer (LC) which gives quite multiple CT findings and this paper describes details to be noted for CT findings of individual lung lesion and cancer according to 5 classes below, together with usefulness of CT-guided biopsy and positron emission tomography (PET) usage. Explained are as follows: Important points in histopathology and CT findings from adenomatous hyperplasia (AH) to atypical AH (pre-invasive lesion); Differential CT diagnosis of benignity or malignancy of pulmonary nodes and tumors; Typical CT findings of LC of peripheral type of invasive or exclusive proliferative type, and pulmonary hillar type; Atypical CT findings of LC/having atypical inner structure such as presenting atypical calcification and atypical cavity/having atypical morphology such as presenting pneumonia-like finding, exhibiting regular or linear edge, and existing at atypical region like extrapleural lumen /having atypical progression rate such as showing rapid or slow doubling time of the volume and shrinking tentatively during the progress/of juvenile LC/and generated from background lung diseases such as interstitial pneumonia, tuberculosis, pneumoconiosis like asbestosis, pneumosilicosis, and pulmonary emphysema and bulla; and Regional ground glass opacity. As well, authors mention about the usefulness of CT-guided needle biopsy of the pulmonary lesion which enables to take the nodal specimen as small as <10 mm. Most frequent complication of the biopsy is pneumothorax (10-50%). How to use PET for LC examination is also commented with its usability and limitation. (T.T.)

  17. CT-guided conformal cryoablation for peripheral NSCLC: Initial experience

    International Nuclear Information System (INIS)

    Zhang, Xiao; Tian, Jinlin; Zhao, Lei; Wu, Bin; Kacher, Daniel S.; Ma, Xuyang; Liu, Shurong; Ren, Chao; Xiao, Yue-Yong

    2012-01-01

    Purpose: To study the feasibility of CT-guided and monitored percutaneous conformal cryoablation of Non-Small Cell Lung Cancer for patients who are not suitable for surgical resection. Materials and method: CT-guided percutaneous conformal cryoablation was performed on 46 patients with peripheral Non-Small Cell Lung Cancer. Patients with tumor sizes less than 3 cm in diameter were treated with double-needle clamping cryoablation, while the patients with 3–5 cm tumor sizes were treated with multiple-needle conformal cryoablation. CT was used to monitor the extent of cryoablation during the procedures. At month 1, 3, 6, 12, and 24 post-procedure, enhanced CT scans and/or PET-CT scans were performed to evaluate the impact of the therapy. Results: The average tumor CT values were 32 ± 10 HU and −21 ± 8 HU before and after cryoablation, respectively. The largest diameters of the lesions at month 1, 3, 6, 12, and 24 post-procedure were 2.63 ± 0.56 cm, 1.93 ± 0.51 cm, 1.55 ± 0.39 cm, 1.43 ± 0.40 cm, and 1.38 ± 0.38 cm, respectively, in patients with tumor diameter less than 3 cm, and 3.63 ± 0.39 cm, 2.98 ± 0.31 cm, 2.62 ± 0.32 cm, 2.54 ± 0.34 cm, and 2.56 ± 0.37 cm respectively in patients with the tumor diameters between 3 and 5 cm. At the 24th month, there were 36 cases of complete response (83.7%), 7 cases of partial response (16.3%), and no cases of stable disease or progressive disease. 3 patients died due to multiple metastases. Conclusion: CT-guided percutaneous conformal cryoablation is a safe, effective, and minimally invasive therapeutic method for peripheral lung cancer.

  18. CT triage for lung malignancy

    DEFF Research Database (Denmark)

    Kusk, Martin Weber; Karstoft, Jens; Mussmann, Bo

    2015-01-01

    Background: Generation of multiplanar reformation (MPR) images has become automatic on most modern computed tomography (CT) scanners, potentially increasing the workload of the reporting radiologists. It is not always clear if this increases diagnostic performance in all clinical tasks. Purpose...

  19. Respiratory gated lung CT using 320-row area detector CT

    International Nuclear Information System (INIS)

    Sakamoto, Ryo; Noma, Satoshi; Higashino, Takanori

    2010-01-01

    Three hundred and twenty-row Area Detector CT (ADCT) has made it possible to scan whole lung field with prospective respiratory gated wide volume scan. We evaluated whether the respiratory gated wide volume scan enables to reduce motion induced artifacts in the lung area. Helical scan and respiratory gated wide volume scan were performed in 5 patients and 10 healthy volunteers under spontaneous breathing. Significant reduction of motion artifact and superior image quality were obtained in respiratory gated scan in comparison with helical scan. Respiratory gated wide volume scan is an unique method using ADCT, and is able to reduce motion artifacts in lung CT scans of patients unable to suspend respiration in clinical scenes. (author)

  20. High resolution CT of the lung

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Harumi (Kyoto Univ. (Japan). Faculty of Medicine)

    1991-02-01

    The emergence of computed tomography (CT) in the early 1970s has greatly contributed to diagnostic radiology. The brain was the first organ examined with CT, followed by the abdomen. For the chest, CT has also come into use shortly after the introduction in the examination of the thoracic cavity and mediastinum. CT techniques were, however, of limited significance in the evaluation of pulmonary diseases, especially diffuse pulmonary diseases. High-resolution CT (HRCT) has been introduced in clinical investigations of the lung field. This article is designed to present chest radiographic and conventional tomographic interpretations and to introduce findings of HRCT corresponding to the same shadows, with a summation of the significance of HRCT and issues of diagnostic imaging. Materials outlined are tuberculosis, pneumoconiosis, bronchopneumonia, mycoplasma pneumonia, lymphangitic carcinomatosis, sarcoidosis, diffuse panbronchiolitis, interstitial pneumonia, and pulmonary emphysema. Finally, an overview of basic investigations evolved from HRCT is given. (N.K.) 140 refs.

  1. Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Nour-Eldin, Nour-Eldin A., E-mail: nour410@hotmail.com; Alsubhi, Mohammed, E-mail: mohammedal-subhi@yahoo.com; Emam, Ahmed, E-mail: morgan101002@hotmail.com; Lehnert, Thomas, E-mail: thomas.lehnert@kgu.de; Beeres, Martin, E-mail: beeres@gmx.net; Jacobi, Volkmar, E-mail: volkmar.jacobi@kgu.de; Gruber-Rouh, Tatjana, E-mail: tatjanagruber2004@yahoo.com; Scholtz, Jan-Erik, E-mail: janerikscholtz@gmail.com; Vogl, Thomas J., E-mail: t.vogl@em.uni-frankfurt.de; Naguib, Nagy N., E-mail: nagynnn@yahoo.com [Johan Wolfgang Goethe – University Hospital, Institute for Diagnostic and Interventional Radiology (Germany)

    2016-02-15

    PurposeTo assess the scope and determining risk factors related to the development of pneumothorax throughout CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques and the outcome of its management.Materials and MethodsThe study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD 5.2) from November 2008 to June 2013 in a retrospective design. Patients were classified according to lung biopsy technique into coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension, or refusal of the procedure. Risk factors related to the occurrence of pneumothorax were classified into: (a) Technical risk factors, (b) patient-related risk factors, and (c) lesion-associated risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher’s exact tests were used for statistical analysis. p values <0.05 were considered statistically significant.ResultsThe incidence of pneumothorax complicating CT-guided lung biopsy was less in the non-coaxial group (23.2 %, 77 out of 332) than the coaxial group (27 %, 86 out of 318). However, the difference in incidence between both groups was statistically insignificant (p = 0.14). Significant risk factors for the development of pneumothorax in both groups were emphysema (p < 0.001 in both groups), traversing a fissure with the biopsy needle (p value 0.005 in non-coaxial group and 0.001 in coaxial group), small lesion, less than 2 cm in diameter (p value of 0.02 in both groups), location of the lesion in the basal or mid sections of the lung (p = 0.003 and <0.001 in non-coaxial and coaxial groups, respectively), and increased needle track path within the lung tissue of more than 2.5 cm (p = 0.01 in both

  2. Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients

    International Nuclear Information System (INIS)

    Nour-Eldin, Nour-Eldin A.; Alsubhi, Mohammed; Emam, Ahmed; Lehnert, Thomas; Beeres, Martin; Jacobi, Volkmar; Gruber-Rouh, Tatjana; Scholtz, Jan-Erik; Vogl, Thomas J.; Naguib, Nagy N.

    2016-01-01

    PurposeTo assess the scope and determining risk factors related to the development of pneumothorax throughout CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques and the outcome of its management.Materials and MethodsThe study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD 5.2) from November 2008 to June 2013 in a retrospective design. Patients were classified according to lung biopsy technique into coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension, or refusal of the procedure. Risk factors related to the occurrence of pneumothorax were classified into: (a) Technical risk factors, (b) patient-related risk factors, and (c) lesion-associated risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher’s exact tests were used for statistical analysis. p values <0.05 were considered statistically significant.ResultsThe incidence of pneumothorax complicating CT-guided lung biopsy was less in the non-coaxial group (23.2 %, 77 out of 332) than the coaxial group (27 %, 86 out of 318). However, the difference in incidence between both groups was statistically insignificant (p = 0.14). Significant risk factors for the development of pneumothorax in both groups were emphysema (p < 0.001 in both groups), traversing a fissure with the biopsy needle (p value 0.005 in non-coaxial group and 0.001 in coaxial group), small lesion, less than 2 cm in diameter (p value of 0.02 in both groups), location of the lesion in the basal or mid sections of the lung (p = 0.003 and <0.001 in non-coaxial and coaxial groups, respectively), and increased needle track path within the lung tissue of more than 2.5 cm (p = 0.01 in both

  3. CT and fluoroscopy guided celiac ganglion block

    International Nuclear Information System (INIS)

    Lim, Sun Kyung; Kwon, Dae Ik; Ahn, Hyup; Kim, Jong Il; Kim, Byung Young; Lee, Jong Gil

    1994-01-01

    To evaluate the effects and usefulness of fluoroscopy guided celiac ganglion block after marking of needle path with CT scan. Celiac ganglion block with 100% ethyl alcohol was performed in 50 cancer patients who were inoperable and had intractable abdominal pain. Duration and degree of pain relief after the procedure and its complication were analyzed. Early pain relief was observed in 98% and long term relief in 68% without serious complication. Fluoroscopy guided celiac ganglion block after marking of needle path with CT scan was a safe and valuable procedure in relieving intractable pain in terminal cancer patients and reduced the time in the CT room

  4. CT-guided biopsies and drainage

    International Nuclear Information System (INIS)

    Scheppers, I.; Wollschlaeger, D.

    2011-01-01

    Following the implementation of computed tomography (CT) or ultrasound-guided biopsy of solid tumors and the puncture and drainage of liquid processes, the number of surgical open biopsies and curative operations for abscess drainage has declined. Such CT-guided interventions are performed in nearly every organ. Instead of aspiration biopsies, more and more core biopsies are being performed to allow histopathological evaluation and thus allowing targeted therapy. This article is intended to give a general overview of techniques, materials, indications and contraindications. Ultrasound-guided biopsies as well as large bore vacuum biopsies of the breast are not included in this review. (orig.) [de

  5. Mass Preserving Registration for lung CT

    DEFF Research Database (Denmark)

    Gorbunova, Vladlena; Lo, Pechin Chien Pau; Loeve, Martin

    2009-01-01

    intensities due to differences in inspiration level, we propose to adjust the intensity of lung tissue according to the local expansion or compression. An image registration method without intensity adjustment is compared to the proposed method. Both approaches are evaluated on a set of 10 pairs of expiration...... and inspiration CT scans of children with cystic fibrosis lung disease. The proposed method with mass preserving adjustment results in significantly better alignment of the vessel trees. Analysis of local volume change for regions with trapped air compared to normally ventilated regions revealed larger...

  6. CT-guided core biopsy and percutaneous fiducial seed placement in the lung: Can these procedures be combined without an increase in complication rate or decrease in technical success?

    Energy Technology Data Exchange (ETDEWEB)

    Mendiratta-Lala, Mishal [Henry Ford Hospital, Department of Radiology, Abdominal Interventional Radiology, 2799 West Grand Blvd, Detroit, MI 48202 (United States); Sheiman, Robert, E-mail: rsheiman@bidmc.harvard.edu [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States); Brook, Olga R. [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States); Gourtsoyianni, Sofia [King' s College London, St Thomas’ Hospital, Lambeth Palace Road, SE1 7EH London (United Kingdom); Mahadevan, Anand [Beth Israel Deaconess Hospital, Radiation Oncology, One Deaconess Road, Boston, MA 02215 (United States); Siewert, Bettina [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States)

    2014-04-15

    Objective: To determine if concomitant CT-guided biopsy and percutaneous fiducial seed placement in the lung can be performed in a selective patient population without increased complication or decreased success rates compared to either procedure alone. Materials and methods: An IRB approved retrospective analysis of 285 consecutive patients that underwent CT-guided placement of fiducial seeds in the lung alone (N = 63), with concomitant core biopsy (N = 53) or only core biopsy (N = 169) was performed. Variables compared included: patient demographics, lesion size, depth from pleura, needle size, number of passes through pleura, number and size of core biopsies, number of seeds placed and technical success rates. Statistical analysis was performed using univariate and multivariate pair-wise comparisons. Results: A pathologic diagnosis of malignancy was confirmed in all cases undergoing seed placement alone and seed placement with concurrent biopsy, and in 144 of the biopsy alone lesions. On univariate analysis, major complication rates were similar for all three groups as were lesion size, depth, number of pleural passes, and technical success. Pair-wise comparisons of the remaining variables demonstrated a significant younger age and smaller needle size in the biopsy only group, and less minor complications in the fiducial only group. Overall there were 80/285 (28.1%) minor and 29/285 (10.2%) major complications. All major complications leading to admission consisted of either pneumothorax or hemothorax, while minor complications included asymptomatic stable or resolving pneumothoraces, transient hemoptysis or small hemothoraces. Conclusions: A combined procedure of percutaneous pulmonary core biopsy and stereotactic seed placement can be performed without additional risk of a major complication when compared to performing these separately.

  7. CT findings of adenocarcinoma of the lung

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, T. J.; Kim, S. J.; Lee, D. Y.; Ahn, C. M [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-03-01

    To evaluate CT findings of primary adenocarcinoma of the lung and to assess distant metastasis at the time of diagnosis. CT findings of 150 patients with adenocarcinoma, confirmed by histopathologic methods, were classified as central or peripheral lesion and pattern analysis of typical findings noted in this cancer was carried out. Intra and extrathoracic metastases of adenocarcinoma were also investigated. Of 150 cases of adenocarcinoma of the lung, 121 were found to be of the peripheral type and 29 were of the central type. These peripheral lesions comprised 105 nodules, 11 consolidations, four cavities and one linear lesion, while the central lesions consisted of 19 cases of atelectasis and tens of branchial wall thickening. lung to lung(nine cases), lymphangitic(five cases), and pleural metastasis(16 cases) were presented as intrathoracic metastasis, while bone(17), brain,(six), liver(two) and adrenal metastasis(one case)were presented as extrathoracic metastasis. The most common radiologic finding of adenocarcinoma is a peripheral single mass or nodule but consolidation, cavity or tubular lesions, as well as atelectasis or bronchial wall thickening alone can be presented as unusual findings of adenocarcinoma. As a consequence, it is in many cases difficult to differentially diagnose. Distant metastasis was also noted in many cases of early T-stage lesion, so to successfully manage the patient, careful evaluation of the metastasis is essential.

  8. CT findings of adenocarcinoma of the lung

    International Nuclear Information System (INIS)

    Jeon, T. J.; Kim, S. J.; Lee, D. Y.; Ahn, C. M

    1996-01-01

    To evaluate CT findings of primary adenocarcinoma of the lung and to assess distant metastasis at the time of diagnosis. CT findings of 150 patients with adenocarcinoma, confirmed by histopathologic methods, were classified as central or peripheral lesion and pattern analysis of typical findings noted in this cancer was carried out. Intra and extrathoracic metastases of adenocarcinoma were also investigated. Of 150 cases of adenocarcinoma of the lung, 121 were found to be of the peripheral type and 29 were of the central type. These peripheral lesions comprised 105 nodules, 11 consolidations, four cavities and one linear lesion, while the central lesions consisted of 19 cases of atelectasis and tens of branchial wall thickening. lung to lung(nine cases), lymphangitic(five cases), and pleural metastasis(16 cases) were presented as intrathoracic metastasis, while bone(17), brain,(six), liver(two) and adrenal metastasis(one case)were presented as extrathoracic metastasis. The most common radiologic finding of adenocarcinoma is a peripheral single mass or nodule but consolidation, cavity or tubular lesions, as well as atelectasis or bronchial wall thickening alone can be presented as unusual findings of adenocarcinoma. As a consequence, it is in many cases difficult to differentially diagnose. Distant metastasis was also noted in many cases of early T-stage lesion, so to successfully manage the patient, careful evaluation of the metastasis is essential

  9. Biopsy system for CT-guided biopsies

    International Nuclear Information System (INIS)

    Onik, G.; Cosman, E.; Wells, T.; Goldberg, H.I.; Moss, A.; Costello, P.; Kane, R.

    1987-01-01

    CT stereotaxic brain biopsies have made brain biopsies safe and minimally invasive. CT-guided biopsies of the body, however, have traditionally used a hand-guidance method. CT biopsy guidance systems for the body have recently become available that have similar capabilities as those of brain biopsy systems. To compare the clinical utility of stereotaxically guided biopsies with hand-guided biopsies, the authors prospectively compared 40 biopsies performed with each method. In the stereotaxic method, a localizor grid was placed on the patient to define a reference point, and a frame was used to guide the needle along the intended path. Computer software programs calculated complex paths from one scan plane to another. Although the results disclosed no significant differences in lesion size or path length between the two groups, the stereotaxically guided biopsies required 75% fewer needle manipulations to hit the intended target. Consequently, the stereotaxically guided biopsies required 40% less time and 80% fewer localization scans to find the biopsy needle than did the hand-guided biopsies

  10. CT-guided interventions in children

    International Nuclear Information System (INIS)

    Honnef, D.; Wildberger, J.E.; Schubert, H.; Hohl, C.; Guenther, R.W.; Mahnken, A.

    2007-01-01

    In pediatric CT-guided interventions specific features have to be taken into account. Due to a lack of cooperation or limited ability to cooperate, procedures are often performed using analgosedation or general anesthesia. To provide radiation protection, justified indication for CT-guided intervention is necessary and sonography and MRI are to be preferred whenever possible. CT examinations also need to be dose-adapted with sequential scanning and a tube voltage and tube current reduction compared to pediatric diagnostic CT studies must be ensured. Gonad shields are recommended for male patients. Biopsy device selection depends on the assumed tumor entity since histology and also immunohistochemical, molecular pathological and cytogenetical analysis are necessary to differentiate pediatric tumors (small, round, blue cell tumors). In addition to diagnostic procedures, therapeutic interventions (drainage, injection therapies, neurolysis, and radiofrequency ablation) can also be used in children and can provide an alternative to surgery in selected cases. With justified indications and precise performance, CT-guided interventions can be successful in pediatric patients with limited risks. (orig.)

  11. Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules

    International Nuclear Information System (INIS)

    Ohno, Yoshiharu; Hatabu, Hiroto; Takenaka, Daisuke; Imai, Masatake; Ohbayashi, Chiho; Sugimura, Kazuro

    2004-01-01

    Objective: To evaluate the utility of multiplanar reconstruction (MPR) image for CT-guided biopsy and determine factors of influencing diagnostic accuracy and the pneumothorax rate. Materials and methods: 390 patients with 396 pulmonary nodules underwent transthoracic CT-guided aspiration biopsy (TNAB) and transthoracic CT-guided cutting needle core biopsy (TCNB) as follows: 250 solitary pulmonary nodules (SPNs) underwent conventional CT-guided biopsy (conventional method), 81 underwent CT-fluoroscopic biopsy (CT-fluoroscopic method) and 65 underwent conventional CT-guided biopsy in combination with MPR image (MPR method). Success rate, overall diagnostic accuracy, pneumothorax rate and total procedure time were compared in each method. Factors affecting diagnostic accuracy and pneumothorax rate of CT-guided biopsy were statistically evaluated. Results: Success rates (TNAB: 100.0%, TCNB: 100.0%) and overall diagnostic accuracies (TNAB: 96.9%, TCNB: 97.0%) of MPR were significantly higher than those using the conventional method (TNAB: 87.6 and 82.4%, TCNB: 86.3 and 81.3%) (P<0.05). Diagnostic accuracy were influenced by biopsy method, lesion size, and needle path length (P<0.05). Pneumothorax rate was influenced by pathological diagnostic method, lesion size, number of punctures and FEV1.0% (P<0.05). Conclusion: The use of MPR for CT-guided lung biopsy is useful for improving diagnostic accuracy with no significant increase in pneumothorax rate or total procedure time

  12. A case of lung abscess successfully treated by transbronchial drainage using a guide sheath

    OpenAIRE

    Izumi, Hiroki; Kodani, Masahiro; Matsumoto, Shingo; Kawasaki, Yuji; Igishi, Tadashi; Shimizu, Eiji

    2017-01-01

    A 51?year?old man was diagnosed with colon cancer in September 2011, and a solitary pulmonary nodule was detected by computed tomography (CT) scan. We performed a transbronchial biopsy with endobronchial ultrasonography using a guide sheath (GS) and diagnosed lung metastasis of colon cancer. The patient experienced remittent fever after the biopsy in spite of intravenous antibiotic therapies. Moreover, his CT scan showed a large lung abscess at the biopsy site. We performed transbronchial dra...

  13. Cone-Beam Computed Tomography (CBCT) Versus CT in Lung Ablation Procedure: Which is Faster?

    Science.gov (United States)

    Cazzato, Roberto Luigi; Battistuzzi, Jean-Benoit; Catena, Vittorio; Grasso, Rosario Francesco; Zobel, Bruno Beomonte; Schena, Emiliano; Buy, Xavier; Palussiere, Jean

    2015-10-01

    To compare cone-beam CT (CBCT) versus computed tomography (CT) guidance in terms of time needed to target and place the radiofrequency ablation (RFA) electrode on lung tumours. Patients at our institution who received CBCT- or CT-guided RFA for primary or metastatic lung tumours were retrospectively included. Time required to target and place the RFA electrode within the lesion was registered and compared across the two groups. Lesions were stratified into three groups according to their size (20 mm). Occurrences of electrode repositioning, repositioning time, RFA complications, and local recurrence after RFA were also reported. Forty tumours (22 under CT, 18 under CBCT guidance) were treated in 27 patients (19 male, 8 female, median age 67.25 ± 9.13 years). Thirty RFA sessions (16 under CBCT and 14 under CT guidance) were performed. Multivariable linear regression analysis showed that CBCT was faster than CT to target and place the electrode within the tumour independently from its size (β = -9.45, t = -3.09, p = 0.004). Electrode repositioning was required in 10/22 (45.4 %) tumours under CT guidance and 5/18 (27.8 %) tumours under CBCT guidance. Pneumothoraces occurred in 6/14 (42.8 %) sessions under CT guidance and in 6/16 (37.5 %) sessions under CBCT guidance. Two recurrences were noted for tumours receiving CBCT-guided RFA (2/17, 11.7 %) and three after CT-guided RFA (3/19, 15.8 %). CBCT with live 3D needle guidance is a useful technique for percutaneous lung ablation. Despite lesion size, CBCT allows faster lung RFA than CT.

  14. Cone-Beam Computed Tomography (CBCT) Versus CT in Lung Ablation Procedure: Which is Faster?

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: r.cazzato@unicampus.it; Battistuzzi, Jean-Benoit, E-mail: j.battistuzzi@bordeaux.unicancer.fr; Catena, Vittorio, E-mail: vittoriocatena@gmail.com [Institut Bergonié, Department of Radiology (France); Grasso, Rosario Francesco, E-mail: r.grasso@unicampus.it; Zobel, Bruno Beomonte, E-mail: b.zobel@unicampus.it [Università Campus Bio-Medico di Roma, Department of Radiology and Diagnostic Imaging (Italy); Schena, Emiliano, E-mail: e.schena@unicampus.it [Università Campus Bio-Medico di Roma, Unit of Measurements and Biomedical Instrumentations, Biomedical Engineering Laboratory (Italy); Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr; Palussiere, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France)

    2015-10-15

    AimTo compare cone-beam CT (CBCT) versus computed tomography (CT) guidance in terms of time needed to target and place the radiofrequency ablation (RFA) electrode on lung tumours.Materials and MethodsPatients at our institution who received CBCT- or CT-guided RFA for primary or metastatic lung tumours were retrospectively included. Time required to target and place the RFA electrode within the lesion was registered and compared across the two groups. Lesions were stratified into three groups according to their size (<10, 10–20, >20 mm). Occurrences of electrode repositioning, repositioning time, RFA complications, and local recurrence after RFA were also reported.ResultsForty tumours (22 under CT, 18 under CBCT guidance) were treated in 27 patients (19 male, 8 female, median age 67.25 ± 9.13 years). Thirty RFA sessions (16 under CBCT and 14 under CT guidance) were performed. Multivariable linear regression analysis showed that CBCT was faster than CT to target and place the electrode within the tumour independently from its size (β = −9.45, t = −3.09, p = 0.004). Electrode repositioning was required in 10/22 (45.4 %) tumours under CT guidance and 5/18 (27.8 %) tumours under CBCT guidance. Pneumothoraces occurred in 6/14 (42.8 %) sessions under CT guidance and in 6/16 (37.5 %) sessions under CBCT guidance. Two recurrences were noted for tumours receiving CBCT-guided RFA (2/17, 11.7 %) and three after CT-guided RFA (3/19, 15.8 %).ConclusionCBCT with live 3D needle guidance is a useful technique for percutaneous lung ablation. Despite lesion size, CBCT allows faster lung RFA than CT.

  15. Automated quantification of emphysema in CT studies of the lung

    International Nuclear Information System (INIS)

    Archer, D.C.; deKemp, R.A.; Coblentz, C.L.; Nahmias, C.

    1991-01-01

    Emphysema by definition is a pathologic diagnosis. Recently, in vivo quantification of emphysema from CT with point counting and with a GE 9800 CT scanner program called Density Mask has been described. These methods are laborious and time-consuming, making them unsuitable for screening. The propose of this paper is to create a screening test for emphysema. The authors developed a computer program that quantifies the amount of emphysema from standard CT-scans. The computer was programmed to recognize the lung edges on each section by identifying abrupt changes in CT numbers; grow regions within each lung to identify and separate the lungs from other structures; count regions of lung containing CT numbers measuring <-900 HU corresponding to areas of emphysema; and calculation the percentage of emphysema present from the volume of normal emphysematous lung. The programs were written in C and urn on a Sun 4/100 workstation

  16. Liver CT-guided aspirative biopsies

    International Nuclear Information System (INIS)

    Santos, Gilda da Cunha; Carvalho, Leda Viegas de; Chojniak, Rubens; Morini, Sandra Regina

    1996-01-01

    Sixty-eight CT-guided aspirative biopsies of hepatic nodules were performed at A.C. Camargo Hospital, Sao Paulo, Brazil, from 1992 to 1995. The cases were distributed as follow: 44(64.7%) with a positive diagnosis for neoplastic cells, 6(8.8%) with a negative diagnosis, and 14 (20.5%) with insufficient material. Of the positive cases (primary neoplasias and metastases), the cytological diagnosis was achieved in 39 cases. There were 36 cases of carcinoma (7 hepato carcinomas, 18 adenocarcinomas, 1 small cell carcinoma and 10 cases of unspecified differentiation), 2 cases of melanoma and 1 case of melanoma and 1 case of sarcoma. The correlation with histopathological exams showed no false positive cases and concordance between cytological and histopathological diagnosis. The results demonstrate that CT-guided aspirative biopsy of hepatic nodules permits a rapid diagnosis of neoplastic lesions, especially for the evaluation of metastases. (author)

  17. CT findings of primary lung cancer

    International Nuclear Information System (INIS)

    Park, Yeon Won; Kim, So Seon; Woo, Young Hoon; Kim, Ho Joon; Chun, Byung Hee; Suh, Jung Hyek; Suh, Soo Jhi

    1985-01-01

    Authors retrospectively analyzed the CT findings of 102 cases of histologically proven bronchogenic carcinoma during last 4 years from January 1980 to July 1984 at Kosin Medical College. The results were as follows: 1. The sex ratio was 86 males to 16 females and the greatest number (66.7%) of cases were seen in fourth and fifth decades. 2. The distribution of histologic types of primary lung cancer as follows: Squamous cell carcinoma 66 cases, Adenocarcinoma 10 cases, Small cell carcinoma 7 cases, Large cell carcinoma 5 cases, Bronchioloalveolar cell carcinoma 1 case, Unclassified 13 cases. 3. Location of primary lesions as follows: Right lung 61 cases, Left lung 40 cases. In both lungs, the greatest number of cases were found in the upper lobes. Ratio between central and peripheral mass was 2.5:1, except adenocarcinoma (6:4). 4. CT findings were as follows: Hilar or central mass (75 cases), Peripheral mass (26), Bronchial abnormalities such as narrowing, obstruction, or displacement (60), Thickening of the posterior wall of the right upper lobe bronchus, bronchus intermedius, or left main bronchus (17), Post-obstructive changes; Atelectasis, Pneumonitis, Emphysema (34, 17, 1 respectively), Hilar adenopathy (21), Mediastinal lymph node enlargement (50), Mediastinal invasion (51), Pericardial thickening (5), SVC syndrome with collateral vessels (3), Pleural effusion (27), Pleural thickening or invasion (14), Chest wall invasion (2), Distant metastasis (26). 5. In most of patients (92 cases), the size of mass was above 3cm, but in 9 cases below 3cm. Margins of the masses were serrated or lobulated in most cases. In 5 cases, cavitary formations were noted, walls of which were thick and irregular, and air-fluid level was noted in 1 case. In 2 cases, eccentric calcification were noted within mass. 6. Among 51 cases of whom direct mediastinal invasion was suspected, 8 cases were operated upon, and this revealed that the masses were not resectable. Among the patients in

  18. Chest Computed Tomography (CT) Immediately after CT-Guided Transthoracic Needle Aspiration Biopsy as a Predictor of Overt Pneumothorax

    Science.gov (United States)

    Noh, Tae June; Lee, Chang Hoon; Kang, Young Ae; Kwon, Sung-Youn; Yoon, Ho-Il; Kim, Tae Jung; Lee, Kyung Won; Lee, Jae Ho

    2009-01-01

    Background/Aims This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. Methods Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. Results Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. Conclusions CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax. PMID:19949733

  19. Usefulness of CT-guided trans-bronchial needle aspiration biopsy for mediastinal lymph nodes

    International Nuclear Information System (INIS)

    Cui Bing; Rong Fu

    2001-01-01

    Objective: To determine the nature of enlarged mediastinal lymph nodes, the study of CT-guided trans-bronchial needle aspiration biopsy (CT-TBNA) was conducted. Methods: According to classification and locating standard of mediastinal lymph nodes, CT-TBNA was performed in 158 mediastinal lymph nodes of 73 patients, including 54 primary lung cancer with enlarged mediastinal lymph nodes, 5 malignant lymphoma, 3 mediastinal abscess and 11 mediastinal inflammatory adenopathy. Results: CT confirmed that the needles were inside all 158 lymph nodes. Adequate aspirates for histologic and/or cytologic diagnosis were obtained in 136 of 158(86%) lymph node biopsies. No serious complications occurred. Conclusion: Locating standard of CT-guided TBNA was reliable. Puncture was safe and cost-effective. CT-TBNA was important for ascertaining the nature of mediastinal adenopathy and staging of neoplasms

  20. Isolate pulmonary nodule. CT-guided biopsy

    International Nuclear Information System (INIS)

    Bruneton, J.N.; Ettore, F.; Rogopoulos, A.; Geoffray, A.; Balu-Maestro, C.; Le Houcq, M.

    1989-01-01

    Transparietal CT-guided biopsy location can be successfully performed for isolate pulmonary nodules, defined as lesions with a maximal diameter of 3 cm, without any other parenchymal or mediastinal abnormality. A 21 G needle has been used according to an identical protocole in 64 cases (10 benign, 54 malignant). The biopsy was successful in 77.7% of the malignant cases. In relation to the diameter of the nodules, biopsy was successful in 66.7% of the nodules smaller than 2 cm and in 76% of the nodules ranging from 2 to 3 cm. The complications observed were rare (1 case of pneumothorax requiring drainage, 9 cases of pneumothorax without clinical signs and simply followed up, 4 cases of minor hemoptysis requiring no treatment and 5 cases of hematomas smaller than 5 cm on CT) [fr

  1. CT staging of lung cancer: the role of artificial pneumothorax

    International Nuclear Information System (INIS)

    Lee, Jin Seong; Im, Jung Gi; Han, Man Chung

    1991-01-01

    To determine the role of artificially induced pneumothorax in the evaluation of the chest wall and mediastinal invasion in patients with peripheral bronchogenic carcinoma. CT scans of 22 patients obtained after induced pneumothorax were evaluated. All patients had peripheral lung mass abutting the pleura on a routine CT scan. Room air of 200-400ml was introduced through intrathoracic negative pressure initially, followed by pressure injection through the 18 gauge long bevelled needle under fluoroscopic control. Conclusively, CT with artificial pneumothorax added more information than conventional CT in the evaluation of the chest wall or mediastinal invasion by lung cancer without notable risk

  2. Measurement of lung tumor motion using respiration-correlated CT

    International Nuclear Information System (INIS)

    Mageras, Gig S.; Pevsner, Alex; Yorke, Ellen D.; Rosenzweig, Kenneth E.; Ford, Eric C.; Hertanto, Agung; Larson, Steven M.; Lovelock, D. Michael; Erdi, Yusuf E.; Nehmeh, Sadek A.; Humm, John L.; Ling, C. Clifton

    2004-01-01

    Purpose: We investigate the characteristics of lung tumor motion measured with respiration-correlated computed tomography (RCCT) and examine the method's applicability to radiotherapy planning and treatment. Methods and materials: Six patients treated for non-small-cell lung carcinoma received a helical single-slice computed tomography (CT) scan with a slow couch movement (1 mm/s), while simultaneously respiration is recorded with an external position-sensitive monitor. Another 6 patients receive a 4-slice CT scan in a cine mode, in which sequential images are acquired for a complete respiratory cycle at each couch position while respiration is recorded. The images are retrospectively resorted into different respiration phases as measured with the external monitor (4-slice data) or patient surface displacement observed in the images (single-slice data). The gross tumor volume (GTV) in lung is delineated at one phase and serves as a visual guide for delineation at other phases. Interfractional GTV variation is estimated by scaling diaphragm position variations measured in gated radiographs at treatment with the ratio of GTV:diaphragm displacement observed in the RCCT data. Results: Seven out of 12 patients show GTV displacement with respiration of more than 1 cm, primarily in the superior-inferior (SI) direction; 2 patients show anterior-posterior displacement of more than 1 cm. In all cases, extremes in GTV position in the SI direction are consistent with externally measured extremes in respiration. Three patients show evidence of hysteresis in GTV motion, in which the tumor trajectory is displaced 0.2 to 0.5 cm anteriorly during expiration relative to inspiration. Significant (>1 cm) expansion of the GTV in the SI direction with respiration is observed in 1 patient. Estimated intrafractional GTV motion for gated treatment at end expiration is 0.6 cm or less in all cases; however; interfraction variation estimates (systematic plus random) are more than 1 cm in 3

  3. 3D Interpolation Method for CT Images of the Lung

    Directory of Open Access Journals (Sweden)

    Noriaki Asada

    2003-06-01

    Full Text Available A 3-D image can be reconstructed from numerous CT images of the lung. The procedure reconstructs a solid from multiple cross section images, which are collected during pulsation of the heart. Thus the motion of the heart is a special factor that must be taken into consideration during reconstruction. The lung exhibits a repeating transformation synchronized to the beating of the heart as an elastic body. There are discontinuities among neighboring CT images due to the beating of the heart, if no special techniques are used in taking CT images. The 3-D heart image is reconstructed from numerous CT images in which both the heart and the lung are taken. Although the outline shape of the reconstructed 3-D heart is quite unnatural, the envelope of the 3-D unnatural heart is fit to the shape of the standard heart. The envelopes of the lung in the CT images are calculated after the section images of the best fitting standard heart are located at the same positions of the CT images. Thus the CT images are geometrically transformed to the optimal CT images fitting best to the standard heart. Since correct transformation of images is required, an Area oriented interpolation method proposed by us is used for interpolation of transformed images. An attempt to reconstruct a 3-D lung image by a series of such operations without discontinuity is shown. Additionally, the same geometrical transformation method to the original projection images is proposed as a more advanced method.

  4. Sacral-neuromodulation CT-guided

    International Nuclear Information System (INIS)

    Amoroso, Lamberto; Ricci, Stefano; Pelliccioni, Giuseppe; Scarpino, Osvaldo; Ghiselli, Roberto; Saba, Vittorio

    2005-01-01

    total of 38 centering. Eight patients underwent the PNE procedure on both the S3 foramina. The sacral foramen was centred at the first attempt in 36 out of 38 cases. Two cases required several attempts to centre correctly the foramen. In 4 patients out of 30 a second electrode was implanted. In one patient who had a non consolidated sacral fracture, CT guidance enabled insertion of the electrode inside the only practicable foramen, a manoeuvre that would have been impossible with fluoroscopic guidance. Only once was repositioned after a CT control. During the whole trial period we had a positive response to the PNE test in 18 out of 30 patients (60%), a partial response in 4 out of 30 patients and a negative response in the remaining 8 patients. None of the patients who underwent the PNE test had infectious complications and the procedure was well tolerated by all. The procedure lasted about 45 minutes. Conclusions: The PNE test under Ct guidance proved to be more efficient compared with the traditional technique as the direct view of the electrode position helped to define with greater reliability the patients who were non-responsive to sacral stimulation. Moreover, this method was particularly efficient in patients with sacral anomalies where the traditional guide might fail. The operators' reduced exposure to radiation is an advantage to be taken into consideration. Finally, the usage of mobile CT apparatus in an operating theatre can improve the technique for permanent implantations [it

  5. 18FDG uptake associated with CT density on PET/CT in lungs with and without chronic interstitial lung diseases

    International Nuclear Information System (INIS)

    Inoue, Kentaro; Okada, Ken; Taki, Yasuyuki; Goto, Ryoi; Kinomura, Shigeo; Fukuda, Hiroshi

    2009-01-01

    The dependent-density of computed tomography (CT) images of positron emission tomography (PET)/CT is sometimes difficult to distinguish from chronic interstitial lung disease (ILD) when it accompanies increased 18 F-fluorodeoxy-D-glucose ( 18 FDG) uptake. Though the possible utility of 18 FDG-PET for the diagnosis of active ILD has been reported, the clinical relevance of mild lung 18 FDG uptake in ILD cases without signs and symptoms suggesting acute progression has not been described. This study aimed to test relationships between 18 FDG uptake and lung density on CT using PET/CT in patients with normal lung as well as clinically stable chronic ILD. Thirty-six patients with normal lungs (controls) and 28 patients with chronic ILD (ILD cases) without acute exacerbation were retrospectively selected from 18 FDG PET/CT scans performed in examination of malignant neoplasms. Elliptical regions of interest (ROIs) were placed on the lung. The relationships between CT density and 18 FDG uptake between the control and ILD cases were tested. The CT density and 18 FDG uptake had a linear correlation in both the controls and the ILD cases without a difference in their regression slopes, and they were overlapped between the controls and the ILD cases with higher mean values in the ILD cases. Lung 18 FDG uptake was considered to reflect a gravity-dependent tissue density in the normal lung. Though the lung 18 FDG uptake as well as the CT density tended to be higher in chronic ILD patients, it may be difficult to distinguish them in normal dependent regions from those related to chronic ILD in some cases. (author)

  6. Volumetric expiratory high-resolution CT of the lung

    International Nuclear Information System (INIS)

    Nishino, Mizuki; Hatabu, Hiroto

    2004-01-01

    We developed a volumetric expiratory high-resolution CT (HRCT) protocol that provides combined inspiratory and expiratory volumetric imaging of the lung without increasing radiation exposure, and conducted a preliminary feasibility assessment of this protocol to evaluate diffuse lung disease with small airway abnormalities. The volumetric expiratory high-resolution CT increased the detectability of the conducting airway to the areas of air trapping (P<0.0001), and added significant information about extent and distribution of air trapping (P<0.0001)

  7. Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants

    International Nuclear Information System (INIS)

    Gierada, David S.; Pinsky, Paul F.; Duan, Fenghai; Garg, Kavita; Hart, Eric M.; Kazerooni, Ella A.; Nath, Hrudaya; Watts, Jubal R.; Aberle, Denise R.

    2017-01-01

    This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen. The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer. By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen (P < 0.001). Cases had higher estimated likelihood of lung cancer (P < 0.001). Abnormalities included pulmonary nodules ≥4 mm (n = 16), mediastinal (n = 8) and hilar (n = 6) masses, and bronchial lesions (n = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers (P < 0.0001). Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening. (orig.)

  8. Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants

    Energy Technology Data Exchange (ETDEWEB)

    Gierada, David S. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, Box 8131, St. Louis, MO (United States); Pinsky, Paul F. [National Cancer Institute, Bethesda, MD (United States); Duan, Fenghai [Brown University School of Public Health, Department of Biostatistics and Center for Statistical Sciences, Providence, RI (United States); Garg, Kavita [University of Colorado School of Medicine, Mail Stop F726, Box 6510, Aurora, CO (United States); Hart, Eric M. [Northwestern University, Feinberg School of Medicine, Department of Radiology, Chicago, IL (United States); Kazerooni, Ella A. [University of Michigan Health System, Department of Radiology, Ann Arbor, MI (United States); Nath, Hrudaya; Watts, Jubal R. [University of Alabama at Birmingham School of Medicine, Department of Radiology-JTN370, Birmingham, AL (United States); Aberle, Denise R. [David Geffen School of Medicine at UCLA, Department of Radiological Sciences, Los Angeles, CA (United States)

    2017-08-15

    This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen. The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer. By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen (P < 0.001). Cases had higher estimated likelihood of lung cancer (P < 0.001). Abnormalities included pulmonary nodules ≥4 mm (n = 16), mediastinal (n = 8) and hilar (n = 6) masses, and bronchial lesions (n = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers (P < 0.0001). Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening. (orig.)

  9. CT imaging of coexisting pulmonary tuberculosis and lung cancer

    International Nuclear Information System (INIS)

    Lv Yan; Xie Ruming; Zhou Xinhua; Zhou Zhen; Xu Jinping; He Wei; Guo Lifang; Ning Fenggang

    2013-01-01

    Objective: To study the CT characteristics of coexisting pulmonary tuberculosis and lung cancer. Methods: One hundred and four patients of coexisting pulmonary tuberculosis and lung cancer proved by histology, cytology or clinical underwent CT examination. All patients were divided into two groups, group Ⅰ were the patients with the lung cancer after tuberculosis or both found simultaneously (group Ⅰ a with peripheral lung cancer and group Ⅰ b with central lung cancer), group Ⅱ with tuberculosis during lung cancer chemotherapy (group Ⅱ a with peripheral lung cancer and group Ⅱ b with central lung cancer). Imaging characteristics of tuberculosis and lung cancer were compared. χ"2 test and t test were used for the statistical analysis. Results: Of 104 patients, there were 92 patients (88.5%) in group Ⅰ and 12 patients (11.5%) in group Ⅱ. Seventy patients (76.1%) of lung cancer and tuberculosis were located in the same lobe and 22 patients (23.9%) in the different lobes in group Ⅰ. There was no significant difference in distribution of tuberculosis between group Ⅰ and group Ⅱ (χ"2 = 4.302, P = 0.507). The fibrous stripes, nodules of calcification and pleural adhesion of tuberculosis were statistically significant between the two groups (χ"2 = 22.737, 15.193, 27.792, P < 0.05). There were 33 central lung cancers and 71 peripheral lung cancers. In group Ⅰ a (64 patients of peripheral lung cancers), 39 patients (60.9%) had typical manifestations and most of the lesions were ≥ 3 cm (n = 49, 76.6%), solid lesions showed variable enhancement. Conclusions: Secondary tuberculosis during lung cancer chemotherapy has the same CT characteristics with the common active tuberculosis. The morphology, enhancement pattern of lesion and follow-up are helpful for the diagnosis of lung cancer after tuberculosis. (authors)

  10. The Danish randomized lung cancer CT screening trial

    DEFF Research Database (Denmark)

    Pedersen, Jesper H; Ashraf, Haseem; Dirksen, Asger

    2009-01-01

    INTRODUCTION: Lung cancer screening with low dose computed tomography (CT) has not yet been evaluated in randomized clinical trials, although several are underway. METHODS: In The Danish Lung Cancer Screening Trial, 4104 smokers and previous smokers from 2004 to 2006 were randomized to either...... lung cancer. Ten of these had stage I disease. Eleven of 17 lung cancers at baseline were treated surgically, eight of these by video assisted thoracic surgery resection. CONCLUSIONS: Screening may facilitate minimal invasive treatment and can be performed with a relatively low rate of false......-positive screen results compared with previous studies on lung cancer screening....

  11. Measurement of lung volumes : usefulness of spiral CT

    International Nuclear Information System (INIS)

    Kang, Ho Yeong; Kwak, Byung Kook; Lee, Sang Yoon; Kim, Soo Ran; Lee, Shin Hyung; Lee, Chang Joon; Park, In Won

    1996-01-01

    To evaluate the usefulness of spiral CT in the measurement of lung volumes. Fifteen healthy volunteers were studied by both spirometer and spiral CT at full inspiration and expiration in order to correlated their results, including total lung capacity (TLC), vital capacity (VC) and residual volume (RV). 3-D images were reconstructed from spiral CT, and we measured lung volumes at a corresponding CT window range ; their volumes were compared with the pulmonary function test (paired t-test). The window range corresponding to TLC was from -1000HU to -150HU (p=0.279, r=0.986), and for VC from -910HU to -800HU (p=0.366, r=0.954) in full-inspiratory CT. The optimal window range for RV in full-expiratory CT was from -1000HU to -450HU (p=0.757, r=0.777), and TLC-VC in full-inspiratory CT was also calculated (p=0.843, r=0.847). Spiral CT at full inspiration can used to lung volumes such as TLC, VC and RV

  12. [CT-Screening for Lung Cancer - what is the Evidence?

    Science.gov (United States)

    Watermann, Iris; Reck, Martin

    2018-04-01

    In patients with lung cancer treatment opportunities and prognosis are correlated to the stage of disease with a chance for curative treatment in patients with early stage disease. Therefore, early detection of lung cancer is of paramount importance for improving the prognosis of lung cancer patients.The National Lung Screening Trial (NLST) has already shown that low-dose CT increases the number of identified early stage lung cancer patients and reduces lung cancer related mortality. Critically considered in terms of CT-screening are false-positive results, overdiagnosis and unessential invasive clarification. Preliminary results of relatively small European trials haven´t yet confirmed the results of the NLST-study.Until now Lung Cancer Screening by low dose CT-scan or other methods is neither approved nor available in Germany.To improve the efficacy of CT-Screening and to introduce early detection of lung cancer in standard practice, additional, complementing methods should be further evaluated. One option might be the supplementary analysis of biomarkers in liquid biopsies or exhaled breath condensates. In addition, defining the high-risk population is of great relevance to identify candidates who might benefit of early detection programs. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Automated ultrafast kilovoltage-megavoltage cone-beam CT for image guided radiotherapy of lung cancer: System description and real-time results.

    Science.gov (United States)

    Blessing, Manuel; Arns, Anna; Wertz, Hansjoerg; Stsepankou, Dzmitry; Boda-Heggemann, Judit; Hesser, Juergen; Wenz, Frederik; Lohr, Frank

    2018-04-01

    To establish a fully automated kV-MV CBCT imaging method on a clinical linear accelerator that allows image acquisition of thoracic targets for patient positioning within one breath-hold (∼15s) under realistic clinical conditions. Our previously developed FPGA-based hardware unit which allows synchronized kV-MV CBCT projection acquisition is connected to a clinical linear accelerator system via a multi-pin switch; i.e. either kV-MV imaging or conventional clinical mode can be selected. An application program was developed to control the relevant linac parameters automatically and to manage the MV detector readout as well as the gantry angle capture for each MV projection. The kV projections are acquired with the conventional CBCT system. GPU-accelerated filtered backprojection is performed separately for both data sets. After appropriate grayscale normalization both modalities are combined and the final kV-MV volume is re-imported in the CBCT system to enable image matching. To demonstrate adequate geometrical accuracy of the novel imaging system the Penta-Guide phantom QA procedure is performed. Furthermore, a human plastinate and different tumor shapes in a thorax phantom are scanned. Diameters of the known tumor shapes are measured in the kV-MV reconstruction. An automated kV-MV CBCT workflow was successfully established in a clinical environment. The overall procedure, from starting the data acquisition until the reconstructed volume is available for registration, requires ∼90s including 17s acquisition time for 100° rotation. It is very simple and allows target positioning in the same way as for conventional CBCT. Registration accuracy of the QA phantom is within ±1mm. The average deviation from the known tumor dimensions measured in the thorax phantom was 0.7mm which corresponds to an improvement of 36% compared to our previous kV-MV imaging system. Due to automation the kV-MV CBCT workflow is speeded up by a factor of >10 compared to the manual

  14. CT quantification of lung and airways in normal Korean subjects

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Song Soo; Lee, Jeong Eun; Shin, Hye Soo [Dept. of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon (Korea, Republic of); Jin, Gong Yong; Li, Yuan Zhe [Dept. of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju (Korea, Republic of)

    2017-08-01

    To measure and compare the quantitative parameters of the lungs and airways in Korean never-smokers and current or former smokers (“ever-smokers”). Never-smokers (n = 119) and ever-smokers (n = 45) who had normal spirometry and visually normal chest computed tomography (CT) results were retrospectively enrolled in this study. For quantitative CT analyses, the low attenuation area (LAA) of LAA{sub I-950}, LAA{sub E-856}, CT attenuation value at the 15th percentile, mean lung attenuation (MLA), bronchial wall thickness of inner perimeter of a 10 mm diameter airway (Pi10), total lung capacity (TLC{sub CT}), and functional residual capacity (FRC{sub CT}) were calculated based on inspiratory and expiratory CT images. To compare the results between groups according to age, sex, and smoking history, independent t test, one way ANOVA, correlation test, and simple and multiple regression analyses were performed. The values of attenuation parameters and volume on inspiratory and expiratory quantitative computed tomography (QCT) were significantly different between males and females (p < 0.001). The MLA and the 15th percentile value on inspiratory QCT were significantly lower in the ever-smoker group than in the never-smoker group (p < 0.05). On expiratory QCT, all lung attenuation parameters were significantly different according to the age range (p < 0.05). Pi10 in ever-smokers was significantly correlated with forced expiratory volume in 1 second/forced vital capacity (r = −0.455, p = 0.003). In simple and multivariate regression analyses, TLC{sub CT}, FRC{sub CT}, and age showed significant associations with lung attenuation (p < 0.05), and only TLC{sub CT} was significantly associated with inspiratory Pi10. In Korean subjects with normal spirometry and visually normal chest CT, there may be significant differences in QCT parameters according to sex, age, and smoking history.

  15. Comparative reading support system for lung cancer CT screening

    International Nuclear Information System (INIS)

    Kubo, Mitsuru; Saita, Shinsuke; Kawata, Yoshiki; Niki, Noboru; Suzuki, Hidenobu; Ohmatsu, Hironobu; Eguchi, Kenji; Kaneko, Masahiro; Moriyama, Noriyuki

    2010-01-01

    The comparative reading is performed using current and past images of the same case obtained from lung cancer CT screening. The result of this is useful for the early detection of lung cancer. Our paper describes the efficiency improvement of comparative reading using 10 mm slice thickness CT images by developing the system consists of slice registration method, pulmonary nodule registration method, and quantitative evaluation method of pulmonary nodule's degree of change. The proposed system is applied to CT images scanned for 1107 times of 85 cases with 198 pulmonary nodules and is evaluated by comparing it with the reading result of the doctors. We show the effectiveness of the system. (author)

  16. Dependent lung opacity at thin-section CT: evaluation by spirometrically-gated CT of the influence of lung volume

    International Nuclear Information System (INIS)

    Lee, Ki Nam; Yoon, Seong Kuk; Sohn, Choon Hee; Choi, Pil Jo; Webb, W. Richard

    2002-01-01

    To evaluate the influence of lung volume on dependent lung opacity seen at thin-section CT. In thirteen healthy volunteers, thin-section CT scans were performed at three levels (upper, mid, and lower portion of the lung) and at different lung volumes (10, 30, 50, and 100% vital capacity), using spirometric gated CT. Using a three-point scale, two radiologists determined whether dependent opacity was present, and estimated its degree. Regional lung attenuation at a level 2 cm above the diaphragm was determined using semiautomatic segmentation, and the diameter of a branch of the right lower posterior basal segmental artery was measured at each different vital capacity. At all three anatomic levels, dependent opacity occurred significantly more often at lower vital capacities (10, 30%) than at 100% vital capacity (p = 0.001). Visually estimated dependent opacity was significantly related to regional lung attenuation (p < 0.0001), which in dependent areas progressively increased as vital capacity decreased (p < 0.0001). The presence of dependent opacity and regional lung attenuation of a dependent area correlated significantly with increased diameter of a segmental arterial branch (r = 0.493 and p = 0.0002; r = 0.486 and p 0.0003, respectively). Visual estimation and CT measurements of dependent opacity obtained by semiautomatic segmentation are significantly influenced by lung volume and are related to vascular diameter

  17. CT features of lung cancer associated with idiopathic pulmonary fibrosis

    International Nuclear Information System (INIS)

    Kim, Jun Hyoung; Song, Koun Sik; Lee, Deok Hee; Kim, Jin Suh; Lim, Tae Hwan

    1996-01-01

    It is well known that the incidence of lung cancer is high in patients with idiopathic pulmonary fibrosis(IPF). We analyzed the CT features of lung cancer associated with IPF. Retrospective analyzed the CT features of lung cancer associated with IPF. Retrospective analysis was performed in 23 patients with lung cancer(24 lung cancers) associated with IPF. The diagnosis of IPF was made by clinical and CT findings, and lung cancer was confirmed pathologically. We divided the location of lung cancer by lobar distribution and central or peripheral lung zone, and measured the size of mass. We classified the mediastinal lymph node enlargement by American Thoracic Society (ATS) mapping scheme. We evaluated the CT pattern of IPF. The subjects consisted of 6 cases of small cell carcinoma and 18 cases of non-small cell lung cancer. Non-small cell lung cancers were located in the right upper lobe in 5 cases, left upper lobe in 6 cases, right middle lobe in 1 case, right lower lobe in 9 cases, and left lower lobe in 3 cases. Twenty cancers(85%) were located in the peripheral lung zone. Eighteen cancers(73%) were surrounded by fibrotic lung. The size of the mass ranged from 1 to 12 cm, and in 12 cases it was below 3cm in diameter. Mediastinal lymph nodes were enlarged in 22 cases(92%) and classified as N2 or N3 in 15 cases out of 18 non-small cell lung. The size of the mass ranged from 1 to 12 cm, and in 12 cases it was below 3 cm in diameter. Mediastinal lymph nodes were enlarged in 22 cases(92%) and classified as N2 or N3 in 15 cases out of 18 non-small cell lung cancers. CT patterns of underlying IPF were honey-combing in 18 patients(78%) and mixed honey-combing and ground-glass opacity in 5 patients(22%). The lung cancer associated with IPF shows variable cell types. Most of the lung cancers were located peripherally, surrounded by end-stage fibrosis, and were associated with mediastinal lymph node enlargement

  18. CT features of lung cancer associated with idiopathic pulmonary fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jun Hyoung; Song, Koun Sik; Lee, Deok Hee; Kim, Jin Suh; Lim, Tae Hwan [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    It is well known that the incidence of lung cancer is high in patients with idiopathic pulmonary fibrosis(IPF). We analyzed the CT features of lung cancer associated with IPF. Retrospective analyzed the CT features of lung cancer associated with IPF. Retrospective analysis was performed in 23 patients with lung cancer(24 lung cancers) associated with IPF. The diagnosis of IPF was made by clinical and CT findings, and lung cancer was confirmed pathologically. We divided the location of lung cancer by lobar distribution and central or peripheral lung zone, and measured the size of mass. We classified the mediastinal lymph node enlargement by American Thoracic Society (ATS) mapping scheme. We evaluated the CT pattern of IPF. The subjects consisted of 6 cases of small cell carcinoma and 18 cases of non-small cell lung cancer. Non-small cell lung cancers were located in the right upper lobe in 5 cases, left upper lobe in 6 cases, right middle lobe in 1 case, right lower lobe in 9 cases, and left lower lobe in 3 cases. Twenty cancers(85%) were located in the peripheral lung zone. Eighteen cancers(73%) were surrounded by fibrotic lung. The size of the mass ranged from 1 to 12 cm, and in 12 cases it was below 3cm in diameter. Mediastinal lymph nodes were enlarged in 22 cases(92%) and classified as N2 or N3 in 15 cases out of 18 non-small cell lung. The size of the mass ranged from 1 to 12 cm, and in 12 cases it was below 3 cm in diameter. Mediastinal lymph nodes were enlarged in 22 cases(92%) and classified as N2 or N3 in 15 cases out of 18 non-small cell lung cancers. CT patterns of underlying IPF were honey-combing in 18 patients(78%) and mixed honey-combing and ground-glass opacity in 5 patients(22%). The lung cancer associated with IPF shows variable cell types. Most of the lung cancers were located peripherally, surrounded by end-stage fibrosis, and were associated with mediastinal lymph node enlargement.

  19. CT guided percutaneous needle biopsy of the chest: initial experience

    African Journals Online (AJOL)

    The objective of this article is to report our first experience of CT guided percutaneous thoracic biopsy and to demonstrate the accuracy and safety of this procedure. This was a retrospective study of 28 CT-Guided Percutaneous Needle Biopsies of the Chest performed on 24 patients between November 2014 and April 2015.

  20. Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules: A Cohort Study.

    Science.gov (United States)

    Bhatt, Kavita M; Tandon, Yasmeen K; Graham, Ruffin; Lau, Charles T; Lempel, Jason K; Azok, Joseph T; Mazzone, Peter J; Schneider, Erika; Obuchowski, Nancy A; Bolen, Michael A

    2018-03-01

    Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P guided sampling (P guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. © RSNA, 2017 Online supplemental material is available for this article.

  1. Diagnosis of Peripheral Lung Lesions via Conventional Flexible Bronchoscopy with Multiplanar CT Planning

    Directory of Open Access Journals (Sweden)

    Marianne Anastasia De Roza

    2016-01-01

    Full Text Available Background. Conventional flexible bronchoscopy has limited sensitivity in the diagnosis of peripheral lung lesions and is dependent on lesion size. However, advancement of CT imaging offers multiplanar reconstruction facilitating enhanced preprocedure planning. This study aims to report efficacy and safety while considering the impact of patient selection and multiplanar CT planning. Method. Prospective case series of patients with peripheral lung lesions suspected of having lung cancer who underwent flexible bronchoscopy (forceps biopsy and lavage. Endobronchial lesions were excluded. Patients with negative results underwent CT-guided transthoracic needle aspiration, surgical biopsy, or clinical-radiological surveillance to establish the final diagnosis. Results. 226 patients were analysed. The diagnostic yield of bronchoscopy was 80.1% (181/226 with a sensitivity of 84.2% and specificity of 100%. In patients with a positive CT-Bronchus sign, the diagnostic yield was 82.4% compared to 72.8% with negative CT-Bronchus sign (p=0.116. Diagnostic yield was 84.9% in lesions > 20 mm and 63.0% in lesions ≤ 20 mm (p=0.001. Six (2.7% patients had transient hypoxia and 2 (0.9% had pneumothorax. There were no serious adverse events. Conclusion. Flexible bronchoscopy with appropriate patient selection and preprocedure planning is more efficacious in obtaining a diagnosis in peripheral lung lesions compared to historical data. This trial is registered with ClinicalTrials.gov Identifier: NCT01374542.

