Abstract:

Article is devoted to a problem of radiation dose during multi-spiral computed tomograpy of abdominal cavity. This review describes the basic and additional methods of reducing the radiation exposure at CT with intravenous contrast enhancement. Results of researches conducted in recent years were considered and analyzed. Nuances of reduction of radiation exposure in specific cases were analyzed. Prospects of reducing the dose of contrast agent in abdominal MDCT with IV contrast media administration were estimated. The importance of control of radiation exposure of patients is proved.

References

1.      Mettle Г F.A., Jr. Bhargavan M., Faulkner K., Gilley D.B. et al. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources-1950-2007. Radiology. 2009; (253): 520-531.

2.      National Council on Radiation Protection and Measurements. Ionizing radiation exposure of the population of the United States (NCRP Report No 160) // National Council on Radiation Protection and Measurements. - 2009.

3.      Brenner D.J. Minimising medically unwarranted computed tomography scans. Ann ICRP. 2012 Oct-Dec; 41(3- 4):161-169.

4.      Ng M., Fleming T., Robinson M, Thomson B. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Aug 30; 384(9945): 746.

5.      Yu L., Fletcher J.G., Grant K.L., Carter R.E. et al. Automatic Selection of Tube Potential for Radiation Dose Reduction in Vascular and Contrast-Enhanced Abdominopelvic CT. Medical physics 37.1 (2010): 234-243.

6.      Yanaga Y, Awai K., Nakaura T., Utsunomiya D. et al. Hepatocellular Carcinoma in Patients Weighing 70 kg or Less: Initial Trial of Compact-Bolus Dynamic CT With Low-Dose Contrast Material at 80 kVp. AJR Am J Roentgenol. 2011 Jun;196(6): 1324-1331.

7.      Hur S., Lee J.M., Kim S.J., Park J.H. et al. 80-kVp CT using Iterative Reconstruction in Image Space algorithm for the detection of hypervascular hepatocellular carcinoma: phantom and initial clinical experience. Korean J Radiol.(2012);13: 152-164.

8.      Winklehner A., Karlo C., Puippe G., Schmidt B. Raw data-based iterative reconstruction in body CTA: evaluation of radiation dose saving potential. Eur Radiol. 2011 Dec;21(12): 2521-2526.

9.      Brenner D.J., Hall E.J. Computed tomography an increasing source of radiation exposure. N Engl J Med. 2007 Nov 29; 357(22): 2277-2284.

10.    Scialpi M., Cagini L., Pierotti L., De Santis F. et al. Detection of small (<2 cm) pancreatic adenocarcinoma and surrounding parenchyma: correlations between enhancement patterns at triphasic MDCT and histologic features. BMC Gastroenterol. 2014 Jan (21): 14-16.

11.    Cabrera F., Preminger G.M., Lipkin M.E. As low as reasonably achievable: Methods for reducing radiation exposure during the management of renal and ureteral stones. Indian J Urol. 2014 Jan; 30(1): 55-59.

12.    Marin D., Choudhury K.R., Gupta RT, Ho L.M. et al. Clinical impact of an adaptive statistical iterative reconstruction algorithm for detection of hypervascular liver tumours using a low tube voltage, high tube current MDCT technique. Eur Radiol. 2013; (23): 3325-3335.

13.    Baker M.E., Dong F., Primak A., Obuchowski N.A. et al. Contrast-to-noise ratio and low-contrast object resolution on full- and low-dose MDCT: SAFIRE versus filtered back projection in a low-contrast object phantom and in the liver. AJR Am J Roentgenol. 2012 Jul; 199(1): 8-18.

14.    Li Q., Gavrielides M.A., Zeng R., Myers K.J. et al. Volume estimation of low-contrast lesions with CT: a comparison of performances from a phantom study, simulations and theoretical analysis. Phys Med Biol. 2015 Jan 21; 60(2): 671-688.

15.    Noda Y, Kanematsu M., Goshima S., Kondo H. et. al. Reducing iodine load in hepatic CT for patients with chronic liver disease with a combination of low-tube- voltage and adaptive statistical iterative reconstruction. Eur J Radiol. 2015 Jan; 84(1): 11-18.

16.    Noda Y, Kanematsu M., Goshima S., Kondo H. et. al. Reduction of iodine load in CT imaging of pancreas acquired with low tube voltage and an adaptive statistical iterative reconstruction technique. J Comput Assist Tomogr. 2014 Sep-Oct;38(5): 714-20.

