communication and technique at the service of body ... · pitch :0.9 collimation 64x0.6mm table...
TRANSCRIPT
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Département diagnostique
Service de radiologie
Communication and technique at the service ofBody Geriatric Imaging: approach with CT
A Technical tool serving Clinique
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Département diagnostique
Service de radiologie
Les Trois-Chêne, HUG; Unique context in Europe
Site presentation :▪ Geriatric Hospital
▪ Mean AGE 84 Y
▪ 300 beds
In Geriatric
Geriatric emergency (11.2015)▪ 7/7 ▪ From 75 year▪ Non-vital emergecies & no trauma
Geriatric Radiology1st to be dedicated to geriatric p.
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Département diagnostique
Service de radiologie
Background – Overview
▪ Geriatric epidemiological transition
▪ Age increase, senses decrease
▪ Concept of fragility or vulnerability
In Geriatric
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Département diagnostique
Service de radiologie
Care Specifies Overview
▪ Failing Cognition
▪ The pain, one way or another
▪ A full “CUMULUS” pathology card
▪ The death in the background , but still alive !
In Geriatric
Global Dimension
Physical Dimension
Psychological Dimension
Spiritual Dimension
Social or Cultural
Dimension
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Département diagnostique
Service de radiologie
Welcome to the CT….
▪ « I warn you, I am claustrophobic! »
▪ Common fear of falling
▪ “Nobody warned me, what the hell am I doing here?”
▪ “What does it mean doing all these exams?”
▪ Veins in very bad condition
▪ « Good morning, I need to pee! »
▪ « There is a beast up to the ceiling! »
In Geriatric
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Département diagnostique
Service de radiologie
The CT-scan: Siemens Somatom Definition AS
UFC DETECTOR 128x0.6mm 64 barrettes
STRATON TUBE
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Département diagnostique
Service de radiologie
Historical Context
1972the first
HOUNSFIELD’s CT
1989Helical CT
1998 CT
Multislice
2018Siemens Force
19301895
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Département diagnostique
Service de radiologie
Problem : sometimes one of ours exams can give that….
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Département diagnostique
Service de radiologie
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Département diagnostique
Service de radiologie
Even if our machine can do this…
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Département diagnostique
Service de radiologie
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Département diagnostique
Service de radiologie
Principel : fight against the kinetic blur of patient breathing
Rotation-tube
Aceleration
Per a CT for
Image more
Diagnostic
Evidently
No trace of inspiration and
apnea befor images.
0.3s
0.5s
PITCH 1.0
PITCH 0.6
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Département diagnostique
Service de radiologie
User Interface
Main Idea: fight against the kinetic blur of patient breathing
List of « Protocoles Rapides » :
• LOWDOSE_THORAX_Rapide• THORAX_SPC_Rapide• THORAX_IV_Rapide• TAP_SPC_Rapide• TAP_IV_Rapide• Thorax_EP_Abdo_IV_Rapide
• --------------------------------------------------------• Abdo_LowDose_Rapide• Abdo_SPC_Rapide• Abdo_iv_Rapide• Abdo_4_phases_Rapide• Abdo_4_Phases_et_Thorax_IV_Rapide• Abdo_4_Phases_et_Thorax_artériel_Rapide• Uro_CT_SPLITBOLUS_Sans_Lasix_Rapide
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Département diagnostique
Service de radiologie
Image quality: Usual Protocol Protocole Rapide
QUALITEIMAGE GLOBALE
CONTRASTE DENSITY
RESOLUTION
SPACERESOLUTION
TEMPORALRESOLUTION
S/NRATIO
ARTEFACTS
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Département diagnostique
Service de radiologie
Temporal Resolution
Problematic of Kinetic Blur in Imaging
Definition: organ movement during acquisition= several positions on the same image
ConclusionProtocole Rapide = Acquisition time can be almost divided by 2.
D = S . tD – Kinetic blur in imageS – speed of patient organs t – acquisition time
U R
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Département diagnostique
Service de radiologie
Abdo IV T rot :0.5 sPitch :0.9Collimation 64x0.6mmTable speed: 6,9 cm/s
Abdo IV RapideT rot :0.3 sPitch :1.0Collimation 64x0.6mmTable speed: 12,8cm/s
Abdo IV RapideT Rot : 0.3sPitch :1.5Collimation: 64x0.6mmTable speed: 19,2cm/s
Temporal Resolution : Aeolian experience
Angular speed of the displacement23.5 Rot/min, otherwise 140°/s
U R
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Département diagnostique
Service de radiologie
Temporal resolution, water challenge
4.93s
13.21s
9.05s
TAP IVU R
U
S
U
A
L
R
A
P
I
D
E
M
A
X
I
M
A
L
NEW RECORD
4.93 s
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Département diagnostique
Service de radiologie
0
0.5
1
1.5
0
0.5
1
1.5
15
.2
18
.2
18
.6
21
.5
24
.1
25
.2
29
.1 30
31
Temps Acquisition Qualité Image Maximale(Préconisation SIEMENS)
Temps Acquisition Usuel CT-3C
Temps Acquisition Rapide 2 Bras en haut
Curves gain of temporal resolution in function of patient BMI
Temporal Resolution and X-ray tube dose rate constraint
0
0.5
1
14
.9
16
.25
19
.4
23
.1
23
.9
26
.7
28
.2
28
.7
U R
Temps
Temps
Temps
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Département diagnostique
Service de radiologie
Temporal resolution, case report: Protocol Thorax SPC , February 2018, CT-3C
U R
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Département diagnostique
Service de radiologie
Temporal resolution, case report:
CT Thorax SPC,Mai 2018:
CT Thorax Low-dose , Mai 2018:
Usual Rapide
U R
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Département diagnostique
Service de radiologie
Temporal resolution, case report:Protocol Abdo IV, April 2018, CT-3C.