  2. Helical CT for secondary screening of lung cancer

    International Nuclear Information System (INIS)

    Mori, Kiyoshi; Onishi, Tsukasa; Tominaga, Keigo; Kishiro, Izumi; Yokoyama, Kohki.

    1995-01-01

    Helical CT was used on a trial basis for secondary screening of lung cancer, and its clinical usefulness is discussed in this report. The subjects of 157 patients with abnormal shadows on plain chest X-ray images were chosen between November 1993 and August 1994. Imaging parameters used for screening CT were as follows: 50 mA, 120 kV, a couch-top movement speed of 20 mm/s, and a beam width of 10 mm. The entire lung field was scanned during a single breath-hold. Reconstructed images were generated at 10-mm intervals by the 180deg interpolation method, and films were produced. Images of the entire lung field were made during a single breath-hold in all patients. Abnormal shadows were detected in 73 of 157 patients by screening CT. These 73 patients included 14 with lung cancer, 53 with benign lesions, one under observation, and five others. The average diameter of the tumors was 11.1 mm. The lung cancers detected all arose in the periphery, and were classified into stage I (10 patients), stage IIIA (3 patients), and stage IV with bone metastases (1 patient). Lung cancers in clinical stage I (3 patients) and stage IV (1 patient) were difficult to see on plain chest X-ray films. We conclude that screening CT is useful for early diagnosis of lung cancer because the entire lung field can be imaged during a single breath-hold. Therefore, helical CT can be expected to be useful in screening for lung cancer. (author)

  3. Study of metastatic foci by CT in autopsied lung cancer

    International Nuclear Information System (INIS)

    Koga, Mitsuru; Nobe, Yoshifumi; Fujii, Kyoichi.

    1983-01-01

    The authors reexamined all of the image diagnoses made during whole hospitalization in 11 lung cancer cases with autopsy. Of 39 metastatic foci observed at autopsy in the liver, kidney, pancreas, adrenal and brain, 12 had been diagnosed on transverse CT images before death. Three foci were missed at initial readings. The period from CT to autopsy was less than 3 months for 9 of 12 correctly diagnosed foci. For 13 of 27 foci undetected by CT, CT was conducted more than 3 months before death. (Chiba, N)

  4. A case of lung abscess successfully treated by transbronchial drainage using a guide sheath.

    Science.gov (United States)

    Izumi, Hiroki; Kodani, Masahiro; Matsumoto, Shingo; Kawasaki, Yuji; Igishi, Tadashi; Shimizu, Eiji

    2017-05-01

    A 51-year-old man was diagnosed with colon cancer in September 2011, and a solitary pulmonary nodule was detected by computed tomography (CT) scan. We performed a transbronchial biopsy with endobronchial ultrasonography using a guide sheath (GS) and diagnosed lung metastasis of colon cancer. The patient experienced remittent fever after the biopsy in spite of intravenous antibiotic therapies. Moreover, his CT scan showed a large lung abscess at the biopsy site. We performed transbronchial drainage using a GS as salvage therapy. The bloody pus was successfully aspirated, and chest X-ray following the procedure showed dramatic shrinkage of the abscess.

  5. Improved quantitation and reproducibility in multi-PET/CT lung studies by combining CT information.

    Science.gov (United States)

    Holman, Beverley F; Cuplov, Vesna; Millner, Lynn; Endozo, Raymond; Maher, Toby M; Groves, Ashley M; Hutton, Brian F; Thielemans, Kris

    2018-06-05

    Matched attenuation maps are vital for obtaining accurate and reproducible kinetic and static parameter estimates from PET data. With increased interest in PET/CT imaging of diffuse lung diseases for assessing disease progression and treatment effectiveness, understanding the extent of the effect of respiratory motion and establishing methods for correction are becoming more important. In a previous study, we have shown that using the wrong attenuation map leads to large errors due to density mismatches in the lung, especially in dynamic PET scans. Here, we extend this work to the case where the study is sub-divided into several scans, e.g. for patient comfort, each with its own CT (cine-CT and 'snap shot' CT). A method to combine multi-CT information into a combined-CT has then been developed, which averages the CT information from each study section to produce composite CT images with the lung density more representative of that in the PET data. This combined-CT was applied to nine patients with idiopathic pulmonary fibrosis, imaged with dynamic 18 F-FDG PET/CT to determine the improvement in the precision of the parameter estimates. Using XCAT simulations, errors in the influx rate constant were found to be as high as 60% in multi-PET/CT studies. Analysis of patient data identified displacements between study sections in the time activity curves, which led to an average standard error in the estimates of the influx rate constant of 53% with conventional methods. This reduced to within 5% after use of combined-CTs for attenuation correction of the study sections. Use of combined-CTs to reconstruct the sections of a multi-PET/CT study, as opposed to using the individually acquired CTs at each study stage, produces more precise parameter estimates and may improve discrimination between diseased and normal lung.

  6. Lung Nodule Detection in CT Images using Neuro Fuzzy Classifier

    Directory of Open Access Journals (Sweden)

    M. Usman Akram

    2013-07-01

    Full Text Available Automated lung cancer detection using computer aided diagnosis (CAD is an important area in clinical applications. As the manual nodule detection is very time consuming and costly so computerized systems can be helpful for this purpose. In this paper, we propose a computerized system for lung nodule detection in CT scan images. The automated system consists of two stages i.e. lung segmentation and enhancement, feature extraction and classification. The segmentation process will result in separating lung tissue from rest of the image, and only the lung tissues under examination are considered as candidate regions for detecting malignant nodules in lung portion. A feature vector for possible abnormal regions is calculated and regions are classified using neuro fuzzy classifier. It is a fully automatic system that does not require any manual intervention and experimental results show the validity of our system.

  7. How to choose PET-CT or CT in the diagnosis and staging of lung cancer. Practical experience in China

    International Nuclear Information System (INIS)

    Jiang, T.; Tao, X.; Liu, H.; Liu, S.; Zheng, X.

    2010-01-01

    How to use CT and PET-CT rationally to raise diagnosis, staging and prognostic assessment of lung cancer to a higher level at the best cost-effect ratio is a subject that Chinese clinicians and radiologists should face conscientiously. We review the rational application of CT and PET-CT in four aspects of lung cancer, including screening and detection, morphologic evaluation, haemodynamic or metabolic feature evaluation, and follow-up, staging and prognostic evaluation. As PET-CT is only available in class III-A hospitals today, CT is the most popular equipment in China. PET-CT is more valuable only in cases where CT presentation of lung cancer is atypical or difficult to determine, or in cases where the diagnosis of lung cancer has been initially confirmed, for which clinical staging and decision concerning on therapeutic regimens are needed. We also recommend the current strategies of CT and PET-CT managing of SPN in China. (orig.)

  8. CT thermometry for cone-beam CT guided ablation

    Science.gov (United States)

    DeStefano, Zachary; Abi-Jaoudeh, Nadine; Li, Ming; Wood, Bradford J.; Summers, Ronald M.; Yao, Jianhua

    2016-03-01

    Monitoring temperature during a cone-beam CT (CBCT) guided ablation procedure is important for prevention of over-treatment and under-treatment. In order to accomplish ideal temperature monitoring, a thermometry map must be generated. Previously, this was attempted using CBCT scans of a pig shoulder undergoing ablation.1 We are extending this work by using CBCT scans of real patients and incorporating more processing steps. We register the scans before comparing them due to the movement and deformation of organs. We then automatically locate the needle tip and the ablation zone. We employ a robust change metric due to image noise and artifacts. This change metric takes windows around each pixel and uses an equation inspired by Time Delay Analysis to calculate the error between windows with the assumption that there is an ideal spatial offset. Once the change map is generated, we correlate change data with measured temperature data at the key points in the region. This allows us to transform our change map into a thermal map. This thermal map is then able to provide an estimate as to the size and temperature of the ablation zone. We evaluated our procedure on a data set of 12 patients who had a total of 24 ablation procedures performed. We were able to generate reasonable thermal maps with varying degrees of accuracy. The average error ranged from 2.7 to 16.2 degrees Celsius. In addition to providing estimates of the size of the ablation zone for surgical guidance, 3D visualizations of the ablation zone and needle are also produced.

  9. Low dose CT in early lung cancer diagnosis: prevalence data

    International Nuclear Information System (INIS)

    Cardinale, Luciano; Cortese, Giancarlo; Ferraris, Fabrizio; Perotto, Fabio; Fava, Cesare; Borasio, Piero; Dogliotti, Luigi; Novello, Silvia; Scagliotti, Giorgio

    2005-01-01

    Purpose. Lung cancer has a high mortality rate and its prognosis largely depends on early detection. We report the prevalence data of the study on early detection of lung cancer with low-dose spiral CT underway at our hospital. Materials and methods. Since the beginning of 2001, 519 asymptomatic volunteers have undergone annual blood tests, sputum tests, urinalyses and low-dose spiral CT. The inclusion criteria were age (55 years old), a history of cigarette smoking and a negative history for previous neoplastic disease. The diagnostic workup varied depending on the size and CT features of the nodules detected. Results. At baseline, the CT scan detected nodules> 5 mm in 22% of subjects; the nodules were single in 42 and multiple in 71. In 53% of cases the findings were completely negative, while in 122 (23.4%) nodules with a diameter [it

  10. Implementation of lung cancer CT screening in the Nordic countries

    DEFF Research Database (Denmark)

    Pedersen, Jesper Holst; Sørensen, Jens Benn; Saghir, Zaigham

    2017-01-01

    INTRODUCTION: We review the current knowledge of CT screening for lung cancer and present an expert-based, joint protocol for the proper implementation of screening in the Nordic countries. MATERIALS AND METHODS: Experts representing all the Nordic countries performed literature review...... and concensus for a joint protocol for lung cancer screening. RESULTS AND DISCUSSION: Areas of concern and caution are presented and discussed. We suggest to perform CT screening pilot studies in the Nordic countries in order to gain experience and develop specific and safe protocols for the implementation...

  11. Lung studies with spiral CT. pitch 1 versus pitch 2

    International Nuclear Information System (INIS)

    Sartoni Galloni, S.; Miceli, M.; Lipparino, M.; Burzi, M.; Gigli, F.; Rossi, M.S.; Santoli, G.; Guidarelli, G.

    1999-01-01

    In Spiral CT, the pitch is the ratio of the distance to tabletop travels per 360 degrees rotation to nominal slice width, expressed in mm. Performing Spiral CT examination with pitch 2 allows to reduce examination time, exposure and contrast dose, and X-ray tube overload. The authors investigated the yield of pitch 2 in lung parenchyma studies, particular relative to diagnostic image quality [it

  12. Diagnosis of malignant pleural effusion and lung cancer with CT

    International Nuclear Information System (INIS)

    Jakimovska, S.; Jakimovska, M.; Jovanovska, S.; Ilieva, S.

    2012-01-01

    Full text: Introduction: A pleural effusion is defined as an abnormal amount of fluid in the space between the layers of tissue (the pleura) that line the lungs. If cancer cells are present in this fluid (pleural cavity) it is called a malignant cancerous pleural effusion. Many benign and malignant disease can cause pleural effusion.The new onset of pleural effusion may herald the presence of a previously undiagnosed malignancy, or more typically, complicate the course of a known lung tumor. Malignant pleural effusions can lead lead to an initial diagnosis of lung cancer in patients.and it was the first symptom of lung cancer. Pleural deposits of tumor cause pleuritic pain. Purpose of this presentation is to show the role of CT in diagnosis of malignant pleural effusion and lung cancer. Material and methods: CT examinations of chest were made to 138 patients for 1 year (1/6/2011- 1/6/2012) with Siemens Somatom Emotion 16 CT Scanner. Patients were at age of 30 -81 years, 93 of them are male and 45 are female. Results: 56 (40.5%) of the patients had pleural effusion. From this group 21 37.5% had malignant pleural effusion and lung cancer. 17 (81%) of them are male, and 4 (19%) are female. 9 (43%) diagnosed lung cancer for first time. Conclusion: Pleural effusion more commonly occur in patient with advanced-stage tumor who frequently have metastases to other organs and long-term survival is uncommon in this group. CT diagnosed malignant pleural effusion and lung cancer and help to choice treatment for these patients

  13. Computed tomography-guided needle biopsy of lung lesions in fourteen cats and dogs

    International Nuclear Information System (INIS)

    Yoshida, K.; Mori, T.; Yamada, M.; Sakaida, M.; Yonemaru, K.; Murakami, M.; Sakai, H.; Maruo, K.

    2007-01-01

    Computed tomography (CT)-guided fine-needle aspirates (FNA) or core biopsies of lung lesions were performed in nine dogs and five cats. A clinical diagnosis was obtained in twelve of fourteen animals (85%), namely 80% FNA and 100% core biopsies. Eight animals had other mass (es) apart from the lung, and five were diagnosed to metastases. In only one case, the lung mass was histopathologically diagnosed as a malignant primary tumor. Iatrogenic complications through the lung biopsies were noted in four animals, and three showed mild pneumothorax on CT images and one was bleeding from the needle. However, between fifteen and thirty minutes after the biopsy, no animal indicated signs of pneumothorax or hemorrhage

  14. Clinical application of multi-detector CT-guided percutaneous coaxial biopsy for pulmonary lesions

    International Nuclear Information System (INIS)

    Jia Ningyang; Liu Shiyuan; Zhang Dianbo; Xiao Xiangsheng; Li Wentao; Li Chenzhou

    2008-01-01

    Objective: To evaluate the clinical application of multi-slice CT-guided percutaneous transthoracic lung coaxial-biopsy for pulmonary lesions. Methods: 152 times of 143 patients were performed with percutaneous transthoracic coaxial biopsy under multiple-slice CT-guidance. Analysis was carried out to investigate the diagnostic accuracy and the relationship between the size of the lesions for coaxial biopsy, together with the complications. Results: The diagnostic accuracy was 94.9% with specificity of 100%, including malignant tumors 116 cases (squamous cell cancer 48 cases, adenocarcinoma 34, small cell undifferentiated carcinoma 6, large cell carcinoma 4, bronchial alveolar carcinoma 8, metastatic carcinoma 16) and 19 cases of benign ones(TB 7 cases, inflammatory pseudotumor 9, hematoma 1, lung abscess 1). The size of lesion had a significant influence on the diagnostic accuracy. Conclusions: Percutaneous transthoracic coaxial lung biopsy is a safety method, possessing a high diagnostic accuracy. (authors)

  15. Low-dose CT: new tool for screening lung cancer?

    International Nuclear Information System (INIS)

    Diederich, S.; Wormanns, D.; Heindel, W.

    2001-01-01

    Lung cancer is the leading cause of death from malignant tumours as it is very common and has a poor prognosis at advanced tumour stages. Prognosis could be improved by treatment at early stages. As these stages are usually asymptomatic, a diagnostic test that would allow detection of early tumour stages in a population at risk could potentially reduce mortality from lung cancer. Previous approaches using chest radiography and sputum cytology in smokers have been disappointing. Fluorescent bronchoscopy and molecular markers are not yet applicable in clinical routine. Because of its high sensitivity for small pulmonary nodules, which are the most common manifestation of early lung cancer, CT appears suitable as a screening test. Low-dose examination parameters can and should be used for this purpose. From clinical practice it is well known that chest CT often demonstrates small pulmonary nodules, which do not represent lung cancer. Therefore, non-invasive diagnostic algorithms are required to avoid unnecessary biopsies in benign lesions. In preliminary studies of low-dose CT using algorithms based on size and density of detected nodules a large proportion of asymptomatic lung cancers and a large proportion of early, resectable tumour stages were found with a small proportion of invasive procedures for benign nodules. Before this technology can be recommended for broad application, however, further information is required regarding appropriate inclusion criteria (smoking habits, age groups) and screening intervals. Most importantly, further data are required to clarify whether lung cancer screening using low-dose CT can actually reduce mortality from lung cancer. (orig.)

  16. Simple and inexpensive method for CT-guided stereotaxy

    Energy Technology Data Exchange (ETDEWEB)

    Wester, K; Sortland, O; Hauglie-Hanssen, E

    1981-01-01

    A simple and inexpensive method for CT-guided stereotaxy is described. The method requires neither sophisticated computer programs nor additional stereotactic equipment, such as special head holders for the CT, and can be easily obtained without technical assistance. The method is designed to yield the vertical coordinates.

  17. The diagnostic significance of CT-guided percutaneous transthoracic cutting needle biopsy for pulmonary lesions

    International Nuclear Information System (INIS)

    Wang Hui; Zhang Fuchen; Ji Hongjian; Chen Liping

    2009-01-01

    Objective: To evaluate the diagnostic significance of CT-guided percutaneous transthoracic cutting needle biopsy for pulmonary lesions. Methods: The clinical data of CT-guided transthoracic cutting needle biopsy in 436 patients performed in past 10 years were retrospectively analyzed. Of 436 cases with pulmonary lesions, primary lung cancer was confirmed in 341, pulmonary metastasis in 62, non-malignant lesions in 33. The diagnostic accuracy and sensitivity were statistically analyzed. The occurrence of complications was discussed. Results: The diagnostic accuracy rate and sensitivity rate in primary lung cancer group were 94.7% and 94.1% respectively, in pulmonary metastasis group were 58.2% and 51.6% respectively and in non-malignant lesions group were 57.6% and 57.6% respectively. The successful rate of biopsy was 97.9%. The occurrence of complications was 15.6%. Conclusion: CT-guided percutaneous transthoracic cutting needle biopsy is a safe and valuable diagnostic technique with high diagnostic accuracy and less complications. It is very helpful in confirming the diagnosis in the patients with suspected primary pulmonary cancer, although the technical procedures need to be further improved for metastatic and non-malignant lung lesions. (authors)

  18. Assessment of airway lesion in obstructive lung diseases by CT

    International Nuclear Information System (INIS)

    Niimi, Akio; Matsumoto, Hisako; Ueda, Tetsuya; Mishima, Michiaki

    2002-01-01

    Airway lesion in obstructive pulmonary diseases, such as asthma or chronic obstructive pulmonary disease (COPD), has recently been assessed quantitatively. Especially in asthma, wall thickening of central airways, and its relation to the severity of disease or airflow obstruction has been clarified. Pathophysiologic importance of peripheral airway lesion has also been highlighted by pathologic or physiologic studies. However, direct evaluation of peripheral airway lesion is beyond resolutional limitation of CT. To assess airway trapping, an indirect CT finding of peripheral airway disease, by quantitative and semiquantitative measures and compare them with clinical indices such as pulmonary function, airway responsiveness, or airway inflammation. Patients with stable asthma (n=20) were studied. HRCT at 3 levels of both lungs were scanned. Low attenuation area (LAA)% and mean lung density were quantitatively assessed by an automatic method. Distribution of mosaic pattern was visually scored semiquantitatively. LAA% and mean lung density at full expiratory phase correlated with the degree of airflow obstruction. Mosaic score at full inspiratory phase correlated with the severity of disease and airflow obstruction. Expiratory/inspiratory ratio of mean lung density was also associated with airway responsiveness or residual volume/total lung capacity (RV/TLC). These CT findings may be useful as markers of asthma pathophysiology. (author)

  19. MDCT-Guided Transthoracic Needle Aspiration Biopsy of the Lung Using the Transscapular Approach

    International Nuclear Information System (INIS)

    Rossi, Umberto G.; Seitun, Sara; Ferro, Carlo

    2011-01-01

    The purpose of this study is to report our preliminary experience using MDCT-guided percutaneous transthoracic needle aspiration biopsy using the transscapular approach in the upper posterolateral lung nodules, an area that it is difficult or hazardous to reach with the conventional approach. Five patients underwent CT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach. A coaxial needle technique was used in all patients. Biopsy was successful in all patients. No major complications were encountered. One patient developed a minimal pneumothorax next to the lesion immediately after biopsy, which resolved spontaneously. MDCT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach is an effective and safe procedure that reduces the risk of pneumothorax in selected patients.

  20. Resectable stage III lung cancer: CT, surgical, and pathologic correlation

    International Nuclear Information System (INIS)

    Scott, I.R.; Muller, N.L.; Miller, R.R.; Evans, K.G.; Nelems, B.

    1987-01-01

    Patients with stage IIIa lung cancer have improved survival following surgery. The authors reviewed the CT, surgical, and pathologic findings in 26 patients with completely resected stage IIIa lung cancer. These include examples of the different subsets of stage IIIa disease. CT correctly predicted chest-wall invasion in only two of ten patients, pericardial involvement in one of three, and tumor extension to within 2 cm of the carina in one of three patients. It detected mediastinal nodal disease in eight of 11 patients. CT is of limited value in assessing chest-wall or pericardial extension; however, such extension does not preclude complete resection. Ipsilateral nodal involvement also doses not preclude surgery

  1. Correlation of iodine uptake and perfusion parameters between dual-energy CT imaging and first-pass dual-input perfusion CT in lung cancer.

    Science.gov (United States)

    Chen, Xiaoliang; Xu, Yanyan; Duan, Jianghui; Li, Chuandong; Sun, Hongliang; Wang, Wu

    2017-07-01

    To investigate the potential relationship between perfusion parameters from first-pass dual-input perfusion computed tomography (DI-PCT) and iodine uptake levels estimated from dual-energy CT (DE-CT).The pre-experimental part of this study included a dynamic DE-CT protocol in 15 patients to evaluate peak arterial enhancement of lung cancer based on time-attenuation curves, and the scan time of DE-CT was determined. In the prospective part of the study, 28 lung cancer patients underwent whole-volume perfusion CT and single-source DE-CT using 320-row CT. Pulmonary flow (PF, mL/min/100 mL), aortic flow (AF, mL/min/100 mL), and a perfusion index (PI = PF/[PF + AF]) were automatically generated by in-house commercial software using the dual-input maximum slope method for DI-PCT. For the dual-energy CT data, iodine uptake was estimated by the difference (λ) and the slope (λHU). λ was defined as the difference of CT values between 40 and 70 KeV monochromatic images in lung lesions. λHU was calculated by the following equation: λHU = |λ/(70 - 40)|. The DI-PCT and DE-CT parameters were analyzed by Pearson/Spearman correlation analysis, respectively.All subjects were pathologically proved as lung cancer patients (including 16 squamous cell carcinoma, 8 adenocarcinoma, and 4 small cell lung cancer) by surgery or CT-guided biopsy. Interobserver reproducibility in DI-PCT (PF, AF, PI) and DE-CT (λ, λHU) were relatively good to excellent (intraclass correlation coefficient [ICC]Inter = 0.8726-0.9255, ICCInter = 0.8179-0.8842; ICCInter = 0.8881-0.9177, ICCInter = 0.9820-0.9970, ICCInter = 0.9780-0.9971, respectively). Correlation coefficient between λ and AF, and PF were as follows: 0.589 (P input CT perfusion analysis method can be applied to assess blood supply of lung cancer patients. Preliminary results demonstrated that the iodine uptake relevant parameters derived from DE-CT significantly correlated with perfusion

  2. CT quantification of lung and airways in normal Korean subjects

    International Nuclear Information System (INIS)

    Kim, Song Soo; Lee, Jeong Eun; Shin, Hye Soo; Jin, Gong Yong; Li, Yuan Zhe

    2017-01-01

    To measure and compare the quantitative parameters of the lungs and airways in Korean never-smokers and current or former smokers (“ever-smokers”). Never-smokers (n = 119) and ever-smokers (n = 45) who had normal spirometry and visually normal chest computed tomography (CT) results were retrospectively enrolled in this study. For quantitative CT analyses, the low attenuation area (LAA) of LAA_I_-_9_5_0, LAA_E_-_8_5_6, CT attenuation value at the 15th percentile, mean lung attenuation (MLA), bronchial wall thickness of inner perimeter of a 10 mm diameter airway (Pi10), total lung capacity (TLC_C_T), and functional residual capacity (FRC_C_T) were calculated based on inspiratory and expiratory CT images. To compare the results between groups according to age, sex, and smoking history, independent t test, one way ANOVA, correlation test, and simple and multiple regression analyses were performed. The values of attenuation parameters and volume on inspiratory and expiratory quantitative computed tomography (QCT) were significantly different between males and females (p < 0.001). The MLA and the 15th percentile value on inspiratory QCT were significantly lower in the ever-smoker group than in the never-smoker group (p < 0.05). On expiratory QCT, all lung attenuation parameters were significantly different according to the age range (p < 0.05). Pi10 in ever-smokers was significantly correlated with forced expiratory volume in 1 second/forced vital capacity (r = −0.455, p = 0.003). In simple and multivariate regression analyses, TLC_C_T, FRC_C_T, and age showed significant associations with lung attenuation (p < 0.05), and only TLC_C_T was significantly associated with inspiratory Pi10. In Korean subjects with normal spirometry and visually normal chest CT, there may be significant differences in QCT parameters according to sex, age, and smoking history

  3. Indeterminate lesions on planar bone scintigraphy in lung cancer patients: SPECT, CT or SPECT-CT?

    International Nuclear Information System (INIS)

    Sharma, Punit; Kumar, Rakesh; Singh, Harmandeep; Bal, Chandrasekhar; Malhotra, Arun; Julka, Pramod Kumar; Thulkar, Sanjay

    2012-01-01

    The objective of the present study was to compare the role of single photon emission computed tomography (SPECT), computed tomography (CT) and SPECT-CT of selected volume in lung cancer patients with indeterminate lesions on planar bone scintigraphy (BS). The data of 50 lung cancer patients (53 ± 10.3 years; range 30-75; male/female 38/12) with 65 indeterminate lesions on planar BS (January 2010 to November 2010) were retrospectively evaluated. All of them underwent SPECT-CT of a selected volume. SPECT, CT and SPECT-CT images were independently evaluated by two experienced readers (experience in musculoskeletal imaging, including CT: 5 and 7 years) in separate sessions. A scoring scale of 1 to 5 was used, in which 1 is definitely metastatic, 2 is probably metastatic, 3 is indeterminate, 4 is probably benign and 5 is definitely benign. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality, taking a score ≤2 as metastatic. With receiver operating characteristic (ROC) curve analysis, areas under the curve (AUC) were calculated for each modality and compared. Clinical and imaging follow-up and/or histopathology were taken as reference standard. For both readers SPECT was inferior to CT (P = 0.004, P = 0.022) and SPECT-CT (P = 0.003, P = 0.037). However, no significant difference was found between CT and SPECT-CT for reader 1 (P = 0.847) and reader 2 (P = 0.592). The findings were similar for lytic as well as sclerotic lesions. Moderate inter-observer agreement was seen for SPECT images (κ = 0.426), while almost perfect agreement was seen for CT (κ = 0.834) and SPECT-CT (κ = 0.971). CT alone and SPECT-CT are better than SPECT for accurate characterisation of indeterminate lesions on planar BS in lung cancer patients. CT alone is not inferior to SPECT-CT for this purpose and might be preferred because of shorter acquisition time and wider availability. (orig.)

  4. The expressions of P53 protein and proliferating cell nuclear antigen in specimens by CT-guidance percutaneous lung biopsy

    International Nuclear Information System (INIS)

    Zhuang Yiping; Shen Zongli; Zhang Jin; Kang Zheng; Zhu Yueqing; Feng Yong; Shen Wenrong; Wang Yaping

    2004-01-01

    Objective: To evaluate relations between lung cancer and the expressions of P53 protein together with proliferating cell nuclear antigen (PCNA) in specimens of lung lesions by needle biopsy. Methods: CT-guidance percutaneous biopsy of lung lesions were performed in 66 patients with the determination of expressions of p53 protein and PCNA by flow cytometer (FCM). Results: 1. The sensitivity of CT-guidance percutaneous biopsy was 94.3% in 53 cases of lung cancer with the diagnostic accuracy of 90.9% totally. The complication rate of pneumothorax was 4.6%. 2. The expression of P53 protein was (29.9 ± 2.7)% in lung cancer (53 cases), while (17.9 ± 2.8)% in benign lesions (13 cases) (t=2.0, P 2 =6.10, P 2 =9.71, P 0.05). Conclusions: FCM plays and valuable role in determining the expression of P53 protein and PCNA in the specimen of lung cancer by CT-guided percutaneous biopsy. The expression of p53 and PCNA may be useful in the diagnosis of lung cancer by providing the relation between imaging of lung cancer and the molecular mechanism, and furthermore revealing the characteristics of molecular biology of lung cancer at protein level. (authors)

  5. Prospective evaluation of the radiologist's hand dose in CT-guided interventions

    International Nuclear Information System (INIS)

    Rogits, B.; Jungnickel, K.; Loewenthal, D.; Dudeck, O.; Pech, M.; Ricke, J.; Kropf, S.; Nekolla, E.A.; Wieners, G.

    2013-01-01

    Purpose: Assessment of radiologist's hand dose in CT-guided interventions and determination of influencing factors. Materials and Methods: The following CT-guided interventions were included: Core biopsy, drainage, periradicular therapy, and celiac plexus neurolysis. The hand dose was measured with an immediately readable dosimeter, the EDD-30 (Unfors, Sweden). The default parameters for CT fluoroscopy were 120 kV, 90 mA and a 4 mm slice thickness. All interventions were performed on a 16-slice CT unit (Aquilion 16 Toshiba, Japan). The tumor size, degree of difficulty (1 - 3), level of experience and device parameters (mAs, dose-length product, scan time) were documented. Results: 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 - 240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 - 140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 - 3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other. Besides physical influencing factors, the degree of difficulty (p = 0.001) and summed puncture depth (p = 0.004) correlated significantly with the hand dose. Conclusion: The median hand dose for different CT-guided interventions was 0.22 mSv. Therefore, the annual hand dose limit would normally only be reached with about 2000 interventions. (orig.)

  6. Quantitative measurement of lung density with x-ray CT and positron CT, (2). Diseased subjects

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kengo; Ito, Masatoshi; Kubota, Kazuo

    1985-05-01

    Lung density was quantitatively measured on six diseased patients with X-ray CT (XCT) and Positron CT(PCT). The findings are as follows: In the silicosis, extravascular lung density was found to be remarkably increased compared to normals (0.29gcm/sup 3/), but blood volume was in normal range. In the post-irradiated lung cancers, extravascular lung density increased in the irradiated sites compared to the non-irradiated opposite sites, and blood volume varied in each case. In a patient with chronic heart failure, blood volume decreased (0.11mlcm/sup 3/) with increased extravascular lung density (0.23gcm/sup 3/). In the chronic obstructive pulmonary disease, both extravascular lung density and blood volume decreased (0.11gcm/sup 3/ and 0.10mlcm/sup 3/ respectively). Lung density measured with XCT was constantly lower than that with PCT in all cases. But changes in the values of lung density measured, correlated well with each other. In conclusion, the method presented here may clarify the etiology of the diffuse pulmonary diseases, and be used to differentiate and grade the diseases.

  7. Quantitative measurement of lung density with x-ray CT and positron CT, (2)

    International Nuclear Information System (INIS)

    Ito, Kengo; Ito, Masatoshi; Kubota, Kazuo

    1985-01-01

    Lung density was quantitatively measured on six diseased patients with X-ray CT (XCT) and Positron CT(PCT). The findings are as follows: In the silicosis, extravascular lung density was found to be remarkably increased compared to normals (0.29gcm -3 ), but blood volume was in normal range. In the post-irradiated lung cancers, extravascular lung density increased in the irradiated sites compared to the non-irradiated opposite sites, and blood volume varied in each case. In a patient with chronic heart failure, blood volume decreased (0.11mlcm -3 ) with increased extravascular lung density (0.23gcm -3 ). In the chronic obstructive pulmonary disease, both extravascular lung density and blood volume decreased (0.11gcm -3 and 0.10mlcm -3 respectively). Lung density measured with XCT was constantly lower than that with PCT in all cases. But changes in the values of lung density measured, correlated well with each other. In conclusion, the method presented here may clarify the etiology of the diffuse pulmonary diseases, and be used to differentiate and grade the diseases. (author)

  8. MRI and CT lung biomarkers: Towards an in vivo understanding of lung biomechanics.

    Science.gov (United States)

    Young, Heather M; Eddy, Rachel L; Parraga, Grace

    2017-09-29

    The biomechanical properties of the lung are necessarily dependent on its structure and function, both of which are complex and change over time and space. This makes in vivo evaluation of lung biomechanics and a deep understanding of lung biomarkers, very challenging. In patients and animal models of lung disease, in vivo evaluations of lung structure and function are typically made at the mouth and include spirometry, multiple-breath gas washout tests and the forced oscillation technique. These techniques, and the biomarkers they provide, incorporate the properties of the whole organ system including the parenchyma, large and small airways, mouth, diaphragm and intercostal muscles. Unfortunately, these well-established measurements mask regional differences, limiting their ability to probe the lung's gross and micro-biomechanical properties which vary widely throughout the organ and its subcompartments. Pulmonary imaging has the advantage in providing regional, non-invasive measurements of healthy and diseased lung, in vivo. Here we summarize well-established and emerging lung imaging tools and biomarkers and how they may be used to generate lung biomechanical measurements. We review well-established and emerging lung anatomical, microstructural and functional imaging biomarkers generated using synchrotron x-ray tomographic-microscopy (SRXTM), micro-x-ray computed-tomography (micro-CT), clinical CT as well as magnetic resonance imaging (MRI). Pulmonary imaging provides measurements of lung structure, function and biomechanics with high spatial and temporal resolution. Imaging biomarkers that reflect the biomechanical properties of the lung are now being validated to provide a deeper understanding of the lung that cannot be achieved using measurements made at the mouth. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. [Predictive factors of complications during CT-guided transthoracic biopsy].

    Science.gov (United States)

    Fontaine-Delaruelle, C; Souquet, P-J; Gamondes, D; Pradat, E; de Leusse, A; Ferretti, G R; Couraud, S

    2017-04-01

    CT-guided transthoracic core-needle biopsy (TTNB) is frequently used for the diagnosis of lung nodules. The aim of this study is to describe TTNBs' complications and to investigate predictive factors of complications. All consecutive TTNBs performed in three centers between 2006 and 2012 were included. Binary logistic regression was used for multivariate analysis. Overall, 970 TTNBs were performed in 929 patients. The complication rate was 34% (life-threatening complication in 6%). The most frequent complications were pneumothorax (29% included 4% which required chest-tube) and hemoptysis (5%). The mortality rate was 0.1% (n=1). In multivariate analysis, predictive factor for a complication was small target size (AOR=0.984; 95% CI [0.976-0.992]; P<0.001). This predictive factor was also found for occurrence of life-threatening complication (AOR=0.982; [0.965-0.999]; P=0.037), of pneumothorax (AOR=0.987; [0.978-0.995]; P=0.002) and of hemoptysis (AOR=0.973; [0.951-0.997]; P=0.024). One complication occurred in one-third of TTNBs. The proportion of life-threatening complication was 6%. A small lesion size was predictive of complication occurrence. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Cristiano Dias de; Nunes, Rodolfo Acatauassu; Saito, Eduardo Haruo; Higa, Claudio; Cardona, Zanier Jose Fernando; Santos, Denise Barbosa dos, E-mail: cristianodiaslima@gmail.co [Hospital Universitario Pedro Ernesto (HUPE/UERJ), Rio de Janeiro, RJ (Brazil). Dept. Cirurgia Toracica

    2011-03-15

    Objective: to analyze the cytological findings of CT-guided percutaneous fine-needle aspiration biopsies of the lung, to demonstrate the diagnostic feasibility of the method in the investigation of pulmonary lesions, and to determine the complications of the procedure, evaluating its safety. Methods: a retrospective analysis of 89 patients with various types of pulmonary lesions who underwent 97 procedures over a period of five years. The patients were divided into groups regarding the indication for the procedure: suspicion of primary lung cancer (stages IIIB or IV); suspicion of lung cancer (stages I, II, or IIIA) and clinical contraindications for surgery; suspicion of pulmonary metastasis from other organs; and pulmonary lesions with benign radiological aspect. All of the procedures were performed with 25-gauge needles and were guided by spiral CT. The final diagnosis was confirmed by surgical biopsy and clinical/oncological follow-up. For the analysis of complications, the total number of procedures was considered. Results: the main indication for the procedure was suspicion of advanced stage primary lung cancer. The accuracy of the method for malignant lesions was 91.5%. The lesion was confirmed as cancer in 73% of the patients. The major complication was pneumothorax (27.8%), which required chest tube drainage in 12.4% of the procedures. Conclusions: the principal indication for CT-guided fine-needle biopsy was suspicion of primary lung cancer in patients who were not surgical candidates. The procedure has high diagnostic feasibility for malignant pulmonary diseases. The most prevalent complication was pneumothorax. However, in most cases, chest tube drainage was unnecessary. No deaths were related to the procedure. (author)

  11. Influence of lung CT changes in chronic obstructive pulmonary disease (COPD on the human lung microbiome.

    Directory of Open Access Journals (Sweden)

    Marion Engel

    Full Text Available Changes in microbial community composition in the lung of patients suffering from moderate to severe COPD have been well documented. However, knowledge about specific microbiome structures in the human lung associated with CT defined abnormalities is limited.Bacterial community composition derived from brush samples from lungs of 16 patients suffering from different CT defined subtypes of COPD and 9 healthy subjects was analyzed using a cultivation independent barcoding approach applying 454-pyrosequencing of 16S rRNA gene fragment amplicons.We could show that bacterial community composition in patients with changes in CT (either airway or emphysema type changes, designated as severe subtypes was different from community composition in lungs of patients without visible changes in CT as well as from healthy subjects (designated as mild COPD subtype and control group (PC1, Padj = 0.002. Higher abundance of Prevotella in samples from patients with mild COPD subtype and from controls and of Streptococcus in the severe subtype cases mainly contributed to the separation of bacterial communities of subjects. No significant effects of treatment with inhaled glucocorticoids on bacterial community composition were detected within COPD cases with and without abnormalities in CT in PCoA. Co-occurrence analysis suggests the presence of networks of co-occurring bacteria. Four communities of positively correlated bacteria were revealed. The microbial communities can clearly be distinguished by their associations with the CT defined disease phenotype.Our findings indicate that CT detectable structural changes in the lung of COPD patients, which we termed severe subtypes, are associated with alterations in bacterial communities, which may induce further changes in the interaction between microbes and host cells. This might result in a changed interplay with the host immune system.

  12. Influence of lung CT changes in chronic obstructive pulmonary disease (COPD) on the human lung microbiome.

    Science.gov (United States)

    Engel, Marion; Endesfelder, David; Schloter-Hai, Brigitte; Kublik, Susanne; Granitsiotis, Michael S; Boschetto, Piera; Stendardo, Mariarita; Barta, Imre; Dome, Balazs; Deleuze, Jean-François; Boland, Anne; Müller-Quernheim, Joachim; Prasse, Antje; Welte, Tobias; Hohlfeld, Jens; Subramanian, Deepak; Parr, David; Gut, Ivo Glynne; Greulich, Timm; Koczulla, Andreas Rembert; Nowinski, Adam; Gorecka, Dorota; Singh, Dave; Gupta, Sumit; Brightling, Christopher E; Hoffmann, Harald; Frankenberger, Marion; Hofer, Thomas P; Burggraf, Dorothe; Heiss-Neumann, Marion; Ziegler-Heitbrock, Loems; Schloter, Michael; Zu Castell, Wolfgang

    2017-01-01

    Changes in microbial community composition in the lung of patients suffering from moderate to severe COPD have been well documented. However, knowledge about specific microbiome structures in the human lung associated with CT defined abnormalities is limited. Bacterial community composition derived from brush samples from lungs of 16 patients suffering from different CT defined subtypes of COPD and 9 healthy subjects was analyzed using a cultivation independent barcoding approach applying 454-pyrosequencing of 16S rRNA gene fragment amplicons. We could show that bacterial community composition in patients with changes in CT (either airway or emphysema type changes, designated as severe subtypes) was different from community composition in lungs of patients without visible changes in CT as well as from healthy subjects (designated as mild COPD subtype and control group) (PC1, Padj = 0.002). Higher abundance of Prevotella in samples from patients with mild COPD subtype and from controls and of Streptococcus in the severe subtype cases mainly contributed to the separation of bacterial communities of subjects. No significant effects of treatment with inhaled glucocorticoids on bacterial community composition were detected within COPD cases with and without abnormalities in CT in PCoA. Co-occurrence analysis suggests the presence of networks of co-occurring bacteria. Four communities of positively correlated bacteria were revealed. The microbial communities can clearly be distinguished by their associations with the CT defined disease phenotype. Our findings indicate that CT detectable structural changes in the lung of COPD patients, which we termed severe subtypes, are associated with alterations in bacterial communities, which may induce further changes in the interaction between microbes and host cells. This might result in a changed interplay with the host immune system.

  13. WE-AB-202-06: Correlating Lung CT HU with Transformation-Based and Xe-CT Derived Ventilation

    International Nuclear Information System (INIS)

    Du, K; Patton, T; Bayouth, J; Reinhardt, J; Christensen, G

    2016-01-01

    Purpose: Regional lung ventilation is useful to reduce radiation-induced function damage during lung cancer radiation therapy. Recently a new direct HU (Hounsfield unit)-based method was proposed to estimate the ventilation potential without image registration. The purpose of this study is to examine if there is a functional dependence between HU values and transformation-based or Xe-CT derived ventilation. Methods: 4DCT images acquired from 13 patients prior to radiation therapy and 4 mechanically ventilated sheep subjects which also have associated Xe-CT images were used for this analysis. Transformation-based ventilation was computed using Jacobian determinant of the transformation field between peak-exhale and peak-inhale 4DCT images. Both transformation and Xe-CT derived ventilation was computed for each HU bin. Color scatter plot and cumulative histogram were used to compare and validate the direct HU-based method. Results: There was little change of the center and shape of the HU histograms between free breathing CT and 4DCT average, with or without smoothing, and between the repeated 4DCT scans. HU of −750 and −630 were found to have the greatest transformation-based ventilation for human and sheep subjects, respectively. Maximum Xe-CT derived ventilation was found to locate at HU of −600 in sheep subjects. The curve between Xe-CT ventilation and HU was noisy for tissue above HU −400, possibly due to less intensity change of Xe gas during wash-out and wash-in phases. Conclusion: Both transformation-based and Xe-CT ventilation demonstrated that lung tissues with HU values in the range of (-750, −600) HU have the maximum ventilation potential. The correlation between HU and ventilation suggests that HU might be used to help guide the ventilation calculation and make it more robust to noise and image registration errors. Research support from NIH grants CA166703 and CA166119 and a gift from Roger Koch.

  14. WE-AB-202-06: Correlating Lung CT HU with Transformation-Based and Xe-CT Derived Ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Du, K; Patton, T; Bayouth, J [University of Wisconsin, Madison, WI (United States); Reinhardt, J; Christensen, G [The University of Iowa, Iowa City, IA (United States)

    2016-06-15

    Purpose: Regional lung ventilation is useful to reduce radiation-induced function damage during lung cancer radiation therapy. Recently a new direct HU (Hounsfield unit)-based method was proposed to estimate the ventilation potential without image registration. The purpose of this study is to examine if there is a functional dependence between HU values and transformation-based or Xe-CT derived ventilation. Methods: 4DCT images acquired from 13 patients prior to radiation therapy and 4 mechanically ventilated sheep subjects which also have associated Xe-CT images were used for this analysis. Transformation-based ventilation was computed using Jacobian determinant of the transformation field between peak-exhale and peak-inhale 4DCT images. Both transformation and Xe-CT derived ventilation was computed for each HU bin. Color scatter plot and cumulative histogram were used to compare and validate the direct HU-based method. Results: There was little change of the center and shape of the HU histograms between free breathing CT and 4DCT average, with or without smoothing, and between the repeated 4DCT scans. HU of −750 and −630 were found to have the greatest transformation-based ventilation for human and sheep subjects, respectively. Maximum Xe-CT derived ventilation was found to locate at HU of −600 in sheep subjects. The curve between Xe-CT ventilation and HU was noisy for tissue above HU −400, possibly due to less intensity change of Xe gas during wash-out and wash-in phases. Conclusion: Both transformation-based and Xe-CT ventilation demonstrated that lung tissues with HU values in the range of (-750, −600) HU have the maximum ventilation potential. The correlation between HU and ventilation suggests that HU might be used to help guide the ventilation calculation and make it more robust to noise and image registration errors. Research support from NIH grants CA166703 and CA166119 and a gift from Roger Koch.

  15. Evaluation of radioactive seeds implantation under PET-CT guidance for the treatment of central lung cancer with obstructive atelectasis

    International Nuclear Information System (INIS)

    Zhou Yi; Jiang Zhongpu; Wang Haiting; Zhang Yanjun; Jiang Qiang; Wang Jun; Ren Lijun; Xie Bin

    2010-01-01

    Objective: To evaluate percutaneous puncturing 125 I seed implantation by using PET-CT guided target localization technique in treating central lung cancer complicated by obstructive pulmonary atelectasis. Methods: A total of 30 patients with suspected central lung cancer complicated by obstructive pulmonary atelectasis on preoperative chest films were enrolled in this study. As no clear distinction existed between the tumor and the atelectatic consolidation shadow on plain chest films, CT scanning was carried out in all patients. If CT scan was still not able to determine the margin of the tumor, an additional PET-CT scanning was adopted. After ascertaining the location of the lung cancer, percutaneous puncturing implantation of 125 I seeds under PET-CT guidance was performed. The clinical data and the therapeutic results were evaluated. Results: A sharp distinction between the tumor and the atelectatic consolidation shadow was demonstrated on PET-CT scans in 21 cases. The mean volume of the targeted lesion reckoned from PET-CT scans was 26 cm 3 , and the 125 I seeds were implanted. The mean volume of the targeted lesion calculated on CT scans was 37 cm 3 . Six months after the treatment, the follow-up CT exam showed that the effective rate was 93% (28/30). The one-year survival rate was 100% . The complications included pneumothorax (n = 8), small amount of hemoptysis (n = 12) and fever (n = 2). No displacement or immigration of the implanted seeds occurred. Conclusion: PET-CT scanning is far superior to conventional CT scanning in determining the target area of the tumor in patients with central lung cancer complicated by obstructive pulmonary atelectasis. (authors)

  16. New approach to lung cancer screening with helical volume CT

    International Nuclear Information System (INIS)

    Midorikawa, S.; Hashimoto, N.; Katakura, T.; Suzuki, K.

    1990-01-01

    This paper evaluates the relationship between reducing radiation dose to the patient and maintaining the clinical quality of the chest image in lung cancer screening by helical-volume CT (HVCT). The authors evaluated the changing relationship between radiation dose and clinical quality after changing the HVCY scanning conditions (such as stroke of patient transport and section thickness) as well as adding copper filters of various thickness and using high-voltage x-ray examination to complement CT examinations. The authors were able to reduce radiation dose by changing the HVCT scanning conditions (eg, stroke of 20 mm/sec, with a section thickness of 10 mm)

  17. Preoperative staging of lung cancer with combined PET-CT

    DEFF Research Database (Denmark)

    Fischer, Barbara; Lassen, Ulrik; Mortensen, Jann

    2009-01-01

    BACKGROUND: Fast and accurate staging is essential for choosing treatment for non-small-cell lung cancer (NSCLC). The purpose of this randomized study was to evaluate the clinical effect of combined positron-emission tomography and computed tomography (PET-CT) on preoperative staging of NSCLC...... one of the following: a thoracotomy with the finding of pathologically confirmed mediastinal lymph-node involvement (stage IIIA [N2]), stage IIIB or stage IV disease, or a benign lung lesion; an exploratory thoracotomy; or a thoracotomy in a patient who had recurrent disease or death from any cause...

  18. MRI-guided and CT-guided cervical nerve root infiltration therapy. A cost comparison

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, M.H.; Froeling, V.; Roettgen, R.; Bucourt, M. de; Hamm, B.; Streitparth, F. [Charite University Medicine Berlin (Germany). Dept. of Diagnostic and Interventional Radiology; Bretschneider, T. [Magdeburg Univ. (Germany). Dept. of Radiology and Nuclear Medicine; Hartwig, T.; Disch, A.C. [Charite University Medicine Berlin (Germany). Center for Musculoskeletal Surgery

    2014-06-15

    Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12-36 min.) for MRI-guided infiltration and 19.7 min. (range: 5-54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. (orig.)

  19. MRI-guided and CT-guided cervical nerve root infiltration therapy. A cost comparison

    International Nuclear Information System (INIS)

    Maurer, M.H.; Froeling, V.; Roettgen, R.; Bucourt, M. de; Hamm, B.; Streitparth, F.; Bretschneider, T.; Hartwig, T.; Disch, A.C.

    2014-01-01

    Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12-36 min.) for MRI-guided infiltration and 19.7 min. (range: 5-54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. (orig.)

  20. CT Guided biopsies of musculoskeletal lesions, radiological and pathologic correlation

    International Nuclear Information System (INIS)

    Hadzihasanovic, B.; Milisic, L.; Zuban, J.; Mujic, E.; Jahic, E.; Gjikolli, B.; Hasanovic, B.; Lincender-Cvijetic, L.; Jaganjac, S.

    2006-01-01

    Full text: The aim of the study is to overview our experiences in taking the CT guided biopsies of musculoskeletal lesions during the period of sixteen months, analysis of validity of samples taken and correlation with pathological findings. CT guided biopsies of musculoskeletal lesions were performed in 32 patients during the period of sixteen months (from December 2004 until March 2006). Age range was from 13 to 78 years. Majorities of the biopsies were performed with coaxial cutting needle system (14 G and 16 G) with introducers size 13 and 15 G. Bone biopsies were performed with Yamsidi needles in purpose of taking the bone cylinder. Majorities of the biopsies were performed under local anaesthesia except a thirteen years old child to whom CT guided biopsy of corpus Th 6 was performed under general anaesthesia. Two samples of tissues were sent in formalin solutions to Pathology Institute for pathological verification. In one case of musculoskeletal lesions CT guided biopsies didn't yield a representative tissue sample. We had high level of congruence between radiological and pathological findings; precise presented in the article. CT guided biopsies of musculoskeletal lesions are method of choice for pathologic verification of musculoskeletal lesions proving incomparable less risk compared to 'open' biopsy which requires operating theatre and general anaesthesia. Coaxial needle systems has shown as suitable for yielding representative tissue samples (two samples for each patient), and samples are also appropriate for immunohistochemical analysis

  1. Fluoroscopy-Guided Percutaneous Lung Biopsy: A Valuable Alternative to Computed Tomography

    International Nuclear Information System (INIS)

    Kurban, L.A.; Gomersall, L.; Weir, J.; Wade, P.

    2008-01-01

    Background: Computed tomography (CT) fluoroscopy nowadays is the most preferred method of guidance to perform percutaneous lung biopsy of pulmonary masses. Conventional fluoroscopy is an increasingly forgotten technique that still can be used to perform lung biopsies, with many advantages. Purpose: To compare the accuracy, safety, and effective dose (ED) of conventional fluoroscopy-guided needle lung biopsy (FNLB) with CT-guided needle lung biopsy procedures (CTNLB) reported in the literature. Material and Methods: 100 consecutive patients who underwent FNLB were reviewed retrospectively. Using the final histological diagnoses and the clinical and radiological course of the disease as references, the accuracy and sensitivity of FNLB were calculated. The complication rates of FNLB were assessed. Using computer software (XDOSE), the ED was calculated. The accuracy, complication rates, and the ED of FNLB were compared with CTNLB reported in the literature. Results: The overall accuracy rate and sensitivity of FNLB were both 87%, which are comparable to the range of accuracies reported in the literature for CTNLB (74-97%). The complication rates of FNLB were also comparable to the complication rates reported for CTNLB. The commonest complication was pneumothorax, at a rate of 25%. The ED of FNLB was small, significantly lower than reported in the literature for CT-guided procedures. The mean ED of FNLB was 0.029 mSv, which is approximately equivalent to one chest X-ray. Conclusion: Conventional fluoroscopy is an accurate, safe, and low-dose alternative modality to CT to obtain an image-guided histological diagnosis of pulmonary lesions

  2. Studies on diagnosis of lung emphysema by CT image using experimental models and clinical cases

    International Nuclear Information System (INIS)

    Nakatani, Seiki

    1998-01-01

    Since the detailed report between the degree of functional disorder in lung emphysema and the analysis of CT image is quite unknown, the present study was attempted to produce the experimental model of lung emphysema with various stages by the administration of papain to the focal lobe in canine lung. Using this model or clinical lung emphysema, the relationship between the degree of destruction of alveolar walls, clinical pulmonary functions and CT images was investigated. CT scan was performed at the level of 50% vital capacity in both experimental models and clinical subjects by using spirometric gating CT. CT density histogram was obtained from CT image which was produced by using the developed software for this purpose. Densitometric parameters, such as mean CT value, %LAA, the peak in the histogram and 5% tile were selected from CT image. Papain solution of 5 mg/kg body weight was cumulatively administered to the left lower lobe in canine lung, resulting in the destruction of lung alveolar walls in parallel to the increasing dosage of papain. There was a significant correlation between not only the increasing dosage of papain, but also %FEV 1.0 and CT densitometric parameters, indicating that the histological changes of alveolar walls and the lung function in lung emphysema could be estimated by analysis of CT image. These experimental and clinical studies suggest that the analysis of CT image can reflect the pathophysiological changes in the lung and be useful for precise clinical diagnosis of lung emphysema. (author)

  3. Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance

    DEFF Research Database (Denmark)

    Josipovic, Mirjana; Persson, Gitte F; Bangsgaard, Jens Peter

    2016-01-01

    OBJECTIVE: We investigated the impact of deep inspiration breath-hold (DIBH) and tumour baseline shifts on image quality and registration uncertainty in image-guided DIBH radiotherapy (RT) for locally advanced lung cancer. METHODS: Patients treated with daily cone beam CT (CBCT)-guided free...

  4. CT findings of small bowel metastases from primary lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2002-11-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  5. CT findings of small bowel metastases from primary lung cancer

    International Nuclear Information System (INIS)

    Kim, Jae Wook; Ha, Hyun Kwon; Kim, Ah Young; Kim, Gab Choul; Kim, Tae Kyoung; Kim, Pyo Nyun; Lee, Moon Gyu

    2002-01-01

    To evaluate the CT findings of small bowel metastases from primary lung cancer. Of the 1468 patients with primary lung cancer between 1990 and 2000, 13 patients who had metastasis to the small intestine were collected. Of these 13 patients, nine who underwent CT scan were included for analysis. The pathologic diagnoses of primary lung cancer in these nine patients were squamous cell carcinoma in six, adenocarcinoma in two, and large cell carcinoma in one. CT scans were analyzed with regard to the site and patterns (intraluminal mass/bowel wall thickening/bowel implants) of metastatic masses, and the presence or absence of complication such as intussusception, obstruction, or perforation of the small bowel. The medical records of the patients were also reviewed retrospectively for evaluation of presenting abdominal symptom and time interval of metastases from initial diagnosis of lung cancer. Metastatic lesions were distributed throughout the small intestine: the duodenum in five, the jejunum in four, the ileum in six, and both jejunum and ileum in one patient. The size of metastatic masses of small bowel ranged from 1.3 cm to 5.0 cm (mean size, 2.6 cm) On CT, the small bowel was involved with intraluminal masses (mean size, 3.4 cm) in eight patients, diffuse wall thickening (mean thickness, 1.6 cm) in five, and bowel implants (mean size, 2.2 cm) in two. Complications occurred in seven patients, including intussusceptions without obstruction in two patients and with obstruction in two, obstruction without intussusceptions in two, and bowel perforation in one. Of 9 patients, 6 had at least one symptom referable to the small bowel including abdominal pain in 4, anemia in 3, vomiting in 1, and jaundice in 1. Lung cancer and small bowel lesions were detected simultaneously in four patients and the time interval of metastases from initial diagnosis of lung cancer ranged from 10 days to 30 months (median interval, 54 days) in patients. CT helps in defining the extent and

  6. Detection of lung nodules with low-dose spiral CT: comparison with conventional dose CT

    International Nuclear Information System (INIS)

    Zhu Tianzhao; Tang Guangjian; Jiang Xuexiang

    2004-01-01

    Objective: To investigate the effect of reducing scan dose on the lung nodules detection rate by scanning a lung nodule model at low dose and conventional dose. Methods: The lung and the thoracic cage were simulated by using a cyst filled with water surrounded by a roll bandage. Flour, butter, and paraffin wax were mixed together by a certain ratio to simulate lung nodules of 10 mm and 5 mm in diameter with the CT values ranging from -10 to 50 HU. Conventional-dose scan (240 mA, 140 kV) and low-dose scan of three different levels (43 mA, 140 kV; 50 mA, 120 kV; 75 mA, 80 kV) together with three different pitches (1.0, 1.5, and 2.0) were performed. The images of the simulated nodules were combined with the CT images of a normal adult's upper, middle, and inferior lung. Three radiologists read the images and the number of the nodules they detected including both the real ones and the false-positive ones was calculated to investigate weather there was any difference among different doses, pitch groups, and different locations. Results: The detection rate of the 10 mm and 5 mm nodules was 100% and 89.6% respectively by the low-dose scan. There was no difference between low-dose and conventional-dose CT (χ 2 =0.6907, P>0.70). The detection rate of 5 mm nodules declined when large pitch was used. Conclusion: The detection rates of 10 mm and 5 mm nodules had no difference between low-dose CT and conventional-dose CT. As the pitch augmented, the detection rate for the nodules declined

  7. Lung cancer screening with low-dose CT

    International Nuclear Information System (INIS)

    Diederich, S.; Wormanns, D.; Heindel, W.

    2003-01-01

    Screening for lung cancer is hoped to reduce mortality from this common tumour, which is characterised by a dismal overall survival, relatively well defined risk groups (mainly heavy cigarette smokers and workers exposed to asbestos) and a lack of early symptoms. In the past studies using sputum cytology and chest radiography have failed to demonstrate any reduction in lung cancer mortality through screening. One of the reasons is probably the relatively poor sensitivity of both these tests in early tumours. Low radiation dose computed tomography (CT) has been shown to have a much higher sensitivity for small pulmonary nodules, which are believed to be the most common presentation of early lung cancer. As, however, small pulmonary nodules are common and most are not malignant, non-invasive diagnostic algorithms are required to correctly classify the detected lesions and avoid invasive procedures in benign nodules. Nodule density, size and the demonstration of growth at follow-up have been shown to be useful in this respect and may in the future be supplemented by contrast-enhanced CT and positron emission tomography. Based on these diagnostic algorithms preliminary studies of low-dose CT in heavy smokers have demonstrated a high proportion of asymptomatic, early, resectable cancers with good survival. As, however, several biases could explain these findings in the absence of the ultimate goal of cancer screening, i.e. mortality reduction, most researchers believe that randomised controlled trials including several 10000 subjects are required to demonstrate a possible mortality reduction. Only then general recommendations to screen individuals at risk of lung cancer with low-dose CT should be made. It can be hoped that international cooperation will succeed in providing results as early as possible

  8. CT screening for lung cancer. Update 2008

    International Nuclear Information System (INIS)

    Henschke, C.I.; Yip, R.; Yankelevitz, D.F.