17.    Choi J.W., Lee J.M., Yoon J.H., Baek J.H. et al. Iterative reconstruction algorithms of computed tomography for the assessment of small pancreatic lesions: phantom study. J Comput Assist Tomogr. 2013; (37): 911-923.

18.    Desmond A.N., O’Regan K., Curran C., McWilliams S. et al. Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008 Nov; 57(11): 1524-1529.

19.    Patino M., Fuentes J.M., Singh S., Hahn P.F. et al. Iterative Reconstruction Techniques in Abdominopelvic CT: Technical Concepts and Clinical Implementation. AJR Am J Roentgenol. 2015 Jul; 205(1): W19-31.

20.    Lambert L., Ourednicek P., Jahoda J., Lambertova A. et al. Model-based vs hybrid iterative reconstruction technique in ultralow-dose submillisievert CT colonography. Br J Radiol. 2015 Apr; 88(1048): 20140667.

21.    Fletcher J.G., Hara A.K., Fidler J.L., Silva A.C. Observer performance for adaptive, image-based denoising and filtered back projection compared to scanner-based iterative reconstruction for lower dose CT enterography. Abdom Imaging. 2015 Jun; 40(5): 1050-1059.

22.    Habibzadeh M.A., Ay M.R., Asl A.R., Ghadiri H. et al. Impact of miscentering on patient dose and image noise in x- ray CT imaging: phantom and clinical studies. Phys Med. 2012 Jul; 28(3): 191-199.

23.    Goo H.W. CT radiation dose optimization and estimation: an update for radiologists. Korean J Radiol. 2012 Jan-Feb; 13(1): 1-11.

24.    Aznaurov V.G., Kondratiev E.V., Oganesyan N.K., Karmazanovsky G.G. MSKT gepatopankreatoduodenalnoj zony s ponizhennoj luchevoj nagruzkoj: opyt prakticheskogo primenenija. [Low-Dose Hepatopancreatic MDCT: Practical Experience of Applicability]. Medical Visualization. 2017 ;(2): 28-35 [In Russ.].

Abstract:

Results of minimal invasive percutaneus drainage interventions under US-control in 45 children, aged 1-4 years with intraabdominal abscesses of different genesis are presented. Intraabdominal abscesses were identified as subdiaphragmatic (16), intrafilar (22) and pelvic (19). Difference between US-characteristics of intraabdominal abscesses, preoperative planning peculiarities and interventional technologies, that depend on localization of abscesses are presented.

The usage of 3D-echography results data in 13,3% of children increased the value of diagnostics: for optimization of surgical approach, kind and volume of intervention.

Percutaneus drainage intervention under ultrasound control is effective and non-traumatic method of treatment. 

    References

1.     Libov S.L. Localised peritonitis in children L., Medicina. 1983:184 [In Russ].

2.     Evdokimova E.Ju. US diagnostic and therapeutic nterventions in patients with postoperative inflammatory outcomes. Abstract of dissertation for the degree «Doctor of Philosophy». Krasnojarsk. 2003: 298[In Russ].

3.     Barsukov M.G. Transcutaneus US-guided draining of abdominal cavity abscesses. Abstract of dissertation for the degree «Doctor of Philosophy». Moskva. 2003: 29 [In Russ].

4.     Judin Ja.B., Prokopenko, Ju.D., Fedorov, K.K., Gabinskaja T.A. Ostryj appendicit u detej Acute appendicitis in children. M.: Medicina. 1998: 256 [In Russ].

5.     Witinin V.E. Localised peritonitis of appendicular genesis in children. Hirurgija 1980; 7: 12-16 [In Russ].

6.     Dvorjakovskij I.V., Beljaeva O.A. US diagnostics in pediatric surgery. M., Profit. 1997: 243 [In Russ].

7.     Beljaeva O.A., Lotov A.N., Musaev G.H., Rozinov V.M. US-guided mini-invasive interventions in children with urgent abdominal patology. Manual for physicians. M.: ANMI. 2002: 25 [In Russ].

