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A Multidisciplinary Assessment of Standard Low Dose Versus Ultra-low Dose Chest CT Scans for Pectus Excavatum Imaging
Charles Hehman1, Shelby Aughtman1, Michael Goretsky2
1Department of Surgery, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, 825 Fairfax Ave, Norfolk, VA, 23507, USA.
Insights
Ultra-low dose CT scans reliably assess pectus excavatum severity using Haller (HI) and Correction indices (CI). This reduces radiation exposure for patients without compromising diagnostic accuracy.
Area of Science:
- Medical Imaging
- Pediatric Radiology
- Thoracic Surgery
Background:
- Pectus excavatum (PE) is a congenital chest wall deformity.
- Accurate assessment of PE severity is crucial for treatment planning.
- Standard low-dose CT (CARE) is used, but radiation exposure is a concern.
Purpose of the Study:
- To evaluate ultra-low dose CT (ULTRA) for assessing PE severity.
- To compare ULTRA with standard low-dose CT (CARE) using Haller index (HI) and Correction index (CI).
- To determine reliability and agreement between the two CT protocols.
Main Methods:
- Prospective study of 32 PE patients undergoing both CARE and ULTRA CT scans.
- Pediatric radiologists and surgeons calculated HI and CI for each scan.
- Intraclass Correlation Coefficient (ICC) and Bland-Altman analysis were used.
Main Results:
- High reliability for HI (ICC=0.89) and CI (ICC=0.91) between CARE and ULTRA.
- Slightly higher reliability for HI in surgeons and CI in radiologists.
- Bland-Altman plots showed no consistent bias between the two methods.
Conclusions:
- Ultra-low dose CT is a reliable alternative for evaluating PE severity.
- This supports developing protocols to reduce radiation exposure in PE patients.
- ULTRA maintains diagnostic accuracy for HI and CI assessment.
Aim:
Evaluation of ultra-low dose chest CT imaging for the assessment of pectus excavatum severity as determined by pediatric radiologists and pediatric surgeons using Haller (HI) and Correction indices (CI).
Methods:
A single institution, prospective evaluation of patients being evaluated for pectus excavatum were scanned with a standard low-dose chest CT protocol (CARE) followed by a consecutive ultra-low dose CT scan (ULTRA). 3 surgeons and 4 radiologists were instructed to determine HI and CI in each series. The Intraclass Correlation Coefficient (ICC) was used to calculate the agreement level between CARE and ULTRA. Bland-Altman (BA) and scatter plots were also performed to determine bias of each approach.
Results:
32 patients had CARE and ULTRA consecutively. The ICC for HI demonstrated good reliability with a value of 0.89 and excellent reliability for CI with a value of 0.91. The reliability for HI was greater in the surgeon group (0.89) compared to the radiologist group (0.88). The reliability for CI was greater in the radiologist group (0.92) compared to the surgeon group (0.90). The Bland Altman plots for the HI and CI demonstrate no consistent bias for CARE or ULTRA approach when evaluating HI and CI.
Conclusion:
Ultra-low dose CT scan imaging compared to standard low-dose CT appears to be a reliable alternative for evaluating PE severity as assessed by HI and CI. This work supports the evaluation and potential development of a standardized CT imaging protocol capable of reducing radiation exposure without sacrificing imaging for PE patients.
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