    2009-01-01

    Screening for a cancer should be considered when the cancer is significant in terms of incidence and mortality, treatment of early stage disease is better than treatment of late stage disease, and there is a screening regimen that provides for earlier diagnosis rather than later, symptom-prompted diagnosis. Lung cancer qualifies as it kills more people than any other cancer worldwide. In the United States it kills more people than colon, breast, and prostate cancer combined and more women than breast cancer. The fundamental concepts of screening are presented. Screening for a cancer is a repetitive process, starting with the baseline round followed by repeat rounds of screening at set intervals. The regimen of screening defines the initial diagnostic test and the sequence of tests to be performed leading to a rule-in diagnosis of the cancer. The regimen should provide lead time of the diagnosis of the cancer. The regimen for the first, baseline round may be different from the regimen for the repeat rounds as the former is inherently different from the subsequent repeat rounds. Baseline screening identifies a greater proportion of cancers with a longer latent (asymptomatic) phase than repeat screening, called length bias. Length bias exists for any screening program, regardless of the design of the study or the cancer. Repeat rounds of screening identify the same proportion of cancer diagnoses found in absence of screening for people having the same risk of the cancer and these repeat rounds of screening can be pooled. It is also a consequence of length bias that cancers found in repeat rounds are earlier in their latent phase than those of the baseline round, a less frequently mentioned consequence. Overdiagnosis bias, another bias of screening, can occur in two ways: a cancer' detected by the screening, pathologically proven, that is not life-threatening even when not resected and a genuine life-threatening cancer that is diagnosed and treated but the person dies

  9. CT of chronic infiltrative lung disease: Prevalence of mediastinal lymphadenopathy

    Energy Technology Data Exchange (ETDEWEB)

    Niimi, Hiroshi; Kang, Eun-Young; Kwong, S. [Univ. of British Columbia and Vancouver Hospital and Health Sciences Centre (Canada)] [and others

    1996-03-01

    Our goal was to determine the prevalence of mediastinal lymph node enlargement at CT in patients with diffuse infiltrative lung disease. The study was retrospective and included 175 consecutive patients with diffuse infiltrative lung diseases. Diagnoses included idiopathic pulmonary fibrosis (IPF) (n = 61), usual interstitial pneumonia associated with collagen vascular disease (CVD) (n = 20), idiopathic bronchiolitis obliterans organizing pneumonia (BOOP) (n = 22), extrinsic allergic alveolitis (EAA) (n = 17), and sarcoidosis (n = 55). Fifty-eight age-matched patients with CT of the chest performed for unrelated conditions served as controls. The presence, number, and sites of enlarged nodes (short axis {ge}10 mm in diameter) were recorded. Enlarged mediastinal nodes were present in 118 of 175 patients (67%) with infiltrative lung disease and 3 of 58 controls (5%) (p < 0.001). The prevalence of enlarged nodes was 84% (46 of 55) in sarcoidosis, 67% (41 of 61) in IPF, 70% (14 of 20) in CVD, 53% (9 of 17) in EAA, and 36% (8 of 22) in BOOP. The mean number of enlarged nodes was higher in sarcoidosis (mean 3.2) than in the other infiltrative diseases (mean 1.2) (p < 0.001). Enlarged nodes were most commonly present in station 10R, followed by 7, 4R, and 5. Patients with infiltrative lung disease frequently have enlarged mediastinal lymph nodes. However, in diseases other than sarcoid, usually only one or two nodes are enlarged and their maximal short axis diameter is <15 mm. 11 refs., 2 figs., 1 tab.

  10. Table incremental slow injection CE-CT in lung cancer

    International Nuclear Information System (INIS)

    Yoshida, Shoji; Maeda, Tomoho; Morita, Masaru

    1988-01-01

    The purpose of this study is to evaluate tumor enhancement in lung cancer under the table incremental study with slow injection of contrast media. The early serial 8 sliced images during the slow injection (1.5 ml/sec) of contrant media were obtained. Following the early images, delayed 8 same sliced images were taken in 2 minutes later. Chacteristic enhanced patterns of the primary cancer and metastatic mediastinal lymphnode were recognized in this study. Enhancement of the primary lesion was classified in 4 patterns, irregular geographic pattern, heterogeneous pattern, homogeneous pattern and rim-enhanced pattern. In mediastinal metastatic lymphadenopathy, three enhanced patterns were obtained, heterogeneous, homogeneous and ring enhanced pattern. Some characteristic enhancement patterns according to the histopathological finding of the lung cancer were obtained. With using this incremental slow injection CE-CT, precise information about the relationship between lung cancer and adjacent mediastinal structure, and obvious staining patterns of the tumor and mediastinal lymphnode were recognized. (author)

  11. CT-guided percutaneous treatment of solitary pyogenic splenic abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Pombo, F. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Suarez, I. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Marini, M. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Arrojo, L. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Echaniz, A. [Dept. of Internal Medicine, Hospital Juan Canalejo, La Coruna (Spain)

    1991-08-01

    Six patients with solitary pyogenic splenic abscesses treated by CT-guided percutaneous drainage (by catheter or needle), are presented. There were 3 unilocular, purely intrasplenic abscesses and 3 complex lesions with loculations and perisplenic involvement. Percutaneous drainage and intravenous antibiotics were curative in 4 patients. In the other 2, who had multiloculated abscesses, despite initially successful drainage, splenectomy was performed because of intractable left upper quadrant pain in one case and persistent fever and drainage of pus after 30 days in the other. These patients also developed large, sterile left pleural effusions. Solitary pyogenic splenic abscesses - particularly if uniloculated - can be effectively treated by CT-guided percutaneous drainage. (orig.)

  12. A Comparison of Endoscopic Ultrasound Guided Biopsy and Positron Emission Tomography with Integrated Computed Tomography in Lung Cancer Staging

    DEFF Research Database (Denmark)

    Larsen, Stine Schmidt; Vilmann, P; Krasnik, K

    2009-01-01

    BACKGROUND AND STUDY AIMS: Exact staging of patients with non-small-cell lung cancer (NSCLC) is important to improve selection of resectable and curable patients for surgery. Positron emission tomography with integrated computed tomography (PET/CT) and endoscopic ultrasound guided fine needle...... aspiration biopsy (EUS-FNA) are new and promising methods, but indications in lung cancer staging are controversial. Only few studies have compared the 2 methods. The aim of this study was to assess and compare the diagnostic values of PET/CT and EUS-FNA for diagnosing advanced lung cancer in patients, who...... had both procedures performed. PATIENTS AND METHODS: 27 patients considered to be potential candidates for resection of NSCLC underwent PET/CT and EUS-FNA. Diagnoses were confirmed either by open thoracotomy, mediastinoscopy or clinical follow-up. Advanced lung cancer was defined as tumour...

  13. Quantitative study on lung volume and lung perfusion using SPECT and CT in thoracal tumors

    International Nuclear Information System (INIS)

    Beyer-Enke, S.A.; Goerich, J.; Strauss, L.G.

    1988-01-01

    22 patients with space occupying lesions in the thoracal region were investigated by computer tomography and by perfusion scintigraphy using SPECT. In order to evaluate the CT images quantitatively, the lung volume was determined using approximation method and compared with the perfusion in the SPECT study. For this, anatomically equivalent transaxial SPECT slices had been coordinated to the CT slices. Between the determined lung volumes and the activity in the ocrresponding layers, a statistically significant correlation was found. It could be shown that the stronger perfusion, frequently observed at the right side of the healthy lung, may be explained by an higher volume of the right pulmonary lobe. Whereas in benign displacing processes the relation activity to volume was similar to the one of the healthy lung, a strongly reduced perfusion together with inconspicuous lung volumes became apparent with malignant tumors. In addition to the great morphological evidence of CT and SPECT studies, additional informations regarding the dignity of displacing processes may be derived from the quantitative evaluation of both methods. (orig.) [de

  14. Methods of in-vivo mouse lung micro-CT

    Science.gov (United States)

    Recheis, Wolfgang A.; Nixon, Earl; Thiesse, Jacqueline; McLennan, Geoffrey; Ross, Alan; Hoffman, Eric

    2005-04-01

    Micro-CT will have a profound influence on the accumulation of anatomical and physiological phenotypic changes in natural and transgenetic mouse models. Longitudinal studies will be greatly facilitated, allowing for a more complete and accurate description of events if in-vivo studies are accomplished. The purpose of the ongoing project is to establish a feasible and reproducible setup for in-vivo mouse lung micro-computed tomography (μCT). We seek to use in-vivo respiratory-gated μCT to follow mouse models of lung disease with subsequent recovery of the mouse. Methodologies for optimizing scanning parameters and gating for the in-vivo mouse lung are presented. A Scireq flexiVent ventilated the gas-anesthetized mice at 60 breaths/minute, 30 cm H20 PEEP, 30 ml/kg tidal volume and provided a respiratory signal to gate a Skyscan 1076 μCT. Physiologic monitoring allowed the control of vital functions and quality of anesthesia, e.g. via ECG monitoring. In contrary to longer exposure times with ex-vivo scans, scan times for in-vivo were reduced using 35μm pixel size, 158ms exposure time and 18μm pixel size, 316ms exposure time to reduce motion artifacts. Gating via spontaneous breathing was also tested. Optimal contrast resolution was achieved at 50kVp, 200μA, applying an aluminum filter (0.5mm). There were minimal non-cardiac related motion artifacts. Both 35μm and 1μm voxel size images were suitable for evaluation of the airway lumen and parenchymal density. Total scan times were 30 and 65 minutes respectively. The mice recovered following scanning protocols. In-vivo lung scanning with recovery of the mouse delivered reasonable image quality for longitudinal studies, e.g. mouse asthma models. After examining 10 mice, we conclude μCT is a feasible tool evaluating mouse models of lung pathology in longitudinal studies with increasing anatomic detail available for evaluation as one moves from in-vivo to ex-vivo studies. Further developments include automated

  15. On the Potential Role of MRI Biomarkers of COPD to Guide Bronchoscopic Lung Volume Reduction.

    Science.gov (United States)

    Adams, Colin J; Capaldi, Dante P I; Di Cesare, Robert; McCormack, David G; Parraga, Grace

    2018-02-01

    In patients with severe emphysema and poor quality of life, bronchoscopic lung volume reduction (BLVR) may be considered and guided based on lobar emphysema severity. In particular, x-ray computed tomography (CT) emphysema measurements are used to identify the most diseased and the second-most diseased lobes as BLVR targets. Inhaled gas magnetic resonance imaging (MRI) also provides chronic obstructive pulmonary disease (COPD) biomarkers of lobar emphysema and ventilation abnormalities. Our objective was to retrospectively evaluate CT and MRI biomarkers of lobar emphysema and ventilation in patients with COPD eligible for BLVR. We hypothesized that MRI would provide complementary biomarkers of emphysema and ventilation that help determine the most appropriate lung lobar targets for BLVR in patients with COPD. We retrospectively evaluated 22 BLVR-eligible patients from the Thoracic Imaging Network of Canada cohort (diffusing capacity of the lung for carbon monoxide = 37 ± 12% predicted , forced expiratory volume in 1 second = 34 ± 7% predicted , total lung capacity = 131 ± 17% predicted , and residual volume = 216 ± 36% predicted ). Lobar CT emphysema, measured using a relative area of concept retrospective analysis, quantitative MRI ventilation and CT emphysema measurements provided different BLVR targets in over 30% of the patients. The presence of large MRI ventilation defects in lobes next to CT-targeted lobes might also change the decision to proceed or to guide BLVR to a different lobar target. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  16. Lung vessel segmentation in CT images using graph-cuts

    Science.gov (United States)

    Zhai, Zhiwei; Staring, Marius; Stoel, Berend C.

    2016-03-01

    Accurate lung vessel segmentation is an important operation for lung CT analysis. Filters that are based on analyzing the eigenvalues of the Hessian matrix are popular for pulmonary vessel enhancement. However, due to their low response at vessel bifurcations and vessel boundaries, extracting lung vessels by thresholding the vesselness is not sufficiently accurate. Some methods turn to graph-cuts for more accurate segmentation, as it incorporates neighbourhood information. In this work, we propose a new graph-cuts cost function combining appearance and shape, where CT intensity represents appearance and vesselness from a Hessian-based filter represents shape. Due to the amount of voxels in high resolution CT scans, the memory requirement and time consumption for building a graph structure is very high. In order to make the graph representation computationally tractable, those voxels that are considered clearly background are removed from the graph nodes, using a threshold on the vesselness map. The graph structure is then established based on the remaining voxel nodes, source/sink nodes and the neighbourhood relationship of the remaining voxels. Vessels are segmented by minimizing the energy cost function with the graph-cuts optimization framework. We optimized the parameters used in the graph-cuts cost function and evaluated the proposed method with two manually labeled sub-volumes. For independent evaluation, we used 20 CT scans of the VESSEL12 challenge. The evaluation results of the sub-volume data show that the proposed method produced a more accurate vessel segmentation compared to the previous methods, with F1 score 0.76 and 0.69. In the VESSEL12 data-set, our method obtained a competitive performance with an area under the ROC curve of 0.975, especially among the binary submissions.

  17. PET/CT-guided Interventions: Personnel Radiation Dose

    International Nuclear Information System (INIS)

    Ryan, E. Ronan; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P.; Hsu, Meier; Quinn, Brian; Dauer, Lawrence T.; Solomon, Stephen B.

    2013-01-01

    PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0–0.13) mSv for the primary operator, 0.01 (range 0–0.05) mSv for the nurse anesthetist, and 0.02 (range 0–0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0–0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient

  18. PET/CT-guided Interventions: Personnel Radiation Dose

    Energy Technology Data Exchange (ETDEWEB)

    Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States); Hsu, Meier [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics (United States); Quinn, Brian; Dauer, Lawrence T. [Memorial Sloan-Kettering Cancer Center, Department of Medical Physics (United States); Solomon, Stephen B. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States)

    2013-08-01

    PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.

  19. CT-guided core-needle biopsy in omental pathology

    International Nuclear Information System (INIS)

    Pombo, F.; Rodriguez, E.; Martin, R.; Lago, M.

    1997-01-01

    Purpose: To assess the accuracy and clinical usefulness of CT-guided core-needle biopsy in the diagnosis of omental pathology. Material and Methods: We retrospectively reviewed the results of CT-guided percutaneous core biopsies in 25 patients with focal (n=2) or diffuse (n=23) omental pathology. These results were compared to the final diagnoses as determined by laparotomy (n=15), laparoscopic biopsy (n=3), endoscopic biopsy (n=1), or by the results of percutaneous biopsy and clinical-radiological and bacteriological modalities (n=6). The final diagnoses showed 4 patients with isolated omental pathology and 21 with widespread peritoneal involvement. The CT-guided biopsies were performed with 1.0=1.8-mm Surecut core-needles. Results: In 16 patients, the final diagnosis was metastatic adenocarcinoma - with the primary tumor sites in the ovary (n=3), stomach (n=1), appendix (n=2), and unknown (n=10). In the remaining 9 patients, the final diagnosis was hepatocellular carcinoma, lymphoma, and mesothelioma in 1 patient each; tuberculosis in 5; and actinomycosis in 1. Sufficient histological (n=16) or cytological (n=8) material was obtained by CT biopsy in 24/25 (96%) cases; the specimen was insufficient for diagnosis in 1 case. In differentiating benign from malignant disease, CT-guided biopsy showed a sensitivity, specificity and accuracy of respectively 89.5%, 100% and 92%. It gave a specific diagnosis in 78.9% (15/19) of patients with malignant conditions and in 50% (3/6) of patients with benign disorders. There were no biopsy-related complications. Conclusion: CT-guided percutaneous core-needle biopsy of the omentum is a safe, useful and highly accurate procedure for diagnosing malignant omental pathology. (orig.)

  20. Radiation exposure during CT-guided biopsies: recent CT machines provide markedly lower doses.

    Science.gov (United States)

    Guberina, Nika; Forsting, Michael; Ringelstein, Adrian; Suntharalingam, Saravanabavaan; Nassenstein, Kai; Theysohn, Jens; Wetter, Axel

    2018-03-28

    To examine radiation dose levels of CT-guided interventional procedures of chest, abdomen, spine and extremities on different CT-scanner generations at a large multicentre institute. 1,219 CT-guided interventional biopsies of different organ regions ((A) abdomen (n=516), (B) chest (n=528), (C) spine (n=134) and (D) extremities (n=41)) on different CT-scanners ((I) SOMATOM-Definition-AS+, (II) Volume-Zoom, (III) Emotion6) were included from 2013-2016. Important CT-parameters and standard dose-descriptors were retrospectively examined. Additionally, effective dose and organ doses were calculated using Monte-Carlo simulation, following ICRP103. Overall, radiation doses for CT interventions are highly dependent on CT-scanner generation: the newer the CT scanner, the lower the radiation dose imparted to patients. Mean effective doses for each of four procedures on available scanners are: (A) (I) 9.3mSv versus (II) 13.9mSv (B) (I) 7.3mSv versus (III) 11.4mSv (C) (I) 6.3mSv versus (II) 7.4mSv (D) (I) 4.3mSv versus (II) 10.8mSv. Standard dose descriptors [standard deviation (SD); CT dose index vol (CTDI vol ); dose-length product (DLP body ); size-specific dose estimate (SSDE)] were also compared. Effective dose, organ doses and SSDE for various CT-guided interventional biopsies on different CT-scanner generations following recommendations of the ICRP103 are provided. New CT-scanner generations involve markedly lower radiation doses versus older devices. • Effective dose, organ dose and SSDE are provided for CT-guided interventional examinations. • These data allow identifying organs at risk of higher radiation dose. • Detailed knowledge of radiation dose may contribute to a better individual risk-stratification. • New CT-scanner generations involve markedly lower radiation doses compared to older devices.

  1. CT diagnosis of primary lung cancer coexisting with pulmonary tuberculosis

    International Nuclear Information System (INIS)

    Kim, Sun Joo; Kim, Young Sook; Oh, Jae Hee; Kim, Eun Kyoung; Kim, Young Chul

    1992-01-01

    When bronchogenic carcinoma is coexisting with pulmonary tuberculosis, it is difficult to differentiate bronchogenic carcinoma from pulmonary tuberculosis radiographically. Thus, the object of this study is to define differential diagnosis of bronchogenic carcinoma by computed tomography. We analyzed CT scans of 27 patients with radiologic findings of pulmonary tuberculosis and mass of which twelve cases were pulmonary tuberculosis and fifteen cases were primary lung cancer. The location of parenchymal infiltration and the mass was the same in 60%(9/15) of the primary lung cancer in cases and 83%(10/12) of the pulmonary tuberculosis cases. The common location of the mass was the both upper lobes in 92%(11/12) of the pulmonary tuberculosis cases and 53%(8/15) of the primary lung cancer cases. The common locations of the mediastinal lymphadenopathy were 4R, 2R of the pulmonary tuberculosis cases and 4R, 10R of the primary lung cancer cases. In the feature of post enhanced lymph nodes, homogenous increased density was more frequent in primary lung cancer. Measurements of the maximum thickness part of the cavity wall was not a reliable indication of malignancy

  2. The comparative study of CT guided and ultrasound guided percutaneous ethanol injection in the treatment of intra-abdominal cyst

    International Nuclear Information System (INIS)

    Li Heping; Yang Jianyong; Chen Wei; Zhuang Wenquan; Huang Yulian; Chen Jianye

    2005-01-01

    Objective: An comparative study of the interventional approach of CT guided and ultiasound guided percutaneous ethanol injection(PEI) in the treatment of intra-abdominal cyst. Methods: CT guided PEI was performed in the treatment of intra-abdominal cyst in 38 patients while ultrasound guided PEI was performed in 45 cases. Results: The puncture procedure of CT guided PEI was totally performed 83 times in treating 56 intra-abdominal cysts in 38 patients and CT guided PEI was unsuccessful in 6 patients. The puncture procedure of ultrasound guided PEI were performed 87 times in treating 71 intra-abdominal cysts in 55 patients and ultrasound guided PEI only failed only in 1 patient. Conclusion: Ultrasound guided PEI is superior to CT guided PEI in the treatment of intra-abdominal cyst. (authors)

  3. Quantitative evaluation of emphysematous changes in the lung by computed tomography (CT)

    International Nuclear Information System (INIS)

    Kitahara, Yoshinari; Hirayama, Takanobu; Hiratsuka, Toshihiko; Tanaka, Yasushi; Takamoto, Masahiro; Ishibashi, Tsuneo; Shinoda, Atsushi

    1987-01-01

    The present studies were undertaken to quantitatively evaluate emphysematous changes in the lung by CT scan. CT scans were made at inspiration and expiration at three levels (base, mid thorax and apex). Low density lesion ratio (LL %) was measured as the proportion of the area under -950 Housfield Unit in each lung field at expiration. Each value of LL % was determined in 6 lung fields (both lung fields at three levels). The LL % was calculated from the mean of these six values. The results suggest that LL % of the emphysematous lungs shows significant elevation of the values compared with those of normal lungs and lungs with bronchial asthma. (author)

  4. Radiofrequency ablation of lung and liver lesions using CT fluoroscopy

    International Nuclear Information System (INIS)

    Chai, A.; Glenn, D.

    2002-01-01

    Full text: Tumour ablation with radiofrequency (RF) energy is a relatively new procedure for the treatment of focal malignant disease. At our institution this is currently being used in the treatment of certain liver and lung lesions with the patients involved being enrolled in clinical trials. The poster describes the technique used at our institution for the placement of the radiofrequency ablation electrode using CT fluoroscopy. Criteria for patient selection are included. Complications from the procedure are described, as well as follow up appearances and results. Our results from the treatment of primary and secondary lesions in the liver correlate well with published literature. Treatment is still not as successful as surgical resection but there is significantly less morbidity. Where this method may be appropriate is when the patient is not a candidate for surgical resection. The treatment of colorectal metastases in the lung shows early promise as a possible second line treatment (as for liver) where the patient is not a candidate for surgery. Preliminary results are soon to be published in conjunction with the Department of Surgery at our institution. RF Electrode placement using CT Fluoroscopy is performed at our institution. While still at its early stages, RF Ablation shows promise as a possible second line treatment (with other adjuvant therapy) for the management of focal malignant disease in the lung and liver. Copyright (2002) Blackwell Science Pty Ltd

  5. CT analysis of lung cancer and coexistent emphysema

    International Nuclear Information System (INIS)

    Noh, Kyung Hee; Chung, Myung Hee; Sung, Mi Sook; Yoo, Won Jong; Son, Kyung Myung; Son, Jung Min; Park, Seog Hee

    2004-01-01

    To evaluate the relation of the location and cell type of lung cancer to the location and degree in coexistent emphysema on high-resolution computed tomography (HRCT) scans. Ninety-eight of 209 lung cancer patients having HRCT scans were retrospectively analyzed to assess the total lung emphysema and peritumoral regional emphysema. Single and primary lung cancers were included. The clinical data, including sex, age, smoking history and the pathologic cancer subtype, were recorded to correlate with the HRCT findings. The lobar distribution, central-peripheral predominance, surrounding parenchymal abnormality for cancer, cephalocaudal predominance, and subtype for emphysema were analyzed on HRCT. Using a CT scoring method, we scored the whole lung emphysema and peritumoral emphysema, and correlated the grading of emphysema with pulmonary functional values. Sixty-nine of 98 patients with lung cancer (71%) had emphysema. Lung cancer with emphysema was significantly higher in men than in women, and was significantly related to smoking. The mean age of cancer patients without emphysema was significantly lower than that of cancer patients with emphysema (68 yrs vs. 61 yrs, p= 0.0006). Emphysema of grade I (0-25%) was found in 52 cases, grade II (25-50%) in 15, and grade III (50-75%) in 2. Total emphysema score was paralleled to peritumoral emphysema score in 64.3%, while the remaining patients had a higher peritumoral emphysema score (grade II or III) than total emphysema score (grade 0 or I). There was no statistical correlation in the developmental location between the emphysema and the lung cancer (significant correlation was only noted in grade II group of total emphysema score). The incidence of non-small cell carcinoma tended to be higher than that of small cell carcinoma in the two groups. The possibility of lung cancer in patients with pulmonary nodule, coexisting emphysema, and especially in elderly patients having a history of smoking must be clarified on HRCT

  6. Transbronchial drainage using endobronchial ultrasonography with guide sheath for lung abscess

    Science.gov (United States)

    Yaguchi, Daizo; Ichikawa, Motoshi; Inoue, Noriko; Kobayashi, Daisuke; Shizu, Masato; Imai, Naoyuki

    2018-01-01

    Abstract Rationale: Lung abscess was previously treated surgically, but is now mainly treated with antibiotics and ideally with direct drainage, although postural drainage canalso be used. Patient concerns: A chest abnormal shadow was detected in an 82-year-old man and he was referred to our department in November 2017. On chest computed tomography (CT), a low-density mass shadow was present in the left S8 segment. Lung abscess and lung cancer were considered as differential diagnoses, and treatment with sulbactam sodium/ampicillin sodium (SBT/ABPC) was first initiated for lung abscess. The etiologic agent could not be identified by sputum examination, and the abscess shadow remained. Diagnoses: Lung abscess. Interventions: Endobronchial ultrasonography with a guide sheath (EBUS-GS)-guided bronchoscopy was performed on hospital day 21 to diagnose the lesion, identify the etiologic agent if the lesion was a lung abscess, and attempt drainage. Vacuum aspiration performed in the guide sheath after the probe was placed within the lesion produced 4-5 ml of gray turbid pus, and the abscess was judged to have been drained. Outcomes: A subsequent pathological examination did not detect malignant cells. Klebsiella pneumoniae, Prevotella spp. was identified as the etiologic agent in bacteriological tests. Antibiotics were changed based on sensitivity test results, and drainage was similarly performed on hospital day 28. The shadow gradually improved and disappeared. Therefore, this procedure and treatment led to identification of the etiologic agent and helped with cure of the disease. Lessons: Based on the basic principle of treatment for abscess using as much drainage as possible, EBUS-GS-guided transbronchial drainage may be considered to be a “new procedure” for lung abscess. PMID:29768382

  7. Transbronchial drainage using endobronchial ultrasonography with guide sheath for lung abscess: A case report.

    Science.gov (United States)

    Yaguchi, Daizo; Ichikawa, Motoshi; Inoue, Noriko; Kobayashi, Daisuke; Shizu, Masato; Imai, Naoyuki

    2018-05-01

    Lung abscess was previously treated surgically, but is now mainly treated with antibiotics and ideally with direct drainage, although postural drainage canalso be used. A chest abnormal shadow was detected in an 82-year-old man and he was referred to our department in November 2017. On chest computed tomography (CT), a low-density mass shadow was present in the left S8 segment. Lung abscess and lung cancer were considered as differential diagnoses, and treatment with sulbactam sodium/ampicillin sodium (SBT/ABPC) was first initiated for lung abscess. The etiologic agent could not be identified by sputum examination, and the abscess shadow remained. Lung abscess. Endobronchial ultrasonography with a guide sheath (EBUS-GS)-guided bronchoscopy was performed on hospital day 21 to diagnose the lesion, identify the etiologic agent if the lesion was a lung abscess, and attempt drainage. Vacuum aspiration performed in the guide sheath after the probe was placed within the lesion produced 4-5 ml of gray turbid pus, and the abscess was judged to have been drained. A subsequent pathological examination did not detect malignant cells. Klebsiella pneumoniae, Prevotella spp. was identified as the etiologic agent in bacteriological tests. Antibiotics were changed based on sensitivity test results, and drainage was similarly performed on hospital day 28. The shadow gradually improved and disappeared. Therefore, this procedure and treatment led to identification of the etiologic agent and helped with cure of the disease. Based on the basic principle of treatment for abscess using as much drainage as possible, EBUS-GS-guided transbronchial drainage may be considered to be a "new procedure" for lung abscess.

  8. Virtual bronchoscopy-guided transbronchial biopsy for aiding the diagnosis of peripheral lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Iwano, Shingo, E-mail: iwano45@med.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi (Japan); Imaizumi, Kazuyoshi [Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550 (Japan); Okada, Tohru [Research Center for Charged Particle Therapy, National Institute of Radiological Science, 4-9-1 Anagawa, Inage-ku, Chiba 2638555 (Japan); Hasegawa, Yoshinori [Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550 (Japan); Naganawa, Shinji [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi (Japan)

    2011-07-15

    Objective: The aim of this study was to evaluate the clinical value of virtual bronchoscopy (VB) in aiding diagnosis of peripheral lung cancer by transbronchial biopsy (TBB). In addition, we sought to systematically analyze the factors that affect the diagnostic sensitivity of VB-guided TBB for the evaluation of peripheral lung cancers. Materials and methods: A hundred and twenty-two peripheral lung cancers from 122 patients (82 men and 40 women, 38-84 years; median 68.5 years) who were performed VB-guided TBB were evaluated retrospectively. VB was reconstructed from 1- or 0.5-mm slice thickness images of multi-detector CT (MDCT). Experienced pulmonologists inserted the conventional and ultrathin bronchoscopes into the target bronchus under direct vision following the VB image. Results: A definitive diagnosis was established by VB-guided TBB in 96 lesions (79%). The diagnostic sensitivity of small pulmonary lesions {<=}30 mm in maximal diameter (71%) was significantly lower than that of lesions >30 mm (91%, p = 0.008). For small pulmonary lesions {<=}30 mm (n = 76), internal opacity of the lesion was the independent predictor of diagnostic sensitivity by VB-guided TBB, and the non-solid type lung cancers were significantly lower than the solid type and part-solid type lung cancers for diagnostic sensitivity (odds ratio = 0.161; 95% confidence interval = 0.033-0.780; p = 0.023). Conclusion: Use of an ultrathin bronchoscope and simulation with VB reconstructed by high quality MDCT images is thought to improve pathological diagnosis of peripheral lung cancers, especially for solid and partly solid types. For small pulmonary lesions {<=}30 mm, the lesion internal opacity is a significant factor for predicting the diagnostic sensitivity, and the sensitivity was low for small non-solid type of lung cancers.

  9. CT Densitometry of the Lung in Healthy Nonsmokers with Normal Pulmonary Function

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Tack Sun; Chae, Eun Jin; Seo, Joon Beom; Jung, Young Ju; Oh, Yeon Mok; Lee, Sang Do [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2012-09-15

    To investigate the upper normal limit of low attenuation area in healthy nonsmokers. A total of 36 nonsmokers with normal pulmonary function test underwent a CT scan. Six thresholds (-980 --930 HU) on inspiration CT and two thresholds (-950 and -910 HU) on expiration CT were used for obtaining low attenuation area. The mean lung density was obtained on both inspiration CT and expiration CT. Descriptive statistics of low attenuation area and the mean lung density, evaluation of difference of low attenuation area and the mean lung density in both sex and age groups, analysis of the relationship between demographic information and CT parameters were performed. Upper normal limit for low attenuation area was 12.96% on inspiration CT (-950 HU) and 9.48% on expiration CT (-910 HU). Upper normal limit for the mean lung density was -837.58 HU on inspiration CT and 686.82 HU on expiration CT. Low attenuation area and the mean lung density showed no significant differences in both sex and age groups. Body mass index (BMI) was negatively correlated with low attenuation area on inspiration CT (-950 HU, r = -0.398, p = 0.016) and positively correlated with the mean lung density on inspiration CT (r 0.539, p = 0.001) and expiration CT (r = 0.432, p = 0.009). Age and body surface area were not correlated with low attenuation area or the mean lung density. Low attenuation area on CT densitometry of the lung could be found in healthy nonsmokers with normal pulmonary function, and showed negative association with BMI. Reference values, such as range and upper normal limit for low attenuation area in healthy subjects could be helpful in quantitative analysis and follow up of early emphysema, using CT densitometry of the lung.

  10. CT evaluation of cavitary lung lesions: focused on lung cancer, tuberculosis and abscess

    International Nuclear Information System (INIS)

    Lee, Young Rahn; Kim, Myung Gyu; Kang, Eun Young; Suh, Won Hyuck

    1992-01-01

    Differential diagnosis of cavitary lung lesions is frequently problematic. We studied 35 patients with cavitary lung lesions, consisting of lung cancer (17 patients), pulmonary tuberculosis (11 patients), and lung abscess (7 patients). We analysed CT scans in terms of irregularities of the cavity wall, maximum wall thickness, the presence of air-fluid level, location of the cavity within the mass, number of cavities within the mass, size of the cavity and the presence of calcification within the mass. Cancer cavity showed irregular inner (100%) and outer margins (100%), and thick wall (mean, 1.94 cm), eccentrical location (94%) and multiplicity within a mass (38%). Tuberculous cavity showed smooth inner (56%) and irregular outer margins (75%), thin wall (mean 0.96 cm), central location (62%), and multiplicity in one patient (36%). Abscess cavity showed irregular inner (57%) and outer margins (91%), relatively thin wall (mean 1.0 cm), central location (57%), and air-fluid level (86%). CT scan could differentiate malignant lesions from benign condition such as tuberculosis and lung abscess by observing characteristics of the cavities

  11. CT evaluation of cavitary lung lesions: focused on lung cancer, tuberculosis and abscess

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Rahn; Kim, Myung Gyu; Kang, Eun Young; Suh, Won Hyuck [College of Medicine, Korea University, Seoul (Korea, Republic of)

    1992-11-15

    Differential diagnosis of cavitary lung lesions is frequently problematic. We studied 35 patients with cavitary lung lesions, consisting of lung cancer (17 patients), pulmonary tuberculosis (11 patients), and lung abscess (7 patients). We analysed CT scans in terms of irregularities of the cavity wall, maximum wall thickness, the presence of air-fluid level, location of the cavity within the mass, number of cavities within the mass, size of the cavity and the presence of calcification within the mass. Cancer cavity showed irregular inner (100%) and outer margins (100%), and thick wall (mean, 1.94 cm), eccentrical location (94%) and multiplicity within a mass (38%). Tuberculous cavity showed smooth inner (56%) and irregular outer margins (75%), thin wall (mean 0.96 cm), central location (62%), and multiplicity in one patient (36%). Abscess cavity showed irregular inner (57%) and outer margins (91%), relatively thin wall (mean 1.0 cm), central location (57%), and air-fluid level (86%). CT scan could differentiate malignant lesions from benign condition such as tuberculosis and lung abscess by observing characteristics of the cavities.

  12. CT-guided radiolabelled aerosol studies for assessing pulmonary impairment in children with bronchiectasis

    International Nuclear Information System (INIS)

    Pifferi, M.; Baldini, M.; Caramella, D.; Bartolozzi, C.; Di Mauro, M.; Cangiotti, A.M.

    2000-01-01

    Objective. To determine whether CT-guided mucociliary clearance studies allow differentiation between bronchiectasis associated with primary ciliary dyskinesia (PCD) and those unrelated to congenital or genetically transmitted defects. Materials and methods. Fifteen children aged 4-18 years with a CT diagnosis of bronchiectasis were included in the study. Six had PCD, while in nine cases no congenital disorder was demonstrated. Results. CT showed bronchiectasis in 26 (29 %) of 90 lung regions. Radiolabelled aerosol studies were conducted globally for each lung and on the regions affected by bronchiectasis. Global half-time of activity (t 1/2 ) values of patients with PCD were significantly higher (P 1/2 values. Patients with bronchiectasis unrelated to congenital disorders showed significantly higher regional t 1/2 values in the affected regions with respect to the corresponding global pulmonary t 1/2 (P < 0.06). Conclusions. The combination of morphological CT information with functional data concerning the clearance of radiolabelled aerosol adds to our understanding of pulmonary impairment in children with bronchiectasis. In particular, regional studies allow the recognition of different mucociliary clearance patterns in bronchiectasis associated with PCD and those unrelated to congenital or genetically transmitted defects. (orig.)

  13. Automated lung volumetry from routine thoracic CT scans: how reliable is the result?

    Science.gov (United States)

    Haas, Matthias; Hamm, Bernd; Niehues, Stefan M

    2014-05-01

    Today, lung volumes can be easily calculated from chest computed tomography (CT) scans. Modern postprocessing workstations allow automated volume measurement of data sets acquired. However, there are challenges in the use of lung volume as an indicator of pulmonary disease when it is obtained from routine CT. Intra-individual variation and methodologic aspects have to be considered. Our goal was to assess the reliability of volumetric measurements in routine CT lung scans. Forty adult cancer patients whose lungs were unaffected by the disease underwent routine chest CT scans in 3-month intervals, resulting in a total number of 302 chest CT scans. Lung volume was calculated by automatic volumetry software. On average of 7.2 CT scans were successfully evaluable per patient (range 2-15). Intra-individual changes were assessed. In the set of patients investigated, lung volume was approximately normally distributed, with a mean of 5283 cm(3) (standard deviation = 947 cm(3), skewness = -0.34, and curtosis = 0.16). Between different scans in one and the same patient the median intra-individual standard deviation in lung volume was 853 cm(3) (16% of the mean lung volume). Automatic lung segmentation of routine chest CT scans allows a technically stable estimation of lung volume. However, substantial intra-individual variations have to be considered. A median intra-individual deviation of 16% in lung volume between different routine scans was found. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

  14. Additional value of PET-CT in the staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT

    International Nuclear Information System (INIS)

    Wever, W. de; Marchal, G.; Bogaert, J.; Verschakelen, J.A.; Ceyssens, S.; Mortelmans, L.; Stroobants, S.

    2007-01-01

    Integrated positron emission tomography (PET) and computed tomography (CT) is a new imaging modality offering anatomic and metabolic information. The purpose was to evaluate retrospectively the accuracy of integrated PET-CT in the staging of a suggestive lung lesion, comparing this with the accuracy of CT alone, PET alone and visually correlated PET-CT. Fifty patients undergoing integrated PET-CT for staging of a suggestive lung lesion were studied. Their tumor, node, metastasis (TNM) statuses were determined with CT, PET, visually correlated PET-CT and integrated PET-CT. These TNM stages were compared with the surgical TNM status. Integrated PET-CT was the most accurate imaging technique in the assessment of the TNM status. Integrated PET-CT predicted correctly the T status, N status, M status and TNM status in, respectively, 86%, 80%, 98%, 70% versus 68%, 66%,88%, 46% with CT, 46%, 70%, 96%, 30% with PET and 72%, 68%, 96%, 54% with visually correlated PET-CT. T status and N status were overstaged, respectively, in 8% and 16% with integrated PET-CT, in 20% and 28% with CT, in 16% and 20% with PET, in 12% and 20% with visually correlated PET-CT and understaged in 6% and 4% with integrated PET-CT, versus 12% and 6% with CT, 38% and 10% with PET and 12% with visually correlated PET-CT. Integrated PET-CT improves the staging of lung cancer through a better anatomic localization and characterization of lesions and is superior to CT alone and PET alone. If this technique is not available, visual correlation of PET and CT can be a valuable alternative. (orig.)

  15. Lung nodule detection in pediatric chest CT: quantitative relationship between image quality and radiologist performance.

    Science.gov (United States)

    Li, Xiang; Samei, Ehsan; Barnhart, Huiman X; Gaca, Ana Maria; Hollingsworth, Caroline L; Maxfield, Charles M; Carrico, Caroline W T; Colsher, James G; Frush, Donald P

    2011-05-01

    To determine the quantitative relationship between image quality and radiologist performance in detecting small lung nodules in pediatric CT. The study included clinical chest CT images of 30 pediatric patients (0-16 years) scanned at tube currents of 55-180 mA. Calibrated noise addition software was used to simulate cases at three nominal mA settings: 70, 35, and 17.5 mA, resulting in quantum noise of 7-32 Hounsfield Unit (HU). Using a validated nodule simulation technique, lung nodules with diameters of 3-5 mm and peak contrasts of 200-500 HU were inserted into the cases, which were then randomized and rated independently by four experienced pediatric radiologists for nodule presence on a continuous scale from 0 (definitely absent) to 100 (definitely present). The receiver operating characteristic (ROC) data were analyzed to quantify the relationship between diagnostic accuracy (area under the ROC curve, AUC) and image quality (the product of nodule peak contrast and displayed diameter to noise ratio, CDNR display). AUC increased rapidly from 0.70 to 0.87 when CDNR display increased from 60 to 130 mm, followed by a slow increase to 0.94 when CDNR display further increased to 257 mm. For the average nodule diameter (4 mm) and contrast (350 HU), AUC decreased from 0.93 to 0.71 with noise increased from 7 to 28 HU. We quantified the relationship between image quality and the performance of radiologists in detecting lung nodules in pediatric CT. The relationship can guide CT protocol design to achieve the desired diagnostic performance at the lowest radiation dose.

  16. Usefulness of CT-guided automatic needle biopsy of solitary pulmonary nodule smaller than 15 mm

    International Nuclear Information System (INIS)

    Jin, Gong Yong; Lim, Yeong Su

    2004-01-01

    To evaluate the usefulness of the CT-guided percutaneous lung biopsy for the solitary pulmonary nodules smaller than 15 mm in diameter. Between April 2002 and May 2003, we evaluated twenty-five patients (11 men, 14 women, mean ages: 52.5 years) who had solitary pulmonary nodules, which we could not discriminate as being benign or malignant on the CT findings. All the subjects had CT-guided percutaenous cutting needle biopsy (PCNB) performed on them at our institution. A definitive diagnosis of benignity or malignancy was established to retrospectively analyze the patient's records. We evaluated the accuracy, sensitivity, specificity and complications of PCNB for the definitive diagnosis of benignity or malignancy. The sensitivity and specificity of PCNB were determined using the Chi-square test, and the correlations with pneumothorax and emphysema after biopsy were analyzed using Spearman's rank correlation coefficient. In two nodules of the twenty-five nodules, no definitive diagnosis could be established. Of the remaining twenty-three nodules, 7 (30.4%) were malignant and 16 (69.6%) were benign. Twenty (87%) of the twenty-three definitively diagnosed nodules were correctly diagnosed with PCNB. Of the twenty nodules, 6 (30%) were malignant and 14 (70%) were benign. The sensitivity and specificity of the malignant nodules were 85.7% (6/7) and 100% (16/16), respectively. The sensitivity and specificity of the benign nodules were 87.5% (14/16) and 85.7% (6/7), respectively. Post-biopsy complication occurred in nine patients (36%): Hemoptysis (n=4, 16%) and pneumothorax (n=5, 20%). However, there was not a statistical significance between pneumothorax and emphysema after biopsy (r=0.3, p=0.15). When CT-guided percutaneous lung biopsy of the solitary pulmonary nodules smaller than 15 mm in diameter was performed without an on-site cytopathologist, we know that PCNB can yield high diagnostic accuracy and very few complications

  17. Transpulmonary CT-guided percutaneous ethanol injection therapy (CT-PEIT) for hepatocellular carcinoma located in the subphrenic region of liver

    International Nuclear Information System (INIS)

    Ueda, Kazushige; Ohkawara, Tohru; Minami, Masahito; Sawa, Yoshihiko; Morinaga, Osamu; Kohli, Yoshihiro; Ohkawara, Yasuo

    2000-01-01

    The purpose of this study is to evaluate the feasibility of transpulmonary CT-guided percutaneous ethanol injection therapy (CT-PEIT) for hepatocellular carcinoma (HCC, 15 lesions) located in the subphrenic region and untreatable by ultrasonography-guided PEIT. The HCC was localized on Lipiodol CT image with a graduated grid system. We advanced a PEIT needle in a stepwise fashion, perpendicularly to the major axis of body through the lung with intermittent localization scans to position the tip of the needle in the lesion. Ethanol was injected with monitoring scans obtained after incremental volumes of injection, until perfusion was judged to be complete. A total of 20 CT-PEIT sessions were performed. The average number of needles passed from skin to liver in each CT-PEIT session was 2.7, the average volume of ethanol injected was 11.7 ml, and the average time required was 53.6 minutes. Complete perfusion of the lesion by ethanol was achieved in all lesions with only a single or double CT-PEIT procedure without severe complications. Local recurrence was detected in 3 to 15 followed up lesions for 14 months on average. In conclusion, transpulmonary CT-PEIT should prove to be a feasible, acceptable treatment for challenging cases of HCC located in the subphrenic region. (author)

  18. Prospective evaluation of the radiologist's hand dose in CT-guided interventions; Prospektive Evaluation der Handdosis des Radiologen im Rahmen von CT-gestuetzten Interventionen

    Energy Technology Data Exchange (ETDEWEB)

    Rogits, B.; Jungnickel, K.; Loewenthal, D.; Dudeck, O.; Pech, M.; Ricke, J. [Magdeburg Univ. (Germany). Radiology and Nuclear Medicine; Kropf, S. [Magdeburg Univ. (Germany). Dept. of Biometry and Medical Informatics; Nekolla, E.A. [The Federal Office for Radiation Protection, Neuherberg (Germany). Dept. of Radiation Protection and Health; Wieners, G. [Charite CVC, Berlin (Germany). Dept. of Radiology

    2013-11-15

    Purpose: Assessment of radiologist's hand dose in CT-guided interventions and determination of influencing factors. Materials and Methods: The following CT-guided interventions were included: Core biopsy, drainage, periradicular therapy, and celiac plexus neurolysis. The hand dose was measured with an immediately readable dosimeter, the EDD-30 (Unfors, Sweden). The default parameters for CT fluoroscopy were 120 kV, 90 mA and a 4 mm slice thickness. All interventions were performed on a 16-slice CT unit (Aquilion 16 Toshiba, Japan). The tumor size, degree of difficulty (1 - 3), level of experience and device parameters (mAs, dose-length product, scan time) were documented. Results: 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 - 240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 - 140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 - 3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other. Besides physical influencing factors, the degree of difficulty (p = 0.001) and summed puncture depth (p = 0.004) correlated significantly with the hand dose. Conclusion: The median hand dose for different CT-guided interventions was 0.22 mSv. Therefore, the annual hand dose limit would normally only be reached with about 2000 interventions. (orig.)

  19. CT guided percutaneous renal cysts puncture with ethanol therapy

    International Nuclear Information System (INIS)

    Zhang Xuezhe; Lu Yan; Wang Wu; Huang Zhengguo; Ren An

    2002-01-01

    Objective: To analyse our clinical experience with CT guided percutaneous renal cysts puncture and ethanol therapy. Methods: Five hundred and ten renal cysts in 445 patients were undergone CT guided percutaneous renal cysts puncture and ethanol therapy. Among the 445 cases, 385 cases had solitary renal cyst, 53 multiple renal cysts, and 7 polycystic kidneys. The renal cysts varied in size from 1.9 to 13.5 cm in diameter. The amount of aspirated fluid varied from 3 to 780 ml. A 18-21 gauge aspiration needles were used for all patients. A 25.0% cyst volume replacement with 99.7% ethanol was approved to be appropriate. Results: 427 renal cysts in 396 patients were followed up by computed tomographic (CT) or ultrasound for less than 3 months to more than one year duration. The curative effective rate and disappearance rate of the renal cystic cavity in solitary renal cysts were 97% and 82%, respectively. In multiple renal cysts, the corresponding values were 95% and 79%. In polycystic kidneys, the curative rate was 67%. The complications such as local abdominal pain (28 cases) and hematuria (four cases) were observed in this series. There were no fatal complications. Conclusions: CT guided percutaneous renal cyst puncture and ethanol therapy is an useful procedure for the treatment of solitary renal cysts and multiple renal cysts

  20. Use of Low-Fidelity Simulation Laboratory Training for Teaching Radiology Residents CT-Guided Procedures.

    Science.gov (United States)

    Picard, Melissa; Nelson, Rachel; Roebel, John; Collins, Heather; Anderson, M Bret

    2016-11-01

    To determine the benefit of the addition of low-fidelity simulation-based training to the standard didactic-based training in teaching radiology residents common CT-guided procedures. This was a prospective study involving 24 radiology residents across all years in a university program. All residents underwent standard didactic lecture followed by low-fidelity simulation-based training on three common CT-guided procedures: random liver biopsy, lung nodule biopsy, and drain placement. Baseline knowledge, confidence, and performance assessments were obtained after the didactic session and before the simulation training session. Approximately 2 months later, all residents participated in a simulation-based training session covering all three of these procedures. Knowledge, confidence, and performance data were obtained afterward. These assessments covered topics related to preprocedure workup, intraprocedure steps, and postprocedure management. Knowledge data were collected based on a 15-question assessment. Confidence data were obtained based on a 5-point Likert-like scale. Performance data were obtained based on successful completion of predefined critical steps. There was significant improvement in knowledge (P = .005), confidence (P simulation-based training to the standard didactic curriculum for all procedures. This study suggests that the addition of low-fidelity simulation-based training to a standard didactic-based curriculum is beneficial in improving resident knowledge, confidence, and tested performance of common CT-guided procedures. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  1. CT-guided biopsy: diagnostic relevance, therapeutic consequences and economic aspects

    International Nuclear Information System (INIS)

    Schwarzenberg, H.; Mueller-Huelsbeck, S.; Link, J.; Brossmann, J.; Fahl, M.; Quirin, A.; Heller, M.

    1996-01-01

    Purpose: To evaluate the diagnostic and clinical relevance and therapeutic consequences of CT-guided biopsy with regard to economic aspects. Methods: 213 CT-guided biopsies in 190 were evaluated. All information regarding patient referral, reason for request, body region, underlying diagnosis, and clinical consequences were registered over a period of 22.2±9.4 month. Results: Patient referral to biopsy was mainly from the departments of surgery, internal medicine, and radiotherapy with the question of tumor and metastasis. Less than 5% of biopsies were performed in outpatients. Main regions were the lung (39%), the abdomen (35%), and the skeleton (11%). Biopsy and surgical histology corresponded in 73%. Largest diagnosis groups were benign unspecific tissues or other benign lesions in 24%. As a result of CTP no further procedures necessary in 22.5%. Follow-up studies or conservative treatment were indicated in 11.3%. Surgical procedures were needed in only 15.5%. There was only one complication requiring therapy. Conclusion: CT-guided biopsy is a safe procedure, which helps to avoid unnecessary cost-intensive diagnostics and surgical treatment. If CTP is performed early and in outpatients residence time in the hospital is reduced and thus money is saved. (orig.) [de

  2. SU-E-J-86: Lobar Lung Function Quantification by PET Galligas and CT Ventilation Imaging in Lung Cancer Patients

    International Nuclear Information System (INIS)

    Eslick, E; Kipritidis, J; Keall, P; Bailey, D; Bailey, E

    2014-01-01

    Purpose: The purpose of this study was to quantify the lobar lung function using the novel PET Galligas ([68Ga]-carbon nanoparticle) ventilation imaging and the investigational CT ventilation imaging in lung cancer patients pre-treatment. Methods: We present results on our first three lung cancer patients (2 male, mean age 78 years) as part of an ongoing ethics approved study. For each patient a PET Galligas ventilation (PET-V) image and a pair of breath hold CT images (end-exhale and end-inhale tidal volumes) were acquired using a Siemens Biograph PET CT. CT-ventilation (CT-V) images were created from the pair of CT images using deformable image registration (DIR) algorithms and the Hounsfield Unit (HU) ventilation metric. A comparison of ventilation quantification from each modality was done on the lobar level and the voxel level. A Bland-Altman plot was used to assess the difference in mean percentage contribution of each lobe to the total lung function between the two modalities. For each patient, a voxel-wise Spearmans correlation was calculated for the whole lungs between the two modalities. Results: The Bland-Altman plot demonstrated strong agreement between PET-V and CT-V for assessment of lobar function (r=0.99, p<0.001; range mean difference: −5.5 to 3.0). The correlation between PET-V and CT-V at the voxel level was moderate(r=0.60, p<0.001). Conclusion: This preliminary study on the three patients data sets demonstrated strong agreement between PET and CT ventilation imaging for the assessment of pre-treatment lung function at the lobar level. Agreement was only moderate at the level of voxel correlations. These results indicate that CT ventilation imaging has potential for assessing pre-treatment lobar lung function in lung cancer patients

  3. Automatic lung segmentation in functional SPECT images using active shape models trained on reference lung shapes from CT.

    Science.gov (United States)

    Cheimariotis, Grigorios-Aris; Al-Mashat, Mariam; Haris, Kostas; Aletras, Anthony H; Jögi, Jonas; Bajc, Marika; Maglaveras, Nicolaos; Heiberg, Einar

    2018-02-01

    Image segmentation is an essential step in quantifying the extent of reduced or absent lung function. The aim of this study is to develop and validate a new tool for automatic segmentation of lungs in ventilation and perfusion SPECT images and compare automatic and manual SPECT lung segmentations with reference computed tomography (CT) volumes. A total of 77 subjects (69 patients with obstructive lung disease, and 8 subjects without apparent perfusion of ventilation loss) performed low-dose CT followed by ventilation/perfusion (V/P) SPECT examination in a hybrid gamma camera system. In the training phase, lung shapes from the 57 anatomical low-dose CT images were used to construct two active shape models (right lung and left lung) which were then used for image segmentation. The algorithm was validated in 20 patients, comparing its results to reference delineation of corresponding CT images, and by comparing automatic segmentation to manual delineations in SPECT images. The Dice coefficient between automatic SPECT delineations and manual SPECT delineations were 0.83 ± 0.04% for the right and 0.82 ± 0.05% for the left lung. There was statistically significant difference between reference volumes from CT and automatic delineations for the right (R = 0.53, p = 0.02) and left lung (R = 0.69, p automatic quantification of wide range of measurements.

  4. CT guided stereotaxy based on scout view imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wester, K; Kjartansson, O; Bakke, S J

    1987-05-01

    A simple and inexpensive method for CT guided sterotaxy is described. The method requires no extra equipment in the interface between the computer tomograph and the stereotaxic frame, and could therefore easily be adopted in most neurosurgical units. With this method, information from the transaxial CT sections is transferred manually via the scout view image to the operation theater skull X-rays, and thereby to the stereotaxic frame. The method has proved to be sufficiently accurate for all current non-functional stereotaxic procedures in our department during 30 months of testing.

  5. CT guided stereotaxy based on scout view imaging

    International Nuclear Information System (INIS)

    Wester, K.; Kjartansson, O.; Bakke, S.J.; Rikshospitalet, Oslo

    1987-01-01

    A simple and inexpensive method for CT guided sterotaxy is described. The method requires no extra equipment in the interface between the computer tomograph and the stereotaxic frame, and could therefore easily be adopted in most neurosurgical units. With this method, information from the transaxial CT sections is transferred manually via the scout view image to the operation theater skull X-rays, and thereby to the stereotaxic frame. The method has proved to be sufficiently accurate for all current non-functional stereotaxic procedures in our department during 30 months of testing. (orig.)

  6. CT and Ultrasound Guided Stereotactic High Intensity Focused Ultrasound (HIFU)

    Science.gov (United States)

    Wood, Bradford J.; Yanof, J.; Frenkel, V.; Viswanathan, A.; Dromi, S.; Oh, K.; Kruecker, J.; Bauer, C.; Seip, R.; Kam, A.; Li, K. C. P.

    2006-05-01

    animals and humans for HIFU-induced ablation and drug delivery. Integrated CT-guided focused ultrasound holds promise for tissue ablation, enhancing local drug delivery, and CT thermometry for monitoring ablation in near real-time.

  7. CT image construction of a totally deflated lung using deformable model extrapolation

    International Nuclear Information System (INIS)

    Sadeghi Naini, Ali; Pierce, Greg; Lee, Ting-Yim

    2011-01-01

    Purpose: A novel technique is proposed to construct CT image of a totally deflated lung from a free-breathing 4D-CT image sequence acquired preoperatively. Such a constructed CT image is very useful in performing tumor ablative procedures such as lung brachytherapy. Tumor ablative procedures are frequently performed while the lung is totally deflated. Deflating the lung during such procedures renders preoperative images ineffective for targeting the tumor. Furthermore, the problem cannot be solved using intraoperative ultrasound (U.S.) images because U.S. images are very sensitive to small residual amount of air remaining in the deflated lung. One possible solution to address these issues is to register high quality preoperative CT images of the deflated lung with their corresponding low quality intraoperative U.S. images. However, given that such preoperative images correspond to an inflated lung, such CT images need to be processed to construct CT images pertaining to the lung's deflated state. Methods: To obtain the CT images of deflated lung, we present a novel image construction technique using extrapolated deformable registration to predict the deformation the lung undergoes during full deflation. The proposed construction technique involves estimating the lung's air volume in each preoperative image automatically in order to track the respiration phase of each 4D-CT image throughout a respiratory cycle; i.e., the technique does not need any external marker to form a respiratory signal in the process of curve fitting and extrapolation. The extrapolated deformation field is then applied on a preoperative reference image in order to construct the totally deflated lung's CT image. The technique was evaluated experimentally using ex vivo porcine lung. Results: The ex vivo lung experiments led to very encouraging results. In comparison with the CT image of the deflated lung we acquired for the purpose of validation, the constructed CT image was very similar. The

  8. Application of CT perfusion imaging in radiotherapy for lung cancer

    International Nuclear Information System (INIS)

    Xia Guangrong; Liu Guimei; He Wen; Jin Guohua; Xie Ruming; Xu Yongxiang; Li Xiaobo; Li Xuebing

    2011-01-01

    Objective: To investigate the value of CT perfusion imaging in evaluation of therapeutic effect and prognosis in radiotherapy for lung cancer. Methods: Fifty-one cases of lung cancer who were unable or refused to be operated on, 36 males and 15 females, aged 37-80, underwent CT perfusion imaging, 29 of which only before radiotherapy and 22 before and after radiotherapy twice. The images were collected by cine dynamic scanning (5 mm/4 slices) and input into the GE AW4.0 workstation for data processing. The slice positions of CT imaging were determined according to the largest tumor size in CT scan. Regions of interest of tumor were drawn at the region corresponding to the original images of CT perfusion. Radiotherapy was performed after CT perfusion imaging. Relevant parameters, including blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) were calculated. The treatment response after radiotherapy was evaluated by RECIST. At 2 -4 weeks after the treatment, CT examination was conducted once more. Results: The tests of the 51 patients showed that the BV was 13.6 ml·100 g -1 , the BF was 129.5 ml·min -1 ·100 g -1 , the MTT was 9.1 s, and the PS was 10.0 ml· min -1 · 100 g -1 before radiotherapy. The tests of the 22 of the 51 patients showed that the values of BV and BF after radiotherapy were 7.6 ml· 100 g -1 and 97.8 ml·min -1 · 100 g -1 , respectively, both lower than those before radiotherapy (11.2 and 108.7 ml·min -1 ·100 g -1 , respectively), however, both not significantly (t=1.28, 0.40, P>0.05); and the values of MTT and PS after radiotherapy were 8.9 s and 7.8 ml·min -1 · 100 g -1 , respectively, both not significantly higher than those before radiotherapy (7.2 s and 6.8 ml· min -1 · 100 g -1 , respectively, t=-1.15, -0.57, P>0.05). The mean area of tumor after radiotherapy was 1189.6 mm 2 , significantly less than that before radiotherapy (1920.3 mm 2 , t=3.98, P<0.05). The MTT of the SCLC patients was 12

  9. High resolution CT for localization of early hilar lung carcinoma

    International Nuclear Information System (INIS)

    Minami, Yuko; Ishikawa, Shigemi; Saida, Yukihisa; Kajitani, Motomasa; Yamamoto, Tatsuo; Sato, Yukio; Onizuka, Masataka; Sakakibara, Yuzuru; Noguchi, Masayuki

    2002-01-01

    The purpose of this study was to analyse the usefulness of high resolution CT (HRCT) for the diagnosis and localization of roentgenographically occult lung cancer. HRCT was performed prospectively on chest X-ray negative patients with bloody sputum or suspicious or positive cells on sputum cytology between 1998 and 2000. After the HRCT scan, white light bronchoscopy and autofluorescence bronchoscopy were performed. HRCT depicted 19 hilar bronchial lesions in 13 cases out of 19 patients, of which 9 lesions were confirmed by white light broncoscope. Of 8 hilar squamous cell carcinomas diagnosed in this study, 7 lesions (87.5%) were depicted by HRCT. One CT-negative case (12.5%) was an in situ carcinoma in left B 1+2 . Four out of 20 lesions which showed bronchoscopic abnormality, could not be depicted by HRCT. HRCT could prospectively detect 80% of the bronchoscopic abnormalities and 87.5% of the hilar squamous cell carcinomas of the tracheobronchial lesions of the lung. Therefore, HRCT can be an effective supplemental means for screening for hilar squamous cell carcinoma. (author)

  10. Quantitative CT characterization of pediatric lung development using routine clinical imaging

    Energy Technology Data Exchange (ETDEWEB)

    Stein, Jill M.; Brody, Alan S.; Fleck, Robert J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Walkup, Laura L. [Cincinnati Children' s Hospital Medical Center, Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati, OH (United States); Woods, Jason C. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati, OH (United States)

    2016-12-15

    The use of quantitative CT analysis in children is limited by lack of normal values of lung parenchymal attenuation. These characteristics are important because normal lung development yields significant parenchymal attenuation changes as children age. To perform quantitative characterization of normal pediatric lung parenchymal X-ray CT attenuation under routine clinical conditions in order to establish a baseline comparison to that seen in pathological lung conditions. We conducted a retrospective query of normal CT chest examinations in children ages 0-7 years from 2004 to 2014 using standard clinical protocol. During these examinations semi-automated lung parenchymal segmentation was performed to measure lung volume and mean lung attenuation. We analyzed 42 CT examinations in 39 children, ages 3 days to 83 months (mean ± standard deviation [SD] = 42 ± 27 months). Lung volume ranged 0.10-1.72 liters (L). Mean lung attenuation was much higher in children younger than 12 months, with values as high as -380 Hounsfield units (HU) in neonates (lung volume 0.10 L). Lung volume decreased to approximately -650 HU by age 2 years (lung volume 0.47 L), with subsequently slower exponential decrease toward a relatively constant value of -860 HU as age and lung volume increased. Normal lung parenchymal X-ray CT attenuation decreases with increasing lung volume and age; lung attenuation decreases rapidly in the first 2 years of age and more slowly thereafter. This change in normal lung attenuation should be taken into account as quantitative CT methods are translated to pediatric pulmonary imaging. (orig.)