8.     Pediatric surgery: national guidance. M.: «GJeOTAR-Media». 2009: 1168 [In Russ].

9.     Vajner Ju.S., Egorov A.B., Vardosanidze V.K. Treatment of abdominal cavity’ abscesses with the help of US-guided mini-invasive interventions. Scientific-practical conference «Transcutaneus and endoscopic interventions in surgery»: abstracts. Moskva. 2010: 48-49 [In Russ].

10.   Shulutko A.M., Nasirov F.N., Natroshvili A.G. Possibilities of US in diagnostics and treatment of abdominal cavity’ abscesses. Scientific-practical conference «Transcutaneus and endoscopic interventions in surgery»: abstracts. Moskva. 2010: 91-92 [In Russ].

11.   Kulezneva Ju.V., Izrailov R.E., Lemeshko Z.A. US in deiagnostics and treatment of acute appendicitis. Moskva: «GJeOTAR-Media». 2009: 72 [In Russ].

12.   Grigovich I.N., Derbenev V.V., Leuhin M.V. Vise conservatism in urgent pediatric surgery. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2011; 4: 16-19 [In Russ].

Abstract:

Introduction of reconstructive-plastic operationts in practice of breast cancer surgical treatment have led to the necessity of dynamic monitoring methods development in patients after such treatment. We have proposed technique of mammography after reconstructive-plastic operations and operations with the use of silicone implants. For the period of 8 yrs 167 patients underwent dynamic mammography monitoring.

Proposed methodics allows to reliably assess the results of reconstructive-plastic operations and predict the appearance of possible complications.

Abstract:

Aim: was to study influence of surgical reconstruction of left ventricular (LV) in patients with postinfarction LV aneurysm, on dynamics of stroke volume (SV) and determine basic predictors of its decreasement.

Materials and Methods: retrospective study included patients with various types of surgical reconstruction of post-infarction LV aneurysm who underwent cardiac MRI before surgery, and subsequent control study by the same method in the postoperative period (mean 17,6 ± 4,7 days ) from March 2010 to February 2014. For statistical analysis, patients were divided into 2 groups according to the postoperative increase or decrease of SV Performed statistical analysis of baseline and post-operative structure - geometric and functional parameters of LV A mathematical model, based on which the multivariate analysis was performed using an automated method of linear modeling tc identify the most important predictor of subsequent risk assessment and its impact on postoperative decrease SV

Results: the left ventricular reconstruction surgery in the early postoperative period leads to reduce of left ventricular end diastolic (LVED) and end-systolic volume (LVES), respectively 22,41% and 21,85% (p <0,001), and an increase in ejection fraction (EF) at 21,76% (p <0,001), that seemingly indicates improvement in the pumping function of the heart. But, however, pointed out that the stroke volume, which more accurately reflects the feature after reconstruction LV increases less than half of patients (42.6%), an average of 11,2±1,6%, (p <0,001) and the majority (57,4%) decreases in average 21,0 ± 1,6%. (p <0,001). Groups with a postoperative increase or decrease in the value of SV differed except its dynamics (p <0,001), for the volume reduction of LVES (p = 0.25) increase in EF (p <0,001), a decrease INLS (p = 0.006). Found that the most important predictor of postoperative dynamics affecting the SV is the surgical reduction of LV volume (LVED). With a decrease in LV volume more than 25% of the original LVED risk reduction SV becomes high (OR 0,53; 95% CI 0,35, 0,79). When surgical volume reduction ratio greater than 35% chance of postoperative improvement SV maximally reduced (RR 4,74; 95% CI 1,27; 17,73; p = 0,042).

Conclusion: after surgical reconstruction of postinfarction LV aneurysms in the early postoperative period increase SV occurs in less than half of patients (42.6%), despite an increase in ejection fraction and decreased LVED. Leading predictor of postoperative determining the dynamics of the SV, is surgical reduction of left ventricular volume. Reduction of the volume of the left ventricle during the operation of surgical correction of left ventricular aneurysm more than 25% of the original LVED increases the risk of postoperative decrease in stroke volume, and more than 35% reduces chances of his promotion. 

References

1.     Borisov N.A., Popov L.V., Bletkin A.N. Hirurgicheskoe lechenie postinfakrtnoj anevrizmy levogo zheludochka [Surgical treatment of postinfarction aneurysm of left ventricular]. Annaly hirurgii. 2002; 3:14-19 [ in Russ].

2.     Cooley D.A. Surgical restoration of left ventricular aneurysm. Oper. Tech. Cardiac. Thorac. Surg. 1997; 2:151-161.

