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    January 01, 2014

    The following are highlights from the current issues of RSNA’s two peer-reviewed journals.

    How to Perform Parathyroid 4D CT: Tips and Traps for Technique and Interpretation

    Coronal arterial phase 4D CT image shows a lesion measuring up to 4 cm in craniocaudal dimension
    (Click to enlarge) Images in a 52-year-old woman with a large left parathyroid adenoma. Coronal arterial phase 4D CT image shows a lesion measuring up to 4 cm in craniocaudal dimension (straight arrows), inferior to the left thyroid lobe and extending between the left common carotid artery (CCA) and brachiocephalic artery (BC). An enlarged inferior thyroid artery terminates at the superior pole of the lesion (curved arrow). Note the contralateral normal inferior thyroid artery (arrowhead).
    (Radiology 2014;270;1:15–24) 

    Parathyroid 4D CT is an imaging technique for preoperative localization of parathyroid adenomas that involves multidetector CT image acquisition during two or more contrast enhancement phases.

    In an article in the January issue of Radiology (RSNA.org/Radiology), Jenny K. Hoang, M.B.B.S., of Duke University Medical Center, Durham, N.C., and colleagues describe the 4D CT technique, provide a practical guide to the radiologist for imaging interpretation and discuss the rationale for imaging, the approach to interpretation, and imaging findings and pitfalls. Awareness of several technical and patient factors can increase the success of performing 4D CT, according to the authors.

    “Interpretation of 4D CT images is challenging because of ectopic lesions, multiglandular disease, and lesion mimics such as thyroid nodules and lymph nodes,” the authors write. “The radiologist’s ability to detect a candidate lesion and differentiate it from mimics can be increased with appreciation of the typical contrast enhancement characteristics and morphologic features of parathyroid adenomas.”

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only. 

    Application of Emerging Techniques for Abdominal CT Dose Optimization: How to Achieve the Dose That Fits the Patient and Diagnostic Task

    Low-dose CT enterographic study performed in a patient with Crohn disease
    (Click to enlarge) Axial 2.5-mm-thick model-based iterative reconstruction images from a low-dose CT enterographic study performed in a patient with Crohn disease at 80 kV with a noise index of 60 at 0.625-mm thickness (CTDIvol value = 1.9 mGy) show wall thickening and enhancement involving the neoterminal ileum (arrow).
    (RadioGraphics 2014;34;4-18) 

    Recent advances in CT scanning techniques have allowed CT radiation dose reduction while maintaining diagnostic image quality. Radiologists need to understand the latest dose optimization strategies and should incorporate them into clinical practice by collaborating with physicists and CT technologists

    In an article in the January-February issue of RadioGraphics (RSNA.org/RadioGraphics), Ravi K. Kaza, M.D., University of Michigan Hospitals, Ann Arbor, and colleagues discuss the use of emerging techniques for the development of optimal imaging protocols aimed at achieving the desired image quality at a reduced dose. Specifically, the authors discuss:

    • Image quality parameters and CT dose
    • Automated tube current modulation (ATCM)
    • Optimal tube voltage
    • Iterative image reconstruction

    Optimization of scanning technique based on imaging task and patient habitus, in conjunction with use of iterative image reconstruction, allows significant radiation dose reduction without compromising image quality, according to the authors.

    “The optimization of scanning protocols requires a collaborative effort between radiologists, medical physicists, and CT technologists, and a full recognition of the potential decrease in image quality when radiation dose is reduced,” the authors write.

    This article is accompanied by an Invited Commentary by Mahadevappa Mahesh, M.S., Ph.D., Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine Baltimore.

    This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only. 
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