  11. Quantitative CT characterization of pediatric lung development using routine clinical imaging

    International Nuclear Information System (INIS)

    Stein, Jill M.; Brody, Alan S.; Fleck, Robert J.; Walkup, Laura L.; Woods, Jason C.

    2016-01-01

    The use of quantitative CT analysis in children is limited by lack of normal values of lung parenchymal attenuation. These characteristics are important because normal lung development yields significant parenchymal attenuation changes as children age. To perform quantitative characterization of normal pediatric lung parenchymal X-ray CT attenuation under routine clinical conditions in order to establish a baseline comparison to that seen in pathological lung conditions. We conducted a retrospective query of normal CT chest examinations in children ages 0-7 years from 2004 to 2014 using standard clinical protocol. During these examinations semi-automated lung parenchymal segmentation was performed to measure lung volume and mean lung attenuation. We analyzed 42 CT examinations in 39 children, ages 3 days to 83 months (mean ± standard deviation [SD] = 42 ± 27 months). Lung volume ranged 0.10-1.72 liters (L). Mean lung attenuation was much higher in children younger than 12 months, with values as high as -380 Hounsfield units (HU) in neonates (lung volume 0.10 L). Lung volume decreased to approximately -650 HU by age 2 years (lung volume 0.47 L), with subsequently slower exponential decrease toward a relatively constant value of -860 HU as age and lung volume increased. Normal lung parenchymal X-ray CT attenuation decreases with increasing lung volume and age; lung attenuation decreases rapidly in the first 2 years of age and more slowly thereafter. This change in normal lung attenuation should be taken into account as quantitative CT methods are translated to pediatric pulmonary imaging. (orig.)

  12. Interobserver variability in visual evaluation of thoracic CT scans and comparison with automatic computer measurements of CT lung density

    DEFF Research Database (Denmark)

    Winkler Wille, Mathilde Marie; Thomsen, Laura Hohwü; Dirksen, Asger

    2012-01-01

    lung density measurements, i.e. densitometry. Methods – In a pilot study 60 CT scans were selected from a sample of 3980 CT scans from The Danish Lung Cancer Screening Trial (DLCST). The amount of emphysema in these scans was scored independently by two observers, who were blinded regarding clinical...... information. The lung was segmented automatically by in-house developed computer software, and the percentage of pixels below -950 HU was used as a surrogate marker for emphysema. The observer variability, as well as the correlation with the lung density measurements, was analysed using Spearman’s rank...... in emphysema grading. However, the agreement with the CT lung density measurement was poor, indicating that the two types of evaluation represent different aspects of emphysema. Most likely, they should be seen as complementary rather than competitive evaluations. Future comparison with physiological tests...

  13. Intracrainal metastases of lung cancer -CT and histopathologic correlation-

    International Nuclear Information System (INIS)

    Park, Hyun Ju; Kim, Myung Soon; Kang, Myung Jae

    1991-01-01

    The authors retrospectively analyzed high resolution (HR) CT scans of the brain in 23 patients with surgically proved primary lung cancer and intracranial metastatic lesions from April 1986 to March 1990. The purpose of this study was to evaluate the relationship between histopathologic types of primary lung cancer and HRCT findings of brain. The results were as follows: The locations of metastatic lesion were intraaxial in 93% and extraaxial in 7%. In the intraaxial lesions, most were in the supratentorial area (83%) and the remainer in the infratentorial area (10%). Among the supratentorial lesions, the parietal lobe was the most commonly involved (33%), while the second most common location was frontal lobe (22%). The HRCT showed multiple lesions in 52% and solitary lesions in 48%. All cell types except for squamous cell carcinoma showed the same incidence in multiplicity, and the squamous cell carcinoma showed slightly more multiple lesions rather than solitary ones. The degree of peritumoral edema was none in 4%, mild in 25%, moderate in 46%, and severe in 25%. All cell types except for squamous cell carcinoma in general showed a moderate degree of edema, and the squamous cell carcinoma mainly showed mild and severe edema. Precontrast CT scans showed mixed density in 52%, isodensity in 24%, low density in 19%, and high density in 5%. All cell types except for large cell carcinoma showed mixed density, the large cell carcinoma showed a low density unlike the others. Hemorrhages were seen in 24% and noted in all cell types except for large cell carcinoma. Postcontrast CT scans showed ring enhancement in 64%, nodular enhancement in 20%, and inhomogeneous enhancement in 16%. All cell types except for small cell carcinoma generally showed ring enhancement, and the small cell carcinoma showed a variable degree of enhancement

  14. Clinical application of CT-guided percutaneous puncturing biopsy of subcarinal lymph node

    International Nuclear Information System (INIS)

    Yuan Xiaodong; Wang Jianhua; Zuo Changjing; Tian Jianming

    2011-01-01

    Objective: To discuss the safety and clinical significance of CT-guided percutaneous puncturing biopsy of subcarinal lymph node. Methods: During the period of July 2006-July 2010, CT-guided percutaneous puncturing biopsy of subcarinal lymph node was carried out in 17 patients (11 males and 6 females, with an average age of 54 years) with enlarged subcarinal lymph nodes. The clinical data were retrospectively analyzed. Immediately after the puncturing procedure was completed, CT scanning was performed to observe if there any complications and to evaluate the safety of puncturing biopsy. Biopsy specimens were sent for pathological examination to assess the puncturing accuracy and to make the pathologic diagnosis. The clinical usefulness of this technique was evaluated. Results: Of the total 17 cases, successful puncturing into the enlarged subcarinal lymph nodes with single procedure was achieved in 14 and sufficient tissue sample was obtained. The biopsy failed in three cases at initial puncturing procedure as the needle could not be placed into the enlarged subcarinal lymph nodes, the puncturing biopsy had to given up in two patients because of hemoptysis and in another patient the second puncturing biopsy performed one week later was successful. The total technical successful rate was 88.2% (15/17). Of the fifteen cases with successful puncturing, definitive pathological diagnosis was obtained in 13 and the diagnosis was uncertain in the remaining two, with a diagnosis positive rate of 86.7% (13/15). Pathologically, the diagnoses included metastatic lymphadenopathy from lung cancer (n=10), proliferative inflammatory lymphadenopathy (n=2) and tuberculous enlargement of lymph nodes (n=1). Complications occurred in 4 patients (23.5%, 4/17), which mainly were pneumothorax and pulmonary hemorrhage. Conclusion: With high successful rate and diagnostic accuracy, CT-guided percutaneous puncturing biopsy of subcarinal lymph node is a safe and effective technique if the

  15. Usefulness of CT fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy

    International Nuclear Information System (INIS)

    O, Dong Hyun; Cho, Young Jun; Park, Yong Sung; Hwang, Cheol Mok; Kim, Keum Won; Kim, Ji Hyung

    2006-01-01

    When pneumothorax occurs during a percutaneous needle biopsy, the radiologist usually stops the biopsy. We evaluated the usefulness of computed tomographic (CT) fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy. We performed 288 CT fluoroscopy guided percutaneous needle biopsies to diagnose the pulmonary nodules. Twenty two of these patients had pneumothorax that occurred during the biopsy without obtaining an adequate specimen. After pneumothorax occurred, we performed immediate CT fluoroscopy guided percutaneous needle biopsies using an 18-gauge cutting needle. We evaluated the success rate of the biopsies and also whether or not the pneumothorax progressed. We classified these patients into two groups according to whether the pneumothorax progressed (Group 2) or not (Group 1) by measuring the longest distance between the parietal pleura and the visceral pleura both in the early and late pneumothorax. Additionally, we analyzed the relationship between the progression of pneumothorax after biopsy and 1) the depth of the pulmonary nodule; 2) the number of biopsies; 3) the presence or absence of emphysema at the biopsy site; and 4) the size of the pulmonary nodule. Biopsy was successful in 19 of 22 nodules (86.3%). Of the 19 nodules, 12 (63.2%) were malignant and 7 (36.8%) were benign. Twelve patients (54.5%) were classified as group 1 and 10 patients (45.4%) as group 2. The distance between the lung lesion and pleura showed a statistically significant difference between these two groups: ≤ 1 cm in distance for group 1 (81.8%) and group 2 (18.2%), and > 1 cm in distance for group 1 (30%) and group 2 (70%), ρ 0.05). When early pneumothorax occurs during a biopsy, CT fluoroscopy guided percutaneous needle biopsy is an effective and safe procedure. Aggravation of pneumothorax after biopsy is affected by the depth of the pulmonary nodule

  16. CT guided fine needle aspiration biopsy of biliopancreatic lesions

    International Nuclear Information System (INIS)

    Geng, Jia-Zheng; Qin, Pan-Rui; Hui, Liu-De; Po, Pei-Dong

    1987-01-01

    CT guided percutaneous fine needle aspiration biopsy was performed on 30 patients with pancreatic and periampullary neoplasms, in the Department of Surgery, China-Japan Friendship Hospital, between March 1985 and January 1986. We obtained positive cytodiagnosis from all cases of carcinoma of the pancreatic head (9 cases), body and tail (4 cases), and ampullary carcinomas (5 cases) (100 per cent). In 2 of 3 duodenal carcinomas (66.6 per cent), and 6 of 7 distal common duct carcinomas (86 per cent), a positive cytodiagnosis was also obtained. On the other hand, 2 cases of pancreatitis both gave a negative cytodiagnosis, i.e. no false positives were obtained. Out of the 30 cases who underwent CT guided biopsy, a correct diagnosis was obtained in 28, i.e. a diagnostic accuracy of 93.3 per cent. The cytodiagnosis of the other two cases was either suspicious or false negative. There have been no clinical complications noted. (author)

  17. CT guided puncture aspiration and sclerosing treatment of ovary cyst

    International Nuclear Information System (INIS)

    Peng Yongjun; Du Xiumei; Yuan Jinrong; Chen Chanqing

    2007-01-01

    Objective: To analyze the method and the curative effect with CT guided percutaneous puncture aspiration and sclerosing treatment of ovary cyst. Method: 22 ovary cysts in 22 patients were treated with percutaneous puncture aspiration and underwent repeated sclerotherapy with 99.7% ethanol injection. Among the 22 patients, 18 patients had solitary ovary cyst and was aspirated with an 18-22G gauge aspiration needle. The amount of aspirated fluid varied from 30ml-500ml and 25%-30% cyst volume was replaced by appropriate ethanol Post treatment follow-up were achieved every 3 months. Results All the Punctures were successfully completed. During the 3 months to one year follow-up, 16 ovary cyst disappeared, 6 cysts were small over 50%, without main complication. Conclusion CT guided percutaneous puncture aspiration and sclerosing treatment of ovary cyst is a treatment of choice because of its safety, low complication, and high curative effect. (authors)

  18. CT-quantified emphysema distribution is associated with lung function decline

    NARCIS (Netherlands)

    Hoesein, F.A.A.M.; Rikxoort, E.M. van; Ginneken, B. van; de Jong, P. A.; Prokop, M.; Lammers, J.W.; Zanen, P.

    2012-01-01

    Emphysema distribution is associated with COPD. It is however unknown whether CT-quantified emphysema distribution (upper/lower lobe) is associated with lung function decline in heavy (former) smokers.587 male participants underwent lung CT-scanning and pulmonary function testing at baseline and

  19. CT-guided stereotactic evacuation of hypertensive intracerebral hematomas

    International Nuclear Information System (INIS)

    Hondo, Hideki

    1983-01-01

    Computerized tomography (CT) is now effective not only for definite diagnosis and location of intracerebral hematomas but also for coordination of the center of a hematoma. CT-guided stereotactic evacuation of hypertensive intracerebral hematoma was performed in 51 cases: 34 of basal ganglionic hematoma with or without ventricular perforation, 11 of subcortical hematoma, 3 of thalamic hematoma and 3 of cerebellar hematoma. Three dimensional CT images or biplane CT images were taken to determine the coordinates of the target point, which was the center of the hematoma. Then, a silicon tube (O.D. 3.5 phi, I.D. 2.1 phi) was inserted into the center of the hematoma through a burr-hole under local anesthesia, and the liquid or solid hematoma was aspirated as completely as possible with a syringe. Urokinase (6,000 I.U./5 ml saline) was administered through this silicon tube every 6 or 12 hours for several days until the hematoma had drained out competely. The silicon tube was taken out when repeated CT scanning revealed no hematoma. The results of clinical follow-ups indicated that this procedure is as good as, or rather better than conventional microsurgery with evacuation of hematoma under direct vision. Moreover this CT-guided stereotactic approach for evacuation of the hematoma has the following advantages: 1) the procedure is simple and safe, 2) operation can be performed under local anesthesia, and 3) the hematoma is drained out completely with the aid of urokinase. This surgery seems indicated as an emergency treatment for high-age or high risk patients and also as a routine surgery for intracerebral hematomas in patients showing no herination signs. (author)

  20. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

    Energy Technology Data Exchange (ETDEWEB)

    Gevargez, A.; Schirp, S.; Braun, M. [Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany); Groenemeyer, D. [Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany); EFMT Development and Research Center for Microtherapy, Bochum (Germany)

    2002-06-01

    Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks. (orig.)

  1. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

    International Nuclear Information System (INIS)

    Gevargez, A.; Schirp, S.; Braun, M.; Groenemeyer, D.

    2002-01-01

    Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks. (orig.)

  2. Spinal CT-guided injections. Clinical applications-limitations

    International Nuclear Information System (INIS)

    Stamatakis, V.; Vlachou, I.; Petrocheilou, G.; Safarika, V.; Geroukis, I.; Petinelli, A.; Stathopoulou, S.; Kokkinis, C.

    2012-01-01

    Full text: Introduction: Chronic spinal pain is an important health issue with serious social and financial consequences. Thus, application of minimal invasive procedures is a popular technique for immediate relief of pain. Objectives and tasks: Our purpose is to present CT guided intraspinal injection of pharmaceutical agents for the relief of persistent pain. Material and methods: Chronic localized or radicular spinal pain may be treated safely and efficiently with injection of various pharmaceutical agents (local anesthetic, opioid analgesic and steroids or combination of these). The possible sites of infiltration include: a) intervertebral joints (facets), b) sacroiliac joints, c)perineural infiltration of the affected nerve roots and d) the epidural space. We will mention the patients choice criteria (combination of clinical symptoms and specific pain evaluation questionnaire) as they are reported in the international bibliography. Finally, we will discuss the repeatability criteria of the method as well as its limitations. Results: CT-guided pharmaceutical agents injection for the relief of persistent spinal pain have an advantage against other methods because of the precision and safety that they offer to the localization and diagnosis of the pain cause. Conclusion: Small complications percentage and satisfactory results have made CT-guided spinal injections a popular technique for chronic back pain relief. In order to apply these techniques the good knowledge of the method, its possibilities and limitations is necessary

  3. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy

    International Nuclear Information System (INIS)

    Khan, M.F.; Straub, R.; Moghaddam, S.R.; Maataoui, A.; Gurung, J.; Thalhammer, A.; Vogl, T.J.; Jacobi, V.; Wagner, T.O.F.; Ackermann, H.

    2008-01-01

    The influence of various variables on the rate of pneumothorax and intrapulmonal hemorrhage associated with computed tomography (CT)-guided transthoracic needle biopsy of the lung were evaluated retrospectivly. One hundred and thirty-three patients underwent CT guided biopsy of a pulmonary lesion. Two patients were biopsied twice. Variables analyzed were lesion size, lesion location, number of pleural needle passes, lesion margin, length of intrapulmonal biopsy path and puncture time. Eighteen-gauge (18G) cutting needles (Trucut, Somatex, Teltow, Germany) were used for biopsy. Pneumothorax occured in 23 of 135 biopsies (17%). Chest tube placement was required in three out of 23 cases of pneumothorax (2% of all biopsies). Pneumothorax rate was significantly higher when the lesions were located in the lung parenchyma compared with locations at the pleura or chest wall (P < 0.05), but all pneumothorax cases which required chest tube treatment occured in lesions located less than 2 cm from the pleura. Longer puncture time led to an increase in pneumothorax rate (P < 0.05). Thirty-seven (27%) out of 135 biopsies showed perifocal hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage and pneumothorax (P < 0.05). Significantly more hemorrhage occured when the pleura was penetrated twice during the puncture (P < 0.05). Lesion size <4 cm is strongly correlated with higher occurence of perifocal hemorrhage (P < 0.05). Lesion margination showed no significant effect on complication rate. CT-guided biopsy of smaller lesions correlates with a higher bleeding rate. Puncture time should be minimized to reduce pneumothorax rate. Passing the pleura twice significantly increases the risk of hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage as well as pneumothorax. (orig.)

  4. An automated landmark-based elastic registration technique for large deformation recovery from 4-D CT lung images

    Science.gov (United States)

    Negahdar, Mohammadreza; Zacarias, Albert; Milam, Rebecca A.; Dunlap, Neal; Woo, Shiao Y.; Amini, Amir A.

    2012-03-01

    The treatment plan evaluation for lung cancer patients involves pre-treatment and post-treatment volume CT imaging of the lung. However, treatment of the tumor volume lung results in structural changes to the lung during the course of treatment. In order to register the pre-treatment volume to post-treatment volume, there is a need to find robust and homologous features which are not affected by the radiation treatment along with a smooth deformation field. Since airways are well-distributed in the entire lung, in this paper, we propose use of airway tree bifurcations for registration of the pre-treatment volume to the post-treatment volume. A dedicated and automated algorithm has been developed that finds corresponding airway bifurcations in both images. To derive the 3-D deformation field, a B-spline transformation model guided by mutual information similarity metric was used to guarantee the smoothness of the transformation while combining global information from bifurcation points. Therefore, the approach combines both global statistical intensity information with local image feature information. Since during normal breathing, the lung undergoes large nonlinear deformations, it is expected that the proposed method would also be applicable to large deformation registration between maximum inhale and maximum exhale images in the same subject. The method has been evaluated by registering 3-D CT volumes at maximum exhale data to all the other temporal volumes in the POPI-model data.

  5. Complications in CT-guided Procedures: Do We Really Need Postinterventional CT Control Scans?

    Energy Technology Data Exchange (ETDEWEB)

    Nattenmüller, Johanna, E-mail: johanna.nattenmueller@med.uni-heidelberg.de; Filsinger, Matthias, E-mail: Matthias_filsinger@web.de; Bryant, Mark, E-mail: mark.bryant@med.uni-heidelberg.de; Stiller, Wolfram, E-mail: Wolfram.Stiller@med.uni-heidelberg.de; Radeleff, Boris, E-mail: boris.radeleff@med.uni-heidelberg.de; Grenacher, Lars, E-mail: lars.grenacher@med.uni-heidelberg.de; Kauczor, Hans-Ullrich, E-mail: hu.kauczor@med.uni-heidelberg.de; Hosch, Waldemar, E-mail: waldemar.hosch@urz.uni-heidelberg.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany)

    2013-06-19

    PurposeThe aim of this study is twofold: to determine the complication rate in computed tomography (CT)-guided biopsies and drainages, and to evaluate the value of postinterventional CT control scans.MethodsRetrospective analysis of 1,067 CT-guided diagnostic biopsies (n = 476) and therapeutic drainages (n = 591) in thoracic (n = 37), abdominal (n = 866), and musculoskeletal (ms) (n = 164) locations. Severity of any complication was categorized as minor or major. To assess the need for postinterventional CT control scans, it was determined whether complications were detected clinically, on peri-procedural scans or on postinterventional scans only.ResultsThe complication rate was 2.5 % in all procedures (n = 27), 4.4 % in diagnostic punctures, and 1.0 % in drainages; 13.5 % in thoracic, 2.0 % in abdominal, and 3.0 % in musculoskeletal procedures. There was only 1 major complication (0.1 %). Pneumothorax (n = 14) was most frequent, followed by bleeding (n = 9), paresthesia (n = 2), material damage (n = 1), and bone fissure (n = 1). Postinterventional control acquisitions were performed in 65.7 % (701 of 1,067). Six complications were solely detectable in postinterventional control acquisitions (3 retroperitoneal bleeds, 3 pneumothoraces); all other complications were clinically detectable (n = 4) and/or visible in peri-interventional controls (n = 21).ConclusionComplications in CT-guided interventions are rare. Of these, thoracic interventions had the highest rate, while pneumothoraces and bleeding were most frequent. Most complications can be detected clinically or peri-interventionally. To reduce the radiation dose, postinterventional CT controls should not be performed routinely and should be restricted to complicated or retroperitoneal interventions only.

  6. Complications in CT-guided Procedures: Do We Really Need Postinterventional CT Control Scans?

    International Nuclear Information System (INIS)

    Nattenmüller, Johanna; Filsinger, Matthias; Bryant, Mark; Stiller, Wolfram; Radeleff, Boris; Grenacher, Lars; Kauczor, Hans-Ullrich; Hosch, Waldemar

    2014-01-01

    PurposeThe aim of this study is twofold: to determine the complication rate in computed tomography (CT)-guided biopsies and drainages, and to evaluate the value of postinterventional CT control scans.MethodsRetrospective analysis of 1,067 CT-guided diagnostic biopsies (n = 476) and therapeutic drainages (n = 591) in thoracic (n = 37), abdominal (n = 866), and musculoskeletal (ms) (n = 164) locations. Severity of any complication was categorized as minor or major. To assess the need for postinterventional CT control scans, it was determined whether complications were detected clinically, on peri-procedural scans or on postinterventional scans only.ResultsThe complication rate was 2.5 % in all procedures (n = 27), 4.4 % in diagnostic punctures, and 1.0 % in drainages; 13.5 % in thoracic, 2.0 % in abdominal, and 3.0 % in musculoskeletal procedures. There was only 1 major complication (0.1 %). Pneumothorax (n = 14) was most frequent, followed by bleeding (n = 9), paresthesia (n = 2), material damage (n = 1), and bone fissure (n = 1). Postinterventional control acquisitions were performed in 65.7 % (701 of 1,067). Six complications were solely detectable in postinterventional control acquisitions (3 retroperitoneal bleeds, 3 pneumothoraces); all other complications were clinically detectable (n = 4) and/or visible in peri-interventional controls (n = 21).ConclusionComplications in CT-guided interventions are rare. Of these, thoracic interventions had the highest rate, while pneumothoraces and bleeding were most frequent. Most complications can be detected clinically or peri-interventionally. To reduce the radiation dose, postinterventional CT controls should not be performed routinely and should be restricted to complicated or retroperitoneal interventions only

  7. 4D CT and lung cancer surgical resectability: a technical innovation

    International Nuclear Information System (INIS)

    Troupis, John M.; Pasricha, Sundeep S.; Narayanan, Harish; Rybicki, Frank J.

    2014-01-01

    A 74-year-old man presents with a left upper lobe lung adenocarcinoma, which demonstrated a wide base intimately with the aortic arch. We utilised 4D CT technique with a wide field of view CT unit to preoperatively determine likely surgical resectability. We propose that 4D CT may be of use in further investigating lung cancer with likely invasion of adjacent structures.

  8. Enabling image fusion for a CT guided needle placement robot

    Science.gov (United States)

    Seifabadi, Reza; Xu, Sheng; Aalamifar, Fereshteh; Velusamy, Gnanasekar; Puhazhendi, Kaliyappan; Wood, Bradford J.

    2017-03-01

    Purpose: This study presents development and integration of hardware and software that enables ultrasound (US) and computer tomography (CT) fusion for a FDA-approved CT-guided needle placement robot. Having real-time US image registered to a priori-taken intraoperative CT image provides more anatomic information during needle insertion, in order to target hard-to-see lesions or avoid critical structures invisible to CT, track target motion, and to better monitor ablation treatment zone in relation to the tumor location. Method: A passive encoded mechanical arm is developed for the robot in order to hold and track an abdominal US transducer. This 4 degrees of freedom (DOF) arm is designed to attach to the robot end-effector. The arm is locked by default and is released by a press of button. The arm is designed such that the needle is always in plane with US image. The articulated arm is calibrated to improve its accuracy. Custom designed software (OncoNav, NIH) was developed to fuse real-time US image to a priori-taken CT. Results: The accuracy of the end effector before and after passive arm calibration was 7.07mm +/- 4.14mm and 1.74mm +/-1.60mm, respectively. The accuracy of the US image to the arm calibration was 5mm. The feasibility of US-CT fusion using the proposed hardware and software was demonstrated in an abdominal commercial phantom. Conclusions: Calibration significantly improved the accuracy of the arm in US image tracking. Fusion of US to CT using the proposed hardware and software was feasible.

  9. Central lung tumors with obstructive pneumonitis; ultrasonographic findings and usefulness of ultrasound-guided biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong An; Kim, Sun Su; Seon, Young Seok; Lee, Kyoung Rok; Kim, Byoung Geun; Park, Byung Ran; Kim, Se Jong [Kwangju Christian Hospital, Kwangju (Korea, Republic of)

    2001-02-01

    To determine the ultrasonographic findings and assess the usefulness of ultrasound (US)-guided biopsy of central lung tumors in patients with obstructive pneumonitis. Fourteen patients with central lung tumors causing obstructive pneumonitis, as seen on chest radiographs and chest CT scans, were examined between January 1997 and January 2000. In no patient conclusive histologic diagnosis obtained by means of bronchoscopic biopsy or sputum cytology. Eleven patients were men and three were women, and their ages ranged from 45 to 83 (mean, 64) years. For all examinations, real-time, linear-array, convex US units with a 3.75-and a 5.0-MHz transducer were used. The images obtained were analyzed for evidence of consolidation or atelectasis in the lung, demonstrable tumors, and tumor size and echogenicity. For US-guided percutaneous transthoracic biopsy, 19.5G automatic biopsy devices, were employed. Lung consolidation due to a wedge-shaped, homogeneous, hypoechoic lesion was revealed by sonographic fluid bronchograms, air bronchograms, air alvelograms, and visualization of intraparenchymal pulmonary vessels, which showed appropriate motion with respiration. The tumor presumed to be causing obstruction was seen as a hypoechoic nodule near the hilum or as a well-defined hyperechoic mass inside the partially consolidated lung. Pleural effusion was observed in one case. The cytologic findings indicated the presence of squamous cell carcinoma (n=4), adenocarcinoma (n=4), small cell carcinoma (n=3), non-small cell carcinoma (n=2) and large cell carcinoma (n=1). The success rate was 100%, and there were no complications. In patients with central lung tumors causing obstructive pneumonitis, chest ultrasonography and US-guided biopsy are useful adjunctive diagnostic modalities and techniques.

  10. The role of pneumothorax CT for the evaluation of aortic invasion by lung cancer

    International Nuclear Information System (INIS)

    Yokoi, Kohei; Mori, Kiyoshi; Miyazawa, Naoto; Magota, Seizo; Honda, Kazuyoshi; Sasagawa, Michizo

    1987-01-01

    To improve the accuracy of T3 diagnosis in lung cancer, Pneumothorax CT was carried out in four patients having diagnosis of plain CT and enhanced CT. Both plain and enhanced CT demonstrated obliteration of low density zone between tumor and the aorta in all cases. In three of four cases, Pneumothorax CT, however, demonstrated free air space where tumor was evaluated to be invaded. Remaining one presented the loss of such free air space even by Pneumothorax CT and was made the diagnosis of aortic invasion, which was confirmed by surgicopathological finding. Pneumothorax CT is useful for the diagnosis of ruling out tumor invasion to the aorta. (author)

  11. Weight preserving image registration for monitoring disease progression in lung CT

    DEFF Research Database (Denmark)

    Gorbunova, Vladlena; Lo, Pechin Chien Pau; Haseem, Ashraf

    2008-01-01

    We present a new image registration based method for monitoring regional disease progression in longitudinal image studies of lung disease. A free-form image registration technique is used to match a baseline 3D CT lung scan onto a following scan. Areas with lower intensity in the following scan...... the density of lung tissue with respect to local expansion or compression such that the total weight of the lungs is preserved during deformation. Our method provides a good estimation of regional destruction of lung tissue for subjects with a significant difference in inspiration level between CT scans...

  12. Weight preserving image registration for monitoring disease progression in lung CT.

    Science.gov (United States)

    Gorbunova, Vladlena; Lol, Pechin; Ashraf, Haseem; Dirksen, Asger; Nielsen, Mads; de Bruijne, Marleen

    2008-01-01

    We present a new image registration based method for monitoring regional disease progression in longitudinal image studies of lung disease. A free-form image registration technique is used to match a baseline 3D CT lung scan onto a following scan. Areas with lower intensity in the following scan compared with intensities in the deformed baseline image indicate local loss of lung tissue that is associated with progression of emphysema. To account for differences in lung intensity owing to differences in the inspiration level in the two scans rather than disease progression, we propose to adjust the density of lung tissue with respect to local expansion or compression such that the total weight of the lungs is preserved during deformation. Our method provides a good estimation of regional destruction of lung tissue for subjects with a significant difference in inspiration level between CT scans and may result in a more sensitive measure of disease progression than standard quantitative CT measures.

  13. A practical approach to radiological evaluation of CT lung cancer screening examinations

    NARCIS (Netherlands)

    Xie, Xueqian; Heuvelmans, Marjolein A.; van Ooijen, Peter M. A.; Oudkerk, Matthijs; Vliegenthart, Rozemarijn

    2013-01-01

    Lung cancer is the most common cause of cancer-related death in the world. The Dutch-Belgian Randomized Lung Cancer Screening Trial (Dutch acronym: NELSON) was launched to investigate whether screening for lung cancer by low-dose multidetector computed tomography (CT) in high-risk patients will lead

  14. CT-Screening for lung cancer does not increase the use of anxiolytic or antidepressant medication

    DEFF Research Database (Denmark)

    Kaerlev, Linda; Iachina, Maria; Pedersen, Jesper Holst

    2012-01-01

    CT screening for lung cancer has recently been shown to reduce lung cancer mortality, but screening may have adverse mental health effects. We calculated risk ratios for prescription of anti-depressive (AD) or anxiolytic (AX) medication redeemed at Danish pharmacies for participants in The Danish...... Lung Cancer Screening Trial (DLCST)....

  15. CT‑guided percutaneous transthoracic lung biopsy: First experience ...

    African Journals Online (AJOL)

    Percutaneous lung biopsy had been described in the nineteenth century by Leyden, but image- guided needle chest biopsy only gained widespread acceptance in the 1970s. Currently, tissue sampling of a thoracic lesion is indicated when the diagnosis cannot be obtained by the non-invasive techniques and cytological ...

  16. High affective risk perception is associated with more lung cancer-specific distress in CT screening for lung cancer

    NARCIS (Netherlands)

    Bunge, Eveline M.; van den Bergh, Karien A. M.; Essink-Bot, Marie-Louise; van Klaveren, Rob J.; de Koning, Harry J.

    2008-01-01

    Screening for cancer can cause distress. People who perceive their risk of cancer as high may be more vulnerable to distress. This study evaluated whether participants of a lung cancer Computed Tomography (CT) screening trial with a high affective risk perception of developing lung cancer had a

  17. Extrapeural locating method: significance in CT-guided transthoracic pulmonary biopsy

    International Nuclear Information System (INIS)

    Tang Guangjian; Wang Rengui; Liu Jianxin; Sun Jingtao

    2008-01-01

    Objective: To evaluate the usefulness of extrapleural locating method in CT-guided transthoracic pulmonary biopsy to prevent or reduce the size of peumothorax. Methods: One hundred and fifteen cases of CT-guided transthoracic pulmonary biopsy with the pulmonary lesions not in direct contact with the pleura were selected. Of 115 cases, 46 were performed with extrapleural locating method (EPL) and 69 cases with lesion edge locating method (LEL). Taking the maximum distance between the partial and visceral pleura (MPVD) measured on the CT image after the procedure as the index of the volume of pneumothorax. The incidence and volume of pneumothorax of both groups were compared and statistically analysed with R x C Chi-Square test. The retention time of the biopsy needle in the lung parenchyma of the two group was documented and the average time was calculated in each group. Results: The incidence of pneumothorax was 45.7% (21/46), median 0.4 cm with EPL group, and 66.7% (46/69) and median 0.3cm with LEL group. When the distance between the lesion and pleura was equal or smaller than 2 cm (≤2cm), the incidence of pneumothorax was 39.4% (13/33) with EPL group and 73.2% (30/41) with LEL group, and the difference of incidence and volume of the pneumothorax between two groups was statistically significant(χ 2 =9.981, P=0.019). When the distance was larger than 2 cm (>2 cm), the incidence and volume of pneumothorax between two groups were not significant statistically. The average retention time of the biopsy needle in the lung parenchyma was (7.2 ± 1.8) s with EPL group and (58.3 ± 11.6) s with LEL group. Conclusion: The extrapleural locating method can reduce effectively the retention time of the biopsy needle in the lung parenchyma and the incidence and volume of pneumothorax in CT-guided transthoracic pulmonary biopsy. (authors)

  18. Ultrasound-guided versus computed tomography-scan guided biopsy of pleural-based lung lesions.

    Science.gov (United States)

    Khosla, Rahul; McLean, Anna W; Smith, Jessica A

    2016-01-01

    Computed tomography (CT) guided biopsies have long been the standard technique to obtain tissue from the thoracic cavity and is traditionally performed by interventional radiologists. Ultrasound (US) guided biopsy of pleural-based lesions, performed by pulmonologists is gaining popularity and has the advantage of multi-planar imaging, real-time technique, and the absence of radiation exposure to patients. In this study, we aim to determine the diagnostic accuracy, the time to diagnosis after the initial consult placement, and the complications rates between the two different modalities. A retrospective study of electronic medical records was done of patients who underwent CT-guided biopsies and US-guided biopsies for pleural-based lesions between 2005 and 2014 and the data collected were analyzed for comparing the two groups. A total of 158 patients underwent 162 procedures during the study period. 86 patients underwent 89 procedures in the US group, and 72 patients underwent 73 procedures in the CT group. The overall yield in the US group was 82/89 (92.1%) versus 67/73 (91.8%) in the CT group (P = 1.0). Average days to the procedure was 7.2 versus 17.5 (P = 0.00001) in the US and CT group, respectively. Complication rate was higher in CT group 17/73 (23.3%) versus 1/89 (1.1%) in the US group (P guided biopsy is similar to that of CT-guided biopsy, with a lower complication rate and a significantly reduced time to the procedure.

  19. Lung cancer in patients with idiopathic pulmonary fibrosis: frequency and CT findings

    International Nuclear Information System (INIS)

    Lee, Hak Jong; Im, Jung Gi; Ahn, Joong Mo; Yeon, Kyung Mo

    1994-01-01

    The incidence of lung cancer in patients with idiopathic pulmonary fibrosis(lPF) is higher than that of general population. To evaluate the frequency and CT findings of lung cancer associated with idiopathic pulmonary fibrosis, we analyzed 19 patients with lung cancer associated with idiopathic pulmonary fibrosis. We analyzed retrospectively 19 patients with histologically confirmed lung cancer out of 208 patients diagnosed as IPF either by CT and clinical findings(n=188) or histologically(n=20). All 19 patients were male, aged 40-85 years (mean 66 years). Scanning techniques were conventional CT in 12 patients, HRCT in 1 patient and both conventional CT and HRCT in 6 patients. We analyzed the CT patterns of lung cancer and IPF, locations of the tumor and histologic types of lung cancer. The incidence of lung cancer in patients with idiopathic pulmonary fibrosis was 9.1%(19/208). In 11 of 19 patients, CT findings of lung cancer were ill-defined consolidation-like mass. Lung cancer was located mainly in lower lobes(right lower lobe; 10/19, left lower lobe; 5/19) and at the periphery(12/19). Histologically, squamous cell carcinoma was the most common cell type (11/19). The incidence of lung cancer in patients with idiopathic pulmonary fibrosis was much higher than that of general population. Typical CT findings of lung cancer were predominantly ill-defined consolidation like mass at the peripheral lung portion which is the location where the most advanced fibrosis occur

  20. Lung cancer in patients with idiopathic pulmonary fibrosis: frequency and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hak Jong; Im, Jung Gi; Ahn, Joong Mo; Yeon, Kyung Mo [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1994-12-15

    The incidence of lung cancer in patients with idiopathic pulmonary fibrosis(lPF) is higher than that of general population. To evaluate the frequency and CT findings of lung cancer associated with idiopathic pulmonary fibrosis, we analyzed 19 patients with lung cancer associated with idiopathic pulmonary fibrosis. We analyzed retrospectively 19 patients with histologically confirmed lung cancer out of 208 patients diagnosed as IPF either by CT and clinical findings(n=188) or histologically(n=20). All 19 patients were male, aged 40-85 years (mean 66 years). Scanning techniques were conventional CT in 12 patients, HRCT in 1 patient and both conventional CT and HRCT in 6 patients. We analyzed the CT patterns of lung cancer and IPF, locations of the tumor and histologic types of lung cancer. The incidence of lung cancer in patients with idiopathic pulmonary fibrosis was 9.1%(19/208). In 11 of 19 patients, CT findings of lung cancer were ill-defined consolidation-like mass. Lung cancer was located mainly in lower lobes(right lower lobe; 10/19, left lower lobe; 5/19) and at the periphery(12/19). Histologically, squamous cell carcinoma was the most common cell type (11/19). The incidence of lung cancer in patients with idiopathic pulmonary fibrosis was much higher than that of general population. Typical CT findings of lung cancer were predominantly ill-defined consolidation like mass at the peripheral lung portion which is the location where the most advanced fibrosis occur.

  1. Lambda-guided calculation method (LGC method) for xenon/CT CBF

    Energy Technology Data Exchange (ETDEWEB)

    Sase, Shigeru [Anzai Medical Co., Ltd., Tokyo (Japan); Honda, Mitsuru; Kushida, Tsuyoshi; Seiki, Yoshikatsu; Machida, Keiichi; Shibata, Iekado [Toho Univ., Tokyo (Japan). School of Medicine

    2001-12-01

    A quantitative CBF calculation method for xenon/CT was developed by logically estimating time-course change rate (rate constant) of arterial xenon concentration from that of end-tidal xenon concentration. A single factor ({gamma}) was introduced to correlate the end-tidal rate constant (Ke) with the arterial rate constant (Ka) in a simplified equation. This factor ({gamma}) is thought to reflect the diffusing capacity of the lung for xenon. When an appropriate value is given to {gamma}, it is possible to calculate the arterial rate constant (Calculated Ka) from Ke. To determine {gamma} for each xenon/CT CBF examination, a procedure was established which utilizes the characteristics of white matter lambda; lambda refers to xenon brain-blood partition coefficient. Xenon/CT studies were performed on four healthy volunteers. Hemispheric CBF values (47.0{+-}9.0 ml/100 g/min) with use of Calculated Ka were close to the reported normative values. For a 27-year-old healthy man, the rate constant for the common carotid artery was successfully measured and nearly equal to Calculated Ka. The authors conclude the method proposed in this work, lambda-guided calculation method, could make xenon/CT CBF substantially reliable and quantitative by effective use of end-tidal xenon. (author)

  2. Lambda-guided calculation method (LGC method) for xenon/CT CBF

    International Nuclear Information System (INIS)

    Sase, Shigeru; Honda, Mitsuru; Kushida, Tsuyoshi; Seiki, Yoshikatsu; Machida, Keiichi; Shibata, Iekado

    2001-01-01

    A quantitative CBF calculation method for xenon/CT was developed by logically estimating time-course change rate (rate constant) of arterial xenon concentration from that of end-tidal xenon concentration. A single factor (γ) was introduced to correlate the end-tidal rate constant (Ke) with the arterial rate constant (Ka) in a simplified equation. This factor (γ) is thought to reflect the diffusing capacity of the lung for xenon. When an appropriate value is given to γ, it is possible to calculate the arterial rate constant (Calculated Ka) from Ke. To determine γ for each xenon/CT CBF examination, a procedure was established which utilizes the characteristics of white matter lambda; lambda refers to xenon brain-blood partition coefficient. Xenon/CT studies were performed on four healthy volunteers. Hemispheric CBF values (47.0±9.0 ml/100 g/min) with use of Calculated Ka were close to the reported normative values. For a 27-year-old healthy man, the rate constant for the common carotid artery was successfully measured and nearly equal to Calculated Ka. The authors conclude the method proposed in this work, lambda-guided calculation method, could make xenon/CT CBF substantially reliable and quantitative by effective use of end-tidal xenon. (author)

  3. CT- and MR-guided interventions in radiology. 2. ed.

    International Nuclear Information System (INIS)

    Mahnken, Andreas H.; Wilhelm, Kai E.; Ricke, Jens

    2013-01-01

    Revised and extended second edition that covers a broad range of non-vascular interventions guided by CT or MR imaging. Discusses in detail indications, materials, techniques, and results. Includes a comprehensive section on interventional oncology. Richly illustrated source of information and guidance for all radiologists who deal with non-vascular procedures. Interventional radiology is an indispensable and still expanding area of modern medicine that encompasses numerous diagnostic and therapeutic procedures. Cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance (MR) have emerged as important techniques for non-vascular interventions, including percutaneous biopsy, drainage, ablation, and neurolysis. Various organs, diseases, and lesions can be approached in this way, permitting the treatment and management of tumors, fluid collections, and pain, the embolization of endoleaks, the provision of access to hollow organs, etc. Accordingly, interventional radiology is now an integral component of the interdisciplinary management of numerous disorders. The revised and significantly extended second edition of this volume covers a broad range of non-vascular interventions guided by CT or MR imaging. Indications, materials, techniques, and results are all carefully discussed. A particularly comprehensive section is devoted to interventional oncology as the most rapidly growing branch of interventional radiology. In addition, detailed information is provided that will assist in establishing and developing an interventional service. This richly illustrated book will be a most valuable source of information and guidance for all radiologists who deal with non-vascular procedures.

  4. CT-guided suprascapular nerve blocks: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Schneider-Kolsky, M.E.; Pike, J.; Connell, D.A. [Department of Medical Imaging, Victoria House Private Hospital, 316 Malvern Road, Prahran 3181, Melbourne, Victoria (Australia)

    2004-05-01

    The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies. CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards. Within 30 min of the block overall pain scores decreased from a mean ({+-}SEM) pain score of 7.0 ({+-}0.4) to 3.5 ({+-}0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% ({+-}4.9, P<0.001) and 16.8% ({+-}4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted. In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability. (orig.)

  5. CT-guided suprascapular nerve blocks: a pilot study

    International Nuclear Information System (INIS)

    Schneider-Kolsky, M.E.; Pike, J.; Connell, D.A.

    2004-01-01

    The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies. CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards. Within 30 min of the block overall pain scores decreased from a mean (±SEM) pain score of 7.0 (±0.4) to 3.5 (±0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% (±4.9, P<0.001) and 16.8% (±4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted. In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability. (orig.)

  6. WE-G-BRD-07: Investigation of Distal Lung Atelectasis Following Stereotactic Body Radiation Therapy Using Regional Lung Volume Changes Between Pre- and Post- Treatment CT Scans

    Energy Technology Data Exchange (ETDEWEB)

    Diot, Q; Kavanagh, B; Miften, M [University of Colorado School of Medicine, Aurora, CO (United States)

    2014-06-15

    Purpose: To propose a quantitative method using lung deformations to differentiate between radiation-induced fibrosis and potential airway stenosis with distal atelectasis in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. Methods: Twenty-four lung patients with large radiation-induced density increases outside the high dose region had their pre- and post-treatment CT scans manually registered. They received SBRT treatments at our institution between 2002 and 2009 in 3 or 5 fractions, to a median total dose of 54Gy (range, 30–60). At least 50 anatomical landmarks inside the lung (airway branches) were paired for the pre- and post-treatment scans to guide the deformable registration of the lung structure, which was then interpolated to the whole lung using splines. Local volume changes between the planning and follow-up scans were calculated using the deformation field Jacobian. Hyperdense regions were classified as atelectatic or fibrotic based on correlations between regional density increases and significant volume contractions compared to the surrounding tissues. Results: Out of 24 patients, only 7 demonstrated a volume contraction that was at least one σ larger than the remaining lung average. Because they did not receive high doses, these shrunk hyperdense regions were likely showing distal atelectasis resulting from radiation-induced airway stenosis rather than conventional fibrosis. On average, the hyperdense regions extended 9.2 cm farther than the GTV contours but not significantly more than 8.6 cm for the other patients (p>0.05), indicating that a large offset between the radiation and hyperdense region centers is not a good surrogate for atelectasis. Conclusion: A method based on the relative comparison of volume changes between different dates was developed to identify potential lung regions experiencing distal atelectasis. Such a tool is essential to study which lung structures need to be avoided to prevent

  7. Two methods for isolating the lung area of a CT scan for density information

    International Nuclear Information System (INIS)

    Hedlund, L.W.; Anderson, R.F.; Goulding, P.L.; Beck, J.W.; Effmann, E.L.; Putman, C.E.

    1982-01-01

    Extracting density information from irregularly shaped tissue areas of CT scans requires automated methods when many scans are involved. We describe two computer methods that automatically isolate the lung area of a CT scan. Each starts from a single, operator specified point in the lung. The first method follows the steep density gradient boundary between lung and adjacent tissues; this tracking method is useful for estimating the overall density and total area of lung in a scan because all pixels within the lung area are available for statistical sampling. The second method finds all contiguous pixels of lung that are within the CT number range of air to water and are not a part of strong density gradient edges; this method is useful for estimating density and area of the lung parenchyma. Structures within the lung area that are surrounded by strong density gradient edges, such as large blood vessels, airways and nodules, are excluded from the lung sample while lung areas with diffuse borders, such as an area of mild or moderate edema, are retained. Both methods were tested on scans from an animal model of pulmonary edema and were found to be effective in isolating normal and diseased lungs. These methods are also suitable for isolating other organ areas of CT scans that are bounded by density gradient edges

  8. Results and complications of CT-guided biopsy with CT fluoroscopy

    International Nuclear Information System (INIS)

    Saika, Yoshinori; Ogura, Yasuharu; Doi, Kenji; Misaki, Toshimasa; Shimizu, Masashi; Narabayashi, Isamu

    2002-01-01

    We studied the results and complications of CT-guided biopsy with CT fluoroscopy performed 66 lesions in 64 patients from March 1999 to February 2001. In addition to the conventional procedure of CT-guided biopsy, we use CT fluoroscopy for confirmation of the location of the tip of the biopsy needle and the accurate contact, in some cases, at the time of puncturing. Examination results showed malignancy in 36 lesions and benign findings in 30 lesions. The sensitivity was 85.7%, specificity was 100.0%, and accuracy was 90.9%. Pneumothorax occurred in 20 out of 64 patients (31.3%). In a study on 26 small lesions (≤2 cm) in 25 patients, the sensitivity was 81.8%, specificity was 100.0%, accuracy was 92.3%. Pneumothorax occurred in 12 out of 25 patients (48.0%), more frequently than in patients with large lesions. In a study on 6 false negative cases, they tended to be intrapulmonary on location, small in diameter, and far from the skin puncture point. Examination results were satisfactory, especially in terms of accuracy in small lesions (≤2 cm). However, when the lesions were small, pneumothorax occurred frequently (48.0%). (author)

  9. Quantitative assessment of smoking-induced emphysema progression in longitudinal CT screening for lung cancer

    Science.gov (United States)

    Suzuki, H.; Mizuguchi, R.; Matsuhiro, M.; Kawata, Y.; Niki, N.; Nakano, Y.; Ohmatsu, H.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, M.; Moriyama, N.

    2015-03-01

    Computed tomography has been used for assessing structural abnormalities associated with emphysema. It is important to develop a robust CT based imaging biomarker that would allow quantification of emphysema progression in early stage. This paper presents effect of smoking on emphysema progression using annual changes of low attenuation volume (LAV) by each lung lobe acquired from low-dose CT images in longitudinal screening for lung cancer. The percentage of LAV (LAV%) was measured after applying CT value threshold method and small noise reduction. Progression of emphysema was assessed by statistical analysis of the annual changes represented by linear regression of LAV%. This method was applied to 215 participants in lung cancer CT screening for five years (18 nonsmokers, 85 past smokers, and 112 current smokers). The results showed that LAV% is useful to classify current smokers with rapid progression of emphysema (0.2%/year, pemphysema in CT screening for lung cancer.

  10. Utility of CT-guided abdominal aspiration procedures

    International Nuclear Information System (INIS)

    Sundaram, M.; Wolverson, M.K.; Heiberg, E.; Pilla, T.; Vas, W.G.; Shields, J.B.

    1982-01-01

    Over 200 consecutive diagnostic needle aspiration procedures of the abdomen were performed under computed tomographic (CT) guidance. Biopsies were done of the liver in 88 patients, the pancreas in 28, the kidney in 20, and the retroperitoneum in 32; 30 underwent an aspiration procedure for characterization of an intraabdominal fluid collection. Accuracy of diagnosis was very high for hepatic (99%) and renal (100%) biopsies and in characterization of fluid collections (100%). Accuracy for retroperitoneal biopsy was 87.5% and for pancreatic biopsy 82%. Overall accuracy for all sites was 95%. There were one false-negative diagnosis for the liver and five false-negative diagnoses for the pancreas. Insufficient material was obtained for diagnosis in four instances of retroperitoneal biopsy. There were no false positives. The technique is facilitated by rapid CT scan time, large aperture gantry, and rapid CT image reconstruction. Twenty gauge needles were used more frequently than 22 gauge needles because of their greater rigidity and ease of control. CT-guided diagnostic aspiration procedures are particularly useful for diagnosis of small, deep-seated lesions and in evaluation of lesions found in severely ill patients. An experienced cytologist is essential to the success of the technique

  11. CT-guided radiofrequency tumor ablation in children

    International Nuclear Information System (INIS)

    Botsa, Evanthia; Poulou, Loukia S.; Koundouraki, Antonia; Thanos, Loukas; Koutsogiannis, Ioannis; Ziakas, Panayiotis D.; Alexopoulou, Efthimia

    2014-01-01

    Image-guided radiofrequency ablation is a well-accepted technique of interventional oncology in adults. To evaluate the efficacy and safety of CT-guided radiofrequency ablation as a minimally invasive treatment for metastatic neoplasms in children. A total of 15 radiofrequency ablation sessions were performed in 12 children and young adults (median age 9.5; range 5-18 years) with metastatic malignancies. Seven children and young adults had secondary hepatic lesions, three had pulmonary and two had bone lesions. Radiofrequency ablation was performed under conscious sedation. The median lesion size was 1.7 cm (range 1.3-2.8 cm). The median time for ablation was 8 min (range 7-10 min). Radiofrequency procedures were technically successful in all tumors. Postablation imaging immediately after, and 1 month and 3 months after radiofrequency ablation showed total necrosis in all patients. At 6-month follow-up, three patients (all with lesion size >2 cm) had local recurrence and underwent a second radiofrequency ablation session. At 2-year follow-up no patient had recurrence of the treated tumor. Post-ablation syndrome occurred in four children. No major complication occurred. CT-guided radiofrequency tumor ablation was safe and efficient for palliative treatment in our cohort of patients. (orig.)

  12. CT-guided radiofrequency tumor ablation in children

    Energy Technology Data Exchange (ETDEWEB)

    Botsa, Evanthia [National and Kapodistrian University of Athens, First Pediatric Clinic, Agia Sofia Children' s Hospital, Athens (Greece); Poulou, Loukia S.; Koundouraki, Antonia; Thanos, Loukas [Sotiria General Hospital for Chest Diseases, Department of Medical Imaging and Interventional Radiology, Athens (Greece); Koutsogiannis, Ioannis [General Military Hospital NIMTS, Department of Medical Imaging, Athens (Greece); Ziakas, Panayiotis D. [Warren Alpert Medical School of Brown University Rhode Island Hospital, Division of Infectious Diseases, Providence, RI (United States); Alexopoulou, Efthimia [Attikon University Hospital, Second Department of Radiology, Athens University School of Medicine, Athens (Greece)

    2014-11-15

    Image-guided radiofrequency ablation is a well-accepted technique of interventional oncology in adults. To evaluate the efficacy and safety of CT-guided radiofrequency ablation as a minimally invasive treatment for metastatic neoplasms in children. A total of 15 radiofrequency ablation sessions were performed in 12 children and young adults (median age 9.5; range 5-18 years) with metastatic malignancies. Seven children and young adults had secondary hepatic lesions, three had pulmonary and two had bone lesions. Radiofrequency ablation was performed under conscious sedation. The median lesion size was 1.7 cm (range 1.3-2.8 cm). The median time for ablation was 8 min (range 7-10 min). Radiofrequency procedures were technically successful in all tumors. Postablation imaging immediately after, and 1 month and 3 months after radiofrequency ablation showed total necrosis in all patients. At 6-month follow-up, three patients (all with lesion size >2 cm) had local recurrence and underwent a second radiofrequency ablation session. At 2-year follow-up no patient had recurrence of the treated tumor. Post-ablation syndrome occurred in four children. No major complication occurred. CT-guided radiofrequency tumor ablation was safe and efficient for palliative treatment in our cohort of patients. (orig.)

  13. Image-guided radiotherapy for fifty-eight patients with lung cancer

    International Nuclear Information System (INIS)

    Liang Jun; Zhang Tao; Wang Wenqin

    2009-01-01

    Objective: To study the value of image-guided radiotherapy (IGRT) in lung cancer. Methods: From Mar. 2007 to Dec. 2007,58 patients with lung cancer were treated with IGRT. Set-up errors in each axial direction was calculated based on IGRT images of each patient. The change of GTV was evaluated on both cone-beam CT and CT simulator images. Results: Twenty-two patients with left lung cancer,30 with right lung cancer, 5 with mediastinal lymphanode metastasis and one with vertebra metastasis were included. The set-up error in x, y and z axes was (0.02±0.26) cm, (0.14±0.49) cm and ( -0.13± 0.27) cm, respectively,while the rotary set-up error in each axis was -0.15 degree ± 1.59 degree, -0.01 degree ± 1.50 degree and 0.12 degree ±1.08 degree, respectively. The set-up errors were significantly decreased by using of IGRT. GTV movement was observed in 15 patients (25.9%) ,including 5 with left upper lung cancer. GTV moving to the anterior direction was observed in 9 patients,including 4 with]eft upper lung cancer. GTV reduced in 23 (44.2%) patients during treatment. Asymmetric GTV reduction of 22 lesions was observed,with a mean reductive volume of 4.9 cm 3 . When GTV began to shrink,the irradiation dose was 4 -46 Gy, with 20 -30 Gy in 9 patients. Conclusions: The use of IGRT can significantly reduce set-up errors. GTV movement and reduction are observed in some cases. The time to modify the target volume needs to be further studied. (authors)

  14. CT-guided puncture for direct MR-arthrography of the shoulder: Description of possible techniques

    Directory of Open Access Journals (Sweden)

    Hauth E

    2016-07-01

    Full Text Available The following report describes the possible techniques of CT-guided puncture for direct magnetic resonance (MR arthrography of the shoulder. CT-guided puncture can be regarded as an alternative technique to fluoroscopic- or ultrasound-guided puncture for MR-arthrography of the shoulder with high efficiency, low dose and extremely low complication rate.

  15. Prognostic value of PET/CT in lung cancer. Study of survival and tumor metabolic characterization

    International Nuclear Information System (INIS)

    Ladron de Guevara, David; Fuentes Anibal; Farina, Ciro; Corral, Camilo; Pefaur, Raul

    2013-01-01

    PET/CT (Positron emission tomography/computed tomography) is a hybrid image modality widely used in oncology, for staging, therapy evaluation or follow up. Aim: To evaluate the prognostic value of PET/CT in lung cancer. Material and Methods: Retrospective review of PET/CT records, selecting 51 patients with a lung malignancy, mass or nodule referred for PET/CT between December 2008 and December 2010. All had pathological confirmation of malignancy and had not been treated previously. Age, gender, body mass index, radiological features of lung tumor and metastases, and lung tumor 18 F-fluoro-2-deoxy-d-glucose uptake using the SUV (Standardized uptake value) index were recorded. Survival was analyzed using Kaplan-Meier curves and a Cox proportional regression analysis. Results: Pathology confirmed the presence of lung cancer in 47 patients aged 30 to 88 years. Four patients (7.8%) had other type of tumors such as carcinoid or lymphoma. Fifty percent of lung cancer patients died during a mean observation lapse of 18 months (range: 2-34 months). Patients with metastases, local lymph node involvement, a lung tumor size ≥ 3 cm and high tumor uptake (SUVmax > 6) had significantly lower survival. Occurrence of metastases was the only independent prognostic factor in the Cox regression. A lung lesion with a SUVmax ≥ 12 was always associated to hilar/mediastinal lymph node involvement. Conclusions: PET/CT imaging gives important prognostic information in lung cancer patients

  16. Comparing Effective Doses During Image-Guided Core Needle Biopsies with Computed Tomography Versus C-Arm Cone Beam CT Using Adult and Pediatric Phantoms

    International Nuclear Information System (INIS)

    Ben-Shlomo, A.; Cohen, D.; Bruckheimer, E.; Bachar, G. N.; Konstantinovsky, R.; Birk, E.; Atar, E.