3.     Otsuji Y, Handschumacher M.D., Liel-Choen N., et al Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: Three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation. J. Am. Coll. Cardiol. 2001; 37:641-648.

4.     Kalon K., Ho. L., Pinsky J.L., Karmd W.B., Levy D. The epidemiology of heart failure: the Framingham Study. J. of AmericanCollege of Cardiology. 1993; 22:6A-13A.

5.     Grigioni F., regurgitationEnriquez-Sarano M., Zehr K.J. et al. Ischaemic mitral. Circulation. 2001; 103: 1759-1764.

6.     Athanasuleas C.L., Buckberg G.D., Stanley A.W., et al. RESTORE group. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J. Am.Coll. Cardiol. 2004; 44:1439-1445.

7.     Di Donato M., Fantini F., Toso A., Castelvecchio S., Menicanti L., Annest L., Burkhoff D. Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2010; 140:1325-1331

8.     Menicanti L., Castelvecchio S., Ranucci M., et al. Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration. J. Thorac. Сardiovasc. Surg. 2007; 134: 433-441.

9.     Annest L., Burkhoff D., JordeU., Wechsler A.S. Stroke volume alterations in patients undergoing left ventricular reconstructive surgery: a meta-analysis of 2131 cases. J. Card. Fail. 2007; 3:118.

10.   Cirillo M., Amaducci A., Brunelli F., et al. Determinants of postinfarction remodeling affect outcome and left ventricular geometry after surgical treatment of ischemic cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2004; 127:1648-1656.

11.   Di Donato M., Toso A., Dor V., et al. Surgical ventricular restoration improves mechanical intraventricular dyssynchrony in ischemic cardiomyopathy. Circulation. 2004; 109:2536-2543.

12.   Menicanti L., Di Donato M. The Dor procedure: what has changed after fifteen years of clinical practice? J. Thorac. Cardiovasc. Surg. 2002; 124:886-890.

13.   O’Neill J.O., Starling R.C., McCarthy P.M., et al. The impact of left ventricular reconstruction on survival in patients with ischemic cardiomyopathy. Eur. J. Cardiothorac. Surg. 2006; 30:753-759.

14.   Patel N.D., Williams J.A., Nwakanma L.U., et al. Impact of lateral wall myocardial infarction on outcomes after surgical ventricular restoration. Ann.Thorac. Surg. 2007; 83:2017-2027.

15.   Tulner     S.A., Bax J.J., Bleeker G.B., et al. Beneficial hemodynamic and clinical effects of surgical ventricular restoration in patients with ischemic dilated cardiomyopathy. Ann. Thorac. Surg. 2006; 82:1721-1727.

16.   Athanasuleas C.L., Stanley A.W. Jr., Buckberg G.D., et al. Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction. RESTORE group. Reconstructive Endoventricular Surgery, returning Torsion Original Radius Elliptical Shape to the LV. J. Am. Coll. Cardiol. 2001; 37:1199-1209.

17.   Dor V., Sabatier M., Montiglio F., Coste P., Di D.M. Endoventricular patch reconstruction in large ischemic wall-motion abnormalities. J. Card .Surg. 1999;14:46-52.

18.   Patel N.D., Williams J.A., Barreiro C.J., et al. Surgical ventricular remodeling for multiterritory myocardial infarction: defining a new patient population. J. Thorac. Cardiovasc. Surg. 2005; 130:1698-1706.

19.   Ribeiro G.A., da Costa C.E., Lopes M.M., et al. Left ventricular reconstruction benefits patients with ischemic cardiomyopathy and non-viable myocardium. Eur. J. Cardiothorac. Surg. 2006; 29: 196-201.

20.   Suma H., Isomura T., Horii T., et al. Nontransplant cardiac surgery for end-stage cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2000; 119:1233-1244.

21.   Yamaguchi A., Adachi H., Kawahito K., et al Left ventricular reconstruction benefits patients with dilated ischemic cardiomyopathy. Ann. Thorac. Surg. 2005; 79:456-461.

22.   Yu H.Y, Chen YS., Tseng W.Y, et al. Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis withmagnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration. J. Thorac. Cardiovasc. Surg. 2009; 137:887-894.