    2016-01-01

    PurposeTo compare the effective doses of needle biopsies based on dose measurements and simulations using adult and pediatric phantoms, between cone beam c-arm CT (CBCT) and CT.MethodEffective doses were calculated and compared based on measurements and Monte Carlo simulations of CT- and CBCT-guided biopsy procedures of the lungs, liver, and kidney using pediatric and adult phantoms.ResultsThe effective doses for pediatric and adult phantoms, using our standard protocols for upper, middle and lower lungs, liver, and kidney biopsies, were significantly lower under CBCT guidance than CT. The average effective dose for a 5-year old for these five biopsies was 0.36 ± 0.05 mSv with the standard CBCT exposure protocols and 2.13 ± 0.26 mSv with CT. The adult average effective dose for the five biopsies was 1.63 ± 0.22 mSv with the standard CBCT protocols and 8.22 ± 1.02 mSv using CT. The CT effective dose was higher than CBCT protocols for child and adult phantoms by 803 and 590 % for upper lung, 639 and 525 % for mid-lung, and 461 and 251 % for lower lung, respectively. Similarly, the effective dose was higher by 691 and 762 % for liver and 513 and 608 % for kidney biopsies.ConclusionsBased on measurements and simulations with pediatric and adult phantoms, radiation effective doses during image-guided needle biopsies of the lung, liver, and kidney are significantly lower with CBCT than with CT.

  17. Comparing Effective Doses During Image-Guided Core Needle Biopsies with Computed Tomography Versus C-Arm Cone Beam CT Using Adult and Pediatric Phantoms

    Energy Technology Data Exchange (ETDEWEB)

    Ben-Shlomo, A. [Soreq NRC, Radiation Protection Domain (Israel); Cohen, D.; Bruckheimer, E. [Schneider Children’s Medical Center, Section of Pediatric Cardiology (Israel); Bachar, G. N.; Konstantinovsky, R. [Rabin Medical Center, Department of Diagnostic Radiology (Israel); Birk, E. [Schneider Children’s Medical Center, Section of Pediatric Cardiology (Israel); Atar, E., E-mail: elia@clalit.org.il [Rabin Medical Center, Department of Diagnostic Radiology (Israel)

    2016-05-15

    PurposeTo compare the effective doses of needle biopsies based on dose measurements and simulations using adult and pediatric phantoms, between cone beam c-arm CT (CBCT) and CT.MethodEffective doses were calculated and compared based on measurements and Monte Carlo simulations of CT- and CBCT-guided biopsy procedures of the lungs, liver, and kidney using pediatric and adult phantoms.ResultsThe effective doses for pediatric and adult phantoms, using our standard protocols for upper, middle and lower lungs, liver, and kidney biopsies, were significantly lower under CBCT guidance than CT. The average effective dose for a 5-year old for these five biopsies was 0.36 ± 0.05 mSv with the standard CBCT exposure protocols and 2.13 ± 0.26 mSv with CT. The adult average effective dose for the five biopsies was 1.63 ± 0.22 mSv with the standard CBCT protocols and 8.22 ± 1.02 mSv using CT. The CT effective dose was higher than CBCT protocols for child and adult phantoms by 803 and 590 % for upper lung, 639 and 525 % for mid-lung, and 461 and 251 % for lower lung, respectively. Similarly, the effective dose was higher by 691 and 762 % for liver and 513 and 608 % for kidney biopsies.ConclusionsBased on measurements and simulations with pediatric and adult phantoms, radiation effective doses during image-guided needle biopsies of the lung, liver, and kidney are significantly lower with CBCT than with CT.

  18. Comparing Effective Doses During Image-Guided Core Needle Biopsies with Computed Tomography Versus C-Arm Cone Beam CT Using Adult and Pediatric Phantoms.

    Science.gov (United States)

    Ben-Shlomo, A; Cohen, D; Bruckheimer, E; Bachar, G N; Konstantinovsky, R; Birk, E; Atar, E

    2016-05-01

    To compare the effective doses of needle biopsies based on dose measurements and simulations using adult and pediatric phantoms, between cone beam c-arm CT (CBCT) and CT. Effective doses were calculated and compared based on measurements and Monte Carlo simulations of CT- and CBCT-guided biopsy procedures of the lungs, liver, and kidney using pediatric and adult phantoms. The effective doses for pediatric and adult phantoms, using our standard protocols for upper, middle and lower lungs, liver, and kidney biopsies, were significantly lower under CBCT guidance than CT. The average effective dose for a 5-year old for these five biopsies was 0.36 ± 0.05 mSv with the standard CBCT exposure protocols and 2.13 ± 0.26 mSv with CT. The adult average effective dose for the five biopsies was 1.63 ± 0.22 mSv with the standard CBCT protocols and 8.22 ± 1.02 mSv using CT. The CT effective dose was higher than CBCT protocols for child and adult phantoms by 803 and 590% for upper lung, 639 and 525% for mid-lung, and 461 and 251% for lower lung, respectively. Similarly, the effective dose was higher by 691 and 762% for liver and 513 and 608% for kidney biopsies. Based on measurements and simulations with pediatric and adult phantoms, radiation effective doses during image-guided needle biopsies of the lung, liver, and kidney are significantly lower with CBCT than with CT.

  19. Bilateral CT-guided percutaneous cordotomy for cancer pain relief

    International Nuclear Information System (INIS)

    Yegul, I.; Erhan, E.

    2003-01-01

    AIM: CT-guided percutaneous cordotomy is a useful procedure for treating unilateral cancer pain, however, bilateral cordotomy can be required on some occasions. We evaluated the effectiveness and complications of bilateral cordotomy. MATERIALS AND METHODS: Two hundred and thirty-four patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients, and nine patients had bilateral cordotomy. Effectiveness and complications were recorded after each procedure. RESULTS: Of nine patents (three women and six men) having bilateral percutaneous cordotomy in our study, four patients had mirror pain after the first procedure. In the remaining five patients the contralateral pain was due to new pain sites. The pain scores before and after the first procedure were 9.3 (range 7-10) and 1.2 (range 0-3), respectively. After the first procedure complete or satisfactory pain relief was achieved in all patients. The duration between the two procedures ranged from 7-243 days (mean 59.8 days). The pain scores before and after the second procedure were 8.4 (range 5-10) and 1.6 (range 0-4), respectively. After the second procedure complete or satisfactory pain relief was reported in all patients. There were no complications in four patients. One patient developed transient motor deficit after the first procedure. Other complications (nausea/vomiting, headache, ipsilateral neck pain, postcordotomy dysesthesia) were mild and transient. CONCLUSION: CT-guided percutaneous cordotomy is a useful procedure for the treatment of severe unilateral cancer pain syndromes. The procedure can be repeated on the other side at least 1 week later. These results show that the success on the second side appears to be similar to the first side with low complication rate for both procedures

  20. Bilateral CT-guided percutaneous cordotomy for cancer pain relief

    Energy Technology Data Exchange (ETDEWEB)

    Yegul, I. E-mail: iyegul@med.ege.edu.tr; Erhan, E. E-mail: elvanerhan@yahoo.com

    2003-11-01

    AIM: CT-guided percutaneous cordotomy is a useful procedure for treating unilateral cancer pain, however, bilateral cordotomy can be required on some occasions. We evaluated the effectiveness and complications of bilateral cordotomy. MATERIALS AND METHODS: Two hundred and thirty-four patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients, and nine patients had bilateral cordotomy. Effectiveness and complications were recorded after each procedure. RESULTS: Of nine patents (three women and six men) having bilateral percutaneous cordotomy in our study, four patients had mirror pain after the first procedure. In the remaining five patients the contralateral pain was due to new pain sites. The pain scores before and after the first procedure were 9.3 (range 7-10) and 1.2 (range 0-3), respectively. After the first procedure complete or satisfactory pain relief was achieved in all patients. The duration between the two procedures ranged from 7-243 days (mean 59.8 days). The pain scores before and after the second procedure were 8.4 (range 5-10) and 1.6 (range 0-4), respectively. After the second procedure complete or satisfactory pain relief was reported in all patients. There were no complications in four patients. One patient developed transient motor deficit after the first procedure. Other complications (nausea/vomiting, headache, ipsilateral neck pain, postcordotomy dysesthesia) were mild and transient. CONCLUSION: CT-guided percutaneous cordotomy is a useful procedure for the treatment of severe unilateral cancer pain syndromes. The procedure can be repeated on the other side at least 1 week later. These results show that the success on the second side appears to be similar to the first side with low complication rate for both procedures.

  1. Differential diagnosis between pulmonary tuberculosis and lung abscess by contrast enhanced CT

    International Nuclear Information System (INIS)

    Kanauchi, Tetsu; Hoshi, Toshiko; Konno, Miyuki; Hando, Yumiko

    2001-01-01

    The contrast enhanced CT findings in 14 patients with active tuberculosis and 26 patients with lung abscess were retrospectively analyzed. Reflecting the difference of pathogenesis between tuberculosis and abscess, the findings are widely different. The findings suggesting pulmonary tuberculosis rather than lung abscess were as follows; multiple and irregular necrotic areas, positive CT angiogram sign, no marginal enhancement surrounding necrosis. Contrast enhanced CT may help to distinguish pulmonary tuberculosis from lung abscess, especially in cases of caseous pneumonia showing broad consolidations or mass-like shadows. (author)

  2. Basic principles of pulmonary anatomy and physiology for CT interpretation of lung diseases

    International Nuclear Information System (INIS)

    Remy-Jardin, M.; Beigelman, C.; Desfontaines, C.; Dupont, S.; Remy, J.

    1989-01-01

    High resolution CT is now the method of choice in the diagnosis of lung diseases, especially in their early recognition. However, the radiologist must be aware of precise anatomic, pathologic and physiologic data which are observed when the patient is supine. This concept leads to a transversal analysis of lung diseases by CT, as previously proposed in the coronal and sagittal planes for conventional chest X Ray interpretation. The aim of the study is to demonstrate that these regional differences in the lung must be included in the method of chest scanning but also in the interpretation of lung diseases [fr

  3. MR imaging-guided percutaneous cryotherapy for lung tumors: initial experience.

    Science.gov (United States)

    Liu, Shangang; Ren, Ruimei; Liu, Ming; Lv, Yubo; Li, Bin; Li, Chengli

    2014-09-01

    To evaluate prospectively the initial clinical experience of magnetic resonance (MR) imaging-guided percutaneous cryotherapy of lung tumors. MR imaging-guided percutaneous cryotherapy was performed in 21 patients with biopsy-proven lung tumors (12 men, 9 women; age range, 39-79 y). Follow-up consisted of contrast-enhanced chest computed tomography (CT) scan performed at 3-month intervals to assess tumor control; CT scanning was carried out for 12 months or until death. Cryotherapy procedures were successfully completed in all 21 patients. Pneumothorax occurred in 7 (33.3%) of 21 patients. Chest tube placement was required in one (4.8%) case. Hemoptysis was exhibited by 11 (52.4%) patients, and pleural effusion occurred in 6 (28.6%) patients. Other complications were observed in 14 (66.7%) patients. The mean follow-up period was 10.5 months (range, 9-12 mo) in patients who died. At month 12 of follow-up, 7 (33.3%) patients had a complete response to therapy, and 10 (47.6%) patients showed a partial response. In addition, two patients had stable disease, and two patients developed progressive disease; one patient developed a tumor in the liver, and the other developed a tumor in the brain. The 1-year local control rate was 81%, and 1-year survival rate was 90.5%. MR imaging-guided percutaneous cryotherapy appears feasible, effective, and minimally invasive for lung tumors. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  4. Integration of PET-CT and cone-beam CT for image-guided radiotherapy with high image quality and registration accuracy

    Science.gov (United States)

    Wu, T.-H.; Liang, C.-H.; Wu, J.-K.; Lien, C.-Y.; Yang, B.-H.; Huang, Y.-H.; Lee, J. J. S.

    2009-07-01

    Hybrid positron emission tomography-computed tomography (PET-CT) system enhances better differentiation of tissue uptake of 18F-fluorodeoxyglucose (18F-FDG) and provides much more diagnostic value in the non-small-cell lung cancer and nasopharyngeal carcinoma (NPC). In PET-CT, high quality CT images not only offer diagnostic value on anatomic delineation of the tissues but also shorten the acquisition time for attenuation correction (AC) compared with PET-alone imaging. The linear accelerators equipped with the X-ray cone-beam computed tomography (CBCT) imaging system for image-guided radiotherapy (IGRT) provides excellent verification on position setup error. The purposes of our study were to optimize the CT acquisition protocols of PET-CT and to integrate the PET-CT and CBCT for IGRT. The CT imaging parameters were modified in PET-CT for increasing the image quality in order to enhance the diagnostic value on tumour delineation. Reproducibility and registration accuracy via bone co-registration algorithm between the PET-CT and CBCT were evaluated by using a head phantom to simulate a head and neck treatment condition. Dose measurement in computed tomography dose index (CTDI) was also estimated. Optimization of the CT acquisition protocols of PET-CT was feasible in this study. Co-registration accuracy between CBCT and PET-CT on axial and helical modes was in the range of 1.06 to 2.08 and 0.99 to 2.05 mm, respectively. In our result, it revealed that the accuracy of the co-registration with CBCT on helical mode was more accurate than that on axial mode. Radiation doses in CTDI were 4.76 to 18.5 mGy and 4.83 to 18.79 mGy on axial and helical modes, respectively. Registration between PET-CT and CBCT is a state-of-the-art registration technology which could provide much information on diagnosis and accurate tumour contouring on radiotherapy while implementing radiotherapy procedures. This novelty technology of PET-CT and cone-beam CT integration for IGRT may have a

  5. Integration of PET-CT and cone-beam CT for image-guided radiotherapy with high image quality and registration accuracy

    International Nuclear Information System (INIS)

    Wu, T-H; Liang, C-H; Wu, J-K; Lien, C-Y; Yang, B-H; Lee, J J S; Huang, Y-H

    2009-01-01

    Hybrid positron emission tomography-computed tomography (PET-CT) system enhances better differentiation of tissue uptake of 18 F-fluorodeoxyglucose ( 18 F-FDG) and provides much more diagnostic value in the non-small-cell lung cancer and nasopharyngeal carcinoma (NPC). In PET-CT, high quality CT images not only offer diagnostic value on anatomic delineation of the tissues but also shorten the acquisition time for attenuation correction (AC) compared with PET-alone imaging. The linear accelerators equipped with the X-ray cone-beam computed tomography (CBCT) imaging system for image-guided radiotherapy (IGRT) provides excellent verification on position setup error. The purposes of our study were to optimize the CT acquisition protocols of PET-CT and to integrate the PET-CT and CBCT for IGRT. The CT imaging parameters were modified in PET-CT for increasing the image quality in order to enhance the diagnostic value on tumour delineation. Reproducibility and registration accuracy via bone co-registration algorithm between the PET-CT and CBCT were evaluated by using a head phantom to simulate a head and neck treatment condition. Dose measurement in computed tomography dose index (CTDI) was also estimated. Optimization of the CT acquisition protocols of PET-CT was feasible in this study. Co-registration accuracy between CBCT and PET-CT on axial and helical modes was in the range of 1.06 to 2.08 and 0.99 to 2.05 mm, respectively. In our result, it revealed that the accuracy of the co-registration with CBCT on helical mode was more accurate than that on axial mode. Radiation doses in CTDI were 4.76 to 18.5 mGy and 4.83 to 18.79 mGy on axial and helical modes, respectively. Registration between PET-CT and CBCT is a state-of-the-art registration technology which could provide much information on diagnosis and accurate tumour contouring on radiotherapy while implementing radiotherapy procedures. This novelty technology of PET-CT and cone-beam CT integration for IGRT may have a

  6. SU-E-T-500: Dose Escalation Strategy for Lung Cancer Patients Using a Biologically- Guided Target Definition

    International Nuclear Information System (INIS)

    Shusharina, N; Khan, F; Choi, N; Sharp, G

    2014-01-01

    Purpose: Dose escalation strategy for lung cancer patients can lead to late symptoms such as pneumonitis and cardiac injury. We propose a strategy to increase radiation dose for improving local tumor control while simultaneously striving to minimize the injury of organs at risk (OAR). Our strategy is based on defining a small, biologically-guided target volume for receiving additional radiation dose. Methods: 106 patients with lung cancer treated with radiotherapy were selected for patients diagnosed with stage II and III disease. Previous research has shown that 50% of the maximum SUV threshold in FDG-PET imaging is appropriate for delineation of the most aggressive part of a tumor. After PET- and CT-derived targets were contoured, an IMRT treatment plan was designed to deliver 60 Gy to the GTV as delineated on a 4D CT (Plan 1). A second plan was designed with additional dose of 18 Gy to the PET-derived volume (Plan 2). A composite plan was generated by the addition of Plan 1 and Plan 2. Results: Plan 1 was compared to the composite plan and increases in OAR dose were assessed. For seven patients on average, lung V5 was increased by 1.4% and V20 by 4.2% for ipsilateral lung and by 13.5% and 7% for contralateral lung. For total lung, V5 and V20 were increased by 4.5% and 4.8% respectively. Mean lung dose was increased by 9.7% for the total lung. The maximum dose to the spinal cord increased by 16% on average. For the heart, V20 increased by 4.2% and V40 by 5.2%. Conclusion: It seems feasible that an additional 18 Gy of radiation dose can be delivered to FDG PET-derived subvolume of the CT-based GTV of the primary tumor without significant increase in total dose to the critical organs such as lungs, spinal cord and heart

  7. SU-E-T-500: Dose Escalation Strategy for Lung Cancer Patients Using a Biologically- Guided Target Definition

    Energy Technology Data Exchange (ETDEWEB)

    Shusharina, N; Khan, F; Choi, N; Sharp, G [Massachusetts General Hospital, Boston, MA (United States)

    2014-06-01

    Purpose: Dose escalation strategy for lung cancer patients can lead to late symptoms such as pneumonitis and cardiac injury. We propose a strategy to increase radiation dose for improving local tumor control while simultaneously striving to minimize the injury of organs at risk (OAR). Our strategy is based on defining a small, biologically-guided target volume for receiving additional radiation dose. Methods: 106 patients with lung cancer treated with radiotherapy were selected for patients diagnosed with stage II and III disease. Previous research has shown that 50% of the maximum SUV threshold in FDG-PET imaging is appropriate for delineation of the most aggressive part of a tumor. After PET- and CT-derived targets were contoured, an IMRT treatment plan was designed to deliver 60 Gy to the GTV as delineated on a 4D CT (Plan 1). A second plan was designed with additional dose of 18 Gy to the PET-derived volume (Plan 2). A composite plan was generated by the addition of Plan 1 and Plan 2. Results: Plan 1 was compared to the composite plan and increases in OAR dose were assessed. For seven patients on average, lung V5 was increased by 1.4% and V20 by 4.2% for ipsilateral lung and by 13.5% and 7% for contralateral lung. For total lung, V5 and V20 were increased by 4.5% and 4.8% respectively. Mean lung dose was increased by 9.7% for the total lung. The maximum dose to the spinal cord increased by 16% on average. For the heart, V20 increased by 4.2% and V40 by 5.2%. Conclusion: It seems feasible that an additional 18 Gy of radiation dose can be delivered to FDG PET-derived subvolume of the CT-based GTV of the primary tumor without significant increase in total dose to the critical organs such as lungs, spinal cord and heart.

  8. Usefulness of CT based SPECT Fusion Image in the lung Disease : Preliminary Study

    International Nuclear Information System (INIS)

    Park, Hoon Hee; Lyu, Kwang Yeul; Kim, Tae Hyung; Shin, Ji Yun

    2012-01-01

    Recently, SPECT/CT system has been applied to many diseases, however, the application is not extensively applied at pulmonary disease. Especially, in case that, the pulmonary embolisms suspect at the CT images, SPECT is performed. For the accurate diagnosis, SPECT/CT tests are subsequently undergoing. However, without SPECT/CT, there are some limitations to apply these procedures. With SPECT/CT, although, most of the examination performed after CT. Moreover, such a test procedures generate unnecessary dual irradiation problem to the patient. In this study, we evaluated the amount of unnecessary irradiation, and the usefulness of fusion images of pulmonary disease, which independently acquired from SPECT and CT. Using NEMA PhantomTM (NU2-2001), SPECT and CT scan were performed for fusion images. From June 2011 to September 2010, 10 patients who didn't have other personal history, except lung disease were selected (male: 7, female: 3, mean age: 65.3±12.7). In both clinical patient and phantom data, the fusion images scored higher than SPECT and CT images. The fusion images, which is combined with pulmonary vessel images from CT and functional images from SPECT, can increase the detection possibility in detecting pulmonary embolism in the resin of lung parenchyma. It is sure that performing SPECT and CT in integral SPECT/CT system were better. However, we believe this protocol can give more informative data to have more accurate diagnosis in the hospital without integral SPECT/CT system.

  9. CT guided interventional therapy for hypertensive cerebral hemorrhage

    International Nuclear Information System (INIS)

    Lin Bo; Duan Bing

    2009-01-01

    Objective: To discuss the curative effect of CT-guided puncture and drainage in treating hypertensive cerebral hemorrhage. Methods: Adjusting the suitable point and direction of puncture according to the form and size of the haematoma and patient's status, the haematoma was eliminated by minimally invasive puncture and drainage guided under CT layer image in 40 cases of hypertensive cerebral hemorrhage. Results: Modality rate of treatment group was 12.5% (5/40), and is much lower than control group, which was 45% (13/30) (P<0.01). When asscess the Activities of Daily Living (ADL) after 6 months follow-up, the ADL1-ADL3 scale in treatment group was 27 cases (70%), and was much higher than that in control group, which was 29.4% (5/17), (P < 0.05). Conclusion: Minimal invasive therapy of cerebral hemorrhage has great superiority in elimination most part of the hematoma such as simple, accurate location, low cost, safe and effective, and is worthy of recommendation clinically. (authors)

  10. The results of CT-guided periradicular pain control

    International Nuclear Information System (INIS)

    Uhlenbrock, D.; Arlinghaus, J.

    1997-01-01

    The effectiveness of CT-guided periradicular pain therapy was studied. Material and method: 55 patients with lumbar and/or radicular pain were treated by periradicular injections of 40 ml triamcinolon, in some cases combined with injection of the facets of the lumbar vertebrae. 36 patients had chronic symptoms; in 7, these were acute, and 12 patients complained of renewed disc symptoms following previous disc surgery. Approximately 4 months after the conclusion of treatment, the patients were requested to complete a questionnaire giving information on the course and after-effects of treatment. The questionnaire was repeated after 5 months. Results: 55% of patients were free of symptoms or had had some improvement at the time of the questionnaire; 30% reported temporary improvement, and in 15% there was no change compared with the pre-treatment symptoms. At the time of the second questionnaire, the proportion of patients who had derived benefit from the treatment was somewhat lower. 49% reported that they were pain-free or improved, while temporary improvement was reported by 36% of patients. Conclusion: CT-guided periradicular pain therapy is a valuable procedure in patients in whom conservative measures prove ineffective, and when surgery is not indicated. However, only about half the treated patients maintain permanent improvement. (orig.) [de

  11. Atypical adenomatous hyperplasia of the lung: correlation between high-resolution CT findings and histopathologic features

    International Nuclear Information System (INIS)

    Kawakami, S.; Takashima, S.; Li, F.; Yang, Z.G.; Maruyama, Y.; Hasegawa, M.; Wang, J.C.; Sone, S.; Honda, T.

    2001-01-01

    We describe herein the CT features of atypical adenomatous hyperplasia (AAH) of the lung and its histopathological characteristics. Among 17,919 individuals screened for lung cancer by CT scanning, ten AAH nodules were detected in nine asymptomatic subjects. On high-resolution CT, the lesions measured from 6 x 6 mm to 15 x 17 mm and their CT number ranged from -500 to -760 HU. The AAHs appeared as round nodules with smooth and distinct borders and showed a ground-glass opacity. Plain chest radiographs failed to identify all lesions. Histopathologically, AAH lesions showed atypical epithelial cell proliferation along slightly thickened alveolar septa. Whereas it is often easy to differentiate these nodules from inflammatory and benign lung lesions, histopathological examination remains at present the only method to differentiate AAH from lung cancers. (orig.)

  12. Atypical adenomatous hyperplasia of the lung: correlation between high-resolution CT findings and histopathologic features

    Energy Technology Data Exchange (ETDEWEB)

    Kawakami, S.; Takashima, S.; Li, F.; Yang, Z.G.; Maruyama, Y.; Hasegawa, M.; Wang, J.C. [Dept. of Radiology, Shinshu University School of Medicine, Matsumoto (Japan); Sone, S. [Dept. of Radiology, Shinshu University School of Medicine, Matsumoto (Japan); Azumi General Hospital, Ikeda, Nagano (Japan); Honda, T. [Dept. of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto (Japan)

    2001-05-01

    We describe herein the CT features of atypical adenomatous hyperplasia (AAH) of the lung and its histopathological characteristics. Among 17,919 individuals screened for lung cancer by CT scanning, ten AAH nodules were detected in nine asymptomatic subjects. On high-resolution CT, the lesions measured from 6 x 6 mm to 15 x 17 mm and their CT number ranged from -500 to -760 HU. The AAHs appeared as round nodules with smooth and distinct borders and showed a ground-glass opacity. Plain chest radiographs failed to identify all lesions. Histopathologically, AAH lesions showed atypical epithelial cell proliferation along slightly thickened alveolar septa. Whereas it is often easy to differentiate these nodules from inflammatory and benign lung lesions, histopathological examination remains at present the only method to differentiate AAH from lung cancers. (orig.)

  13. Time evolution of regional CT density changes in normal lung after IMRT for NSCLC

    International Nuclear Information System (INIS)

    Bernchou, Uffe; Schytte, Tine; Bertelsen, Anders; Bentzen, Søren M.; Hansen, Olfred; Brink, Carsten

    2013-01-01

    Purpose: This study investigates the clinical radiobiology of radiation induced lung disease in terms of regional computed tomography (CT) density changes following intensity modulated radiotherapy (IMRT) for non-small-cell lung cancer (NSCLC). Methods: A total of 387 follow-up CT scans in 131 NSCLC patients receiving IMRT to a prescribed dose of 60 or 66 Gy in 2 Gy fractions were analyzed. The dose-dependent temporal evolution of the density change was analyzed using a two-component model, a superposition of an early, transient component and a late, persistent component. Results: The CT density of healthy lung tissue was observed to increase significantly (p 12 months. Conclusions: The radiobiology of lung injury may be analyzed in terms of CT density change. The initial transient change in density is consistent with radiation pneumonitis, while the subsequent stabilization of the density is consistent with pulmonary fibrosis

  14. A technique for adaptive image-guided helical tomotherapy for lung cancer

    International Nuclear Information System (INIS)

    Ramsey, Chester R.; Langen, Katja M.; Kupelian, Patrick A.; Scaperoth, Daniel D.; Meeks, Sanford L.; Mahan, Stephen L.; Seibert, Rebecca M.

    2006-01-01

    Purpose: The gross tumor volume (GTV) for many lung cancer patients can decrease during the course of radiation therapy. As the tumor reduces in size during treatment, the margin added around the GTV effectively becomes larger, which can result in the excessive irradiation of normal lung tissue. The specific goal of this study is to evaluate the feasibility of using image-guided adaptive radiation therapy to adjust the planning target volume weekly based on the previous week's CT image sets that were used for image-guided patient setup. Methods and Materials: Megavoltage computed tomography (MVCT) images of the GTV were acquired daily on a helical tomotherapy system. These images were used to position the patient and to measure reduction in GTV volume. A planning study was conducted to determine the amount of lung-sparing that could have been achieved if adaptive therapy had been used. Treatment plans were created in which the target volumes were reduced after tumor reduction was measured. Results: A total of 158 MVCT imaging sessions were performed on 7 lung patients. The GTV was reduced by 60-80% during the course of treatment. The tumor reduction in the first 60 days of treatment can be modeled using the second-order polynomial R 0.0002t 2 - 0.0219t + 1.0, where R is the percent reduction in GTV, and t is the number of elapsed days. Based on these treatment planning studies, the absolute volume of ipsilateral lung receiving 20 Gy can be reduced between 17% and 23% (21% mean) by adapting the treatment delivery. The benefits of adaptive therapy are the greatest for tumor volumes ≥25 cm 3 and are directly dependent on GTV reduction during treatment. Conclusions: Megavoltage CT-based image guidance can be used to position lung cancer patients daily. This has the potential to decrease margins associated with daily setup error. Furthermore, the adaptive therapy technique described in this article can decrease the volume of healthy lung tissue receiving above 20 Gy

  15. Moderate hypofractionated image-guided thoracic radiotherapy for locally advanced node-positive non-small cell lung cancer patients with very limited lung function: a case report

    International Nuclear Information System (INIS)

    Manapov, Farkhad; Roengvoraphoj, Olarn; Li, Ming Lun; Eze, Chukwuka

    2017-01-01

    Patients with locally advanced lung cancer and very limited pulmonary function (forced expiratory volume in 1 second [FEV1] ≤ 1 L) have dismal prognosis and undergo palliative treatment or best supportive care. We describe two cases of locally advanced node-positive non-small cell lung cancer (NSCLC) patients with very limited lung function treated with induction chemotherapy and moderate hypofractionated image-guided radiotherapy (Hypo-IGRT). Hypo-IGRT was delivered to a total dose of 45 Gy to the primary tumor and involved lymph nodes. Planning was based on positron emission tomography-computed tomography (PET/ CT) and four-dimensional computed tomography (4D-CT). Internal target volume (ITV) was defined as the overlap of gross tumor volume delineated on 10 phases of 4D-CT. ITV to planning target volume margin was 5 mm in all directions. Both patients showed good clinical and radiological response. No relevant toxicity was documented. Hypo-IGRT is feasible treatment option in locally advanced node-positive NSCLC patients with very limited lung function (FEV1 ≤ 1 L)

  16. Moderate hypofractionated image-guided thoracic radiotherapy for locally advanced node-positive non-small cell lung cancer patients with very limited lung function: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Manapov, Farkhad; Roengvoraphoj, Olarn; Li, Ming Lun; Eze, Chukwuka [Dept. of Radiation Oncology, Ludwig-Maximilian University of Munich, Munich (Germany)

    2017-06-15

    Patients with locally advanced lung cancer and very limited pulmonary function (forced expiratory volume in 1 second [FEV1] ≤ 1 L) have dismal prognosis and undergo palliative treatment or best supportive care. We describe two cases of locally advanced node-positive non-small cell lung cancer (NSCLC) patients with very limited lung function treated with induction chemotherapy and moderate hypofractionated image-guided radiotherapy (Hypo-IGRT). Hypo-IGRT was delivered to a total dose of 45 Gy to the primary tumor and involved lymph nodes. Planning was based on positron emission tomography-computed tomography (PET/ CT) and four-dimensional computed tomography (4D-CT). Internal target volume (ITV) was defined as the overlap of gross tumor volume delineated on 10 phases of 4D-CT. ITV to planning target volume margin was 5 mm in all directions. Both patients showed good clinical and radiological response. No relevant toxicity was documented. Hypo-IGRT is feasible treatment option in locally advanced node-positive NSCLC patients with very limited lung function (FEV1 ≤ 1 L)

  17. Lung Dose Calculation With SPECT/CT for {sup 90}Yittrium Radioembolization of Liver Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Naichang, E-mail: yun@ccf.org [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States); Srinivas, Shaym M.; DiFilippo, Frank P.; Shrikanthan, Sankaran [Department of Nuclear Medicine, Cleveland Clinic, Cleveland, OH (United States); Levitin, Abraham; McLennan, Gordon; Spain, James [Department of Interventional Radiology, Cleveland Clinic, Cleveland, OH (United States); Xia, Ping; Wilkinson, Allan [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States)

    2013-03-01

    Purpose: To propose a new method to estimate lung mean dose (LMD) using technetium-99m labeled macroaggregated albumin ({sup 99m}Tc-MAA) single photon emission CT (SPECT)/CT for {sup 90}Yttrium radioembolization of liver tumors and to compare the LMD estimated using SPECT/CT with clinical estimates of LMD using planar gamma scintigraphy (PS). Methods and Materials: Images of 71 patients who had SPECT/CT and PS images of {sup 99m}Tc-MAA acquired before TheraSphere radioembolization of liver cancer were analyzed retrospectively. LMD was calculated from the PS-based lung shunt assuming a lung mass of 1 kg and 50 Gy per GBq of injected activity shunted to the lung. For the SPECT/CT-based estimate, the LMD was calculated with the activity concentration and lung volume derived from SPECT/CT. The effect of attenuation correction and the patient's breathing on the calculated LMD was studied with the SPECT/CT. With these effects correctly taken into account in a more rigorous fashion, we compared the LMD calculated with SPECT/CT with the LMD calculated with PS. Results: The mean dose to the central region of the lung leads to a more accurate estimate of LMD. Inclusion of the lung region around the diaphragm in the calculation leads to an overestimate of LMD due to the misregistration of the liver activity to the lung from the patient's breathing. LMD calculated based on PS is a poor predictor of the actual LMD. For the subpopulation with large lung shunt, the mean overestimation from the PS method for the lung shunt was 170%. Conclusions: A new method of calculating the LMD for TheraSphere and SIR-Spheres radioembolization of liver cancer based on {sup 99m}Tc-MAA SPECT/CT is presented. The new method provides a more accurate estimate of radiation risk to the lungs. For patients with a large lung shunt calculated from PS, a recalculation of LMD based on SPECT/CT is recommended.

  18. Lung Dose Calculation With SPECT/CT for 90Yittrium Radioembolization of Liver Cancer

    International Nuclear Information System (INIS)

    Yu, Naichang; Srinivas, Shaym M.; DiFilippo, Frank P.; Shrikanthan, Sankaran; Levitin, Abraham; McLennan, Gordon; Spain, James; Xia, Ping; Wilkinson, Allan

    2013-01-01

    Purpose: To propose a new method to estimate lung mean dose (LMD) using technetium-99m labeled macroaggregated albumin ( 99m Tc-MAA) single photon emission CT (SPECT)/CT for 90 Yttrium radioembolization of liver tumors and to compare the LMD estimated using SPECT/CT with clinical estimates of LMD using planar gamma scintigraphy (PS). Methods and Materials: Images of 71 patients who had SPECT/CT and PS images of 99m Tc-MAA acquired before TheraSphere radioembolization of liver cancer were analyzed retrospectively. LMD was calculated from the PS-based lung shunt assuming a lung mass of 1 kg and 50 Gy per GBq of injected activity shunted to the lung. For the SPECT/CT-based estimate, the LMD was calculated with the activity concentration and lung volume derived from SPECT/CT. The effect of attenuation correction and the patient's breathing on the calculated LMD was studied with the SPECT/CT. With these effects correctly taken into account in a more rigorous fashion, we compared the LMD calculated with SPECT/CT with the LMD calculated with PS. Results: The mean dose to the central region of the lung leads to a more accurate estimate of LMD. Inclusion of the lung region around the diaphragm in the calculation leads to an overestimate of LMD due to the misregistration of the liver activity to the lung from the patient's breathing. LMD calculated based on PS is a poor predictor of the actual LMD. For the subpopulation with large lung shunt, the mean overestimation from the PS method for the lung shunt was 170%. Conclusions: A new method of calculating the LMD for TheraSphere and SIR-Spheres radioembolization of liver cancer based on 99m Tc-MAA SPECT/CT is presented. The new method provides a more accurate estimate of radiation risk to the lungs. For patients with a large lung shunt calculated from PS, a recalculation of LMD based on SPECT/CT is recommended

  19. Lung dose calculation with SPECT/CT for ⁹⁰Yittrium radioembolization of liver cancer.

    Science.gov (United States)

    Yu, Naichang; Srinivas, Shaym M; Difilippo, Frank P; Shrikanthan, Sankaran; Levitin, Abraham; McLennan, Gordon; Spain, James; Xia, Ping; Wilkinson, Allan

    2013-03-01

    To propose a new method to estimate lung mean dose (LMD) using technetium-99m labeled macroaggregated albumin ((99m)Tc-MAA) single photon emission CT (SPECT)/CT for (90)Yttrium radioembolization of liver tumors and to compare the LMD estimated using SPECT/CT with clinical estimates of LMD using planar gamma scintigraphy (PS). Images of 71 patients who had SPECT/CT and PS images of (99m)Tc-MAA acquired before TheraSphere radioembolization of liver cancer were analyzed retrospectively. LMD was calculated from the PS-based lung shunt assuming a lung mass of 1 kg and 50 Gy per GBq of injected activity shunted to the lung. For the SPECT/CT-based estimate, the LMD was calculated with the activity concentration and lung volume derived from SPECT/CT. The effect of attenuation correction and the patient's breathing on the calculated LMD was studied with the SPECT/CT. With these effects correctly taken into account in a more rigorous fashion, we compared the LMD calculated with SPECT/CT with the LMD calculated with PS. The mean dose to the central region of the lung leads to a more accurate estimate of LMD. Inclusion of the lung region around the diaphragm in the calculation leads to an overestimate of LMD due to the misregistration of the liver activity to the lung from the patient's breathing. LMD calculated based on PS is a poor predictor of the actual LMD. For the subpopulation with large lung shunt, the mean overestimation from the PS method for the lung shunt was 170%. A new method of calculating the LMD for TheraSphere and SIR-Spheres radioembolization of liver cancer based on (99m)Tc-MAA SPECT/CT is presented. The new method provides a more accurate estimate of radiation risk to the lungs. For patients with a large lung shunt calculated from PS, a recalculation of LMD based on SPECT/CT is recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Quantative pre-surgical lung function estimation with SPECT/CT

    International Nuclear Information System (INIS)

    Bailey, Dale L.; Timmins, Sophi; Harris, Benjamin E.; Bailey, Elizabeth A.; Roach, Paul J.; Willowson, Kathy P.

    2009-01-01

    Full text: Objectives: To develop methodology to predict lobar lung function based on SPECT/CT ventilation 6 k perfusion (V/Q) scanning in candidates for lobectomy for lung cancer. This combines two development areas from our group: quantitative SPECT based on CT-derived corrections for scattering and attenuation of photons, and SPECT V/Q scanning with lobar segmentation from CT Six patients underwent baseline pulmonary function testing (PFT) including spirometry, measurement of DLCO and cardio-pulmonary exercise testing. A SPECT/CT V/Q scan was acquired at baseline. Using in-house software each lobe was anatomically defined using CT to provide lobar ROIs which could be applied to the SPECT data. From these, individual lobar contribution to overall function was calculated from counts within the lobe and post-operative FEVl, DLCO and V02 peak were predicted. This was compared with the quantitative planar scan method using 3 rectangular ROIs over each lung.

  1. CT-guided biopsies and drainage; CT-gesteuerte Punktionen und Drainagen

    Energy Technology Data Exchange (ETDEWEB)

    Scheppers, I.; Wollschlaeger, D. [Staedtisches Klinikum Karlsruhe gGmbH, Zentralinstitut fuer Bildgebende Diagnostik, Karlsruhe (Germany)

    2011-11-15

    Following the implementation of computed tomography (CT) or ultrasound-guided biopsy of solid tumors and the puncture and drainage of liquid processes, the number of surgical open biopsies and curative operations for abscess drainage has declined. Such CT-guided interventions are performed in nearly every organ. Instead of aspiration biopsies, more and more core biopsies are being performed to allow histopathological evaluation and thus allowing targeted therapy. This article is intended to give a general overview of techniques, materials, indications and contraindications. Ultrasound-guided biopsies as well as large bore vacuum biopsies of the breast are not included in this review. (orig.) [German] Infolge der Durchfuehrung von bildgesteuerten Biopsien solider Raumforderungen und Punktionen mit Drainageeinlage bei liquiden Prozessen ist die Zahl chirurgischer Exzisionsbiopsien und Abszesssanierungen zurueckgegangen. Diese Eingriffe werden in nahezu allen Organgebieten durchgefuehrt. Neben den Aspirationsbiopsien werden haeufig Schneid- oder Stanzbiopsien durchgefuehrt. Nach histologischer und immunhistologischer Untersuchung der hierbei gewonnenen Proben in der Pathologie kann fruehzeitig die nachfolgende Therapie geplant werden. Der vorliegende Beitrag soll einen allgemeinen Ueberblick ueber Methoden, Materialien, Indikationen und Kontraindikationen geben. Die ultraschallgesteuerten Biopsien sowie die Vakuumsaugbiopsien im Rahmen des Mammographiescreenings werden bewusst nicht besprochen. (orig.)

  2. A hybrid approach for fusing 4D-MRI temporal information with 3D-CT for the study of lung and lung tumor motion

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Y. X.; Van Reeth, E.; Poh, C. L., E-mail: clpoh@ntu.edu.sg [School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637459 (Singapore); Teo, S.-K. [Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore 138632 (Singapore); Tan, C. H. [Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433 (Singapore); Tham, I. W. K. [Department of Radiation Oncology, National University Cancer Institute, Singapore 119082 (Singapore)

    2015-08-15

    Purpose: Accurate visualization of lung motion is important in many clinical applications, such as radiotherapy of lung cancer. Advancement in imaging modalities [e.g., computed tomography (CT) and MRI] has allowed dynamic imaging of lung and lung tumor motion. However, each imaging modality has its advantages and disadvantages. The study presented in this paper aims at generating synthetic 4D-CT dataset for lung cancer patients by combining both continuous three-dimensional (3D) motion captured by 4D-MRI and the high spatial resolution captured by CT using the authors’ proposed approach. Methods: A novel hybrid approach based on deformable image registration (DIR) and finite element method simulation was developed to fuse a static 3D-CT volume (acquired under breath-hold) and the 3D motion information extracted from 4D-MRI dataset, creating a synthetic 4D-CT dataset. Results: The study focuses on imaging of lung and lung tumor. Comparing the synthetic 4D-CT dataset with the acquired 4D-CT dataset of six lung cancer patients based on 420 landmarks, accurate results (average error <2 mm) were achieved using the authors’ proposed approach. Their hybrid approach achieved a 40% error reduction (based on landmarks assessment) over using only DIR techniques. Conclusions: The synthetic 4D-CT dataset generated has high spatial resolution, has excellent lung details, and is able to show movement of lung and lung tumor over multiple breathing cycles.

  3. High-resolution CT of the lungs: Anatomic-pathologic correlation

    International Nuclear Information System (INIS)

    Stein, M.G.; Webb, W.R.; Finkbeiner, W.; Gamsu, G.

    1986-01-01

    The interpretation of thin-section (1.5-mm), high-resolution CT scans of the lungs has been limited by lack of direct radiologic and pathologic correlation. The author scanned fresh inflated isolated lungs from ten healthy and five diseased subjects using thin-section, high-resolution techniques. The lungs were then fixed by inflation with endobronchial Formalin. Gough sections (1 mm thick) were obtained at the same levels as the CT scans. In healthy subjects, secondary lobules were identified by the presence of visible interlobular septa and central arterioles. In some patients with disease, septal thickening was visible. In patients with honeycombing cystic areas of destroyed lung were seen, along with areas of fibrosis. Emphysema was well evaluated. Thin-section, high-resolution CT can define lung architecture and may resolve mild changes of the interstitium

  4. Measurement of total lung capacity : a comparison of spiral CT and spirometry

    International Nuclear Information System (INIS)

    Chung, Kyung Il; Park, Kyung Ju; Lee, Eh Hyung; Yune, Heun Young; Suh, Jung Ho; Choe, Kyu Ok; Lim, Tae Hwan; Chung, In Hyuk

    1996-01-01

    To determine the potential of spiral CT as a functional imaging modality of the lung aside from its proven value in morphological depiction. Spiral CT scan was performed in ten normal female and nine normal male adults (mean age: 39, height: 163 cm, weight: 62 kg ) after single full breath-holding. Three dimensional lung images were reconstructed(minimal threshold value: -1,000HU, maximal threshold values: -150, 250, -350, -450 HU) to obtain total lung volume(TLV) on a histogram. Total lung volume measured by spiral CT was compared with TLV obtained by spirometry. Mean TLV measured by spirometry was 5.62L and TLV measured by CT at maximal threshold values of -150, -250, -350, and -450 HU was 5.53, 5.33, 5.15, and 4.98L, respectively. Mean absolute differences between the modalities of 0.17L(3%), 0.32L(5.6%), 0.48L(8.5%), 0.65L(11.5%) were statistically significant(p<0.001). Linear regression coefficients between the modalities were 0.99, 0.97, 095, and 0.94 and no statistically significant differences in accuracy of threshold levels in the estimation of lung volume(r=0.99, standard error=0.034L in all) were seen. TLV measured by spiral CT closely approximated that measured by spirometry. Spiral CT may be useful as a means of evaluating lung function

  5. Treatment of osteoid osteoma using CT-guided radiofrequency ablation versus MR-guided laser ablation: A cost comparison

    International Nuclear Information System (INIS)

    Maurer, M.H.; Gebauer, B.; Wieners, G.; De Bucourt, M.; Renz, D.M.; Hamm, B.; Streitparth, F.

    2012-01-01

    Objective: To compare the costs of CT-guided radiofrequency ablation (RFA) and MR-guided laser ablation (LA) for minimally invasive percutaneous treatment of osteoid osteoma. Materials and methods: Between November 2005 and October 2011, 20 patients (14 males, 6 females, mean age 20.3 ± 9.1 years) underwent CT-guided RFA and 24 patients (18 males, 6 females; mean age, 23.8 ± 13.8 years) MR-guided LA (open 1.0 Tesla, Panorama HFO, Philips, Best, Netherlands) for osteoid osteoma diagnosed on the basis of clinical presentation and imaging findings. Prorated costs of equipment use (purchase, depreciation, and maintenance), staff costs, and expenditure for disposables were identified for CT-guided RFA and MR-guided LA procedures. Results: The average total costs per patient were EUR 1762 for CT-guided RFA and EUR 1417 for MR-guided LA. These were (RFA/LA) EUR 92/260 for equipment use, EUR 149/208 for staff, and EUR 870/300 for disposables. Conclusion: MR-guided LA is less expensive than CT-guided RFA for minimally invasive percutaneous ablation of osteoid osteoma. The higher costs of RFA are primarily due to the higher price of the disposable RFA probes.

  6. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... to: guide biopsies and other procedures such as abscess drainages and minimally invasive tumor treatments. plan for ... many types of tissue as well as the lungs, bones, and blood vessels. CT examinations are fast ...

  7. Models to teach lung sonopathology and ultrasound-guided thoracentesis

    Directory of Open Access Journals (Sweden)

    Jacek A. Wojtczak

    2014-12-01

    Full Text Available Lung sonography allows rapid diagnosis of lung emergencies such as pulmonary edema, hemothorax or pneumothorax. The ability to timely diagnose an intraoperative pneumothorax is an important skill for the anesthesiologist. However, lung ultrasound exams require an interpretation of not only real images but also complex acoustic artifacts such as A-lines and B-lines. Therefore, appropriate training to gain proficiency is important. Simulated environment using ultrasound phantom models allows controlled, supervised learning. We have developed hybrid models that combine dry or wet polyurethane foams, porcine rib cages and human hand simulating a rib cage. These models simulate fairly accurately pulmonary sonopathology and allow supervised teaching of lung sonography with the immediate feedback. In-vitro models can also facilitate learning of procedural skills, improving transducer and needle positioning and movement, rapid recognition of thoracic anatomy and hand – eye coordination skills. We described a new model to teach an ultrasound guided thoracentesis. This model consists of the experimenter’s hand placed on top of the water-filled container with a wet foam. Metacarpal bones of the human hand simulate a rib cage and a wet foam simulates a diseased lung immersed in the pleural fluid. Positive fluid flow offers users feedback when a simulated pleural effusion is accurately assessed.

  8. The findings of bronchial artery change in lung cancer with 16-slice CT

    International Nuclear Information System (INIS)

    Zeng Qingsi; Wu Xiaomei; Cen Renli; Zhang Chaoliang; Chen Yongfu

    2007-01-01

    Objective: To evaluate the difference of internal diameter of bronchial artery in big lung cancer, small lung cancer, and normal lung with multiple slice CT. Methods: MSCT angiographies of 44 patients with lung cancer confirmed by pathology were retrospectively analyzed, and 29 patients were with big lung cancer (≥3 cm) and 15 patients with small lung cancer (<3 cm). Contrast enhanced helical thin slice CT scan was performed in all patients. Three dimensional images of bronchial artery were processed on workstation. The internal diameter of bronchial artery was measured. Results: The diameter of bronchial artery was (1.9±0.4) mm in 15 small lung cancer and (2.5±0.5) mm in 29 big lung cancer, respectively. There was a significant difference in internal diameter of bronchial artery between big and small lung cancer (P<0.05). Conclusion: Bronchial artery in lung cancer is dilated, and the dilation of bronchial artery in big lung cancer is more prominent than in small lung cancer. (authors)

  9. Characterization of the relation between CT technical parameters and accuracy of quantification of lung attenuation on quantitative chest CT.

    Science.gov (United States)

    Trotta, Brian M; Stolin, Alexander V; Williams, Mark B; Gay, Spencer B; Brody, Alan S; Altes, Talissa A

    2007-06-01

    The purpose of this study was to assess the compromise between CT technical parameters and the accuracy of CT quantification of lung attenuation. Materials that simulate water (0 H), healthy lung (-650 H), borderline emphysematous lung (-820 H), and severely emphysematous lung (-1,000 H) were placed at both the base and the apex of the lung of an anthropomorphic phantom and outside the phantom. Transaxial CT images through the samples were obtained while the effective tube current was varied from 440 to 10 mAs, kilovoltage from 140 to 80 kVp, and slice thickness from 0.625 to 10 mm. Mean +/- SD attenuation within the samples and the standard quantitative chest CT measurements, the percentage of pixels with attenuation less than -910 H and 15th percentile of attenuation, were computed. Outside the phantom, variations in CT parameters produced less than 2.0% error in all measurements. Within the anthropomorphic phantom at 30 mAs, error in measurements was much larger, ranging from zero to 200%. Below approximately 80 mAs, mean attenuation became increasingly biased. The effects were most pronounced at the apex of the lungs. Mean attenuation of the borderline emphysematous sample of apex decreased 55 H as the tube current was decreased from 300 to 30 mAs. Both the 15th percentile of attenuation and percentage of pixels with less than -910 H attenuation were more sensitive to variations in effective tube current than was mean attenuation. For example, the -820 H sample should have 0% of pixels less than -910 H, which was true at 400 mA. At 30 mA in the lung apex, however, the measurement was highly inaccurate, 51% of pixels being below this value. Decreased kilovoltage and slice thickness had analogous, but lesser, effects. The accuracy of quantitative chest CT is determined by the CT acquisition parameters. There can be significant decreases in accuracy at less than 80 mAs for thin slices in an anthropomorphic phantom, the most pronounced effects occurring in the lung

  10. Assessment of CF lung disease using motion corrected PROPELLER MRI: a comparison with CT

    Energy Technology Data Exchange (ETDEWEB)

    Ciet, Pierluigi [General Hospital Ca' Foncello, Radiology Department, Treviso (Italy); Sophia Children' s Hospital, Pediatric Pulmonology Erasmus MC, Rotterdam (Netherlands); Erasmus MC, Radiology, Rotterdam (Netherlands); Serra, Goffredo; Catalano, Carlo [University of Rome ' ' Sapienza' ' , Radiology, Rome (Italy); Bertolo, Silvia; Morana, Giovanni [General Hospital Ca' Foncello, Radiology Department, Treviso (Italy); Spronk, Sandra [Erasmus MC, Radiology, Rotterdam (Netherlands); Erasmus MC, Epidemiology, Rotterdam (Netherlands); Ros, Mirco [Ca' Foncello Hospital, Pediatrics, Treviso (Italy); Fraioli, Francesco [University College London (UCL), Institute of Nuclear Medicine, London (United Kingdom); Quattrucci, Serena [University of Rome Sapienza, Pediatrics, Rome (Italy); Assael, M.B. [Azienda Ospedaliera di Verona, Verona CF Center, Verona (Italy); Pomerri, Fabio [University of Padova, Department of Medicine-DIMED, Padova (Italy); Tiddens, Harm A.W.M. [Sophia Children' s Hospital, Pediatric Pulmonology Erasmus MC, Rotterdam (Netherlands); Erasmus MC, Radiology, Rotterdam (Netherlands)

    2016-03-15

    To date, PROPELLER MRI, a breathing-motion-insensitive technique, has not been assessed for cystic fibrosis (CF) lung disease. We compared this technique to CT for assessing CF lung disease in children and adults. Thirty-eight stable CF patients (median 21 years, range 6-51 years, 22 female) underwent MRI and CT on the same day. Study protocol included respiratory-triggered PROPELLER MRI and volumetric CT end-inspiratory and -expiratory acquisitions. Two observers scored the images using the CF-MRI and CF-CT systems. Scores were compared with intra-class correlation coefficient (ICC) and Bland-Altman plots. The sensitivity and specificity of MRI versus CT were calculated. MRI sensitivity for detecting severe CF bronchiectasis was 0.33 (CI 0.09-0.57), while specificity was 100 % (CI 0.88-1). ICCs for bronchiectasis and trapped air were as follows: MRI-bronchiectasis (0.79); CT-bronchiectasis (0.85); MRI-trapped air (0.51); CT-trapped air (0.87). Bland-Altman plots showed an MRI tendency to overestimate the severity of bronchiectasis in mild CF disease and underestimate bronchiectasis in severe disease. Motion correction in PROPELLER MRI does not improve assessment of CF lung disease compared to CT. However, the good inter- and intra-observer agreement and the high specificity suggest that MRI might play a role in the short-term follow-up of CF lung disease (i.e. pulmonary exacerbations). (orig.)

  11. Assessment of CF lung disease using motion corrected PROPELLER MRI: a comparison with CT

    International Nuclear Information System (INIS)

    Ciet, Pierluigi; Serra, Goffredo; Catalano, Carlo; Bertolo, Silvia; Morana, Giovanni; Spronk, Sandra; Ros, Mirco; Fraioli, Francesco; Quattrucci, Serena; Assael, M.B.; Pomerri, Fabio; Tiddens, Harm A.W.M.

    2016-01-01

    To date, PROPELLER MRI, a breathing-motion-insensitive technique, has not been assessed for cystic fibrosis (CF) lung disease. We compared this technique to CT for assessing CF lung disease in children and adults. Thirty-eight stable CF patients (median 21 years, range 6-51 years, 22 female) underwent MRI and CT on the same day. Study protocol included respiratory-triggered PROPELLER MRI and volumetric CT end-inspiratory and -expiratory acquisitions. Two observers scored the images using the CF-MRI and CF-CT systems. Scores were compared with intra-class correlation coefficient (ICC) and Bland-Altman plots. The sensitivity and specificity of MRI versus CT were calculated. MRI sensitivity for detecting severe CF bronchiectasis was 0.33 (CI 0.09-0.57), while specificity was 100 % (CI 0.88-1). ICCs for bronchiectasis and trapped air were as follows: MRI-bronchiectasis (0.79); CT-bronchiectasis (0.85); MRI-trapped air (0.51); CT-trapped air (0.87). Bland-Altman plots showed an MRI tendency to overestimate the severity of bronchiectasis in mild CF disease and underestimate bronchiectasis in severe disease. Motion correction in PROPELLER MRI does not improve assessment of CF lung disease compared to CT. However, the good inter- and intra-observer agreement and the high specificity suggest that MRI might play a role in the short-term follow-up of CF lung disease (i.e. pulmonary exacerbations). (orig.)

  12. Clinical value of 99Tcm-octreotide SPECT/CT in diagnostics of lung cancer

    International Nuclear Information System (INIS)

    Liu Xiaofang; Li Mei; Liu Yong; Li Ran; Xu Jie; Sun yongchang; Dai Haojie

    2012-01-01

    Objective: To evaluate the clinical value of 99 Tc m -Octreotide SPECT-CT in the diagnosis of lung cancer. Methods: Sixty-five consecutive patients with suspected lung cancer received intravenous injection of 740 MBq 99 Tc m -Octreotide and additional SPECT images of the chest were performed at 4h post injection. The SPECT/CT images were interpreted separately. The tumor uptake of 99 Tc m -Octreotide was visually determined and then measured and expressed as the activity ratio of tumor to normal tissues (T/N). The differences between lung cancer and benign lung lesion and between SCLC and NSCLC, and between adenocarcinoma and squamous carcinoma were studied by statistical analysis. Moreover, the receiver operating characteristic ROC curves were plotted and the predicted probabilities and areas under the curve were calculated. Results: Fifty-one patients and fourteen patients in 65 cases were diagnosed as lung cancer and benign lung lesion by histopathological analysis, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of 99 Tc m -Octreotide SPECT/CT in diagnosis of lung cancer were 92.2%, 85.7%, 95.9% and 75%, respectively. The area under ROC curve was 0.889 (P 99 Tc m -Octreotide SPECT/CT could play an important role in the diagnosis of lung cancer, and it may be useful for identifying SCLC and NSCLC. (authors)

  13. Has PET/CT a role in the characterization of indeterminate lung lesions on staging CT in colorectal cancer? A prospective study

    DEFF Research Database (Denmark)

    Jess, P.; Seiersen, M.; Ovesen, H.

    2014-01-01

    Purpose CT has been found superior to chest x-ray to detect lung malignances. However, indeterminate lung lesions (ILL) are found in 4-42% by using CT in staging colorectal cancer (CRC) patients. Our aim was to examine the frequency of ILL on staging CT and the rate of the ILL being malignant...... CT performed 6, 12, 18 and 24 months postoperatively. Results Twenty percent of the patients had ILL. Four of these patients (8.5%) had lung metastases detected median 9 months postoperatively, while 2 (4.3%) had other lung malignancies. One patient had TB. In patients with normal staging chest CT 10...... of the 185 patients (5.4%) developed lung metastases detected median 16 months postoperatively. This was significantly later than in patients with ILL (p lung metastases no significant difference was found between the groups (p = 0...

  14. Application of Real-Time 3D Navigation System in CT-Guided Percutaneous Interventional Procedures: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Priya Bhattacharji

    2017-01-01

    Full Text Available Introduction. To evaluate the accuracy of a quantitative 3D navigation system for CT-guided interventional procedures in a two-part study. Materials and Methods. Twenty-two procedures were performed in abdominal and thoracic phantoms. Accuracies of the 3D anatomy map registration and navigation were evaluated. Time used for the navigated procedures was recorded. In the IRB approved clinical evaluation, 21 patients scheduled for CT-guided thoracic and hepatic biopsy and ablations were recruited. CT-guided procedures were performed without following the 3D navigation display. Accuracy of navigation as well as workflow fitness of the system was evaluated. Results. In phantoms, the average 3D anatomy map registration error was 1.79 mm. The average navigated needle placement accuracy for one-pass and two-pass procedures, respectively, was 2.0±0.7 mm and 2.8±1.1 mm in the liver and 2.7±1.7 mm and 3.0±1.4 mm in the lung. The average accuracy of the 3D navigation system in human subjects was 4.6 mm ± 3.1 for all procedures. The system fits the existing workflow of CT-guided interventions with minimum impact. Conclusion. A 3D navigation system can be performed along the existing workflow and has the potential to navigate precision needle placement in CT-guided interventional procedures.

  15. Megavoltage conebeam CT cine as final verification of treatment plan in lung stereotactic body radiotherapy

    International Nuclear Information System (INIS)

    Kudithipudi, Vijay; Gayou, Olivier; Colonias, Athanasios

    2016-01-01

    To analyse the clinical impact of megavoltage conebeam computed tomography (MV-CBCT) cine on internal target volume (ITV) coverage in lung stereotactic body radiotherapy (SBRT). One hundred and six patients received lung SBRT. All underwent 4D computed tomography simulation followed by treatment via image guided 3D conformal or intensity modulated radiation. Prior to SBRT, all patients underwent MV-CBCT cine, in which raw projections are displayed as beam's-eye-view fluoroscopic series with the planning target volume (PTV) projected onto each image, enabling verification of tumour motion relative to the PTV and assessment of adequacy of treatment margin. Megavoltage conebeam computed tomography cine was completed 1–2 days prior to SBRT. Four patients (3.8%) had insufficient ITV coverage inferiorly at cine review. All four plans were changed by adding 5 mm on the PTV margin inferiorly. The mean change in PTV volumes was 3.9 cubic centimetres (cc) (range 1.85–6.32 cc). Repeat cine was performed after plan modification to ensure adequate PTV coverage in the modified plans. PTV margin was adequate in the majority of patients with this technique. MV-CBCT cine did show insufficient coverage in a small subset of patients. Insufficient PTV margins may be a function of 4D CT simulation inadequacies or deficiencies in visualizing the ITV inferior border in the full-inhale phase. MV-CBCT cine is a valuable tool for final verification of PTV margins.

  16. Value of integrated PET/CT in clinical staging of patients with lung cancer

    International Nuclear Information System (INIS)

    Zhao Jun; Guan Yihui; Zuo Chuantao; Hua Fengchun; Lin Xiangtong

    2004-01-01

    Objectives: The purpose of this study was to evaluate the value of combined fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) in patients with lung cancer, and to compare the results of PET/CT with those of FDG PET and CT alone. Methods: Forty-two patients were studied in this group. 3D whole body images were acquired using Siemens Biograph Sensetionl6 PET/CT scanner. Attenuation corrected PET images, CT and fusion images were interpreted. Reports were compared for each patient including identified the number of lesions, their anatomical localization and certainty of diagnosis. Results: PET/CT increased the number of lesions reported as being definitely abnormal or normal (+22%). In 12 patients (28.6%), the PET/CT report positively impacted surgical management when compared to the PET report alone. 6 patients were correctly downstaged negating further treatment or imaging, 3 patient was upstaged to inoperable and in another 3 ones improved localization by PET/CT led to an altered surgical incision with decreased morbidity. Lesion-based evaluation showed sensitivity for regional lymph node involvement of 61% for CT alone, 88% for FDG PET alone, and 96% for integrated PET/CT imaging respectively. In addition, PET/CT could identify some benign disease, including lung tuberculosis, cyst of liver and kidney, calculus etc. Conclusion: PET/CT improves anatomical localization and increases the certainty in reporting abnormal and normal lesions. PET/CT imaging is superior to CT alone and has additional benefit over FDG PET alone, and is accurate in clinical staging for lung cancer. (authors)

  17. Imaging-guided thoracoscopic resection of a ground-glass opacity lesion in a hybrid operating room equipped with a robotic C-arm CT system.

    Science.gov (United States)

    Hsieh, Chen-Ping; Hsieh, Ming-Ju; Fang, Hsin-Yueh; Chao, Yin-Kai

    2017-05-01

    The intraoperative identification of small pulmonary nodules through video-assisted thoracoscopic surgery remains challenging. Although preoperative CT-guided nodule localization is commonly used to detect tumors during video-assisted thoracoscopic surgery (VATS), this approach carries inherent risks. We report the case of a patient with stage I lung cancer presenting as an area of ground-glass opacity (GGO) in the right upper pulmonary lobe. He successfully underwent a single-stage, CT-guided localization and removal of the pulmonary nodule within a hybrid operating room (OR) equipped with a robotic C-arm.

  18. A hybrid approach for fusing 4D-MRI temporal information with 3D-CT for the study of lung and lung tumor motion.

    Science.gov (United States)

    Yang, Y X; Teo, S-K; Van Reeth, E; Tan, C H; Tham, I W K; Poh, C L

    2015-08-01

    Accurate visualization of lung motion is important in many clinical applications, such as radiotherapy of lung cancer. Advancement in imaging modalities [e.g., computed tomography (CT) and MRI] has allowed dynamic imaging of lung and lung tumor motion. However, each imaging modality has its advantages and disadvantages. The study presented in this paper aims at generating synthetic 4D-CT dataset for lung cancer patients by combining both continuous three-dimensional (3D) motion captured by 4D-MRI and the high spatial resolution captured by CT using the authors' proposed approach. A novel hybrid approach based on deformable image registration (DIR) and finite element method simulation was developed to fuse a static 3D-CT volume (acquired under breath-hold) and the 3D motion information extracted from 4D-MRI dataset, creating a synthetic 4D-CT dataset. The study focuses on imaging of lung and lung tumor. Comparing the synthetic 4D-CT dataset with the acquired 4D-CT dataset of six lung cancer patients based on 420 landmarks, accurate results (average error lung details, and is able to show movement of lung and lung tumor over multiple breathing cycles.

  19. [The Clinical Application of Video Mediastinoscopy and CT in the N Staging of Preoperative Lung Cancer.].

    Science.gov (United States)

    Wang, Zhiheng; Qi, Weibo; Zhu, Yong; Lin, Ruobai

    2009-10-20

    Preoperative lung cancer with mediastinal lymph nodes metastasis can be diagnosed by vedio mediastinoscopy (VM) and CT. This study was to explore the value of VM and CT in the diagnosis of N staging of preoperative lung cancer, and to discuss the difference between the two methods. Forty-eight cases diagnosed of lung cancer by CT or PET-CT were examined by VM. The sensitivity, specificity, validity, positive predictive value and negative predictive value of VM and CT were speculated according to the postoperative pathological reports, and the difference between VM and CT in the diagnosis of lung cancer with mediastinal lymph nodes metastasis was discussed. (1)Under the examination of VM, 31 patients with the negative outcome received the direct operation; 14 patients with N2 received 2 courses of neoadjuvant chemotherapy before operation; 3 patients with N3 received chemotherapy and/or radiotherapy. (2)Forty-one cases with final diagnosis of lung cancer were used as samples to speculate the sensitivity, specificity, validity, positive predictive value and negative predictive value of VM. They were 93.3%, 100%, 97.6%, 100%, 96.3%, which of CT were 66.7%, 53.8%, 58.5%, 45.5%, 73.7% (Chi-square=4.083, P=0.039), the difference between VM and CT was statistically significant. (3)In this group, the complications of VM incidence rate was 2.08% (1/48), and the case was pneumothorax. VM is superior to CT in the diagnosis of N staging of preoperative lung cancer; Due to its safety and effectiveness, VM will be wildly used in the field of thoracic surgery.

  20. The Clinical Application of Video Mediastinoscopy and CT in the N Staging of Preoperative Lung Cancer

    Directory of Open Access Journals (Sweden)

    Zhiheng WANG

    2009-10-01

    Full Text Available Background and objective Preoperative lung cancer with mediastinal lymph nodes metastasis can be diagnosed by vedio mediastinoscopy (VM and CT. This study was to explore the value of VM and CT in the diagnosis of N staging of preoperative lung cancer, and to discuss the difference between the 2 methods. Methods 48 cases diagnosed of lung cancer by CT or PET-CT were examined by VM. The sensitivity, specificity, validity, positive predictive value and negative predictive value of VM and CT were speculated according to the postoperative pathological reports, and the difference between VM and CT in the diagnosis of lung cancer with mediastinal lymph nodes metastasis was discussed. Results ①Under the examination of VM, 31 patients with the negative outcome received the direct operation, 14 patients with N2 received 2 courses of neoadjuvant chemotherapy before operation, 3 patients with N3 received chemotherapy and/or radiotherapy. ②Forty-one cases with final diagnosis of lung cancer were used as samples to speculate the sensitivity, specificity, validity, positive predictive value and negative predictive value of VM. They were 93.3%, 100%, 97.6%, 100%, 96.3%, which of CT were 66.7%, 53.8%, 58.5%, 45.5%, 73.7% (χ2=4.083, P=0.039, the difference between VM and CT was statistically significant. ③In this group, the complications of VM incidence rate is 2.08% (1/48, the case is pneumothorax. Conclusion VM is superior to CT in the diagnosis of N staging of preoperative lung cancer, it is safe and effective, and there will be a wide perspective for VM in thoracic surgery.

  1. WE-B-207-02: CT Lung Cancer Screening and the Medical Physicist: A Dosimetry Summary of CT Participants in the National Lung Cancer Screening Trial (NLST)

    International Nuclear Information System (INIS)

    Lee, C.

    2015-01-01

    The US National Lung Screening Trial (NLST) was a multi-center randomized, controlled trial comparing a low-dose CT (LDCT) to posterior-anterior (PA) chest x-ray (CXR) in screening older, current and former heavy smokers for early detection of lung cancer. Recruitment was launched in September 2002 and ended in April 2004 when 53,454 participants had been randomized at 33 screening sites in equal proportions. Funded by the National Cancer Institute this trial demonstrated that LDCT screening reduced lung cancer mortality. The US Preventive Services Task Force (USPSTF) cited NLST findings and conclusions in its deliberations and analysis of lung cancer screening. Under the 2010 Patient Protection and Affordable Care Act, the USPSTF favorable recommendation regarding lung cancer CT screening assisted in obtaining third-party payers coverage for screening. The objective of this session is to provide an introduction to the NLST and the trial findings, in addition to a comprehensive review of the dosimetry investigations and assessments completed using individual NLST participant CT and CXR examinations. Session presentations will review and discuss the findings of two independent assessments, a CXR assessment and the findings of a CT investigation calculating individual organ dosimetry values. The CXR assessment reviewed a total of 73,733 chest x-ray exams that were performed on 92 chest imaging systems of which 66,157 participant examinations were used. The CT organ dosimetry investigation collected scan parameters from 23,773 CT examinations; a subset of the 75,133 CT examinations performed using 97 multi-detector CT scanners. Organ dose conversion coefficients were calculated using a Monte Carlo code. An experimentally-validated CT scanner simulation was coupled with 193 adult hybrid computational phantoms representing the height and weight of the current U.S. population. The dose to selected organs was calculated using the organ dose library and the abstracted scan

  2. WE-B-207-02: CT Lung Cancer Screening and the Medical Physicist: A Dosimetry Summary of CT Participants in the National Lung Cancer Screening Trial (NLST)

    Energy Technology Data Exchange (ETDEWEB)

    Lee, C. [National Cancer Institute (United States)

    2015-06-15

    The US National Lung Screening Trial (NLST) was a multi-center randomized, controlled trial comparing a low-dose CT (LDCT) to posterior-anterior (PA) chest x-ray (CXR) in screening older, current and former heavy smokers for early detection of lung cancer. Recruitment was launched in September 2002 and ended in April 2004 when 53,454 participants had been randomized at 33 screening sites in equal proportions. Funded by the National Cancer Institute this trial demonstrated that LDCT screening reduced lung cancer mortality. The US Preventive Services Task Force (USPSTF) cited NLST findings and conclusions in its deliberations and analysis of lung cancer screening. Under the 2010 Patient Protection and Affordable Care Act, the USPSTF favorable recommendation regarding lung cancer CT screening assisted in obtaining third-party payers coverage for screening. The objective of this session is to provide an introduction to the NLST and the trial findings, in addition to a comprehensive review of the dosimetry investigations and assessments completed using individual NLST participant CT and CXR examinations. Session presentations will review and discuss the findings of two independent assessments, a CXR assessment and the findings of a CT investigation calculating individual organ dosimetry values. The CXR assessment reviewed a total of 73,733 chest x-ray exams that were performed on 92 chest imaging systems of which 66,157 participant examinations were used. The CT organ dosimetry investigation collected scan parameters from 23,773 CT examinations; a subset of the 75,133 CT examinations performed using 97 multi-detector CT scanners. Organ dose conversion coefficients were calculated using a Monte Carlo code. An experimentally-validated CT scanner simulation was coupled with 193 adult hybrid computational phantoms representing the height and weight of the current U.S. population. The dose to selected organs was calculated using the organ dose library and the abstracted scan

  3. PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer

    Energy Technology Data Exchange (ETDEWEB)

    Du, Xue-lian, E-mail: duxuelian23800@yahoo.com.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Jiang, Tao, E-mail: melody23800@yahoo.com.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Sheng, Xiu-gui, E-mail: jnsd2000@yahoo.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Li, Qing-shui, E-mail: lqs1966@126.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Wang, Cong, E-mail: jnwc1981@hotmail.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Yu, Hao, E-mail: jnyh2200@sina.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China)

    2012-11-15

    Objective: This study was undertaken to evaluate the clinical contribution of positron emission tomography using {sup 18}F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer. Materials and methods: Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated. Results: Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P = 0.021; PR: 25.0% vs. 13.3%, P = 0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P = 0.014). Conclusions: PET/CT guided IMRT in recurrent ovarian cancer patients improved the delineation of GTV and reduce the likelihood of geographic misses and therefore improve the clinical outcome.

  4. Chest Fat Quantification via CT Based on Standardized Anatomy Space in Adult Lung Transplant Candidates.

    Directory of Open Access Journals (Sweden)

    Yubing Tong

    Full Text Available Overweight and underweight conditions are considered relative contraindications to lung transplantation due to their association with excess mortality. Yet, recent work suggests that body mass index (BMI does not accurately reflect adipose tissue mass in adults with advanced lung diseases. Alternative and more accurate measures of adiposity are needed. Chest fat estimation by routine computed tomography (CT imaging may therefore be important for identifying high-risk lung transplant candidates. In this paper, an approach to chest fat quantification and quality assessment based on a recently formulated concept of standardized anatomic space (SAS is presented. The goal of the paper is to seek answers to several key questions related to chest fat quantity and quality assessment based on a single slice CT (whether in the chest, abdomen, or thigh versus a volumetric CT, which have not been addressed in the literature.Unenhanced chest CT image data sets from 40 adult lung transplant candidates (age 58 ± 12 yrs and BMI 26.4 ± 4.3 kg/m2, 16 with chronic obstructive pulmonary disease (COPD, 16 with idiopathic pulmonary fibrosis (IPF, and the remainder with other conditions were analyzed together with a single slice acquired for each patient at the L5 vertebral level and mid-thigh level. The thoracic body region and the interface between subcutaneous adipose tissue (SAT and visceral adipose tissue (VAT in the chest were consistently defined in all patients and delineated using Live Wire tools. The SAT and VAT components of chest were then segmented guided by this interface. The SAS approach was used to identify the corresponding anatomic slices in each chest CT study, and SAT and VAT areas in each slice as well as their whole volumes were quantified. Similarly, the SAT and VAT components were segmented in the abdomen and thigh slices. Key parameters of the attenuation (Hounsfield unit (HU distributions were determined from each chest slice and from the

  5. A case of transitional cell carcinoma associated with pericalyceal diverticulum diagnosed by CT guided percutaneous cystgraphy

    International Nuclear Information System (INIS)

    Sasaki, Fumio; Koga, Sukehiko; Takeuchi, Akira; Anno, Hirofumi; Hujita, Tamio

    1983-01-01

    Computed tomography (CT) performed on a 42-year-old male patient with a chief complaint of hematuria revealed a renal cyst with a thickened and irregularly shaped wall. CT with contrast medium injected into the cyst by puncture under CT guide detected tumors on the cystic wall preoperatively. (Ueda, J.)

  6. Radiation dosage of various CT-methods in lung diagnostics

    International Nuclear Information System (INIS)

    Heinz-Peer, G.; Weninger, F.; Nowotny, R.; Herold, C.J.

    1996-01-01

    Introduction of the computed tomography index CTDI and the multiple scan average dose (MSAD) has led to standardization of the dose description in CT examinations. Despite the use of these dose parameters, many different dosages are reported in the literature for different CT methods. In addition, there is still a wide range of radiation dosimetry results reported for conventional CT, helical CT, and HRCT used in chest examinations. The variations in dosage are mainly due to difference in factors affecting the dose, i.e. beam geometry, beam quality, scanner geometry ('generation'), and operating parameters. In addition, CT dosimetry instrumentation and methodology make a contribution to dosages. Recent studies calculating differences in factors affecting dosage and CT dosimetry and using similar operating parameters, show similar results in CT dosimetry for conventional and helical CT. On the other hand, dosages for HRCT were greatly reduced. This was mainly caused by narrow beam collimation and increasing section spacing. (orig.) [de

  7. CT guided stereotactic evacuation for hypertensive intracerebral hematoma

    International Nuclear Information System (INIS)

    Nakajima, Hideo

    1990-01-01

    Sixty-one cases of hypertensive intracerebral hematoma were evacuated by CT guided stereotactic method. The operation was performed in the CT room under general anesthesia using the KOMAI-NAKAJIMA STEREOTACTIC DEVICE. This instrument has a micromanipulater that can be used for various kinds of stereotactic procedures. Three dimensional position of the target point (aspiration point of the hematoma) was determined on the film obtained from CT scanning of the patient in the stereotactic system. If the hematoma was small, the target point was enough to be one point at the center of the hematoma, but in case of the large hematoma, several target points were given according to the shape of hematoma. The probe, ordinarily a steel tube 4 mm in outer diameter, was inserted through brain to the target point and the hematoma was aspirated through a silicon tube connected to a vacuum system. Among 61 cases examined, 30 cases of thalamic hemorrhage were operated upon and 36 cases were not operated. They were classified according to the volume of hematoma into 3 groups as follows: A=less than 10 ml, B=11-25 ml, C=more than 25 ml. The operated cases were compared with the non operated cases on the improvement of consciousness in each group. In the A group, the operated patients in the level I recovered more slowly than the non operated patients, but in the level II patients, this was reversed. In the B group, the operated patients improved more quickly except the level I patients. In the C group, almost all of non operated patients died. Thus, this operation was very useful in improving consciousness of level II or III patients independent of hematoma volume. It accelerated the recovery of motor function in the level I. This non inversive technique is considered effective for the removal of deep intracerebral hematoma. (author)

  8. CT-guided stereotactic operation for hypertensive intracerebral hematoma

    International Nuclear Information System (INIS)

    Takahashi, Shinichiro; Sonobe, Makoto; Koshu, Keiji; Kusunose, Mutsuo; Tsumura, Kotaro

    1989-01-01

    CT-guided stereotactic operation was performed in 55 patients with hypertensive intracerebral hematoma. Location of the hematoma was putamen in 28 cases, thalamus in 14 cases, subcortical area in 9 cases, cerebellum in 3 cases and pons in one case. Ages ranged from 36 to 85 years (mean 59.5). The mean timing of the surgery after bleeding was 4.2 days. The estimated volume of the hematoma on CT was 8 ml to 57 ml in putaminal, 9 ml to 40 ml in thalamic, 18 ml to 77 ml in subcortical, 17 ml to 26 ml in cerebellar and 5 ml in pontine hemorrhage. Aspiration rate at surgery was 60.4% in putaminal, 37.9% in thalamic, 41.7% in subcortical, 45.2% in cerebellar and 30% in pontine hemorrhage. In addition, we evaluated ADL at 6 months postoperatively in patients with putaminal and thalamic hamorrhage. It is concluded that stereotactic operation is advisable in those cases with 10 to 50 ml hematoma volumes in putamen or thalamus. On the other hand, in cases with over 50ml volume, hematoma should be evacuated by craniotomy. (author)

  9. CT guided stereotactic evacuation of hypertensive and traumatic intracerebral hematomas

    International Nuclear Information System (INIS)

    Hondo, Hideki; Matsumoto, Keizo

    1983-01-01

    Recent advancement of CT system provides not only definite diagnosis and location of intracerebral hematoma but also coordinates of the center of the hematoma. Trials of stereotactic evacuation of the hematoma have been reported by some authors in the cases of subacute or chronic stages of hypertensive intracerebral hemorrhage. In this series, similar surgery has been performed in 33 cases of hypertensive intracerebral hematoma including 22 cases in acute stage, and 2 cases of traumatic hematoma. Clinical outcomes were investigated and the results were considered to be equivalent or rather better in the conventional microsurgery with evacuation of hematoma under direct vision. However, there still remained controversial problems in the cases of threatened herniation signs, because in these cases regular surgery with total evacuation of the hematoma at one time might have been preferable. The benefits of this CT guided stereotactic approach for the evacuation of the hematoma were thought to be as follow: 1) the procedure is simple and safe, 2) operation is readily performed under local anesthesia, and 3) the hematoma was drained out totally by means of urokinase activity. It is our impression that this surgery not only is indicated as emergency treatment for the patients of high-age or in high risk, but also can institute as a routine surgery for the intracerebral hematomas in patients showing no herniation sign. (J.P.N.)

  10. WE-D-207-00: CT Lung Cancer Screening and the Medical Physicist: Moving Forward

    International Nuclear Information System (INIS)

    2015-01-01

    In the United States, Lung Cancer is responsible for more cancer deaths than the next four cancers combined. In addition, the 5 year survival rate for lung cancer patients has not improved over the past 40 to 50 years. To combat this deadly disease, in 2002 the National Cancer Institute launched a very large Randomized Control Trial called the National Lung Screening Trial (NLST). This trial would randomize subjects who had substantial risk of lung cancer (due to age and smoking history) into either a Chest X-ray arm or a low dose CT arm. In November 2010, the National Cancer Institute announced that the NLST had demonstrated 20% fewer lung cancer deaths among those who were screened with low-dose CT than with chest X-ray. In December 2013, the US Preventive Services Task Force recommended the use of Lung Cancer Screening using low dose CT and a little over a year later (Feb. 2015), CMS announced that Medicare would also cover Lung Cancer Screening using low dose CT. Thus private and public insurers are required to provide Lung Cancer Screening programs using CT to the appropriate population(s). The purpose of this Symposium is to inform medical physicists and prepare them to support the implementation of Lung Screening programs. This Symposium will focus on the clinical aspects of lung cancer screening, requirements of a screening registry for systematically capturing and tracking screening patients and results (such as required Medicare data elements) as well as the role of the medical physicist in screening programs, including the development of low dose CT screening protocols. Learning Objectives: To understand the clinical basis and clinical components of a lung cancer screening program, including eligibility criteria and other requirements. To understand the data collection requirements, workflow, and informatics infrastructure needed to support the tracking and reporting components of a screening program. To understand the role of the medical physicist in

  11. Automated interpretation of PET/CT images in patients with lung cancer

    DEFF Research Database (Denmark)

    Gutte, Henrik; Jakobsson, David; Olofsson, Fredrik

    2007-01-01

    cancer. METHODS: A total of 87 patients who underwent PET/CT examinations due to suspected lung cancer comprised the training group. The test group consisted of PET/CT images from 49 patients suspected with lung cancer. The consensus interpretations by two experienced physicians were used as the 'gold...... method measured as the area under the receiver operating characteristic curve, was 0.97 in the test group, with an accuracy of 92%. The sensitivity was 86% at a specificity of 100%. CONCLUSIONS: A completely automated method using artificial neural networks can be used to detect lung cancer......PURPOSE: To develop a completely automated method based on image processing techniques and artificial neural networks for the interpretation of combined [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) images for the diagnosis and staging of lung...

  12. CT diagnosis of pleural dissemination without pleural effusion in primary lung cancer

    International Nuclear Information System (INIS)

    Murayama, Sadayuki; Murakami, Junji; Yoshimitsu, Kengo; Torii, Yoshikuni; Masuda, Kouji; Ishida, Teruyoshi.

    1996-01-01

    We retrospectively reviewed the CT scans of 25 primary lung cancers with disseminated pleural nodules or minimal malignant pleural effusion that were not recognized preparatively. Special attention was devoted to abutting interlobar fissures, thick major fissures, and disseminated nodules on the chest wall, the diaphragm, and in the interlobar fissures. Among 10 primary tumors abutting interlobar fissures, nine (90%) had at least one of these findings. Among 15 primary lung tumors which did not abut interlobar fissures, four (27%) had at least one of these findings. We conclude that CT is a useful modality for detecting the pleural dissemination of primary lung cancers when primary lung cancers abut interlobar fissures even if no pleural effusion is detectable on CT. (author)

  13. Comparison of distribution of lung aeration measured with EIT and CT in spontaneously breathing, awake patients1.

    Science.gov (United States)

    Radke, Oliver C; Schneider, Thomas; Braune, Anja; Pirracchio, Romain; Fischer, Felix; Koch, Thea

    2016-09-28

    Both Electrical Impedance Tomography (EIT) and Computed Tomography (CT) allow the estimation of the lung area. We compared two algorithms for the detection of the lung area per quadrant from the EIT images with the lung areas derived from the CT images. 39 outpatients who were scheduled for an elective CT scan of the thorax were included in the study. For each patient we recorded EIT images immediately before the CT scan. The lung area per quadrant was estimated from both CT and EIT data using two different algorithms for the EIT data. Data showed considerable variation during spontaneous breathing of the patients. Overall correlation between EIT and CT was poor (0.58-0.77), the correlation between the two EIT algorithms was better (0.90-0.92). Bland-Altmann analysis revealed absence of bias, but wide limits of agreement. Lung area estimation from CT and EIT differs significantly, most probably because of the fundamental difference in image generation.

  14. CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions

    International Nuclear Information System (INIS)

    Li, Y.; Du, Y.; Yang, H.F.; Yu, J.H.; Xu, X.X.

    2013-01-01

    Aim: To assess the accuracy and risk factors for complications of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤20 mm) pulmonary lesions. Materials and methods: A retrospective study was undertaken comprising 169 patients who underwent CT-guided CNB for small (≤20 mm) pulmonary lesions. To assess the accuracy of the procedure, the diagnosis at biopsy was compared with the diagnosis after definitive surgery or clinical follow-up. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables. Results: The overall diagnostic accuracy was 93.5%. The sensitivity for malignancy and specificity for benign lesions were 90.4% and 100%, respectively. Positive and negative predictive values were 100% and 83.3%, respectively. Twenty-five patients (14.8%) had pneumothorax after CT percutaneous CNB of the lung. The significant risk factors affecting the incidence of pneumothorax were lesion–pleural distance (p = 0.008) and needle–pleural angle (p = 0.012). The highest rate of pneumothorax correlated with a lesion–pleural distance ≥21 mm (OR = 18.46; 95%CI: 2.27–149.95) and a needle–pleural angle ≥51° (OR = 8.22; 95%CI: 2.14–31.49). Bleeding occurred in 30 patients (17.8%). The only significant risk factor affecting the incidence of bleeding was lesion–pleural distance (p = 0.011). The highest bleeding rate correlated with a lesion–pleural distance ≥21 mm (OR = 7.93; 95%CI: 1.73–36.43). Conclusion: CT-guided percutaneous CNB of small (≤20 mm) pulmonary lesions provides high diagnostic accuracy with acceptable complications. A lesion–pleural distance of ≥21 mm and needle–pleural angle of ≥51° are identified as the risk factors for highest pneumothorax rate. In addition, the needle–pleural angle is a novel predictor of pneumothorax. A lesion–pleural distance of ≥21 mm is also identified as a risk factor for the highest bleeding rate.

  15. PET/CT imaging in response evaluation of patients with small cell lung cancer

    DEFF Research Database (Denmark)

    Fischer, Barbara M; Mortensen, Jann; Langer, Seppo W

    2006-01-01

    UNLABELLED: There is an increasing amount of evidence on the usability of PET in response evaluation of non-small cell lung cancer. However, data on SCLC is scarce and mainly retrospective. This prospective study assesses the use of PET (positron emission tomography) and PET/CT in response...... evaluation of patients with small cell lung cancer (SCLC). METHODS: Assignment of early and final response was compared between PET, PET/CT, and CT in 20 patients with SCLC. Final response as assigned by CT (RECIST) served as reference. RESULTS: At response evaluation after one cycle of chemotherapy major...... by PET/CT is feasible, but it is uncertain whether it adds further information to evaluation by RECIST, thus further studies and standardization of methods are needed....

  16. The diagnostic value of PET-CT on peripheral lung cancer

    International Nuclear Information System (INIS)

    Li Lebao; Peng Xiang; Ye Hui; Mo Yi; Xie Aimin

    2010-01-01

    Objective: To evaluate the value of PET-CT in the diagnosis of peripheral lung cancer. cancer proved pathology characteristics and standardized uptake value (SUV) of 70 patients with lung cancer proved by pathology were analyzed retrospectively. Results: Of the 70 cases, 32 cases were squamous carcinoma, 25 cases were adenocarcinoma, 8 cases were small cell lung cancer, 3 cases were adenosquamous carcinoma and 2 cases were megacell lung cancer. The average SUV of the lung cancer was 4.94±1.53. In the group of lung cancer, hypermetabolic lesions were found in 66 cases and the SUV was more than 2.5 while the SUV was less than 2.5 in 4 cases. Positive correlation was showed in the SUV and the size of tumors. Conclusions: The peripheral lung cancer has its special imaging appearances of PET-CT. PET-CT is an excellent modality in the diagnosis and differential diagnosis of preipheral lung cancer. The SUV combining with morphological findings sometimes may be helpful for the differential diagnosis. (authors)

  17. CT reconstruction techniques for improved accuracy of lung CT airway measurement

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, A. [Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705 (United States); Ranallo, F. N. [Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705 and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792 (United States); Judy, P. F. [Brigham and Women’s Hospital, Boston, Massachusetts 02115 (United States); Gierada, D. S. [Department of Radiology, Washington University, St. Louis, Missouri 63110 (United States); Fain, S. B., E-mail: sfain@wisc.edu [Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705 (United States); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792 (United States); Department of Biomedical Engineering,University of Wisconsin School of Engineering, Madison, Wisconsin 53706 (United States)

    2014-11-01

    Purpose: To determine the impact of constrained reconstruction techniques on quantitative CT (qCT) of the lung parenchyma and airways for low x-ray radiation dose. Methods: Measurement of small airways with qCT remains a challenge, especially for low x-ray dose protocols. Images of the COPDGene quality assurance phantom (CTP698, The Phantom Laboratory, Salem, NY) were obtained using a GE discovery CT750 HD scanner for helical scans at x-ray radiation dose-equivalents ranging from 1 to 4.12 mSv (12–100 mA s current–time product). Other parameters were 40 mm collimation, 0.984 pitch, 0.5 s rotation, and 0.625 mm thickness. The phantom was sandwiched between 7.5 cm thick water attenuating phantoms for a total length of 20 cm to better simulate the scatter conditions of patient scans. Image data sets were reconstructed using STANDARD (STD), DETAIL, BONE, and EDGE algorithms for filtered back projection (FBP), 100% adaptive statistical iterative reconstruction (ASIR), and Veo reconstructions. Reduced (half) display field of view (DFOV) was used to increase sampling across airway phantom structures. Inner diameter (ID), wall area percent (WA%), and wall thickness (WT) measurements of eight airway mimicking tubes in the phantom, including a 2.5 mm ID (42.6 WA%, 0.4 mm WT), 3 mm ID (49.0 WA%, 0.6 mm WT), and 6 mm ID (49.0 WA%, 1.2 mm WT) were performed with Airway Inspector (Surgical Planning Laboratory, Brigham and Women’s Hospital, Boston, MA) using the phase congruency edge detection method. The average of individual measures at five central slices of the phantom was taken to reduce measurement error. Results: WA% measures were greatly overestimated while IDs were underestimated for the smaller airways, especially for reconstructions at full DFOV (36 cm) using the STD kernel, due to poor sampling and spatial resolution (0.7 mm pixel size). Despite low radiation dose, the ID of the 6 mm ID airway was consistently measured accurately for all methods other than STD

  18. CT reconstruction techniques for improved accuracy of lung CT airway measurement

    International Nuclear Information System (INIS)

    Rodriguez, A.; Ranallo, F. N.; Judy, P. F.; Gierada, D. S.; Fain, S. B.

    2014-01-01

    Purpose: To determine the impact of constrained reconstruction techniques on quantitative CT (qCT) of the lung parenchyma and airways for low x-ray radiation dose. Methods: Measurement of small airways with qCT remains a challenge, especially for low x-ray dose protocols. Images of the COPDGene quality assurance phantom (CTP698, The Phantom Laboratory, Salem, NY) were obtained using a GE discovery CT750 HD scanner for helical scans at x-ray radiation dose-equivalents ranging from 1 to 4.12 mSv (12–100 mA s current–time product). Other parameters were 40 mm collimation, 0.984 pitch, 0.5 s rotation, and 0.625 mm thickness. The phantom was sandwiched between 7.5 cm thick water attenuating phantoms for a total length of 20 cm to better simulate the scatter conditions of patient scans. Image data sets were reconstructed using STANDARD (STD), DETAIL, BONE, and EDGE algorithms for filtered back projection (FBP), 100% adaptive statistical iterative reconstruction (ASIR), and Veo reconstructions. Reduced (half) display field of view (DFOV) was used to increase sampling across airway phantom structures. Inner diameter (ID), wall area percent (WA%), and wall thickness (WT) measurements of eight airway mimicking tubes in the phantom, including a 2.5 mm ID (42.6 WA%, 0.4 mm WT), 3 mm ID (49.0 WA%, 0.6 mm WT), and 6 mm ID (49.0 WA%, 1.2 mm WT) were performed with Airway Inspector (Surgical Planning Laboratory, Brigham and Women’s Hospital, Boston, MA) using the phase congruency edge detection method. The average of individual measures at five central slices of the phantom was taken to reduce measurement error. Results: WA% measures were greatly overestimated while IDs were underestimated for the smaller airways, especially for reconstructions at full DFOV (36 cm) using the STD kernel, due to poor sampling and spatial resolution (0.7 mm pixel size). Despite low radiation dose, the ID of the 6 mm ID airway was consistently measured accurately for all methods other than STD

  19. Pulmonary emphysema is a predictor of pneumothorax after CT-guided transthoracic pulmonary biopsies of pulmonary nodules.

    Science.gov (United States)

    Lendeckel, Derik; Kromrey, Marie-Luise; Ittermann, Till; Schäfer, Sophia; Mensel, Birger; Kühn, Jens-Peter

    2017-01-01

    Pneumothoraces are the most frequently occurring complications of CT-guided percutaneous transthoracic pulmonary biopsies (PTPB). The aim of this study was to evaluate the influence of pre-diagnostic lung emphysema on the incidence and extent of pneumothoraces and to establish a risk stratification for the evaluation of the pre-procedure complication probability. CT-guided PTPB of 100 pre-selected patients (mean age 67.1±12.8 years) were retrospectively enrolled from a single center database of 235 PTPB performed between 2012-2014. Patients were grouped according to pneumothorax appearance directly after PTPB (group I: without pneumothorax, n = 50; group II: with pneumothorax, n = 50). Group II was further divided according to post-interventional treatment (group IIa: chest tube placement, n = 24; group IIb: conservative therapy, n = 26). For each patient pre-diagnostic percentage of emphysema was quantified using CT density analysis. Emphysema stages were compared between groups using bivariate analyses and multinomial logistic regression analyses. Emphysema percentage was significantly associated with the occurrence of post-interventional pneumothorax (p = 0.006). Adjusted for potential confounders (age, gender, lesion size and length of interventional pathway) the study yielded an OR of 1.07 (p = 0.042). Absolute risk of pneumothorax increased from 43.4% at an emphysema rate of 5% to 73.8% at 25%. No differences could be seen in patients with pneumothorax between percentage of emphysema and mode of therapy (p = 0.721). The rate of lung emphysema is proportionally related to the incidence of pneumothorax after CT-guided PTPB and allows pre-interventional risk stratification. There is no association between stage of emphysema and post-interventional requirement of chest tube placement.

  20. Experimental estimation of regional lung water volume by histogram of pulmonary CT numbers

    International Nuclear Information System (INIS)

    Kato, Shiro; Momoki, Shigeru; Asai, Toshihiko; Shimada, Takeshi; Tamano, Masahiro; Nakamoto, Takaaki; Yoshimura, Masaharu

    1989-01-01

    Both in vitro and in vivo experiments were made to assess the ability of pulmonary CT numbers to quantitatively determine regional water volume in cases of pulmonary congestion or edema associated with left heart failure. In vitro experiment revealed a good linear correlation between the volume of injected water and the determined CT number of polyethylene tube packed with sponge. In the subsequent in vivo experiment with 10 adult mongrel dogs, lung water volumes obtained by pulmonary CT numbers were found to be consistent with the actual volumes. Pulmonary CT numbers for water volume proved to become parameters to quantitatively evaluate pulmonary congestion or edema. (Namekawa, K)

  1. Clinical outcome of hypofractionated breath-hold image-guided SABR of primary lung tumors and lung metastases

    International Nuclear Information System (INIS)

    Boda-Heggemann, Judit; Wenz, Frederik; Lohr, Frank; Frauenfeld, Anian; Weiss, Christel; Simeonova, Anna; Neumaier, Christian; Siebenlist, Kerstin; Attenberger, Ulrike; Heußel, Claus Peter; Schneider, Frank

    2014-01-01

    Stereotactic Ablative RadioTherapy (SABR) of lung tumors/metastases has been shown to be an effective treatment modality with low toxicity. Outcome and toxicity were retrospectively evaluated in a unique single-institution cohort treated with intensity-modulated image-guided breath-hold SABR (igSABR) without external immobilization. The dose–response relationship is analyzed based on Biologically Equivalent Dose (BED). 50 lesions in 43 patients with primary NSCLC (n = 27) or lung-metastases of various primaries (n = 16) were consecutively treated with igSABR with Active-Breathing-Coordinator (ABC®) and repeat-breath-hold cone-beam-CT. After an initial dose-finding/-escalation period, 5x12 Gy for peripheral lesions and single doses of 5 Gy to varying dose levels for central lesions were applied. Overall-survival (OS), progression-free-survival (PFS), progression pattern, local control (LC) and toxicity were analyzed. The median BED2 was 83 Gy. 12 lesions were treated with a BED2 of <80 Gy, and 38 lesions with a BED2 of >80 Gy. Median follow-up was 15 months. Actuarial 1- and 2-year OS were 67% and 43%; respectively. Cause of death was non-disease-related in 27%. Actuarial 1- and 2-year PFS was 42% and 28%. Progression site was predominantly distant. Actuarial 1- and 2 year LC was 90% and 85%. LC showed a trend for a correlation to BED2 (p = 0.1167). Pneumonitis requiring conservative treatment occurred in 23%. Intensity-modulated breath-hold igSABR results in high LC-rates and low toxicity in this unfavorable patient cohort with inoperable lung tumors or metastases. A BED2 of <80 Gy was associated with reduced local control

  2. Quantifying lung morphology with respiratory-gated micro-CT in a murine model of emphysema

    Science.gov (United States)

    Ford, N. L.; Martin, E. L.; Lewis, J. F.; Veldhuizen, R. A. W.; Holdsworth, D. W.; Drangova, M.

    2009-04-01

    Non-invasive micro-CT imaging techniques have been developed to investigate lung structure in free-breathing rodents. In this study, we investigate the utility of retrospectively respiratory-gated micro-CT imaging in an emphysema model to determine if anatomical changes could be observed in the image-derived quantitative analysis at two respiratory phases. The emphysema model chosen was a well-characterized, genetically altered model (TIMP-3 knockout mice) that exhibits a homogeneous phenotype. Micro-CT scans of the free-breathing, anaesthetized mice were obtained in 50 s and retrospectively respiratory sorted and reconstructed, providing 3D images representing peak inspiration and end expiration with 0.15 mm isotropic voxel spacing. Anatomical measurements included the volume and CT density of the lungs and the volume of the major airways, along with the diameters of the trachea, left bronchus and right bronchus. From these measurements, functional parameters such as functional residual capacity and tidal volume were calculated. Significant differences between the wild-type and TIMP-3 knockout groups were observed for measurements of CT density over the entire lung, indicating increased air content in the lungs of TIMP-3 knockout mice. These results demonstrate retrospective respiratory-gated micro-CT, providing images at multiple respiratory phases that can be analyzed quantitatively to investigate anatomical changes in murine models of emphysema.

  3. Quantifying lung morphology with respiratory-gated micro-CT in a murine model of emphysema

    International Nuclear Information System (INIS)

    Ford, N L; Martin, E L; Lewis, J F; Veldhuizen, R A W; Holdsworth, D W; Drangova, M

    2009-01-01

    Non-invasive micro-CT imaging techniques have been developed to investigate lung structure in free-breathing rodents. In this study, we investigate the utility of retrospectively respiratory-gated micro-CT imaging in an emphysema model to determine if anatomical changes could be observed in the image-derived quantitative analysis at two respiratory phases. The emphysema model chosen was a well-characterized, genetically altered model (TIMP-3 knockout mice) that exhibits a homogeneous phenotype. Micro-CT scans of the free-breathing, anaesthetized mice were obtained in 50 s and retrospectively respiratory sorted and reconstructed, providing 3D images representing peak inspiration and end expiration with 0.15 mm isotropic voxel spacing. Anatomical measurements included the volume and CT density of the lungs and the volume of the major airways, along with the diameters of the trachea, left bronchus and right bronchus. From these measurements, functional parameters such as functional residual capacity and tidal volume were calculated. Significant differences between the wild-type and TIMP-3 knockout groups were observed for measurements of CT density over the entire lung, indicating increased air content in the lungs of TIMP-3 knockout mice. These results demonstrate retrospective respiratory-gated micro-CT, providing images at multiple respiratory phases that can be analyzed quantitatively to investigate anatomical changes in murine models of emphysema.

  4. Quantifying lung morphology with respiratory-gated micro-CT in a murine model of emphysema

    Energy Technology Data Exchange (ETDEWEB)

    Ford, N L [Department of Physics, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 (Canada); Martin, E L; Lewis, J F; Veldhuizen, R A W [Lawson Health Research Institute, 268 Grosvenor Street, London, Ontario N6A 4V2 (Canada); Holdsworth, D W; Drangova, M [Imaging Research Laboratories, Robarts Research Institute, 100 Perth Drive, PO Box 5015, London, Ontario N6A 5K8 (Canada)], E-mail: nlford@ryerson.ca

    2009-04-07

    Non-invasive micro-CT imaging techniques have been developed to investigate lung structure in free-breathing rodents. In this study, we investigate the utility of retrospectively respiratory-gated micro-CT imaging in an emphysema model to determine if anatomical changes could be observed in the image-derived quantitative analysis at two respiratory phases. The emphysema model chosen was a well-characterized, genetically altered model (TIMP-3 knockout mice) that exhibits a homogeneous phenotype. Micro-CT scans of the free-breathing, anaesthetized mice were obtained in 50 s and retrospectively respiratory sorted and reconstructed, providing 3D images representing peak inspiration and end expiration with 0.15 mm isotropic voxel spacing. Anatomical measurements included the volume and CT density of the lungs and the volume of the major airways, along with the diameters of the trachea, left bronchus and right bronchus. From these measurements, functional parameters such as functional residual capacity and tidal volume were calculated. Significant differences between the wild-type and TIMP-3 knockout groups were observed for measurements of CT density over the entire lung, indicating increased air content in the lungs of TIMP-3 knockout mice. These results demonstrate retrospective respiratory-gated micro-CT, providing images at multiple respiratory phases that can be analyzed quantitatively to investigate anatomical changes in murine models of emphysema.

  5. Early detection of lung cancer from CT images: nodule segmentation and classification using deep learning

    Science.gov (United States)

    Sharma, Manu; Bhatt, Jignesh S.; Joshi, Manjunath V.

    2018-04-01

    Lung cancer is one of the most abundant causes of the cancerous deaths worldwide. It has low survival rate mainly due to the late diagnosis. With the hardware advancements in computed tomography (CT) technology, it is now possible to capture the high resolution images of lung region. However, it needs to be augmented by efficient algorithms to detect the lung cancer in the earlier stages using the acquired CT images. To this end, we propose a two-step algorithm for early detection of lung cancer. Given the CT image, we first extract the patch from the center location of the nodule and segment the lung nodule region. We propose to use Otsu method followed by morphological operations for the segmentation. This step enables accurate segmentation due to the use of data-driven threshold. Unlike other methods, we perform the segmentation without using the complete contour information of the nodule. In the second step, a deep convolutional neural network (CNN) is used for the better classification (malignant or benign) of the nodule present in the segmented patch. Accurate segmentation of even a tiny nodule followed by better classification using deep CNN enables the early detection of lung cancer. Experiments have been conducted using 6306 CT images of LIDC-IDRI database. We achieved the test accuracy of 84.13%, with the sensitivity and specificity of 91.69% and 73.16%, respectively, clearly outperforming the state-of-the-art algorithms.

  6. Establishment of an orthotopic lung cancer model in nude mice and its evaluation by spiral CT.

    Science.gov (United States)

    Liu, Xiang; Liu, Jun; Guan, Yubao; Li, Huiling; Huang, Liyan; Tang, Hailing; He, Jianxing

    2012-04-01

    To establish a simple and highly efficient orthotopic animal model of lung cancer cell line A549 and evaluate the growth pattern of intrathoracic tumors by spiral CT. A549 cells (5×10(6) mL(-1)) were suspended and inoculated into the right lung of BALB/c nude mice via intrathoracic injection. Nude mice were scanned three times each week by spiral CT after inoculation of lung cancer cell line A549. The survival time and body weight of nude mice as well as tumor invasion and metastasis were examined. Tissue was collected for subsequent histological assay after autopsia of mice. The tumor-forming rate of the orthotopic lung cancer model was 90%. The median survival time was 30.7 (range, 20-41) days. The incidence of tumor metastasis was 100%. The mean tumor diameter and the average CT value gradually increased in a time-dependent manner. The method of establishing the orthotopic lung cancer model through transplanting A549 cells into the lung of nude mice is simple and highly successful. Spiral CT can be used to evaluate intrathoracic tumor growth in nude mice vividly and dynamically.

  7. Comparison of measured and estimated maximum skin doses during CT fluoroscopy lung biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Zanca, F., E-mail: Federica.Zanca@med.kuleuven.be [Department of Radiology, Leuven University Center of Medical Physics in Radiology, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium and Imaging and Pathology Department, UZ Leuven, Herestraat 49, Box 7003 3000 Leuven (Belgium); Jacobs, A. [Department of Radiology, Leuven University Center of Medical Physics in Radiology, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium); Crijns, W. [Department of Radiotherapy, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium); De Wever, W. [Imaging and Pathology Department, UZ Leuven, Herestraat 49, Box 7003 3000 Leuven, Belgium and Department of Radiology, UZ Leuven, Herestraat 49, 3000 Leuven (Belgium)

    2014-07-15

    Purpose: To measure patient-specific maximum skin dose (MSD) associated with CT fluoroscopy (CTF) lung biopsies and to compare measured MSD with the MSD estimated from phantom measurements, as well as with the CTDIvol of patient examinations. Methods: Data from 50 patients with lung lesions who underwent a CT fluoroscopy-guided biopsy were collected. The CT protocol consisted of a low-kilovoltage (80 kV) protocol used in combination with an algorithm for dose reduction to the radiology staff during the interventional procedure, HandCare (HC). MSD was assessed during each intervention using EBT2 gafchromic films positioned on patient skin. Lesion size, position, total fluoroscopy time, and patient-effective diameter were registered for each patient. Dose rates were also estimated at the surface of a normal-size anthropomorphic thorax phantom using a 10 cm pencil ionization chamber placed at every 30°, for a full rotation, with and without HC. Measured MSD was compared with MSD values estimated from the phantom measurements and with the cumulative CTDIvol of the procedure. Results: The median measured MSD was 141 mGy (range 38–410 mGy) while the median cumulative CTDIvol was 72 mGy (range 24–262 mGy). The ratio between the MSD estimated from phantom measurements and the measured MSD was 0.87 (range 0.12–4.1) on average. In 72% of cases the estimated MSD underestimated the measured MSD, while in 28% of the cases it overestimated it. The same trend was observed for the ratio of cumulative CTDIvol and measured MSD. No trend was observed as a function of patient size. Conclusions: On average, estimated MSD from dose rate measurements on phantom as well as from CTDIvol of patient examinations underestimates the measured value of MSD. This can be attributed to deviations of the patient's body habitus from the standard phantom size and to patient positioning in the gantry during the procedure.

  8. Comparison of measured and estimated maximum skin doses during CT fluoroscopy lung biopsies

    International Nuclear Information System (INIS)

    Zanca, F.; Jacobs, A.; Crijns, W.; De Wever, W.

    2014-01-01

    Purpose: To measure patient-specific maximum skin dose (MSD) associated with CT fluoroscopy (CTF) lung biopsies and to compare measured MSD with the MSD estimated from phantom measurements, as well as with the CTDIvol of patient examinations. Methods: Data from 50 patients with lung lesions who underwent a CT fluoroscopy-guided biopsy were collected. The CT protocol consisted of a low-kilovoltage (80 kV) protocol used in combination with an algorithm for dose reduction to the radiology staff during the interventional procedure, HandCare (HC). MSD was assessed during each intervention using EBT2 gafchromic films positioned on patient skin. Lesion size, position, total fluoroscopy time, and patient-effective diameter were registered for each patient. Dose rates were also estimated at the surface of a normal-size anthropomorphic thorax phantom using a 10 cm pencil ionization chamber placed at every 30°, for a full rotation, with and without HC. Measured MSD was compared with MSD values estimated from the phantom measurements and with the cumulative CTDIvol of the procedure. Results: The median measured MSD was 141 mGy (range 38–410 mGy) while the median cumulative CTDIvol was 72 mGy (range 24–262 mGy). The ratio between the MSD estimated from phantom measurements and the measured MSD was 0.87 (range 0.12–4.1) on average. In 72% of cases the estimated MSD underestimated the measured MSD, while in 28% of the cases it overestimated it. The same trend was observed for the ratio of cumulative CTDIvol and measured MSD. No trend was observed as a function of patient size. Conclusions: On average, estimated MSD from dose rate measurements on phantom as well as from CTDIvol of patient examinations underestimates the measured value of MSD. This can be attributed to deviations of the patient's body habitus from the standard phantom size and to patient positioning in the gantry during the procedure

  9. SPECT/CT of lung nodules using 111In-DOTA-c(RGDfK) in a mouse lung carcinogenesis model.

    Science.gov (United States)

    Hayakawa, Takuya; Mutoh, Michihiro; Imai, Toshio; Tsuta, Koji; Yanaka, Akinori; Fujii, Hirofumi; Yoshimoto, Mitsuyoshi

    2013-08-01

    Lung cancer is one of the leading causes of cancer-related deaths worldwide, including Japan. Although computed tomography (CT) can detect small lung lesions such as those appearing as ground glass opacity, it cannot differentiate between malignant and non-malignant lesions. Previously, we have shown that single photon emission computed tomography (SPECT) imaging using (111)In-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid-cyclo-(Arg-Gly-Asp-D-Phe-Lys) (DOTA-c(RGDfK)), an imaging probe of αvβ3 integrin, is useful for the early detection of pancreatic cancer in a hamster pancreatic carcinogenesis model. In this study, we aimed to assess the usefulness of SPECT/CT with (111)In-DOTA-c(RGDfK) for the evaluation of the malignancy of lung cancer. Lung tumors were induced by a single intraperitoneal injection (250 mg/kg) of urethane in male A/J mice. Twenty-six weeks after the urethane treatment, SPECT was performed an hour after injection of (111)In-DOTA-c(RGDfK). Following this, the radioactivity ratios of tumor to normal lung tissue were measured by autoradiography (ARG) in the excised lung samples. We also examined the expression of αvβ3 integrin in mouse and human lung samples. Urethane treatment induced 5 hyperplasias, 41 adenomas and 12 adenocarcinomas in the lungs of 8 A/J mice. SPECT with (111)In-DOTA-c(RGDfK) could clearly visualize lung nodules, though we failed to detect small lung nodules like adenoma and hyperplasias (adenocarcinoma: 66.7%, adenoma: 33.6%, hyperplasia: 0.0%). ARG analysis revealed significant uptake of (111)In-DOTA-c(RGDfK) in all the lesions. Moreover, tumor to normal lung tissue ratios increased along with the progression of carcinogenesis. Histopathological examination using human lung tissue samples revealed clear up-regulation of αvβ3 integrin in well-differentiated adenocarcinoma (Noguchi type B and C) rather than atypical adenomatous hyperplasia. Although there are some limitations in evaluating the malignancy of

  10. Current concepts in F18 FDG PET/CT-based Radiation Therapy planning for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Percy eLee

    2012-07-01

    Full Text Available Radiation therapy is an important component of cancer therapy for early stage as well as locally advanced lung cancer. The use of F18 FDG PET/CT has come to the forefront of lung cancer staging and overall treatment decision-making. FDG PET/CT parameters such as standard uptake value and metabolic tumor volume provide important prognostic and predictive information in lung cancer. Importantly, FDG PET/CT for radiation planning has added biological information in defining the gross tumor volume as well as involved nodal disease. For example, accurate target delineation between tumor and atelectasis is facilitated by utilizing PET and CT imaging. Furthermore, there has been meaningful progress in incorporating metabolic information from FDG PET/CT imaging in radiation treatment planning strategies such as radiation dose escalation based on standard uptake value thresholds as well as using respiratory gated PET and CT planning for improved target delineation of moving targets. In addition, PET/CT based follow-up after radiation therapy has provided the possibility of early detection of local as well as distant recurrences after treatment. More research is needed to incorporate other biomarkers such as proliferative and hypoxia biomarkers in PET as well as integrating metabolic information in adaptive, patient-centered, tailored radiation therapy.

  11. A method for smoothing segmented lung boundary in chest CT images

    Science.gov (United States)

    Yim, Yeny; Hong, Helen

    2007-03-01

    To segment low density lung regions in chest CT images, most of methods use the difference in gray-level value of pixels. However, radiodense pulmonary vessels and pleural nodules that contact with the surrounding anatomy are often excluded from the segmentation result. To smooth lung boundary segmented by gray-level processing in chest CT images, we propose a new method using scan line search. Our method consists of three main steps. First, lung boundary is extracted by our automatic segmentation method. Second, segmented lung contour is smoothed in each axial CT slice. We propose a scan line search to track the points on lung contour and find rapidly changing curvature efficiently. Finally, to provide consistent appearance between lung contours in adjacent axial slices, 2D closing in coronal plane is applied within pre-defined subvolume. Our method has been applied for performance evaluation with the aspects of visual inspection, accuracy and processing time. The results of our method show that the smoothness of lung contour was considerably increased by compensating for pulmonary vessels and pleural nodules.

  12. Detection and Severity Scoring of Chronic Obstructive Pulmonary Disease Using Volumetric Analysis of Lung CT Images

    International Nuclear Information System (INIS)

    Hosseini, Mohammad Parsa; Soltanian-Zadeh, Hamid; Akhlaghpoor, Shahram

    2012-01-01

    Chronic obstructive pulmonary disease (COPD) is a devastating disease.While there is no cure for COPD and the lung damage associated with this disease cannot be reversed, it is still very important to diagnose it as early as possible. In this paper, we propose a novel method based on the measurement of air trapping in the lungs from CT images to detect COPD and to evaluate its severity. Twenty-five patients and twelve normal adults were included in this study. The proposed method found volumetric changes of the lungs from inspiration to expiration. To this end, trachea CT images at full inspiration and expiration were compared and changes in the areas and volumes of the lungs between inspiration and expiration were used to define quantitative measures (features). Using these features,the subjects were classified into two groups of normal and COPD patients using a Bayesian classifier. In addition, t-tests were applied to evaluate discrimination powers of the features for this classification. For the cases studied, the proposed method estimated air trapping in the lungs from CT images without human intervention. Based on the results, a mathematical model was developed to relate variations of lung volumes to the severity of the disease. As a computer aided diagnosis (CAD) system, the proposed method may assist radiologists in the detection of COPD. It quantifies air trapping in the lungs and thus may assist them with the scoring of the disease by quantifying the severity of the disease

  13. Lung cancer screening with thoracic X-ray and CT. Current situation; Lungenkarzinomscreening mit Roentgenthorax oder CT. Aktuelle Datenlage

    Energy Technology Data Exchange (ETDEWEB)

    Stackelberg, O. von; Kauczor, H.U. [Universitaetsklinikum Heidelberg, Diagnostische und Interventionelle Radiologe, Heidelberg (Germany); Translationales Lungen Forschungszentrum Heidelberg (TLRC), Mitglied des Deutschen Zentrums fuer Lungenforschung (DZL), Heidelberg (Germany)

    2016-09-15

    Attempts at the early detection of lung cancer using imaging methods began as far back as the 1950s. Several studies attempted to demonstrate a reduction of lung cancer mortality by chest radiography screening but all were unsuccessful. Even the first small screening studies using computed tomography (CT) could not demonstrate a reduction in lung cancer-specific mortality until in 2011 the results of the largest randomized controlled low-dose CT screening study in the USA (NLST) were published. The NLST results could show a significant 20 % reduction of lung cancer mortality in elderly and heavy smokers using CT. Confirmation of the NLST results are urgently needed so that the data of the largest European study (NELSON) are eagerly awaited. Pooled with the data from several smaller European studies these results will provide important information and evidence for the establishment of future CT screening programs in Europe. Randomized controlled trials are the basis of evidence-based medicine; therefore, the positive results of the methodologically very good NLST study cannot be ignored, even if it is the only such study completed so far with highly convincing conclusions. The NLST results clearly demonstrate that positive effects for the health of the population can only be expected if the processes are clearly defined and the quality is assured. (orig.) [German] Bestrebungen zur Frueherkennung von Lungenkrebs mit bildgebenden Methoden gibt es schon lange. Alle Studien, die eine Reduktion der Lungenkrebsmortalitaet mittels Roentgenthoraxscreening nachzuweisen versuchten, scheiterten. Auch die ersten kleineren Screeningstudien mit der CT konnten keine Reduktion der Lungenkrebssterblichkeit nachweisen, bis 2011 die Ergebnisse der bisher groessten randomisierten kontrollierten Niedrigdosis-CT-Screeningstudie (NLST) aus den USA veroeffentlicht wurden. Diese konnten eine signifikante 20 %ige Reduktion der Lungenkrebssterblichkeit bei Personen, die aelter und starke

  14. Activity-based cost analysis of hepatic tumor ablation using CT-guided high-dose rate brachytherapy or CT-guided radiofrequency ablation in hepatocellular carcinoma.