23.   Rossejkin E.V., Kobzev E. E., Bazylev V. V. Neposredstvennye rezul'taty hirurgicheskoj rekonstrukcii levogo zheludochka [Immediate results of surgical reconstruction of left ventricular]. XIX Vserossijskij s#ezd serdechno-sosudistyh hirurgov. 2013. http://new.rassh.ru/report/neposredstvennye _rezultaty_khirurgi_cheskoy_rekonstruktsii_ levogo_ zheludochka/[In Russ].

24.   Shabalkin B.V., Rabkin I.H., Belov Ju.V. i dr. Prognozirovanie posleoperacionnoj serdechnoj nedostatochnosti pri hirurgicheskom lechenii anevrizm serdca. Krovosnabzhenie, metabolizm i funkcija organov pri reko struktivnyh operacijah. [Prognosis of post-operative heart insufficiency on surgical treatment of heart aneurysms. Blood circulation, metabolism and functioning of organs during reconstruction operations.] Erevan 1984; 166-168 [In Russ].

25.   Komeda M., David T.E., Malik A., Ivanov J., Sun Z. Operative risks and long-term results of operation for left ventricular aneurysm. Ann. Thorac. Surg. 1992; 53:22-29.

26.   Van         der Wall E.E., Bax J.J. Different imaging approaches in the assessment of left ventricular dysfunction: all things equal? Eur. Heart J. 2000; 21:1295-1297.

27.   Lorenz C.H., Walker E.S., Morgan V. L., Klein, S.S., Graham T.P. Jr. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J. Cardiovasc. Magn. Reson. 1999; 1:7-21.

28.   Belov Ju.V. Postinfarktnoe remodelirovanie levogo zheludochka serdca: ot koncepcii k hirurgicheskomu lecheniju [Postinfarction remodeling of left ventricular: from concept to surgical treatment.]. M., izd. De-Novo. 2002; S:194 [In Russ].

29.   Dor V., Sbatier M., DiDonato M., et al. Efficacy of endoventricular patchplasty in large post-infarction akinetic scar and severe left ventricular dysfunction: comparison with a series of large dyskinetic scars. J. Thorac. Cardiovasc. Surg. 1998;116:50-59.

30.   Dor V., Civaia F., Alexandrescu C., Sabatier M., Montiglio F. Favorable effects of left ventricular reconstruction in patients excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial. J. Thorac. Cardiovasc. Surg. 2011; 141:905-9164.

31.   Bokerija L.A., Fedorov G.G. Hirurgicheskoe lechenie bol'nyh s postinfarktnymi anevrizmami serdca i soputstvujushhimi tahiaritmijam [Surgical treatment of patients with postinfarction aneurysms accompanying tachyarrhythmia.]. Grudnaja i serd.-sosud.hirurgija. 1994; 4:4-8 [In Russ].

32.   Cooley D.A. Repair of post-infarction aneurysm of the left ventricle. Cardiac surgery: state of the art reviews, Vol. 4, No. 2. Philadelphia: Hanley and Belfus, 1990; P. 309

33.   Dor V. Clinical, Sabatier M., Montiglio F., et al. Hemodynamic, and electrophysiologic results of 207 left ventricular patch reconstructions for infarction left ventricular aneurysm. l. Presented at the 72nd Annual Meeting of the American Association for Thoracic Surgery, Los Angeles, CA, April. 1992; 26-29.

34.   Artrip J.H., Oz M., Burkhoff D. Left ventricular volume reduction surgery for heart failure: a physiologic perspective. J. Thorac. Cardiovasc. Surg. 2001;122: 75-82.

35.   Burkhoff D., Wechsler A.S. Surgical ventricular remodeling: a balancing act on systolic and diastolic properties. J. Thorac. Cardiovasc. Surg. 2006;132:459-63.

36.   Ratcliffe M.B., Guy T.S. The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling. J. Thorac. Cardiovasc. Surg. 2007; 134:280-283

37.   Jones R.H., Velazquez E.J. Michler R.E., et al. Coronary bypass surgery with or without surgical ventricular reconstruction. N. Engl. J .Med. 2009;360:1705-17.

38.   Chernjavskij A.M., Marchenko A.V., Karas'kov A.M. Raschet ploshhadi vykljuchenija postinfarktnoj anevrizmy levogo zheludochka [Calculation of area of postinfarction aneurism dismiss]. (Grudnaja i serdechnososudistaja hirurgija. 2002; 6. 54-58 [In Russ].