    Science.gov (United States)

    Schnapauff, D; Collettini, F; Steffen, I; Wieners, G; Hamm, B; Gebauer, B; Maurer, M H

    2016-02-25

    To analyse and compare the costs of hepatic tumor ablation with computed tomography (CT)-guided high-dose rate brachytherapy (CT-HDRBT) and CT-guided radiofrequency ablation (CT-RFA) as two alternative minimally invasive treatment options of hepatocellular carcinoma (HCC). An activity based process model was created determining working steps and required staff of CT-RFA and CT-HDRBT. Prorated costs of equipment use (purchase, depreciation, and maintenance), costs of staff, and expenditure for disposables were identified in a sample of 20 patients (10 treated by CT-RFA and 10 by CT-HDRBT) and compared. A sensitivity and break even analysis was performed to analyse the dependence of costs on the number of patients treated annually with both methods. Costs of CT-RFA were nearly stable with mean overall costs of approximately 1909 €, 1847 €, 1816 € and 1801 € per patient when treating 25, 50, 100 or 200 patients annually, as the main factor influencing the costs of this procedure was the single-use RFA probe. Mean costs of CT-HDRBT decreased significantly per patient ablation with a rising number of patients treated annually, with prorated costs of 3442 €, 1962 €, 1222 € and 852 € when treating 25, 50, 100 or 200 patients, due to low costs of single-use disposables compared to high annual fix-costs which proportionally decreased per patient with a higher number of patients treated annually. A break-even between both methods was reached when treating at least 55 patients annually. Although CT-HDRBT is a more complex procedure with more staff involved, it can be performed at lower costs per patient from the perspective of the medical provider when treating more than 55 patients compared to CT-RFA, mainly due to lower costs for disposables and a decreasing percentage of fixed costs with an increasing number of treatments.

  15. Optimization of CT image reconstruction algorithms for the lung tissue research consortium (LTRC)

    Science.gov (United States)

    McCollough, Cynthia; Zhang, Jie; Bruesewitz, Michael; Bartholmai, Brian

    2006-03-01

    To create a repository of clinical data, CT images and tissue samples and to more clearly understand the pathogenetic features of pulmonary fibrosis and emphysema, the National Heart, Lung, and Blood Institute (NHLBI) launched a cooperative effort known as the Lung Tissue Resource Consortium (LTRC). The CT images for the LTRC effort must contain accurate CT numbers in order to characterize tissues, and must have high-spatial resolution to show fine anatomic structures. This study was performed to optimize the CT image reconstruction algorithms to achieve these criteria. Quantitative analyses of phantom and clinical images were conducted. The ACR CT accreditation phantom containing five regions of distinct CT attenuations (CT numbers of approximately -1000 HU, -80 HU, 0 HU, 130 HU and 900 HU), and a high-contrast spatial resolution test pattern, was scanned using CT systems from two manufacturers (General Electric (GE) Healthcare and Siemens Medical Solutions). Phantom images were reconstructed using all relevant reconstruction algorithms. Mean CT numbers and image noise (standard deviation) were measured and compared for the five materials. Clinical high-resolution chest CT images acquired on a GE CT system for a patient with diffuse lung disease were reconstructed using BONE and STANDARD algorithms and evaluated by a thoracic radiologist in terms of image quality and disease extent. The clinical BONE images were processed with a 3 x 3 x 3 median filter to simulate a thicker slice reconstructed in smoother algorithms, which have traditionally been proven to provide an accurate estimation of emphysema extent in the lungs. Using a threshold technique, the volume of emphysema (defined as the percentage of lung voxels having a CT number lower than -950 HU) was computed for the STANDARD, BONE, and BONE filtered. The CT numbers measured in the ACR CT Phantom images were accurate for all reconstruction kernels for both manufacturers. As expected, visual evaluation of the

  16. PET/CT-guided interventional procedures: rationale, justification, initial study, and research plan

    Energy Technology Data Exchange (ETDEWEB)

    Wong, K.; Rahill, J.; Cleary, K. [Computer Aided Interventions and Medical Robotics (CAIMR), Imaging Science and Information Systems (ISIS) Center, Georgetown Univ. Medical Center, Washington, DC (United States); Petrillo, S.; Earl-Graef, D. [Dept. of Radiology, Georgetown Univ. Hospital, MedStar Health, Washington, DC (United States); Banovac, F.; Levy, E. [Computer Aided Interventions and Medical Robotics (CAIMR), Imaging Science and Information Systems (ISIS) Center, Georgetown Univ. Medical Center, Washington, DC (United States); Dept. of Radiology, Georgetown Univ. Hospital, MedStar Health, Washington, DC (United States); Shekhar, R. [Dept. of Radiology, Univ. of Maryland Medical Center, Baltimore, MD (United States)

    2007-06-15

    Positron-emission tomography (PET) and PET/CT (computed tomography) are becoming increasingly important for diagnosis and treatment of cancer. Clinically relevant changes can sometimes be seen on PET that are not seen on other imaging modalities. However, PET is not suitable for guiding biopsy as the images are not obtained in real-time. Therefore, our research group has begun developing a concept for PET/CT-guided interventional procedures. This paper presents the rationale for this concept, outlines our research plan, and includes an initial study to evaluate the relative sensitivity of CT and PET/CT in detecting suspicious lesions. (orig.)

  17. Hypofractionated radiotherapy for lung tumors with online cone beam CT guidance and active breathing control

    Directory of Open Access Journals (Sweden)

    Wang Xin

    2010-02-01

    Full Text Available Abstract Background To study the set-up errors, PTV margin and toxicity of cone beam CT (CBCT guided hypofractionated radiotherapy with active breathing control (ABC for patients with non-small cell lung cancer (NSCLC or metastatic tumors in lung. Methods 32 tumors in 20 patients were treated. Based on the location of tumor, dose per fraction given to tumor was divided into three groups: 12 Gy, 8 Gy and 6 Gy. ABC is applied for every patient. During each treatment, patients receive CBCT scan for online set-up correction. The pre- and post-correction setup errors between fractions, the interfractional and intrafractional, set-up errors, PTV margin as well as toxicity are analyzed. Results The pre-correction systematic and random errors in the left-right (LR, superior-inferior (SI, anterior-posterior (AP directions were 3.7 mm and 5.3 mm, 3.1 mm and 2.1 mm, 3.7 mm and 2.8 mm, respectively, while the post-correction residual errors were 0.6 mm and 0.8 mm, 0.8 mm and 0.8 mm, 1.2 mm and 1.3 mm, respectively. There was an obvious intrafractional shift of tumor position. The pre-correction PTV margin was 9.5 mm in LR, 14.1 mm in SI and 8.2 mm in AP direction. After CBCT guided online correction, the PTV margin was markedly reduced in all three directions. The post-correction margins ranged 1.5 to 2.1 mm. The treatment was well tolerated by patients, of whom there were 4 (20% grade1-2 acute pneumonitis, 3 (15% grade1 acute esophagitis, 2 (10% grade1 late pneumonitis and 1 (5% grade 1 late esophagitis. Conclusion The positioning errors for lung SBRT using ABC were significant. Online correction with CBCT image guidance should be applied to reduce setup errors and PTV margin, which may reduce radiotherapy toxicity of tissues when ABC was used.

  18. Hypofractionated radiotherapy for lung tumors with online cone beam CT guidance and active breathing control

    Science.gov (United States)

    2010-01-01

    Background To study the set-up errors, PTV margin and toxicity of cone beam CT (CBCT) guided hypofractionated radiotherapy with active breathing control (ABC) for patients with non-small cell lung cancer (NSCLC) or metastatic tumors in lung. Methods 32 tumors in 20 patients were treated. Based on the location of tumor, dose per fraction given to tumor was divided into three groups: 12 Gy, 8 Gy and 6 Gy. ABC is applied for every patient. During each treatment, patients receive CBCT scan for online set-up correction. The pre- and post-correction setup errors between fractions, the interfractional and intrafractional, set-up errors, PTV margin as well as toxicity are analyzed. Results The pre-correction systematic and random errors in the left-right (LR), superior-inferior (SI), anterior-posterior (AP) directions were 3.7 mm and 5.3 mm, 3.1 mm and 2.1 mm, 3.7 mm and 2.8 mm, respectively, while the post-correction residual errors were 0.6 mm and 0.8 mm, 0.8 mm and 0.8 mm, 1.2 mm and 1.3 mm, respectively. There was an obvious intrafractional shift of tumor position. The pre-correction PTV margin was 9.5 mm in LR, 14.1 mm in SI and 8.2 mm in AP direction. After CBCT guided online correction, the PTV margin was markedly reduced in all three directions. The post-correction margins ranged 1.5 to 2.1 mm. The treatment was well tolerated by patients, of whom there were 4 (20%) grade1-2 acute pneumonitis, 3 (15%) grade1 acute esophagitis, 2 (10%) grade1 late pneumonitis and 1 (5%) grade 1 late esophagitis. Conclusion The positioning errors for lung SBRT using ABC were significant. Online correction with CBCT image guidance should be applied to reduce setup errors and PTV margin, which may reduce radiotherapy toxicity of tissues when ABC was used. PMID:20187962

  19. Hypofractionated radiotherapy for lung tumors with online cone beam CT guidance and active breathing control

    International Nuclear Information System (INIS)

    Shen, Yali; Zhang, Hong; Wang, Jin; Zhong, Renming; Jiang, Xiaoqing; Xu, Qinfeng; Wang, Xin; Bai, Sen; Xu, Feng

    2010-01-01

    To study the set-up errors, PTV margin and toxicity of cone beam CT (CBCT) guided hypofractionated radiotherapy with active breathing control (ABC) for patients with non-small cell lung cancer (NSCLC) or metastatic tumors in lung. 32 tumors in 20 patients were treated. Based on the location of tumor, dose per fraction given to tumor was divided into three groups: 12 Gy, 8 Gy and 6 Gy. ABC is applied for every patient. During each treatment, patients receive CBCT scan for online set-up correction. The pre- and post-correction setup errors between fractions, the interfractional and intrafractional, set-up errors, PTV margin as well as toxicity are analyzed. The pre-correction systematic and random errors in the left-right (LR), superior-inferior (SI), anterior-posterior (AP) directions were 3.7 mm and 5.3 mm, 3.1 mm and 2.1 mm, 3.7 mm and 2.8 mm, respectively, while the post-correction residual errors were 0.6 mm and 0.8 mm, 0.8 mm and 0.8 mm, 1.2 mm and 1.3 mm, respectively. There was an obvious intrafractional shift of tumor position. The pre-correction PTV margin was 9.5 mm in LR, 14.1 mm in SI and 8.2 mm in AP direction. After CBCT guided online correction, the PTV margin was markedly reduced in all three directions. The post-correction margins ranged 1.5 to 2.1 mm. The treatment was well tolerated by patients, of whom there were 4 (20%) grade1-2 acute pneumonitis, 3 (15%) grade1 acute esophagitis, 2 (10%) grade1 late pneumonitis and 1 (5%) grade 1 late esophagitis. The positioning errors for lung SBRT using ABC were significant. Online correction with CBCT image guidance should be applied to reduce setup errors and PTV margin, which may reduce radiotherapy toxicity of tissues when ABC was used

  20. PET/CT in therapy evaluation of patients with lung cancer

    DEFF Research Database (Denmark)

    Langer, Natasha Hemicke; Christensen, Tine Nøhr; Langer, Seppo W

    2014-01-01

    FDG-PET/CT is a well documented and widespread used imaging modality for the diagnosis and staging of patient with lung cancer. FDG-PET/CT is increasingly used for the assessment of treatment effects during and after chemotherapy. However, PET is not an accepted surrogate end-point for assessment...... of response rate in clinical trials. The aim of this review is to present current evidence on the use of PET in response evaluation of patients with lung cancer and to introduce the pearls and pitfalls of the PET-technology relating to response assessment. Based on this and relating to validation criteria......, including stable technology, standardization, reproducibility and broad availability, the review discusses why, despite numerous studies on response assessment indicating a possible role for FDG-PET/CT, PET still has no place in guidelines relating to response evaluation in lung cancer....

  1. Clinical application of percutaneous needling lung abscess drairnage under CT guidance

    International Nuclear Information System (INIS)

    Hu Xiaokun; Wang Mingyou; Li Chenjun; Lv Dongfang; Li Xiaodong; Yu Zhaocun

    2004-01-01

    Objective: To discuss the clinical application of drainage for lung abscess by needle puncture under CT guidance. Methods: 18 cases of lung abscess were drainaged by needle puncture under CT guidance, including direct aspiration by puncture needle 1-3 times (n=8) and retaining drainage tube continuously (n=10). Results: 17 cases with this procedure were succeeded possessing success rate of 94.7%(17/18). The patients were followed up for 11-35 days with symptom relieving better obviously and the focus shrinkage or disappeared (n=16), the curative rate reached 88.9%(16/18). The main complication was pneumothorax with capacities of 30%(n=1). Conclusions: The curative course of lung abscess can be shortened greatly by percutaneous needling drainage under CT guidance with mild trauma. The procedure is simple with high successful rate and less complication. (authors)

  2. CT-guided percutaneous aspiration and drainage of postoperative abdominal fluid collections

    International Nuclear Information System (INIS)

    Marano, I.; Mainenti, P.P.; Selva, G.; Cannavale, M.; Sodano, A.

    1999-01-01

    The authors report the personal techniques and the results of CT-guided percutaneous drainage of postoperative abdominal fluid collections. CT-guided percutaneous drainage offers many advantages over surgery: it is less invasive, can be repeated and requires no anesthesia, there are not surgery-related risks and lower morbidity and mortality rates. Moreover, subsequent hospitalization is shorter and costs are consequently reduced. The authors conclude that CT-guided percutaneous drainage is the method of choice in the treatment of postoperative abdominal fluid collections [it

  3. CT guided celiac plexus and splanchnic nerve neurolysis : the modified anterior approach

    International Nuclear Information System (INIS)

    Lee, Jeong Min; Lee, Mi Suk; Ym, Seong Hee; Lee, Jin Hee

    1997-01-01

    Since it was first described by Kappis, celiac plexus neurolysis (CPN) has been performed under fluoroscopic guidance by anesthetists or surgeons for the relief of intractable pain caused by upper abdominal malignancy. Recently, however, several groups have reported a computed tomography (CT)-guided technique that increased the safety of the blocking procedure and improved its results. The authors present a new technique CT-guided celiac plexus and splanchic nerve block, to be used simultaneously with a modified anterior approach. Using CT to guide needle tip placement, an anterior approach that permitted direct neurolysis of the celiac ganglia and splanchnic nerve was developed

  4. Smartphone-Guided Needle Angle Selection During CT-Guided Procedures.

    Science.gov (United States)

    Xu, Sheng; Krishnasamy, Venkatesh; Levy, Elliot; Li, Ming; Tse, Zion Tsz Ho; Wood, Bradford John

    2018-01-01

    In CT-guided intervention, translation from a planned needle insertion angle to the actual insertion angle is estimated only with the physician's visuospatial abilities. An iPhone app was developed to reduce reliance on operator ability to estimate and reproduce angles. The iPhone app overlays the planned angle on the smartphone's camera display in real-time based on the smartphone's orientation. The needle's angle is selected by visually comparing the actual needle with the guideline in the display. If the smartphone's screen is perpendicular to the planned path, the smartphone shows the Bull's-Eye View mode, in which the angle is selected after the needle's hub overlaps the tip in the camera. In phantom studies, we evaluated the accuracies of the hardware, the Guideline mode, and the Bull's-Eye View mode and showed the app's clinical efficacy. A proof-of-concept clinical case was also performed. The hardware accuracy was 0.37° ± 0.27° (mean ± SD). The mean error and navigation time were 1.0° ± 0.9° and 8.7 ± 2.3 seconds for a senior radiologist with 25 years' experience and 1.5° ± 1.3° and 8.0 ± 1.6 seconds for a junior radiologist with 4 years' experience. The accuracy of the Bull's-Eye View mode was 2.9° ± 1.1°. Combined CT and smart-phone guidance was significantly more accurate than CT-only guidance for the first needle pass (p = 0.046), which led to a smaller final targeting error (mean distance from needle tip to target, 2.5 vs 7.9 mm). Mobile devices can be useful for guiding needle-based interventions. The hardware is low cost and widely available. The method is accurate, effective, and easy to implement.

  5. CT fluoroscopy-guided core needle biopsy of anterior mediastinal masses.

    Science.gov (United States)

    Iguchi, T; Hiraki, T; Matsui, Y; Fujiwara, H; Sakurai, J; Masaoka, Y; Uka, M; Tanaka, T; Gobara, H; Kanazawa, S

    2018-02-01

    To retrospectively evaluate the safety, diagnostic yield, and risk factors of diagnostic failure of computed tomography (CT) fluoroscopy-guided biopsies of anterior mediastinal masses. Biopsy procedures and results of anterior mediastinal masses in 71 patients (32 women/39 men; mean [±standard deviation] age, 53.8±20.0years; range, 14-88years) were analyzed. Final diagnoses were based on surgical outcomes, imaging findings, or clinical follow-up findings. The biopsy results were compared with the final diagnosis, and the biopsy procedures grouped by pathologic findings into diagnostic success and failure groups. Multiple putative risk factors for diagnostic failure were then assessed. Seventy-one biopsies (71 masses; mean size, 67.5±27.3mm; range 8.6-128.2mm) were analyzed. We identified 17 grade 1 and one grade 2 adverse events (25.4% overall) according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Sixty-nine biopsies (97.2%) provided samples fit for pathologic analysis. Diagnostic failure was found for eight (11.3%) masses; the 63 masses diagnosed successfully included thymic carcinoma (n=17), lung cancer (n=14), thymoma (n=12), malignant lymphoma (n=11), germ cell tumor (n=3), and others (n=6). Using a thinner needle (i.e., a 20-gauge needle) was the sole significant risk factor for diagnostic failure (P=0.039). CT fluoroscopy-guided biopsy of anterior mediastinal masses was safe and had a high diagnostic yield; however, using a thinner biopsy needle significantly increased the risk of a failed diagnosis. Copyright © 2017 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  6. Automated lung nodule classification following automated nodule detection on CT: A serial approach

    International Nuclear Information System (INIS)

    Armato, Samuel G. III; Altman, Michael B.; Wilkie, Joel; Sone, Shusuke; Li, Feng; Doi, Kunio; Roy, Arunabha S.

    2003-01-01

    We have evaluated the performance of an automated classifier applied to the task of differentiating malignant and benign lung nodules in low-dose helical computed tomography (CT) scans acquired as part of a lung cancer screening program. The nodules classified in this manner were initially identified by our automated lung nodule detection method, so that the output of automated lung nodule detection was used as input to automated lung nodule classification. This study begins to narrow the distinction between the 'detection task' and the 'classification task'. Automated lung nodule detection is based on two- and three-dimensional analyses of the CT image data. Gray-level-thresholding techniques are used to identify initial lung nodule candidates, for which morphological and gray-level features are computed. A rule-based approach is applied to reduce the number of nodule candidates that correspond to non-nodules, and the features of remaining candidates are merged through linear discriminant analysis to obtain final detection results. Automated lung nodule classification merges the features of the lung nodule candidates identified by the detection algorithm that correspond to actual nodules through another linear discriminant classifier to distinguish between malignant and benign nodules. The automated classification method was applied to the computerized detection results obtained from a database of 393 low-dose thoracic CT scans containing 470 confirmed lung nodules (69 malignant and 401 benign nodules). Receiver operating characteristic (ROC) analysis was used to evaluate the ability of the classifier to differentiate between nodule candidates that correspond to malignant nodules and nodule candidates that correspond to benign lesions. The area under the ROC curve for this classification task attained a value of 0.79 during a leave-one-out evaluation

  7. Cerebral metastases from lung carcinoma: neurological and CT correlation: work in progress

    International Nuclear Information System (INIS)

    Tarver, R.D.; Richmond, B.D.; Klatte, E.C.

    1984-01-01

    To determine the role of brain CT in neurologically asymptomatic lung cancer patients a review was made of the CT and clinical findings in 279 patients. Brain metastases were found in 94.5% of patients with specific abnormal neurological findings, 26.6% of patients with vague neurological signs and symptoms, 11% of patients with oat cell carcinoma and a normal neurological examination, and 40% of patients with adenocarcinoma and a normal neurological examination. Brain metastasis was not seen on CT in the 29 patients with squamous cell carcinoma and a normal neurological examination. It is concluded that brain CT is useful for the detection of occult brain metastases, particularly oat cell carcinoma and adenocarcinoma, in neurologically asymptomatic lung cancer patients

  8. Smoking habits in the randomised Danish Lung Cancer Screening Trial with low-dose CT

    DEFF Research Database (Denmark)

    Ashraf, Haseem; Saghir, Zaigham; Dirksen, Asger

    2014-01-01

    BACKGROUND: We present the final results of the effect of lung cancer screening with low-dose CT on the smoking habits of participants in a 5-year screening trial. METHODS: The Danish Lung Cancer Screening Trial (DLCST) was a 5-year screening trial that enrolled 4104 subjects; 2052 were randomised...... to annual low-dose CT (CT group) and 2052 received no intervention (control group). Participants were current and ex-smokers (≥4 weeks abstinence from smoking) with a tobacco consumption of ≥20 pack years. Smoking habits were determined annually. Missing values for smoking status at the final screening...... round were handled using two different models. RESULTS: There were no statistically significant differences in annual smoking status between the CT group and control group. Overall the ex-smoker rates (CT + control group) significantly increased from 24% (baseline) to 37% at year 5 of screening (p

  9. The percutaneous interventional therapy of lung abscess and pyothorax under the CT guidance

    International Nuclear Information System (INIS)

    Gao Xinghan; Zhu Zhenfang; Lv Fanzhen; Yan Dejun; Su Baomin

    2003-01-01

    Objective: To study the indication, the procedure, the necessity and feasibility of the percutaneous interventional therapy of lung abscess and pyothorax under the CT guidance. Methods: The group included 18 patients who received percutaneous interventional therapy of lung abscess and pyothorax. Results: 13 patients were cured by a single procedure, 3 patients received twice intervention. Triple therapies were done in 2 patients. 2 cases out of 18 were eventually diagnosed as peripheral lung cancer. The body temperature and the WBC count returned to normal range after the procedures. 16 patients completely recovered in 1-5 weeks after the therapies. Conclusion: The interventional therapy under CT guidance not only helps the diagnosis and differential diagnosis of chronic or acute lung abscess and pyothorax, but also shortens the course of treatment and avoids the open surgery. It is a safe, simple and convenient method

  10. Evaluation of classification method of lung lobe for multi-slice CT images

    International Nuclear Information System (INIS)

    Sakurai, Kousuke; Matsuhiro, Mikio; Saita, Shinsuke

    2010-01-01

    Recently, due to the introduction of multi-slice CT, to obtain a high resolution 3D CT image is possible in a short time. The temporal and spatial resolutions are high, so a highly accurate 3D image analysis is possible. To develop a structure analysis of the lung is needed and to be used as a fundamental technology for early detection of the disease. By separating the lung into lung lobes may provide important information for analysis, diagnosis and treatment of lung diseases. Therefore in this report, we adapt to abnormality example with the classification algorithms using the anatomical information of the bronchus, the pulmonary vein and interlobar fissure information, we evaluate the classification. (author)

  11. Cone-Beam CT Localization of Internal Target Volumes for Stereotactic Body Radiotherapy of Lung Lesions

    International Nuclear Information System (INIS)

    Wang Zhiheng; Wu, Q. Jackie; Marks, Lawrence B.; Larrier, Nicole; Yin Fangfang

    2007-01-01

    Purpose: In this study, we investigate a technique of matching internal target volumes (ITVs) in four-dimensional (4D) simulation computed tomography (CT) to the composite target volume in free-breathing on-board cone-beam (CB) CT. The technique is illustrated by using both phantom and patient cases. Methods and Materials: A dynamic phantom with a target ball simulating respiratory motion with various amplitude and cycle times was used to verify localization accuracy. The dynamic phantom was scanned using simulation CT with a phase-based retrospective sorting technique. The ITV was then determined based on 10 sets of sorted images. The size and epicenter of the ITV identified from 4D simulation CT images and the composite target volume identified from on-board CBCT images were compared to assess localization accuracy. Similarly, for two clinical cases of patients with lung cancer, ITVs defined from 4D simulation CT images and CBCT images were compared. Results: For the phantom, localization accuracy between the ITV in 4D simulation CT and the composite target volume in CBCT was within 1 mm, and ITV was within 8.7%. For patient cases, ITVs on simulation CT and CBCT were within 8.0%. Conclusion: This study shows that CBCT is a useful tool to localize ITV for targets affected by respiratory motion. Verification of the ITV from 4D simulation CT using on-board free-breathing CBCT is feasible for the target localization of lung tumors

  12. Vanishing lung syndrome: the importance of the high-resolution CT in its diagnostic

    International Nuclear Information System (INIS)

    Rodriguez Cerezo, M.I.; Porres Azcona, E.; Pina Insausti, L.; Inchusta Sarasibar, M.I.; Mellado Rodriguez, M.

    1995-01-01

    Vanishing lung syndrome, also referred to as idiopathic giant bullions emphysema is a dissolver that has yet to be fully characterized. It is considered a different entry from classic pulmonary emphysema. It is characterized by the presence of large bullae associated with some type of emphysema. High-resolution CT is the best imaging technique to identify the underlying type of emphysema and it helps to determine the viability of the nonbullous lung. We present the case of an asymptomatic patient in whom the diagnosis was suspected on the basis of plain chest X ray and was confirmed by high-resolution CT. 13 refs

  13. Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the ''fallen lung'' sign

    International Nuclear Information System (INIS)

    Wintermark, M.; Schnyder, P.; Wicky, S.

    2001-01-01

    Tracheo-bronchial injuries occur in less than 1 % of blunt chest trauma patients. Indirect signs, such as pneumomediastinum, pneumothorax, and/or subcutaneous emphysema, are revealed on admission plain films and chest CT survey. In most instances, however, tracheo-bronchoscopy is mandatory in assessing the definite diagnosis of tracheo-bronchial lesion. Occasionally, an abnormal course of a mainstem bronchus or a ''fallen lung'' sign, featuring a collapsed lung in a dependent position, hanging on the hilum only by its vascular attachments, may allow for CT diagnosis of a blunt traumatic bronchial injury. (orig.)

  14. Automatic lung tumor segmentation on PET/CT images using fuzzy Markov random field model.

    Science.gov (United States)

    Guo, Yu; Feng, Yuanming; Sun, Jian; Zhang, Ning; Lin, Wang; Sa, Yu; Wang, Ping

    2014-01-01

    The combination of positron emission tomography (PET) and CT images provides complementary functional and anatomical information of human tissues and it has been used for better tumor volume definition of lung cancer. This paper proposed a robust method for automatic lung tumor segmentation on PET/CT images. The new method is based on fuzzy Markov random field (MRF) model. The combination of PET and CT image information is achieved by using a proper joint posterior probability distribution of observed features in the fuzzy MRF model which performs better than the commonly used Gaussian joint distribution. In this study, the PET and CT simulation images of 7 non-small cell lung cancer (NSCLC) patients were used to evaluate the proposed method. Tumor segmentations with the proposed method and manual method by an experienced radiation oncologist on the fused images were performed, respectively. Segmentation results obtained with the two methods were similar and Dice's similarity coefficient (DSC) was 0.85 ± 0.013. It has been shown that effective and automatic segmentations can be achieved with this method for lung tumors which locate near other organs with similar intensities in PET and CT images, such as when the tumors extend into chest wall or mediastinum.

  15. Automatic Lung Tumor Segmentation on PET/CT Images Using Fuzzy Markov Random Field Model

    Directory of Open Access Journals (Sweden)

    Yu Guo

    2014-01-01

    Full Text Available The combination of positron emission tomography (PET and CT images provides complementary functional and anatomical information of human tissues and it has been used for better tumor volume definition of lung cancer. This paper proposed a robust method for automatic lung tumor segmentation on PET/CT images. The new method is based on fuzzy Markov random field (MRF model. The combination of PET and CT image information is achieved by using a proper joint posterior probability distribution of observed features in the fuzzy MRF model which performs better than the commonly used Gaussian joint distribution. In this study, the PET and CT simulation images of 7 non-small cell lung cancer (NSCLC patients were used to evaluate the proposed method. Tumor segmentations with the proposed method and manual method by an experienced radiation oncologist on the fused images were performed, respectively. Segmentation results obtained with the two methods were similar and Dice’s similarity coefficient (DSC was 0.85 ± 0.013. It has been shown that effective and automatic segmentations can be achieved with this method for lung tumors which locate near other organs with similar intensities in PET and CT images, such as when the tumors extend into chest wall or mediastinum.

  16. A COMPREHENSIVE FRAMEWORK FOR AUTOMATIC DETECTION OF PULMONARY NODULES IN LUNG CT IMAGES

    Directory of Open Access Journals (Sweden)

    Mehdi Alilou

    2014-03-01

    Full Text Available Solitary pulmonary nodules may indicate an early stage of lung cancer. Hence, the early detection of nodules is the most efficient way for saving the lives of patients. The aim of this paper is to present a comprehensive Computer Aided Diagnosis (CADx framework for detection of the lung nodules in computed tomography images. The four major components of the developed framework are lung segmentation, identification of candidate nodules, classification and visualization. The process starts with segmentation of lung regions from the thorax. Then, inside the segmented lung regions, candidate nodules are identified using an approach based on multiple thresholds followed by morphological opening and 3D region growing algorithm. Finally, a combination of a rule-based procedure and support vector machine classifier (SVM is utilized to classify the candidate nodules. The proposed CADx method was validated on CT images of 60 patients, containing the total of 211 nodules, selected from the publicly available Lung Image Database Consortium (LIDC image dataset. Comparing to the other state of the art methods, the proposed framework demonstrated acceptable detection performance (Sensitivity: 0.80; Fp/Scan: 3.9. Furthermore, we visualize a range of anatomical structures including the 3D lung structure and the segmented nodules along with the Maximum Intensity Projection (MIP volume rendering method that will enable the radiologists to accurately and easily estimate the distance between the lung structures and the nodules which are frequently difficult at best to recognize from CT images.

  17. Learning with distribution of optimized features for recognizing common CT imaging signs of lung diseases

    Science.gov (United States)

    Ma, Ling; Liu, Xiabi; Fei, Baowei

    2017-01-01

    Common CT imaging signs of lung diseases (CISLs) are defined as the imaging signs that frequently appear in lung CT images from patients. CISLs play important roles in the diagnosis of lung diseases. This paper proposes a novel learning method, namely learning with distribution of optimized feature (DOF), to effectively recognize the characteristics of CISLs. We improve the classification performance by learning the optimized features under different distributions. Specifically, we adopt the minimum spanning tree algorithm to capture the relationship between features and discriminant ability of features for selecting the most important features. To overcome the problem of various distributions in one CISL, we propose a hierarchical learning method. First, we use an unsupervised learning method to cluster samples into groups based on their distribution. Second, in each group, we use a supervised learning method to train a model based on their categories of CISLs. Finally, we obtain multiple classification decisions from multiple trained models and use majority voting to achieve the final decision. The proposed approach has been implemented on a set of 511 samples captured from human lung CT images and achieves a classification accuracy of 91.96%. The proposed DOF method is effective and can provide a useful tool for computer-aided diagnosis of lung diseases on CT images.

  18. Active contour modes Crisp: new technique for segmentation of the lungs in CT images

    International Nuclear Information System (INIS)

    Reboucas Filho, Pedro Pedrosa; Cortez, Paulo Cesar; Holanda, Marcelo Alcantara

    2011-01-01

    This paper proposes a new active contour model (ACM), called ACM Crisp, and evaluates the segmentation of lungs in computed tomography (CT) images. An ACM draws a curve around or within the object of interest. This curve changes its shape, when some energy acts on it and moves towards the edges of the object. This process is performed by successive iterations of minimization of a given energy, associated with the curve. The ACMs described in the literature have limitations when used for segmentations of CT lung images. The ACM Crisp model overcomes these limitations, since it proposes automatic initiation and new external energy based on rules and radiological pulmonary densities. The paper compares other ACMs with the proposed method, which is shown to be superior. In order to validate the algorithm a medical expert in the field of Pulmonology of the Walter Cantidio University Hospital from the Federal University of Ceara carried out a qualitative analysis. In these analyses 100 CT lung images were used. The segmentation efficiency was evaluated into 5 categories with the following results for the ACM Crisp: 73% excellent, without errors, 20% acceptable, with small errors, and 7% reasonable, with large errors, 0% poor, covering only a small part of the lung, and 0% very bad, making a totally incorrect segmentation. In conclusion the ACM Crisp is considered a useful algorithm to segment CT lung images, and with potential to integrate medical diagnosis systems. (author)

  19. Risk-benefit analysis and cost-effectiveness analysis of lung cancer screening by spiral CT

    International Nuclear Information System (INIS)

    Iinuma, Takeshi

    1999-01-01

    Mass screening of lung cancer has been widely performed using indirect chest X-ray method in Japan. However reduction of the mortality for lung cancer is questioned. We have proposed that recently developed spiral CT should be adopted for the screening of lung cancer, since CT has an excellent detectability for small nodule. Lung Cancer Screening CT (LSCT) has been developed by author's group using spiral CT with low dose and light weight in order to make a mobile unit. In this paper risk-benefit analysis and cost-effectiveness analysis are described for the LSCT screening of lung cancer. As a risk, radiation carcinogenesis due to exposure from LSCT are compared with gain of life-expectancy by screening and men of 40 years or more and women of 45 years or more are justified. The cost per person-year is estimated for LSCT screening which is better than that of present method, although total cost is higher. The LSCT screening could be recommended if total cost is affordable. (author)

  20. Clinical value of CT-based preoperative software assisted lung lobe volumetry for predicting postoperative pulmonary function after lung surgery

    Science.gov (United States)

    Wormanns, Dag; Beyer, Florian; Hoffknecht, Petra; Dicken, Volker; Kuhnigk, Jan-Martin; Lange, Tobias; Thomas, Michael; Heindel, Walter

    2005-04-01

    This study was aimed to evaluate a morphology-based approach for prediction of postoperative forced expiratory volume in one second (FEV1) after lung resection from preoperative CT scans. Fifteen Patients with surgically treated (lobectomy or pneumonectomy) bronchogenic carcinoma were enrolled in the study. A preoperative chest CT and pulmonary function tests before and after surgery were performed. CT scans were analyzed by prototype software: automated segmentation and volumetry of lung lobes was performed with minimal user interaction. Determined volumes of different lung lobes were used to predict postoperative FEV1 as percentage of the preoperative values. Predicted FEV1 values were compared to the observed postoperative values as standard of reference. Patients underwent lobectomy in twelve cases (6 upper lobes; 1 middle lobe; 5 lower lobes; 6 right side; 6 left side) and pneumonectomy in three cases. Automated calculation of predicted postoperative lung function was successful in all cases. Predicted FEV1 ranged from 54% to 95% (mean 75% +/- 11%) of the preoperative values. Two cases with obviously erroneous LFT were excluded from analysis. Mean error of predicted FEV1 was 20 +/- 160 ml, indicating absence of systematic error; mean absolute error was 7.4 +/- 3.3% respective 137 +/- 77 ml/s. The 200 ml reproducibility criterion for FEV1 was met in 11 of 13 cases (85%). In conclusion, software-assisted prediction of postoperative lung function yielded a clinically acceptable agreement with the observed postoperative values. This method might add useful information for evaluation of functional operability of patients with lung cancer.

  1. Megavoltage conebeam CT cine as final verification of treatment plan in lung stereotactic body radiotherapy.

    Science.gov (United States)

    Kudithipudi, Vijay; Gayou, Olivier; Colonias, Athanasios

    2016-06-01

    To analyse the clinical impact of megavoltage conebeam computed tomography (MV-CBCT) cine on internal target volume (ITV) coverage in lung stereotactic body radiotherapy (SBRT). One hundred and six patients received lung SBRT. All underwent 4D computed tomography simulation followed by treatment via image guided 3D conformal or intensity modulated radiation. Prior to SBRT, all patients underwent MV-CBCT cine, in which raw projections are displayed as beam's-eye-view fluoroscopic series with the planning target volume (PTV) projected onto each image, enabling verification of tumour motion relative to the PTV and assessment of adequacy of treatment margin. Megavoltage conebeam computed tomography cine was completed 1-2 days prior to SBRT. Four patients (3.8%) had insufficient ITV coverage inferiorly at cine review. All four plans were changed by adding 5 mm on the PTV margin inferiorly. The mean change in PTV volumes was 3.9 cubic centimetres (cc) (range 1.85-6.32 cc). Repeat cine was performed after plan modification to ensure adequate PTV coverage in the modified plans. PTV margin was adequate in the majority of patients with this technique. MV-CBCT cine did show insufficient coverage in a small subset of patients. Insufficient PTV margins may be a function of 4D CT simulation inadequacies or deficiencies in visualizing the ITV inferior border in the full-inhale phase. MV-CBCT cine is a valuable tool for final verification of PTV margins. © 2016 The Royal Australian and New Zealand College of Radiologists.

  2. Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance

    DEFF Research Database (Denmark)

    Josipovic, Mirjana; Persson, Gitte F; Bangsgaard, Jens Peter

    2016-01-01

    OBJECTIVE: We investigated the impact of deep inspiration breath-hold (DIBH) and tumour baseline shifts on image quality and registration uncertainty in image-guided DIBH radiotherapy (RT) for locally advanced lung cancer. METHODS: Patients treated with daily cone beam CT (CBCT)-guided free...... for the craniocaudal direction in FB, where it was >3 mm. On the 31st fraction, the intraobserver uncertainty increased compared with the second fraction. This increase was more pronounced in FB. Image quality scores improved in DIBH compared with FB for all parameters in all patients. Simulated tumour baseline shifts...... ≤2 mm did not affect the CBCT image quality considerably. CONCLUSION: DIBH CBCT improved image quality and reduced registration uncertainty in the craniocaudal direction in image-guided RT of locally advanced lung cancer. Baseline shifts ≤2 mm in DIBH during CBCT acquisition did not affect image...

  3. PET/CT for diagnostics and therapy stratification of lung cancer

    International Nuclear Information System (INIS)

    Kratochwil, C.; Haberkorn, U.; Giesel, F.L.

    2010-01-01

    With the introduction of positron emission tomography (PET) and more recently the hybrid systems PET/CT, the management of cancer patients in the treatment strategy has changed tremendously. The combination of PET with multidetector CT scanning enables the integration of metabolic and high resolution morphological image information. PET/CT is nowadays an established modality for tumor detection, characterization, staging and response monitoring. The increased installation of PET/CT systems worldwide and also the increased scientific publications underline the importance of this imaging modality. PET/CT is particular the imaging modality of choice in lung cancer staging and re-staging (T, N and M staging). The possible increased success of surgery in lung cancer patients and also the expected reduction in additional invasive diagnostics lead to benefits for both the individual patient and the healthcare system. In this review article PET and PET/CT is presented for diagnostic and therapeutic stratification in lung cancer. The fundamentals of glucose metabolism, staging, tumor recurrence and therapeutic monitoring are presented. (orig.) [de

  4. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    Energy Technology Data Exchange (ETDEWEB)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel (Dept. of Radiology, Medical Faculty, Univ. Duesseldorf, Duesseldorf (Germany)), email: Patric.Kroepil@med.uni-duesseldorf.de

    2011-10-15

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 +- 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 +- 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 +- 33 vs. n = 126 +- 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  5. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    International Nuclear Information System (INIS)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel

    2011-01-01

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 ± 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 ± 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 ± 33 vs. n = 126 ± 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  6. Impact of the planning CT scan time on the reflection of the lung tumor motion

    International Nuclear Information System (INIS)

    Kim, Su San; Choi, Eun Kyung; Yi, Byong Yong; Ha, Sung Whan

    2004-01-01

    To evaluate the reflection of tumor motion according to the planning CT scan time. A model of N-shape, which moved along the longitudinal axis during the ventilation caused by a mechanical ventilator, was produced. The model was scanned by planning CT, while setting the relative CT scan time (T; CT scan time/ventilatory period) to 0.33, 0.50, 0.67, 0.75, 1.00, 1.33 T, and 1.53 T. In addition, three patients with non-small cell lung cancer who received stereotactic radiosurgery in the Department of Radiation Oncology, Asan Medical Center from 03/19/2002 to 05/21/2002 were scanned. Slow (IQ Premier, Picker, scan time 2.0 seconds per slice) and fast CT scans (Light Speed, GE Medical System, with a scan time of 0.8 second per slice) were performed for each patient. The magnitude of reflected movement of the N-shaped model was evaluated by measuring the transverse length, which reflected the movement of the declined bar of the model at each slice. For patients' scans, all CT data sets were registered using a stereotactic body frame scale with the gross tumor volumes delineated in one CT image set. The volume and three-dimensional diameter of the gross tumor volume were measured and analyzed between the slow and fast CT scans. The reflection degree of longitudinal movement of the model increased in proportion to the relative CT scan times below 1.00 T, but remained constant above 1.00 T. Assuming the mean value of scanned transverse lengths with CT scan time 1.00 T to be 100%, CT scans with scan times of 0.33, 0.50, 0.67, and 0.75 T missed the tumor motion by 30, 27, 20, and 7.0% respectively. Slow (scan time 2.0 sec) and Fast (scan time 0.8 sec) CT scans of three patients with longitudinal movement of 3, 5, and 10 mm measured by fluoroscopy revealed the increases in the diameter along the longitudinal axis increased by 6.3, 17, and 23% in the slow CT scans. As the relative CT scan time increased, the reflection of the respiratory tumor movement on planning CT also

  7. Clinical investigation of CT-guided ozone-blowing and fumigation ...

    African Journals Online (AJOL)

    Clinical investigation of CT-guided ozone-blowing and fumigation therapy for the chronic ... African Journal of Biotechnology ... In control group, seven patients were completely cured in 45 days after being treated by traditional surgery.

  8. Functional Image-Guided Radiotherapy Planning in Respiratory-Gated Intensity-Modulated Radiotherapy for Lung Cancer Patients With Chronic Obstructive Pulmonary Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Tomoki, E-mail: tkkimura@hiroshima-u.ac.jp [Department of Radiation Oncology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima City (Japan); Nishibuchi, Ikuno; Murakami, Yuji; Kenjo, Masahiro; Kaneyasu, Yuko; Nagata, Yasushi [Department of Radiation Oncology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima City (Japan)

    2012-03-15

    Purpose: To investigate the incorporation of functional lung image-derived low attenuation area (LAA) based on four-dimensional computed tomography (4D-CT) into respiratory-gated intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) in treatment planning for lung cancer patients with chronic obstructive pulmonary disease (COPD). Methods and Materials: Eight lung cancer patients with COPD were the subjects of this study. LAA was generated from 4D-CT data sets according to CT values of less than than -860 Hounsfield units (HU) as a threshold. The functional lung image was defined as the area where LAA was excluded from the image of the total lung. Two respiratory-gated radiotherapy plans (70 Gy/35 fractions) were designed and compared in each patient as follows: Plan A was an anatomical IMRT or VMAT plan based on the total lung; Plan F was a functional IMRT or VMAT plan based on the functional lung. Dosimetric parameters (percentage of total lung volume irradiated with {>=}20 Gy [V20], and mean dose of total lung [MLD]) of the two plans were compared. Results: V20 was lower in Plan F than in Plan A (mean 1.5%, p = 0.025 in IMRT, mean 1.6%, p = 0.044 in VMAT) achieved by a reduction in MLD (mean 0.23 Gy, p = 0.083 in IMRT, mean 0.5 Gy, p = 0.042 in VMAT). No differences were noted in target volume coverage and organ-at-risk doses. Conclusions: Functional IGRT planning based on LAA in respiratory-guided IMRT or VMAT appears to be effective in preserving a functional lung in lung cancer patients with COPD.

  9. Quantification of neonatal lung parenchymal density via ultrashort echo time MRI with comparison to CT.

    Science.gov (United States)

    Higano, Nara S; Fleck, Robert J; Spielberg, David R; Walkup, Laura L; Hahn, Andrew D; Thomen, Robert P; Merhar, Stephanie L; Kingma, Paul S; Tkach, Jean A; Fain, Sean B; Woods, Jason C

    2017-10-01

    To demonstrate that ultrashort echo time (UTE) magnetic resonance imaging (MRI) can achieve computed tomography (CT)-like quantification of lung parenchyma in free-breathing, non-sedated neonates. Because infant CTs are used sparingly, parenchymal disease evaluation via UTE MRI has potential for translational impact. Two neonatal control cohorts without suspected pulmonary morbidities underwent either a research UTE MRI (n = 5; 1.5T) or a clinically-ordered CT (n = 9). Whole-lung means and anterior-posterior gradients of UTE-measured image intensity (arbitrary units, au, normalized to muscle) and CT-measured density (g/cm 3 ) were compared (Mann-Whitney U-test). Separately, a diseased neonatal cohort (n = 5) with various pulmonary morbidities underwent both UTE MRI and CT. UTE intensity and CT density were compared with Spearman correlations within ∼33 anatomically matched regions of interest (ROIs) in each diseased subject, spanning low- to high-density tissues. Radiological classifications were evaluated in all ROIs, with mean UTE intensities and CT densities compared in each classification. In control subjects, whole-lung UTE intensities (0.51 ± 0.04 au) were similar to CT densities (0.44 ± 0.09 g/cm 3 ) (P = 0.062), as were UTE (0.021 ± 0.020 au/cm) and CT (0.034 ± 0.024 [g/cm 3 ]/cm) anterior-posterior gradients (P = 0.351). In diseased subjects' ROIs, significant correlations were observed between UTE and CT (P ≤0.007 in each case). Relative differences between UTE and CT were small in all classifications (4-25%). These results demonstrate a strong association between UTE image intensity and CT density, both between whole-lung tissue in control patients and regional radiological pathologies in diseased patients. This indicates the potential for UTE MRI to longitudinally evaluate neonatal pulmonary disease and to provide visualization of pathologies similar to CT, without sedation/anesthesia or ionizing radiation

  10. INTEGRATED PET-CT SCAN IN THE STAGING OF NON SMALL CELL LUNG CANCER

    Directory of Open Access Journals (Sweden)

    I Made Ngurah Agus Surya Negara S

    2013-09-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Lung cancer is a common disease and is a leading cause of death in many countries. The most kind of lung cancer was Non Small Cell Lung Cancer. The management of lung cancer is directed by an optimal staging of the tumour. On 1998, integrated positron emission tomography (PET-computed tomography (CT was published. PET-CT is an anatomo-metabolic imaging modality that has recently been introduced to clinical practice and combines two different techniques: CT, which provides very detailed anatomic information; and PET, which provides metabolic information. One of the advantages of PET/CT is the improved image interpretation. There wasbetter results for PET/CT in the staging of non small cell lung cancer in comparison with CT nor PET alone. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  11. PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art.

    Science.gov (United States)

    Cazzato, Roberto Luigi; Garnon, Julien; Shaygi, Behnam; Koch, Guillaume; Tsoumakidou, Georgia; Caudrelier, Jean; Addeo, Pietro; Bachellier, Philippe; Namer, Izzie Jacques; Gangi, Afshin

    2018-02-01

    Positron emission tomography/computed tomography (PET/CT) represents an emerging imaging guidance modality that has been applied to successfully guide percutaneous procedures such as biopsies and tumour ablations. The aim of the present narrative review is to report the indications, advantages and disadvantages of PET/CT-guided procedures in the field of interventional oncology and to briefly describe the experience gained with this new emerging technique while performing biopsies and tumor ablations.

  12. A study on CT-guided stereotactic technique for functional neurosurgery

    International Nuclear Information System (INIS)

    Uetsuhara, Koichi; Asakura, Tetsuhiko; Hirahara, Kazuho; Gondo, Masazumi; Oda, Hiroshige

    1987-01-01

    Recently, CT-guided stereotactic surgery has become of major interest, and some authors have discussed its potential in functional neurosurgery. The following is a comparative study of the CT-guided stereotactic technique and the conventional roentogenographic stereotactic technique. The Brown-Roberts-Wells apparatus was used for both types of procedures. 37 stereotactic procedures were performed on 35 patients under local anesthesia; 16 for stereotactic biopsy and 21 for stereotactic functional neurosurgery. Target points for stereotactic biopsy were determined by the CT-guided technique and target points for functional neurosurgery were determined by the conventional roentogenographic technique. The correlation with the position of target point determined by both techniques was investigated in the 21 functional neurosurgical procedures. On these occasions the authors used the reformatted horizontal and sagittal CT through the anterior and posterior commissure to determine the position of target point by the CT-guided technique. Results: It was found that the AC-PC line crossed with Reid's base line at angle of 11 ± 1 deg, and therefore it is important to obtain a CT images including AC-PC line at this angle. When applying the CT guided stereotactic procedure for functional surgery, it should be known that there could be a discrepancy within 2 mm from the conventional target determination. (author)

  13. Spiculation of lung mass on CT; carcinoma vs. tuberculoma

    International Nuclear Information System (INIS)

    Han, Tae Il; Sung, Dong Wook; Lim, Seung Jae; Yoon, Yup

    1994-01-01

    Spiculation pathologically correlated with irregular fibrosis, localized lymphatic spread of tumor, or an infiltrative growth pattern of tumor, and the spiculation was observed in malignant mass. But the spiculation was also observed in benign mass, particularly in tuberculoma. We retrospectively reviewed the length of spiculation under the hypothesis that the length of spiculation could be one of differential diagnostic points between lung cancer and tuberculoma. We studied thirty seven patients (27 men and 10 women) ranging in age from 35 to 80 years (mean, 60 years). Analysis of spiculation included (a) the number of spicules (b) the mean length of spicules (c) the mean length of the longest spicule (d) the percentage of the mean length of spicules to the longest diameter of mass (e) the percentage of the mean length of spicules to the shortest diameter of mass. The mean length of spicules of tuberculoma was 13.8 mm (S. D. 6.7) and that of lung cancer was 5.7 mm (S. D. 3.5). The percentage of the mean length of spicules to the longest diameter of tuberculoma was 63.6% and that of lung cancer was 13.7%. The percentage of the mean length of spicules to the shortest diameter of tuberculoma was 90.4% and that of lung cancer was 18.3%. It is hard to differentiate lung cancer from tuberculoma on the basis of the spiculation being present or not, but we suggest that the longer spiculation be more highly suggestive of tuberculoma rather than lung cancer. The length of spiculation may help us differentiate lung cancer from tuberculoma

  14. CT imaging of congenital lung lesions: effect of iterative reconstruction on diagnostic performance and radiation dose

    International Nuclear Information System (INIS)

    Haggerty, Jay E.; Smith, Ethan A.; Dillman, Jonathan R.; Kunisaki, Shaun M.

    2015-01-01

    Different iterative reconstruction techniques are available for use in pediatric computed tomography (CT), but these techniques have not been systematically evaluated in infants. To determine the effect of iterative reconstruction on diagnostic performance, image quality and radiation dose in infants undergoing CT evaluation for congenital lung lesions. A retrospective review of contrast-enhanced chest CT in infants (<1 year) with congenital lung lesions was performed. CT examinations were reviewed to document the type of lung lesion, vascular anatomy, image noise measurements and image reconstruction method. CTDI vol was used to calculate size-specific dose estimates (SSDE). CT findings were correlated with intraoperative and histopathological findings. Analysis of variance and the Student's t-test were used to compare image noise measurements and radiation dose estimates between groups. Fifteen CT examinations used filtered back projection (FBP; mean age: 84 days), 15 used adaptive statistical iterative reconstruction (ASiR; mean age: 93 days), and 11 used model-based iterative reconstruction (MBIR; mean age: 98 days). Compared to operative findings, 13/15 (87%), 14/15 (93%) and 11/11 (100%) lesions were correctly characterized using FBP, ASiR and MBIR, respectively. Arterial anatomy was correctly identified in 12/15 (80%) using FBP, 13/15 (87%) using ASiR and 11/11 (100%) using MBIR. Image noise was less for MBIR vs. ASiR (P < 0.0001). Mean SSDE was different among groups (P = 0.003; FBP = 7.35 mGy, ASiR = 1.89 mGy, MBIR = 1.49 mGy). Congenital lung lesions can be adequately characterized in infants using iterative CT reconstruction techniques while maintaining image quality and lowering radiation dose. (orig.)

  15. CT imaging of congenital lung lesions: effect of iterative reconstruction on diagnostic performance and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Haggerty, Jay E.; Smith, Ethan A.; Dillman, Jonathan R. [University of Michigan Health System, Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States); Kunisaki, Shaun M. [University of Michigan Health System, Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children' s Hospital, Ann Arbor, MI (United States)

    2015-07-15

    Different iterative reconstruction techniques are available for use in pediatric computed tomography (CT), but these techniques have not been systematically evaluated in infants. To determine the effect of iterative reconstruction on diagnostic performance, image quality and radiation dose in infants undergoing CT evaluation for congenital lung lesions. A retrospective review of contrast-enhanced chest CT in infants (<1 year) with congenital lung lesions was performed. CT examinations were reviewed to document the type of lung lesion, vascular anatomy, image noise measurements and image reconstruction method. CTDI{sub vol} was used to calculate size-specific dose estimates (SSDE). CT findings were correlated with intraoperative and histopathological findings. Analysis of variance and the Student's t-test were used to compare image noise measurements and radiation dose estimates between groups. Fifteen CT examinations used filtered back projection (FBP; mean age: 84 days), 15 used adaptive statistical iterative reconstruction (ASiR; mean age: 93 days), and 11 used model-based iterative reconstruction (MBIR; mean age: 98 days). Compared to operative findings, 13/15 (87%), 14/15 (93%) and 11/11 (100%) lesions were correctly characterized using FBP, ASiR and MBIR, respectively. Arterial anatomy was correctly identified in 12/15 (80%) using FBP, 13/15 (87%) using ASiR and 11/11 (100%) using MBIR. Image noise was less for MBIR vs. ASiR (P < 0.0001). Mean SSDE was different among groups (P = 0.003; FBP = 7.35 mGy, ASiR = 1.89 mGy, MBIR = 1.49 mGy). Congenital lung lesions can be adequately characterized in infants using iterative CT reconstruction techniques while maintaining image quality and lowering radiation dose. (orig.)

  16. Paraseptal Emphysema: Prevalence and Distribution on CT and Association with Interstitial Lung Abnormalities

    Science.gov (United States)

    Araki, Tetsuro; Nishino, Mizuki; Zazueta, Oscar E.; Gao, Wei; Dupuis, Josée; Okajima, Yuka; Latourelle, Jeanne C.; Rosas, Ivan O.; Murakami, Takamichi; O’Connor, George T.; Washko, George R.; Hunninghake, Gary M.; Hatabu, Hiroto

    2015-01-01

    Objective To investigate the prevalence and distribution of paraseptal emphysema on chest CT images in the Framingham Heart Study (FHS) population, and assess its impact on pulmonary function. Also pursued was the association with interstitial lung abnormalities. Materials and Methods We assessed 2633 participants in the FHS for paraseptal emphysema on chest CT. Characteristics of participants, including age, sex, smoking status, clinical symptoms, and results of pulmonary function tests, were compared between those with and without paraseptal emphysema. The association between paraseptal emphysema and interstitial lung abnormalities was investigated. Results Of the 2633 participants, 86 (3%) had pure paraseptal emphysema (defined as paraseptal emphysema with no other subtypes of emphysema other than paraseptal emphysema or a very few centrilobular emphysema involved) in at least one lung zone. The upper zone of the lungs was almost always involved. Compared to the participants without paraseptal emphysema, those with pure paraseptal emphysema were significantly older, and were more frequently male and smokers (mean 64 years, 71% male, mean 36 pack-years, pemphysema and interstitial lung abnormalities (pemphysema was 3% in the FHS population, predominantly affects the upper lung zone, and contributes to decreased pulmonary function. Cigarette smoking, aging, and male gender were the factors associated with the presence of paraseptal emphysema. Significant association between paraseptal emphysema and interstitial lung abnormalities was observed. PMID:25868675

  17. WE-B-207-00: CT Lung Cancer Screening Part 1

    International Nuclear Information System (INIS)

    2015-01-01

    The US National Lung Screening Trial (NLST) was a multi-center randomized, controlled trial comparing a low-dose CT (LDCT) to posterior-anterior (PA) chest x-ray (CXR) in screening older, current and former heavy smokers for early detection of lung cancer. Recruitment was launched in September 2002 and ended in April 2004 when 53,454 participants had been randomized at 33 screening sites in equal proportions. Funded by the National Cancer Institute this trial demonstrated that LDCT screening reduced lung cancer mortality. The US Preventive Services Task Force (USPSTF) cited NLST findings and conclusions in its deliberations and analysis of lung cancer screening. Under the 2010 Patient Protection and Affordable Care Act, the USPSTF favorable recommendation regarding lung cancer CT screening assisted in obtaining third-party payers coverage for screening. The objective of this session is to provide an introduction to the NLST and the trial findings, in addition to a comprehensive review of the dosimetry investigations and assessments completed using individual NLST participant CT and CXR examinations. Session presentations will review and discuss the findings of two independent assessments, a CXR assessment and the findings of a CT investigation calculating individual organ dosimetry values. The CXR assessment reviewed a total of 73,733 chest x-ray exams that were performed on 92 chest imaging systems of which 66,157 participant examinations were used. The CT organ dosimetry investigation collected scan parameters from 23,773 CT examinations; a subset of the 75,133 CT examinations performed using 97 multi-detector CT scanners. Organ dose conversion coefficients were calculated using a Monte Carlo code. An experimentally-validated CT scanner simulation was coupled with 193 adult hybrid computational phantoms representing the height and weight of the current U.S. population. The dose to selected organs was calculated using the organ dose library and the abstracted scan

  18. WE-B-207-00: CT Lung Cancer Screening Part 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-06-15

    The US National Lung Screening Trial (NLST) was a multi-center randomized, controlled trial comparing a low-dose CT (LDCT) to posterior-anterior (PA) chest x-ray (CXR) in screening older, current and former heavy smokers for early detection of lung cancer. Recruitment was launched in September 2002 and ended in April 2004 when 53,454 participants had been randomized at 33 screening sites in equal proportions. Funded by the National Cancer Institute this trial demonstrated that LDCT screening reduced lung cancer mortality. The US Preventive Services Task Force (USPSTF) cited NLST findings and conclusions in its deliberations and analysis of lung cancer screening. Under the 2010 Patient Protection and Affordable Care Act, the USPSTF favorable recommendation regarding lung cancer CT screening assisted in obtaining third-party payers coverage for screening. The objective of this session is to provide an introduction to the NLST and the trial findings, in addition to a comprehensive review of the dosimetry investigations and assessments completed using individual NLST participant CT and CXR examinations. Session presentations will review and discuss the findings of two independent assessments, a CXR assessment and the findings of a CT investigation calculating individual organ dosimetry values. The CXR assessment reviewed a total of 73,733 chest x-ray exams that were performed on 92 chest imaging systems of which 66,157 participant examinations were used. The CT organ dosimetry investigation collected scan parameters from 23,773 CT examinations; a subset of the 75,133 CT examinations performed using 97 multi-detector CT scanners. Organ dose conversion coefficients were calculated using a Monte Carlo code. An experimentally-validated CT scanner simulation was coupled with 193 adult hybrid computational phantoms representing the height and weight of the current U.S. population. The dose to selected organs was calculated using the organ dose library and the abstracted scan

  19. Collateral Ventilation to Congenital Hyperlucent Lung Lesions Assessed on Xenon-Enhanced Dynamic Dual-Energy CT: an Initial Experience

    OpenAIRE

    Goo, Hyun Woo; Yang, Dong Hyun; Kim, Namkug; Park, Seung Il; Kim, Dong Kwan; Kim, Ellen Ai-Rhan

    2011-01-01

    Objective We wanted to evaluate the resistance to collateral ventilation in congenital hyperlucent lung lesions and to correlate that with the anatomic findings on xenon-enhanced dynamic dual-energy CT. Materials and Methods Xenon-enhanced dynamic dual-energy CT was successfully and safely performed in eight children (median age: 5.5 years, 4 boys and 4 girls) with congenital hyperlucent lung lesions. Functional assessment of the lung lesions on the xenon map was done, including performing a ...

  20. PET/CT staging of T1-stage non-small cell lung cancer

    International Nuclear Information System (INIS)

    Salman, K. A.; Steinmann, C. H.; Von Schulthess, G. K.; Steinert, H. C.; Sukumar, V. P.

    2009-01-01

    Full text:Purpose: To evaluate the value of PET/CT in detecting occult metastases in patients with T 1 -stage non-small cell lung cancer (NSCLC). Method: Patients with proven NSCLC and T 1 -stage ( c m) were retrospectively analyzed. In all patients a whole-body 18 F-FDG PET/CT scan for initial staging was performed. The PET/CT findings were compared with all available clinical information, intra-operative findings and the histopathological results. Results: 95 patients (39 men, 56 women; age range, 19-85 years) were analyzed in our study. PET/CT in 68-95 patients correctly excluded mediastinal and distant metastases. In 17/95 patients (18%) mediastinal lymph-node metastases were proven (N 2 n=15; N 3 n=2). PET/CT correctly detected in 10/17 patients (58.8%) mediastinal nodal disease. The smallest mediastinal lymph-node metastasis detected by PET/CT had a size of 0.7 c m. In 7 patients PET/CT missed N 2 -stage. In three of these patients the SUVmax of the primary was c m. Only in one missed N 2 -stage metastasis was sized > 1.0 c m. The tumor histology (adenocarcinoma, squamous cell carcinoma) and location of the primary (central, periphery) did not influence the missed N 2 -stage by PET/CT. PET/CT diagnosed correctly N 3 -stage in 2 patients. 10/95 patients (10.5%) had distant metastases. PET/CT detected unknown M 1 -stage in 4/10 patients. In one patient a metastasis of the parietal pleura was missed by PET/CT. Conclusion: In our study, 28% patients with T 1 -stage NSCLC showed mediastinal or distant metastases. PET/CT was efficient in the detection of occult metastases. However, the sensitivity of PET/CT in mediastinal staging was only 64%.

  1. Functional mechanism of lung mosaic CT attenuation: assessment with deep-inspiration breath-hold perfusion SPECT-CT fusion imaging and non-breath-hold Technegas SPECT.

    Science.gov (United States)

    Suga, K; Yasuhiko, K; Iwanaga, H; Tokuda, O; Matsunaga, N

    2009-01-01

    The functional mechanism of lung mosaic computed tomography attenuation (MCA) in pulmonary vascular disease (PVD) and obstructive airway disease (OAD) has not yet been fully clarified. To clarify the mechanism of MCA in these diseases by assessing the relationship between regional lung function and CT attenuation change at MCA sites with the use of automated deep-inspiratory breath-hold (DIBrH) perfusion single-photon emission computed tomography (SPECT)-CT fusion images and non-breath-hold Technegas SPECT. Subjects were 42 PVD patients (31 pulmonary thromboembolism, four primary/two secondary pulmonary hypertension, and five Takayasu arteritis), 12 OAD patients (five acute asthma, four obliterative bronchiolitis, and three bronchiectasis), and 12 normal controls, all of whom had MCA on DIBrH CT. The relationship between regional lung function and CT attenuation change at the lung slices with MCA was assessed using DIBrH perfusion SPECT-CT fusion images and non-breath-hold Technegas SPECT. The severity of perfusion defects with or without MCA was quantified by regions-of-interest analysis. On DIBrH CT and perfusion SPECT, in contrast to no noticeable CT attenuation abnormality and fairly uniform perfusion in controls, 60 MCA and 274 perfusion defects in PVD patients, and 18 MCA and 61 defects in OAD patients were identified, with a total of 77 ventilation defects on Technegas SPECT in all patients. SPECT-CT correlation showed that, throughout the 78 MCA sites of all patients, lung perfusion was persistently decreased at low CT attenuation and preserved at intervening high CT attenuation, while lung ventilation was poorly correlated with CT attenuation change. The radioactivity ratios of reduced perfusion and the intervening preserved perfusion at the 78 perfusion defects with MCA were significantly lower than those at the remaining 257 defects without MCA (P<0.0001). Although further validation is required, our results indicate that heterogeneous pulmonary arterial

  2. Simulation of spatiotemporal CT data sets using a 4D MRI-based lung motion model.

    Science.gov (United States)

    Marx, Mirko; Ehrhardt, Jan; Werner, René; Schlemmer, Heinz-Peter; Handels, Heinz

    2014-05-01

    Four-dimensional CT imaging is widely used to account for motion-related effects during radiotherapy planning of lung cancer patients. However, 4D CT often contains motion artifacts, cannot be used to measure motion variability, and leads to higher dose exposure. In this article, we propose using 4D MRI to acquire motion information for the radiotherapy planning process. From the 4D MRI images, we derive a time-continuous model of the average patient-specific respiratory motion, which is then applied to simulate 4D CT data based on a static 3D CT. The idea of the motion model is to represent the average lung motion over a respiratory cycle by cyclic B-spline curves. The model generation consists of motion field estimation in the 4D MRI data by nonlinear registration, assigning respiratory phases to the motion fields, and applying a B-spline approximation on a voxel-by-voxel basis to describe the average voxel motion over a breathing cycle. To simulate a patient-specific 4D CT based on a static CT of the patient, a multi-modal registration strategy is introduced to transfer the motion model from MRI to the static CT coordinates. Differences between model-based estimated and measured motion vectors are on average 1.39 mm for amplitude-based binning of the 4D MRI data of three patients. In addition, the MRI-to-CT registration strategy is shown to be suitable for the model transformation. The application of our 4D MRI-based motion model for simulating 4D CT images provides advantages over standard 4D CT (less motion artifacts, radiation-free). This makes it interesting for radiotherapy planning.

  3. Phylogenetic ctDNA analysis depicts early stage lung cancer evolution

    DEFF Research Database (Denmark)

    Abbosh, Christopher; Birkbak, Nicolai Juul; Wilson, Gareth A.

    2017-01-01

    The early detection of relapse following primary surgery for non-small cell lung cancer and the characterization of emerging subclones seeding metastatic sites might offer new therapeutic approaches to limit tumor recurrence. The potential to non-invasively track tumor evolutionary dynamics in ct...

  4. [Lung cancer screening with thoracic X‑ray and CT : Current situation].

    Science.gov (United States)

    von Stackelberg, O; Kauczor, H-U

    2016-09-01

    Attempts at the early detection of lung cancer using imaging methods began as far back as the 1950s. Several studies attempted to demonstrate a reduction of lung cancer mortality by chest radiography screening but all were unsuccessful. Even the first small screening studies using computed tomography (CT) could not demonstrate a reduction in lung cancer-specific mortality until in 2011 the results of the largest randomized controlled low-dose CT screening study in the USA (NLST) were published. The NLST results could show a significant 20 % reduction of lung cancer mortality in elderly and heavy smokers using CT. Confirmation of the NLST results are urgently needed so that the data of the largest European study (NELSON) are eagerly awaited. Pooled with the data from several smaller European studies these results will provide important information and evidence for the establishment of future CT screening programs in Europe. Randomized controlled trials are the basis of evidence-based medicine; therefore, the positive results of the methodologically very good NLST study cannot be ignored, even if it is the only such study completed so far with highly convincing conclusions. The NLST results clearly demonstrate that positive effects for the health of the population can only be expected if the processes are clearly defined and the quality is assured.

  5. The impact of radiologists' expertise on screen results decisions in a CT lung cancer screening trial

    International Nuclear Information System (INIS)

    Heuvelmans, Marjolein A.; Vliegenthart, Rozemarijn; Oudkerk, Matthijs; Jong, Pim A. de; Mali, Willem P.; Groen, Harry J.M.

    2015-01-01

    To evaluate the impact of radiological expertise on screen result decisions in a CT lung cancer screening trial. In the NELSON lung cancer screening trial, the baseline CT result was based on the largest lung nodule's volume. The protocol allowed radiologists to manually adjust screen results in cases of high suspicion of benign or malignant nodule nature. Participants whose baseline CT result was based on a solid or part-solid nodule were included in this study. Adjustments by radiologists at baseline were evaluated. Histology was the reference for diagnosis or to confirm benignity and stability on subsequent CT examinations. A total of 3,318 participants (2,796 male, median age 58.0 years) were included. In 195 participants (5.9 %) the initial baseline screen result was adjusted by the radiologist. Adjustment was downwards from positive or indeterminate to negative in two and 119 participants, respectively, and from positive to indeterminate in 65 participants. None of these nodules turned out to be malignant. In 9/195 participants (4.6 %) the screen result was adjusted upwards from negative to indeterminate or indeterminate to positive; two nodules were malignant. In one in 20 cases of baseline lung cancer screening, nodules were reclassified by the radiologist, leading to a reduction of false-positive screen results. (orig.)

  6. Small lung neoplasms with growing attitude of alveolar lining. CT-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Nozawa, Kumiko; Kuramochi, Masashi; Nakajima, Kotaro; Doi, Mikio; Endo, Katsuyuki [Hitachi General Hospital, Ibaraki (Japan); Saida, Yukihisa; Itai, Yuji

    2000-01-01

    The article correlates CT and pathologic findings in 25 lung nodules with ground glass attenuation, which are small than 2 cm in diameter. They includes adenocarcinomas (Noguchi's classification type A, B, C) and a typical adenomatous hyperplasia. (author)

  7. The relationship between microvessels density and CT enhancement of the peripheral lung cancer

    International Nuclear Information System (INIS)

    Liu Shiyuan; Zhou Kangrong; Xiao Xiangsheng; Ye Tingjun; Zhang Zhiyong

    1999-01-01

    Objective: To investigate the relationship between microvessel density (MVD), clinical prognosis and CT enhancement of the peripheral lung cancer. Methods: 127 cases of peripheral lung cancer were examined with CT (87 cases retrospectively and 40 cases prospectively), and MVD were measured with immunohistochemical method by factor VIII on the specimens of the resected tumors. The results were analyzed and compared with CT enhancement, metastasis and prognosis. Results: The MVD was higher in the peripheral junction zone and interstitial areas than that in the parenchymal areas and necrotic zones of the tumors. Patients with nodal metastasis had higher MVD than those without nodal metastasis (56.9 +- 18.1 versus 43.8 +- 23.6, P 0.05); but the enhancement of the lung cancer correlated well with MVD (r 0.8874). Conclusions: Measurement of the microvessel density of tumor can determine the degree of angiogenesis of neoplasm and predict the metastasis or prognosis of the lung cancer. Angiogenesis not only constitutes the basis of enhancement of the tumor, but also determine the various degrees and patterns of enhancement. Spiral dynamic CT is the technique ideal to demonstrate the enhancement features, which might be helpful in making differential diagnosis of pulmonary nodules

  8. Recruitment for 'A pilot study of randomized controlled trial to evaluate the efficacy of lung cancer screening by thoracic CT'

    International Nuclear Information System (INIS)

    Sagawa, Motoyasu; Tanaka, Makoto; Mizukami, Satoru

    2011-01-01

    The objective of this study was to evaluate the efficacy of lung cancer screening by thoracic computed tomography (CT), a randomized controlled trial was planned in Japan. The randomized trial was designed as follows: participants were randomly assigned into 2 groups, CT group and XP group; XP group would receive 10 times of lung cancer screening by chest x-ray annually for 10 years; smokers in CT group would receive 10 times of lung cancer screening by thoracic CT annually for 10 years; non-smokers in CT group would receive 3 times of lung cancer screening by thoracic CT and 7 times of chest x-ray during 10 years. A pilot study was performed to evaluate the feasibility of the trial. A letter for recruitment to participate in the above trial was mailed to the citizens in Hakui City, who were 50-64 years old and underwent regular lung cancer screening using chest x-ray this year. In the letter we explained that the efficacy of lung cancer screening by thoracic CT had not been proved yet; only half of the participants could undergo thoracic CT screening; thoracic CT screening might cause unfavorable consequences like radiation exposure, false positives or overdiagnosis. Of 329 persons who received the letter of recruitment, 117 replied. After meeting with us for detailed explanation, 111 persons participated in the above randomized trial. The compliance of recruitment is high (approximately one third) and the above trial may be feasible. (author)

  9. Quantitative assessment of emphysema from whole lung CT scans: comparison with visual grading

    Science.gov (United States)

    Keller, Brad M.; Reeves, Anthony P.; Apanosovich, Tatiyana V.; Wang, Jianwei; Yankelevitz, David F.; Henschke, Claudia I.

    2009-02-01

    Emphysema is a disease of the lungs that destroys the alveolar air sacs and induces long-term respiratory dysfunction. CT scans allow for imaging of the anatomical basis of emphysema and for visual assessment by radiologists of the extent present in the lungs. Several measures have been introduced for the quantification of the extent of disease directly from CT data in order to add to the qualitative assessments made by radiologists. In this paper we compare emphysema index, mean lung density, histogram percentiles, and the fractal dimension to visual grade in order to evaluate the predictability of radiologist visual scoring of emphysema from low-dose CT scans through quantitative scores, in order to determine which measures can be useful as surrogates for visual assessment. All measures were computed over nine divisions of the lung field (whole lung, individual lungs, and upper/middle/lower thirds of each lung) for each of 148 low-dose, whole lung scans. In addition, a visual grade of each section was also given by an expert radiologist. One-way ANOVA and multinomial logistic regression were used to determine the ability of the measures to predict visual grade from quantitative score. We found that all measures were able to distinguish between normal and severe grades (p<0.01), and between mild/moderate and all other grades (p<0.05). However, no measure was able to distinguish between mild and moderate cases. Approximately 65% prediction accuracy was achieved from using quantitative score to predict visual grade, with 73% if mild and moderate cases are considered as a single class.

  10. PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

    Energy Technology Data Exchange (ETDEWEB)

    Klaeser, Bernd; Wartenberg, Jan; Weitzel, Thilo; Krause, Thomas [Bern University Hospital and University of Bern, Department of Nuclear Medicine, Inselspital, Bern (Switzerland); Wiskirchen, Jakub [Bern University Hospital and University of Bern, Department of Nuclear Medicine, Inselspital, Bern (Switzerland); University Hospital Tuebingen, Department of Radiology, Neuroradiology, and Nuclear Medicine, Tuebingen (Germany); Schmid, Ralph A. [Bern University Hospital and University of Bern, Department of Thoracic Surgery, Inselspital, Bern (Switzerland); Mueller, Michel D. [Bern University Hospital and University of Bern, Department of Obstetrics and Gynaecology, Inselspital, Bern (Switzerland)

    2010-11-15

    In a minority of cases a definite diagnosis and stage grouping in cancer patients is not possible based on the imaging information of PET/CT. We report our experience with percutaneous PET/CT-guided bone biopsies to histologically verify the aetiology of hypermetabolic bone lesions. We retrospectively reviewed the data of 20 consecutive patients who underwent multimodal image-guided bone biopsies using a dedicated PET/CT system in a step-by-step technique. Technical and clinical success rates of PET/CT-guided biopsies were evaluated. Questionnaires were sent to the referring physicians to assess the impact of biopsies on patient management and to check the clinical need for PET/CT-guided biopsies. Clinical indications for biopsy were to histologically verify the aetiology of metabolically active bone lesions without a morphological correlate confirming the suspicion of metastases in 15 patients, to determine the origin of suspected metastases in 3 patients and to evaluate the appropriateness of targeted therapy options in 2 patients. Biopsies were technically successful in all patients. In 19 of 20 patients a definite histological diagnosis was possible. No complications or adverse effects occurred. The result of PET/CT-guided bone biopsies determined a change of the planned treatment in overall 56% of patients, with intramodality changes, e.g. chemotherapy with palliative instead of curative intent, and intermodality changes, e.g. systemic therapy instead of surgery, in 22 and 50%, respectively. PET/CT-guided bone biopsies are a promising alternative to conventional techniques to make metabolically active bone lesions - especially without a distinctive morphological correlate - accessible for histological verification. PET/CT-guided biopsies had a major clinical impact in patients who otherwise cannot be reliably stage grouped at the time of treatment decisions. (orig.)

  11. Left Vocal Cord Paralysis Detected by PET/CT in a Case of Lung Cancer

    Directory of Open Access Journals (Sweden)

    Ali Ozan Oner

    2015-01-01

    Full Text Available We report a patient with lung cancer. The first PET/CT imaging revealed hypermetabolic mass in the left aortopulmonary region and hypermetabolic nodule in the anterior segment of the upper lobe of the left lung. After completing chemotherapy and radiotherapy against the primary mass in the left lung, the patient underwent a second PET/CT examination for evaluation of treatment response. This test demonstrated, compared with the first PET/CT, an increase in the size and metabolic activity of the primary mass in the left lung in addition to multiple, pathologic-sized, hypermetabolic metastatic lymph nodes as well as multiple metastatic sclerotic areas in bones. These findings were interpreted as progressive disease. In addition, an asymmetrical FDG uptake was noticed at the level of right vocal cord. During follow-up, a laryngoscopy was performed, which demonstrated left vocal cord paralysis with no apparent mass. Thus, we attributed the paralytic appearance of the left vocal cord to infiltration of the left recurrent laryngeal nerve by the primary mass located in the apical region of the left lung. In conclusion, the knowledge of this pitfall is important to avoid false-positive PET results.

  12. Low-dosage helical CT applications for chest medical checkup and lung cancer screening

    International Nuclear Information System (INIS)

    Wang Ping; Cui Fa; Liang Huanqing; Zheng Minfei

    2005-01-01

    Objective: A discussion on low-dosage helical CT applications on chest medical checkup and lung cancer screening. Methods: On the 100 chest medical check up with three different of protocols, including standard-dosage (the tube current was 230 mAs) were compared with low-dose (tube current was 50 mAs or 30 mAs). Results: Low-dosage helical CT scan provides excellent images. In 100 chest medical checkup, 39 nodules or masses were revealed, enlarged lymph node was noted in 1 case; emphysema or bullae was demonstrated in 3 segments; thickening of bronchial wall was shown in 2 cases; and localized pleural thickening was found in 1 case. Conclusion: In chest checkup or lung cancer screening low-dosage helical CT (tube current 30 mAs) will not only guarantee image quality but also reduce the radiation dose during the examination. (authors)

  13. High-resolution CT in eosinophilic granuloma (histiocytosis X) of the lung

    International Nuclear Information System (INIS)

    Godwin, J.D.; Buschman, D.L.; Moore, A.D.A.; Muller, N.L.; Naidich, D.P.; Carvalho, C.R.R.; Takasugi, J.E.; Schmidt, R.A.

    1988-01-01

    Eosinophilic granuloma of the lung is fascinating but poorly understood. Computed tomographic (CT) scans in 18 cases (11 high resolution) showed a variety of striking patterns: cysts up to 4 cm with thin or indiscernible walls, ranging from a few lesions to confluent honeycombing; retriculonodular infiltrate; and nodules 2 mm-2cm, sometimes cavitated. CT showed that the ill-defined lucencies barely visible on radiographs are indeed cysts, rather than preserved normal lung surrounded by infiltrate. High-resolution CT showed that some of the early, small nodules were concentrated along terminal bronchioles within the secondary lobules. The differential diagnosis includes sarcoidosis and idiopathic fibrosis, but the prominent cystic abnormality and the lack of peripheral concentration help to distinguish eosinophilic granuloma

  14. Automatic block-matching registration to improve lung tumor localization during image-guided radiotherapy

    Science.gov (United States)

    Robertson, Scott Patrick

    To improve relatively poor outcomes for locally-advanced lung cancer patients, many current efforts are dedicated to minimizing uncertainties in radiotherapy. This enables the isotoxic delivery of escalated tumor doses, leading to better local tumor control. The current dissertation specifically addresses inter-fractional uncertainties resulting from patient setup variability. An automatic block-matching registration (BMR) algorithm is implemented and evaluated for the purpose of directly localizing advanced-stage lung tumors during image-guided radiation therapy. In this algorithm, small image sub-volumes, termed "blocks", are automatically identified on the tumor surface in an initial planning computed tomography (CT) image. Each block is independently and automatically registered to daily images acquired immediately prior to each treatment fraction. To improve the accuracy and robustness of BMR, this algorithm incorporates multi-resolution pyramid registration, regularization with a median filter, and a new multiple-candidate-registrations technique. The result of block-matching is a sparse displacement vector field that models local tissue deformations near the tumor surface. The distribution of displacement vectors is aggregated to obtain the final tumor registration, corresponding to the treatment couch shift for patient setup correction. Compared to existing rigid and deformable registration algorithms, the final BMR algorithm significantly improves the overlap between target volumes from the planning CT and registered daily images. Furthermore, BMR results in the smallest treatment margins for the given study population. However, despite these improvements, large residual target localization errors were noted, indicating that purely rigid couch shifts cannot correct for all sources of inter-fractional variability. Further reductions in treatment uncertainties may require the combination of high-quality target localization and adaptive radiotherapy.

  15. Reproducibility of Lobar Perfusion and Ventilation Quantification Using SPECT/CT Segmentation Software in Lung Cancer Patients.

    Science.gov (United States)

    Provost, Karine; Leblond, Antoine; Gauthier-Lemire, Annie; Filion, Édith; Bahig, Houda; Lord, Martin

    2017-09-01

    Planar perfusion scintigraphy with 99m Tc-labeled macroaggregated albumin is often used for pretherapy quantification of regional lung perfusion in lung cancer patients, particularly those with poor respiratory function. However, subdividing lung parenchyma into rectangular regions of interest, as done on planar images, is a poor reflection of true lobar anatomy. New tridimensional methods using SPECT and SPECT/CT have been introduced, including semiautomatic lung segmentation software. The present study evaluated inter- and intraobserver agreement on quantification using SPECT/CT software and compared the results for regional lung contribution obtained with SPECT/CT and planar scintigraphy. Methods: Thirty lung cancer patients underwent ventilation-perfusion scintigraphy with 99m Tc-macroaggregated albumin and 99m Tc-Technegas. The regional lung contribution to perfusion and ventilation was measured on both planar scintigraphy and SPECT/CT using semiautomatic lung segmentation software by 2 observers. Interobserver and intraobserver agreement for the SPECT/CT software was assessed using the intraclass correlation coefficient, Bland-Altman plots, and absolute differences in measurements. Measurements from planar and tridimensional methods were compared using the paired-sample t test and mean absolute differences. Results: Intraclass correlation coefficients were in the excellent range (above 0.9) for both interobserver and intraobserver agreement using the SPECT/CT software. Bland-Altman analyses showed very narrow limits of agreement. Absolute differences were below 2.0% in 96% of both interobserver and intraobserver measurements. There was a statistically significant difference between planar and SPECT/CT methods ( P software is highly reproducible. This tridimensional method yields statistically significant differences in measurements for right lung lobes when compared with planar scintigraphy. We recommend that SPECT/CT-based quantification be used for all lung

  16. CT findings of pulmonary consolidation: focused on tuberculosis, malignant obstructive pneumonitis, and lung abscess

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Wang Jung; Kim, Sung Jin; Cha, Sang Hoon; Park, Kit Sun; Kim, Dae Young [College of Medicine, Chung Buk National University, Cheongju (Korea, Republic of); Han, Gi Seuk [Seoul National University Hospital, Seoul (Korea, Republic of)

    1994-12-15

    The aim of our study was to identify the CT features helpful in the differential diagnosis of Iobar consolidation. We evaluated the CT findings in 52 consecutive patients with lobar consolidation which were proved to be pulmonary tuberculosis(n=24), malignant obstructive pneumonitis due to bronchogenic carcinoma(n=21), and lung abscess(n=7). We retrospectively reviewed CT scans with respect to 1) number of cavities or low attenuation area suggesting necrosis(we described these as cavity), 2) the contour of cavity, 3) enhancement of the cavity wall, 4) enhancement of pleura, 5) small nodules adjacent to the consolidation, 6) similar lesion in other location in lung, 7) air-bronchogram 8) mediastinal lymph node enlargement, and 9) extrapleural change. The helpful CT findings in the patients with pulmonary tuberculosis were multiple cavities(more than three; 79.2%), small nodules adjacent to the lobar consolidation(75.0%), similar lesion in another lobe or lung(91.7%), air-bronchogram(91.7%), and mediastinal lymph node enlargement(58.3%). Although extrapleural change had low sensitivity it was highly specific for pulmonary tuberculosis(sensitivity, 43.5%; specificity, 91.7%). Multiple cavities(61.9%) and mediastinal lymph node enlargement(52.4%) were common findings of malignant obstructive pneumonitis. In the patients with lung abscess, the common findings were small number of cavities(one or two, 85.7%) and air-bronchogram(85.7%). However, other findings of pulmonary tuberculosis were rarely seen in the patients with malignant obstructive pneumonitis or lung abscess. The CT findings of lobar consolidation may be used as useful adjuncts in the differential diagnosis of lobar consolidation.

  17. Feasibility of using intravenous contrast-enhanced computed tomography (CT) scans in lung cancer treatment planning

    International Nuclear Information System (INIS)

    Xiao Jianghong; Zhang Hong; Gong Youling; Fu Yuchuan; Tang Bin; Wang Shichao; Jiang Qingfeng; Li Ping

    2010-01-01

    Background and purpose: To investigate the feasibility of using intravenous contrast-enhanced computed tomography (CT) scans in 3-dimensional conformal radiotherapy (3D-CRT), stereotactic body radiation therapy (SBRT) and intensity-modulated radiotherapy (IMRT) treatment planning for lung cancers, respectively. Materials and methods: Twelve patients with bulky lung tumors and 14 patients with small lung tumors were retrospectively analyzed. Each patient took two sets of CT in the same position with active breathing control (ABC) technique before and after intravenous contrast agent (CA) injections. Bulky tumors were planned with 3D-CRT, while SBRT plans were generated for patients with small tumors based on CT scans with intravenous CA. In addition, IMRT plans were generated for patients with bulky tumors to continue on a planning study. All plans were copied and replaced on the scans without intravenous CA. The radiation doses calculated from the two sets of CTs were compared with regard to planning volumes (PTV), the organ at-risk (OAR) and the lungs using Wilcoxon's signed rank test. Results: In comparisons for 3D-CRT plans, CT scans with intravenous CA reduced the mean dose and the maximum dose of PTV with significant differences (p 95 ) for targets, respectively (p < 0.05). There was no statistical significance for lung parameters between two sets of scans in SBRT plans and IMRT plans. Conclusions: The enhanced CT scans can be used for both target delineation and treatment planning in 3D-CRT. The dose difference caused by intravenous CA is small. But for SBRT and IMRT, the minimum irradiation dose in targets may be estimated to be increased up to 2.71% while the maximum dose may be estimated to be decreased up to 1.36%. However, the difference in dose distribution in most cases were found to be clinical tolerable.

  18. CT findings of pulmonary consolidation: focused on tuberculosis, malignant obstructive pneumonitis, and lung abscess

    International Nuclear Information System (INIS)

    Kim, Wang Jung; Kim, Sung Jin; Cha, Sang Hoon; Park, Kit Sun; Kim, Dae Young; Han, Gi Seuk

    1994-01-01

    The aim of our study was to identify the CT features helpful in the differential diagnosis of Iobar consolidation. We evaluated the CT findings in 52 consecutive patients with lobar consolidation which were proved to be pulmonary tuberculosis(n=24), malignant obstructive pneumonitis due to bronchogenic carcinoma(n=21), and lung abscess(n=7). We retrospectively reviewed CT scans with respect to 1) number of cavities or low attenuation area suggesting necrosis(we described these as cavity), 2) the contour of cavity, 3) enhancement of the cavity wall, 4) enhancement of pleura, 5) small nodules adjacent to the consolidation, 6) similar lesion in other location in lung, 7) air-bronchogram 8) mediastinal lymph node enlargement, and 9) extrapleural change. The helpful CT findings in the patients with pulmonary tuberculosis were multiple cavities(more than three; 79.2%), small nodules adjacent to the lobar consolidation(75.0%), similar lesion in another lobe or lung(91.7%), air-bronchogram(91.7%), and mediastinal lymph node enlargement(58.3%). Although extrapleural change had low sensitivity it was highly specific for pulmonary tuberculosis(sensitivity, 43.5%; specificity, 91.7%). Multiple cavities(61.9%) and mediastinal lymph node enlargement(52.4%) were common findings of malignant obstructive pneumonitis. In the patients with lung abscess, the common findings were small number of cavities(one or two, 85.7%) and air-bronchogram(85.7%). However, other findings of pulmonary tuberculosis were rarely seen in the patients with malignant obstructive pneumonitis or lung abscess. The CT findings of lobar consolidation may be used as useful adjuncts in the differential diagnosis of lobar consolidation

  19. Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Cardoso, Luciana Vargas; Souza Júnior, Arthur Soares, E-mail: fabianonatividade@terra.com.br [Rio Preto-Ultra-X Radiological Diagnosis Institute, São José do Rio Preto, SP (Brazil)

    2014-07-15

    Objective: To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs). Methods: We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions. Results: Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively). Conclusions: In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy. (author)

  20. Direct assessment of lung function in COPD using CT densitometric measures

    International Nuclear Information System (INIS)

    Gu, Suicheng; Leader, Joseph; Gur, David; Pu, Jiantao; Zheng, Bin; Chen, Qihang; Sciurba, Frank; Kminski, Naftali

    2014-01-01

    To investigate whether lung function in patients with chronic obstructive pulmonary disease (COPD) can be directly predicted using CT densitometric measures and assess the underlying prediction errors as compared with the traditional spirometry-based measures. A total of 600 CT examinations were collected from a COPD study. In addition to the entire lung volume, the extent of emphysema depicted in each CT examination was quantified using density mask analysis (densitometry). The partial least square regression was used for constructing the prediction model, where a repeated random split-sample validation was employed. For each split, we randomly selected 400 CT exams for training (regression) purpose and the remaining 200 exams for assessing performance in prediction of lung function (e.g., FEV1 and FEV1/FVC) and disease severity. The absolute and percentage errors as well as their standard deviations were computed. The averaged percentage errors in prediction of FEV1, FEV1/FVC%, TLC, RV/TLC% and DLco% predicted were 33%, 17%, 9%, 18% and 23%, respectively. When classifying the exams in terms of disease severity grades using the CT measures, 37% of the subjects were correctly classified with no error and 83% of the exams were either correctly classified or classified into immediate neighboring categories. The linear weighted kappa and quadratic weighted kappa were 0.54 (moderate agreement) and 0.72 (substantial agreement), respectively. Despite the existence of certain prediction errors in quantitative assessment of lung function, the CT densitometric measures could be used to relatively reliably classify disease severity grade of COPD patients in terms of GOLD. (paper)

  1. Lung and heart dose volume analyses with CT simulator in radiation treatment of breast cancer

    International Nuclear Information System (INIS)

    Das, Indra J.; Cheng, Elizabeth C.; Freedman, Gary; Fowble, Barbara

    1998-01-01

    Purpose: Radiation pneumonitis and cardiac effects are directly related to the irradiated lung and heart volumes in the treatment fields. The central lung distance (CLD) from a tangential breast radiograph is shown to be a significant indicator of ipsilateral irradiated lung volume. Retrospective analysis of the pattern of dose volume of lung and heart with actual volume data from a CT simulator in the treatment of breast cancer is presented with respect to CLD. Methods and Materials: The heart and lung volumes in the tangential treatment fields were analyzed in 108 consecutive cases (52 left and 56 right breast) referred for CT simulation. All patients in this study were immobilized and placed on an inclined breast board in actual treatment setup. Both arms were stretched over head to avoid collision with the scanner aperture. Radiopaque marks were placed on the medial and lateral borders of the tangential fields. All patients were scanned in spiral mode with slice width and thickness of 3 mm each, respectively. The lung and heart structures as well as irradiated areas were delineated on each slice and respective volumes were accurately measured. The treatment beam parameters were recorded and the digitally reconstructed radiographs (DRRs) were generated for the measurement of the CLD and analysis. Results: Using CT data the mean volume and standard deviation of left and right lungs were 1307.7 ± 297.7 cm 3 and 1529.6 ± 298.5 cm 3 , respectively. The magnitude of irradiated volume in left and right lung is nearly equal for the same CLD that produces different percent irradiated volumes (PIV). The left and right PIV lungs are 8.3 ± 4.7% and 6.6 ± 3.7%, respectively. The PIV data have shown to correlate with CLD with second- and third-degree polynomials; however, in this study a simple straight line regression is used to provide better confidence than the higher order polynomials. The regression lines for the left and right breasts are very different based on

  2. Interactive lung segmentation in abnormal human and animal chest CT scans

    International Nuclear Information System (INIS)

    Kockelkorn, Thessa T. J. P.; Viergever, Max A.; Schaefer-Prokop, Cornelia M.; Bozovic, Gracijela; Muñoz-Barrutia, Arrate; Rikxoort, Eva M. van; Brown, Matthew S.; Jong, Pim A. de; Ginneken, Bram van

    2014-01-01

    Purpose: Many medical image analysis systems require segmentation of the structures of interest as a first step. For scans with gross pathology, automatic segmentation methods may fail. The authors’ aim is to develop a versatile, fast, and reliable interactive system to segment anatomical structures. In this study, this system was used for segmenting lungs in challenging thoracic computed tomography (CT) scans. Methods: In volumetric thoracic CT scans, the chest is segmented and divided into 3D volumes of interest (VOIs), containing voxels with similar densities. These VOIs are automatically labeled as either lung tissue or nonlung tissue. The automatic labeling results can be corrected using an interactive or a supervised interactive approach. When using the supervised interactive system, the user is shown the classification results per slice, whereupon he/she can adjust incorrect labels. The system is retrained continuously, taking the corrections and approvals of the user into account. In this way, the system learns to make a better distinction between lung tissue and nonlung tissue. When using the interactive framework without supervised learning, the user corrects all incorrectly labeled VOIs manually. Both interactive segmentation tools were tested on 32 volumetric CT scans of pigs, mice and humans, containing pulmonary abnormalities. Results: On average, supervised interactive lung segmentation took under 9 min of user interaction. Algorithm computing time was 2 min on average, but can easily be reduced. On average, 2.0% of all VOIs in a scan had to be relabeled. Lung segmentation using the interactive segmentation method took on average 13 min and involved relabeling 3.0% of all VOIs on average. The resulting segmentations correspond well to manual delineations of eight axial slices per scan, with an average Dice similarity coefficient of 0.933. Conclusions: The authors have developed two fast and reliable methods for interactive lung segmentation in

  3. CT-guided fixation of sacral fractures and sacrolilac joint disruptions

    International Nuclear Information System (INIS)

    Nelson, D.W.; Duwelius, P.

    1990-01-01

    Placement of sacral fixation screws at surgery is performed blindly (ie, by palpation). The authors of this paper employed CT to localize the screw between the neutral foramina and anterior sacral cortex and to decrease the morbidity associated with general anesthesia and surgery. Six patients underwent CT-guided sacral fixation performed by means of the 7.0 mm A0 cannulated screw system. All patients had reducible vertical sacral fractures or sacroiliac joint disruptions. Following placement of an epidural catheter for anesthesia, patients were scanned in the prone or decubitus position. Measurements for placement of the guide pin were made from the preliminary scans. Following CT confirmation of satisfactory guide pin placement across the fracture, the screw track was drilled, the screw length was determined, and the fixation screw was placed in position. A CT scan was obtained to evaluate the final position of the screw

  4. Automatic Classification of Normal and Cancer Lung CT Images Using Multiscale AM-FM Features

    Directory of Open Access Journals (Sweden)

    Eman Magdy

    2015-01-01

    Full Text Available Computer-aided diagnostic (CAD systems provide fast and reliable diagnosis for medical images. In this paper, CAD system is proposed to analyze and automatically segment the lungs and classify each lung into normal or cancer. Using 70 different patients’ lung CT dataset, Wiener filtering on the original CT images is applied firstly as a preprocessing step. Secondly, we combine histogram analysis with thresholding and morphological operations to segment the lung regions and extract each lung separately. Amplitude-Modulation Frequency-Modulation (AM-FM method thirdly, has been used to extract features for ROIs. Then, the significant AM-FM features have been selected using Partial Least Squares Regression (PLSR for classification step. Finally, K-nearest neighbour (KNN, support vector machine (SVM, naïve Bayes, and linear classifiers have been used with the selected AM-FM features. The performance of each classifier in terms of accuracy, sensitivity, and specificity is evaluated. The results indicate that our proposed CAD system succeeded to differentiate between normal and cancer lungs and achieved 95% accuracy in case of the linear classifier.

  5. The frequency and the degree of fusion of the lung on high-resolution CT

    International Nuclear Information System (INIS)

    Shin, Hwan Sik; Kim, Sung Jin; Bae, Il Hun; Song, Kyung Sup; Kim, Joo Chang; Han, Ki Suk; Cha, Sang Hoon; Park, Kil Sun

    2000-01-01

    To evaluate the frequency and degree of fusion of the lung as seen on high-resolution CT (HRCT). In 210 patients high-resolution CT scans from the apex to the diaphragm were obtained at 1 mm collimation and 7 mm interval. We retrospectively analysed the frequency and degree of fusion of the lung bordering each interlobar fissure. Fusion of the lung was defined when fissure appeared without complete lobar separation. The degree of lung fusion was classified as mild (less than 1/3 of the fissure), moderate (greater than 1/3 and less than 2/3 of fissure), or severe (greater than 2/3 of the fissure). In 90 of 210 patients, all fissures were identified. In 73 of these 90 (81.1%), lung fusion was noted, the most frequent site of this being between the right upper and right middle lobe (53.3%) . The least frequent site was between the upper portion of the left upper and left lower lobe (32.2%). Am mild degree of fusion was most frequently found between the right middle and right lower lobe (83.9%0, while a severe degree was most frequent between the right middle and right upper lobe (50.0%), followed by the lingular division and the left lower lobe (41.9%). HRCT can be used to evaluate the frequency and degree of interlobar lung fusion. (author)

  6. Positron emission tomography/computed tomography (PET/CT) and CT for N staging of non-small cell lung cancer.

    Science.gov (United States)

    Vegar Zubović, Sandra; Kristić, Spomenka; Hadžihasanović, Besima

    2017-08-01

    Aim The aim of this study is to investigate the possibilities of non-invasive diagnostic imaging methods, positron emission tomography/computed tomography (PET/CT) and CT, in clinical N staging of non-small cell lung cancer (NSCLC). Methods Retrospective clinical study included 50 patients with diagnosed NSCLC who have undergone PET/CT for the purpose of disease staging. The International association for the study of lung cancer (IASLC) nodal mapping system was used for analysis of nodal disease. Data regarding CT N-staging and PET/CT Nstaging were recorded. Two methods were compared using χ2 test and Spearman rank correlation coefficient. Results Statistical analysis showed that although there were some differences in determining the N stage between CT and PET/CT, these methods were in significant correlation. CT and PET/CT findings established the same N stage in 74% of the patients. In five patients based on PET/CT findings the staging was changed from operable to inoperable, while in four patients staging was changed from inoperable to operable. Conclusion PET/CT and CT are noninvasive methods that can be reliably used for N staging of NSCLC. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

  7. Preliminary assessment of the dose to the interventional radiologist in fluoro-CT-guided procedures

    International Nuclear Information System (INIS)

    Pereira, M. F.; Alves, J. G.; Sarmento, S.; Santos, J. A. M.; Sousa, M. J.; Gouvea, M.; Oliveira, A. D.; Cardoso, J. V.; Santos, L. M.

    2011-01-01

    A preliminary assessment of the occupational dose to the intervention radiologist received in fluoroscopy computerised tomography (CT) used to guide the collection of lung and bone biopsies is presented. The main aim of this work was to evaluate the capability of the reading system as well as of the available whole-body (WB) and extremity dosemeters used in routine monthly monitoring periods to measure per procedure dose values. The intervention radiologist was allocated 10 WB detectors (LiF: Mg, Ti, TLD-100) placed at chest and abdomen levels above and below the lead apron, and at both right and left arms, knees and feet. A special glove was developed with casings for the insertion of 11 extremity detectors (LiF:Mg, Cu, P, TLD-100H) for the identification of the most highly exposed fingers. The H p (10) dose values received above the lead apron (ranged 0.20-0.02 mSv) depend mainly on the duration of the examination and on the placement of physician relative to the beam, while values below the apron are relatively low. The left arm seems to receive a higher dose value. H p (0.07) values to the hand (ranged 36.30-0.06 mSv) show that the index, middle and ring fingers are the most highly exposed. In this study, the wrist dose was negligible compared with the finger dose. These results are preliminary and further studies are needed to better characterise the dose assessment in CT fluoroscopy. (authors)

  8. Paraseptal emphysema: Prevalence and distribution on CT and association with interstitial lung abnormalities

    International Nuclear Information System (INIS)

    Araki, Tetsuro; Nishino, Mizuki; Zazueta, Oscar E.; Gao, Wei; Dupuis, Josée; Okajima, Yuka; Latourelle, Jeanne C.; Rosas, Ivan O.; Murakami, Takamichi; O’Connor, George T.; Washko, George R.; Hunninghake, Gary M.

    2015-01-01

    Highlights: • The prevalence of pure paraseptal emphysema was 3% (85/2633) in the Framingham Heart Study population, predominantly affects the upper lung zone, and contributes to slightly decreased pulmonary function. • There was significant association between paraseptal emphysema and interstitial lung abnormalities, which is a novel finding. • Prevalence of paraseptal emphysema and its impact on pulmonary function could have been underestimated in the previous reports. - Abstract: Objective: To investigate the prevalence and distribution of paraseptal emphysema on chest CT images in the Framingham Heart Study (FHS) population, and assess its impact on pulmonary function. Also pursued was the association with interstitial lung abnormalities. Materials and methods: We assessed 2633 participants in the FHS for paraseptal emphysema on chest CT. Characteristics of the participants, including age, sex, smoking status, clinical symptoms, and results of pulmonary function tests, were compared between those with and without paraseptal emphysema. The association between paraseptal emphysema and interstitial lung abnormalities was investigated. Results: Of the 2633 participants, 86 (3%) had pure paraseptal emphysema (defined as paraseptal emphysema with no other subtypes of emphysema other than paraseptal emphysema or a very few centrilobular emphysema involved) in at least one lung zone. The upper zone of the lungs was almost always involved. Compared to the participants without paraseptal emphysema, those with pure paraseptal emphysema were significantly older, and were more frequently male and smokers (mean 64 years, 71% male, mean 36 pack-years, P < 0.001) and had significantly decreased FEV 1 /FVC% (P = 0.002), and diffusion capacity of carbon monoxide (DLCO) (P = 0.002). There was a significant association between pure paraseptal emphysema and interstitial lung abnormalities (P < 0.001). Conclusions: The prevalence of pure paraseptal emphysema was 3% in the FHS

  9. Development of the robot system to assist CT-guided brain surgery

    International Nuclear Information System (INIS)

    Koyama, H.; Funakubo, H.; Komeda, T.; Uchida, T.; Takakura, K.

    1999-01-01

    The robot technology was introduced into the stereotactic neurosurgery for application to biopsy, blind surgery, and functional neurosurgery. The authors have developed a newly designed the robot system to assist CT-guided brain surgery, designed to allow a biopsy needle to reach the targget such as a cerebral tumor within a brain automatically on the basis of the X,Y, and Z coordinates obtained by CT scanner. In this paper we describe construction of the robot, the control of the robot by CT image, robot simulation, and investigated a phantom experiment using CT image. (author)

  10. Accuracy of lung nodule volumetry in low-dose CT with iterative reconstruction: an anthropomorphic thoracic phantom study.

    Science.gov (United States)

    Doo, K W; Kang, E-Y; Yong, H S; Woo, O H; Lee, K Y; Oh, Y-W

    2014-09-01

    The purpose of this study was to assess accuracy of lung nodule volumetry in low-dose CT with application of iterative reconstruction (IR) according to nodule size, nodule density and CT tube currents, using artificial lung nodules within an anthropomorphic thoracic phantom. Eight artificial nodules (four diameters: 5, 8, 10 and 12 mm; two CT densities: -630 HU that represents ground-glass nodule and +100 HU that represents solid nodule) were randomly placed inside a thoracic phantom. Scans were performed with tube current-time product to 10, 20, 30 and 50 mAs. Images were reconstructed with IR and filtered back projection (FBP). We compared volume estimates to a reference standard and calculated the absolute percentage error (APE). The APE of all nodules was significantly lower when IR was used than with FBP (7.5 ± 4.7% compared with 9.0 ±6.9%; p volumetry in low-dose CT by application of IR showed reliable accuracy in a phantom study. Lung nodule volumetry can be reliably applicable to all lung nodules including small, ground-glass nodules even in ultra-low-dose CT with application of IR. IR significantly improved the accuracy of lung nodule volumetry compared with FBP particularly for ground-glass (-630 HU) nodules. Volumetry in low-dose CT can be utilized in patient with lung nodule work-up, and IR has benefit for small, ground-glass lung nodules in low-dose CT.

  11. Analysis of histological type and CT features on patients with haemoptysis in primary lung cancer

    International Nuclear Information System (INIS)

    Zhang Yixing; Huang Jinhuo

    2008-01-01

    Objective: To explore the CT features and histological types of haemoptysis patients with primary lung cancer. Methods: 50 haemoptysis patients (group A) with primary lung cancer confirmed by bronchoendoscopic examination or operation were analyzed. 50 cases of primary lung cancer without haemoptysis were studied as the contrast group (group B). The tumor size, shape, cavity, as well as location and pathological type were compared. Results: The proportions of adenocarcinoma and squamous cell carcinoma were 48%, 26% in Group A and 23%, 31% in Group B respectively. The occurrent rate of adenocarcinoma showed significant difference between Group A and B (P>0.05). The proportion of central lung cancer and peripheral lung cancer were 54%, 50% and 46%, 50% in Group A and B respectively. No significant difference occurred in both two types of cancer between two groups (P>0.05). The average size of cancer mass were 30±2.54 mm in Group A and 32±1.93mm in group B. The occurrence rate of lung cavity was 18% and 15% respectively in Group A and B. No significant difference existed in size and the occurrence rate of lung cancer mass between Group A and B (P>0.05). Conclusion: Haemoptysis in patients of primary lung cancer was correlated with pathology type, instead of location, size and cavities. (authors)

  12. Accuracy of CT-guided biopsies in 158 patients with thoracic spinal lesions

    International Nuclear Information System (INIS)

    Hao, D.J.; He, B.R.; Liu, T.J.; Zhao, Q.P.; Sun, H.H.; Jiang, Y.H.

    2011-01-01

    Background. Inconsistent accuracies of CT-guided thoracic spinal biopsies have been reported in previous studies. Purpose. To determine the accuracy of CT-guided thoracic spinal biopsy, to compare the results with those previously reported, and to determine if there are any factors that influence the accuracy of CT-guided thoracic spinal biopsy. Material and Methods. In total, 158 consecutive CT-guided percutaneous thoracic spine procedures (performed at the Dept. of Spinal Surgery, Xian Red Cross Hospital between April 2000 and July 2010) were reviewed. The 158 lesions were categorized by location and radiographic features. Pathological and clinical follow-up were used to determine accuracy. Results. The diagnostic accuracy of CT-guided thoracic spinal biopsy was 90.5% overall. Biopsy of metastatic bone disease (98.2%) was significantly more accurate than biopsies of primary tumors (80.9%) and of hematological malignancies (47.0%) (P < 0.05 and P < 0.005, respectively). The diagnostic accuracy of CT-guided thoracic spinal biopsy was significantly higher for the lower thoracic spine (97.6%) than for the middle (90.0%) or upper thoracic spine (80.4%) (P < 0.05 and P < 0.025, respectively). The diagnostic accuracy was significantly higher for lytic lesions (96.4%) than for sclerotic lesions (81.3%) (P < 0.010). The accuracy of biopsies performed using the transpedicular approach (91.0%) was not significantly different from that of biopsies performed using posterolateral approaches (91.5%) (0.25 < P < 0.5). Conclusion. Percutaneous CT-guided thoracic spinal biopsy is a viable alternative to open surgical biopsy. The diagnostic accuracy was not affected by any of the variables except for lesion level, histology, and radiographic features

  13. Accuracy of CT-guided biopsies in 158 patients with thoracic spinal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Hao, D.J.; He, B.R.; Liu, T.J.; Zhao, Q.P. (Dept. of Spinal Surgery, Xian Red Cross Hospital, Xian Shaanxi (China)), email: zqpddn1@gmail.com; Sun, H.H. (Dept. of Orthopaedic, Tangdu Hospital, Fourth Military Medical Univ., Xian Shaanxi (China)); Jiang, Y.H. (Dept. of Radiology, Xian Red Cross Hospital, Xian Shaanxi (China))

    2011-11-15

    Background. Inconsistent accuracies of CT-guided thoracic spinal biopsies have been reported in previous studies. Purpose. To determine the accuracy of CT-guided thoracic spinal biopsy, to compare the results with those previously reported, and to determine if there are any factors that influence the accuracy of CT-guided thoracic spinal biopsy. Material and Methods. In total, 158 consecutive CT-guided percutaneous thoracic spine procedures (performed at the Dept. of Spinal Surgery, Xian Red Cross Hospital between April 2000 and July 2010) were reviewed. The 158 lesions were categorized by location and radiographic features. Pathological and clinical follow-up were used to determine accuracy. Results. The diagnostic accuracy of CT-guided thoracic spinal biopsy was 90.5% overall. Biopsy of metastatic bone disease (98.2%) was significantly more accurate than biopsies of primary tumors (80.9%) and of hematological malignancies (47.0%) (P < 0.05 and P < 0.005, respectively). The diagnostic accuracy of CT-guided thoracic spinal biopsy was significantly higher for the lower thoracic spine (97.6%) than for the middle (90.0%) or upper thoracic spine (80.4%) (P < 0.05 and P < 0.025, respectively). The diagnostic accuracy was significantly higher for lytic lesions (96.4%) than for sclerotic lesions (81.3%) (P < 0.010). The accuracy of biopsies performed using the transpedicular approach (91.0%) was not significantly different from that of biopsies performed using posterolateral approaches (91.5%) (0.25 < P < 0.5). Conclusion. Percutaneous CT-guided thoracic spinal biopsy is a viable alternative to open surgical biopsy. The diagnostic accuracy was not affected by any of the variables except for lesion level, histology, and radiographic features

  14. Basic pattern in CT of the lung and differential diagnosis

    International Nuclear Information System (INIS)

    Jacobi, V.; Thalhammer, A.

    2006-01-01

    Infectious, physical, chemical or other noxae elicit a limited number of reactions in lung tissue. As in the case of other organs and tissues, lung tissue has specific reactions that are often more indicative of the particular organ than the harmful agent. The resulting radiological features are usually ambiguous and therefore prevent definitive diagnosis. This complicates etiological categorization of the disease. Pathognomonic findings are rare. The same noxa can yield different radiographic features and clinical pictures for different patients. A diagnosis is generally not comprised of a single radiographic feature, but rather of a combination of a plurality of features. Although the number of possible diagnoses can be limited via radiological means, a final diagnosis is determined in conjunction with the medical history, the clinical picture, as well as lab and histopathological values. This article defines the most common pulmonary changes and also discusses differential diagnostic criteria. (orig.)

  15. Resolution enhancement of lung 4D-CT via group-sparsity

    International Nuclear Information System (INIS)

    Bhavsar, Arnav; Wu, Guorong; Shen, Dinggang; Lian, Jun

    2013-01-01

    Purpose: 4D-CT typically delivers more accurate information about anatomical structures in the lung, over 3D-CT, due to its ability to capture visual information of the lung motion across different respiratory phases. This helps to better determine the dose during radiation therapy for lung cancer. However, a critical concern with 4D-CT that substantially compromises this advantage is the low superior-inferior resolution due to less number of acquired slices, in order to control the CT radiation dose. To address this limitation, the authors propose an approach to reconstruct missing intermediate slices, so as to improve the superior-inferior resolution.Methods: In this method the authors exploit the observation that sampling information across respiratory phases in 4D-CT can be complimentary due to lung motion. The authors’ approach uses this locally complimentary information across phases in a patch-based sparse-representation framework. Moreover, unlike some recent approaches that treat local patches independently, the authors’ approach employs the group-sparsity framework that imposes neighborhood and similarity constraints between patches. This helps in mitigating the trade-off between noise robustness and structure preservation, which is an important consideration in resolution enhancement. The authors discuss the regularizing ability of group-sparsity, which helps in reducing the effect of noise and enables better structural localization and enhancement.Results: The authors perform extensive experiments on the publicly available DIR-Lab Lung 4D-CT dataset [R. Castillo, E. Castillo, R. Guerra, V. Johnson, T. McPhail, A. Garg, and T. Guerrero, “A framework for evaluation of deformable image registration spatial accuracy using large landmark point sets,” Phys. Med. Biol. 54, 1849–1870 (2009)]. First, the authors carry out empirical parametric analysis of some important parameters in their approach. The authors then demonstrate, qualitatively as well as

  16. MRI-guided tumor tracking in lung cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Cervino, Laura I; Jiang, Steve B [Center for Advanced Radiotherapy Technology and Department of Radiation Oncology, University of California San Diego, 3960 Health Sciences Dr., La Jolla, CA 92093-0865 (United States); Du, Jiang, E-mail: lcervino@ucsd.edu [Department of Radiology, University of California San Diego, 200 West Arbor Dr., San Diego, CA 92103-8226 (United States)

    2011-07-07

    Precise tracking of lung tumor motion during treatment delivery still represents a challenge in radiation therapy. Prototypes of MRI-linac hybrid systems are being created which have the potential of ionization-free real-time imaging of the tumor. This study evaluates the performance of lung tumor tracking algorithms in cine-MRI sagittal images from five healthy volunteers. Visible vascular structures were used as targets. Volunteers performed several series of regular and irregular breathing. Two tracking algorithms were implemented and evaluated: a template matching (TM) algorithm in combination with surrogate tracking using the diaphragm (surrogate was used when the maximum correlation between the template and the image in the search window was less than specified), and an artificial neural network (ANN) model based on the principal components of a region of interest that encompasses the target motion. The mean tracking error e and the error at 95% confidence level e{sub 95} were evaluated for each model. The ANN model led to e = 1.5 mm and e{sub 95} = 4.2 mm, while TM led to e = 0.6 mm and e{sub 95} = 1.0 mm. An extra series was considered separately to evaluate the benefit of using surrogate tracking in combination with TM when target out-of-plane motion occurs. For this series, the mean error was 7.2 mm using only TM and 1.7 mm when the surrogate was used in combination with TM. Results show that, as opposed to tracking with other imaging modalities, ANN does not perform well in MR-guided tracking. TM, however, leads to highly accurate tracking. Out-of-plane motion could be addressed by surrogate tracking using the diaphragm, which can be easily identified in the images.

  17. Value of CT-guided biopsy in malignant lymphoma; Wertigkeit der CT-gesteuerten Biopsie maligner Lymphome

    Energy Technology Data Exchange (ETDEWEB)

    Libicher, M.; Noeldge, G.; Radeleff, B.; Gholipur, F.; Richter, G.M. [Abteilung Radiodiagnostik, Universitaetsklinikum Heidelberg (Germany)

    2002-12-01

    Management of diagnosing malignant lymphomas has changed with development of CT-guided techniques and reliable biopsy tools.Pathologists can use representative tissue samples for sub classification in more than 90%.Evaluation of residual lymphoma or relapse can be nearly as effective. Therefore percutaneous biopsy can be considered as primary diagnostic tool in the absence of peripheral lymphadenopathy. CT-guided biopsies can be performed on an outpatient basis under conscious sedation considering contraindications as well as regional complications. Acceptance of percutaneous biopsy by the pathologist and oncologist is based on diagnostic effectiveness that is significantly improved if more than 3{dagger}solid tissue samples are taken. This article reviews the value of CT-guided biopsy in comparison to surgical procedures in patients with malignant lymphoma. Essential aspects that lead to a diagnostic percutaneous biopsy are discussed on grounds of the current literature. (orig.) [German] Mit der Entwicklung CT-gesteuerter Biopsieverfahren sowie zuverlaessiger Biopsiesysteme hat sich die Vorgehensweise bei der Diagnostik maligner Lymphome geaendert. Repraesentative Stanzzylinder mit hoher Praeparatequalitaet ermoeglichen dem Pathologen eine Subklassifikation der Lymphome in ueber 90%. Eine aehnlich hohe Treffsicherheit ist auch bei der Rezidivdiagnostik moeglich. Deshalb sind perkutane Biopsien bei fehlender peripherer Lymphadenopathie als primaere diagnostische Methode geeignet. Unter Beachtung der Kontraindikationen sowie der regional unterschiedlichen Komplikationsmoeglichkeiten koennen die meisten CT-gesteuerten Biopsien ambulant unter Analgosedierung durchgefuehrt werden. Die Akzeptanz perkutaner Biopsien durch Pathologen und Onkologen ist an die diagnostische Genauigkeit gekoppelt. Diese wird durch Gewinnung von mindestens 3 repraesentativen Biopsiezylindern aus den soliden Anteilen eines Lymphoms signifikant erhoeht. Die vorliegende Uebersichtsarbeit

  18. Dual modality CT/PET imaging in lung cancer staging

    International Nuclear Information System (INIS)

    Diaz, Gabriel A.

    2005-01-01

    Purpose: To compare the diagnostic capability of PET-HCT image fusion and helical computed tomography (HCT) for nodal and distant metastases detection in patients with lung cancer. Material and methods: Between February, 2003 and March, 2004 sixty-six consecutive lung cancer patients (45 men and 21 women, mean ages: 63 years old, range: 38 to 96 years old) who underwent HCT and PET-HCT fusion imaging were evaluated retrospectively. All patients had histological confirmation of lung cancer and a definitive diagnosis established on the basis of pathology results and/or clinical follow-up. Results: For global nodal staging (hilar and mediastinal) HCT showed a sensitivity, specificity, positive predictive value and negative predictive value of 72%, 47%, 62% and 58% respectively, versus 94%, 77%, 83% and 92% corresponding to PET-HCT examination. For assessment of advanced nodal stage (N3) PET-HCT showed values of 92%, 100%, 100% and 98% respectively. For detection of distant metastasis, HCT alone had values of 67%, 93%, 84% and 83% respectively versus 100%, 98%, 96% and 100% for the PET-HCT fusion imaging. In 20 (30%) patients under-staged or over-staged on the basis of HCT results, PET-HCT allowed accurate staging. Conclusions: PET-HCT fusion imaging was more effective than HCT alone for nodal and distant metastasis detection and oncology staging. (author)

  19. Complications in CT-guided, semi-automatic coaxial core biopsy of potentially malignant pulmonary lesions; Komplikationen bei CT-gesteuerter, koaxialer Stanzbiopsie malignomverdaechtiger Lungenherde in halbautomatischer Technik

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, R. [Klinik Loewenstein (Germany). Dept. of Radiology; Seebacher, G.; Enderes, B.; Kugler, G.; Graeter, T.P. [Klinik Loewenstein (Germany). Dept. of Thoracic and Vascular Surgery; Fischer, J.R. [Klinik Loewenstein (Germany). Dept. of Oncology

    2015-08-15

    Histological verification of pulmonary lesions is important to ensure correct treatment. Computed tomographic (CT) transthoracic core biopsy is a well-established procedure for this. Comparison of available studies is difficult though, as technical and patient characteristics vary. Using a standardized biopsy technique, we evaluated our results for CT-guided coaxial core biopsy in a semi-automatic technique. Within 2 years, 664 consecutive transpulmonary biopsies were analyzed retrospectively. All interventions w