U R
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Département diagnostique
Service de radiologie
Temporal resolution, case report : Protocol Abdo IV, April 2018, CT-3C.
Usual Rapide
U R
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Département diagnostique
Service de radiologie
Space Resolution
Go into « rapide » mode (Trot 0.3s et Pitch 1) lead to moderate loss of sampling
➢ Numbre of slice profile / Rotation decrease➢ Pitch increase➢ Sinogramme less riche➢ Identical matrix of image reconstruction in axials views ( 10242 )
However the quality of resolution sufficient and adequate for a diagnostic analysis (Siemens Healthcare)
Aliasing Artifacts and Noise in CT Images
U R
Usual Rapide
Z
YX
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Département diagnostique
Service de radiologie
S/N Ratio
Go into a « Rapide » mode leads to a light decrease of SNR with the equivalent dose
The beam hardening : Moiré pattern Case report: streaks and noise
U RR
apid
e
U
sual
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Département diagnostique
Service de radiologie
Contrast density Resolution
Light loss intrinsic contrast,usually due to the KV stepped up.
➢Compton effect increase therefore the diffuse radiation increase as well➢Incident radiation has higher energetic value, ➢The µ absorption of the: air; water, bone decrease and get closer
90
100
110
120
16
.62
17
.15
18
.11
9.5
19
.71
9.7
21
.42
1.7
22
.68
22
.92
3.4
26
.62
8.1 29
29
.12
9.3
32
.05
36
.6
KV Abdo IV Usuel
KV Abdo IV Rapide
90
100
110
120
15.2 17.1 18.5 20.9 22.5 25.2 26.1 30.2 31.7 34.4KV TAP IV Usuel
KV TAP IV Rapide
Abdo IV Usual, 100KV Abdo IV Rapide: 120KV
194 UH
270 UH
206 UH
143 UH
173 UH136 UH
113 UH
136 UH
Exam of the same patient, in 2 days apart, September 2017
U R
80ml Acc 350 78ml Acc 350
KV
KV
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Département diagnostique
Service de radiologie
90
100
110
120
15
.4
16
.3
19
.8 22
23
.1
23
.1
23
.2
25
.3
27
.4
28
.2
28
.3
33
.6
36
.2
KV Thorax SPC Usuel
KV Thorax SPC Rapide
Contrast Density Resolution
70
80
90
100
110
120
KV Thorax IV Usuel
KV Thorax IV Rapide
Rapport Contraste sur bruit
Rapport Signal sur bruit
U R
KV
KV
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Département diagnostique
Service de radiologie
Quality Image Conclusion
Maximal Image vs Optimal Image
U R
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Département diagnostique
Service de radiologie
Day by day: the Radiographer’s choice of the right technic
✓ The smelling of the radiographer
✓ Communication Channels:“On a tous quelque chose en nous de…” « De la Garanderie »
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Département diagnostique
Service de radiologie
Et au Quotidien: Le choix de la technique par le TRM (suite)
✓ Le cognitif, mais aussi l’émotionnel :L’empathie, une approche décisive
✓ Cela fait écho sur notre émotionnel.
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Département diagnostique
Service de radiologie
OUI
NON
How Does the Radiographer CT-3C decide between Usual or Rapide
OUI
NON
OUI
NON
OUI
NON
OUI
NON
ACCUEIL✓ Présentations réciproques✓ Prise de contact✓ Evaluation du TRM✓ Radiologue averti
Contact possible ? Le patient ne semble pas
comprendre ce qu’on lui dit.Il peut être opposant
L’examen est
réalisable ?
Le Patient accepte ?
EVALUATION DU BLOQUAGEInformer le prescripteur,Discussion multilatérale,dans le respect du droit du patient
Le patient accepte
au final ?
PHASE PREPARATOIRE✓ Explication du déroulement
d’examen, ✓ Transmission des consignes d’apnée,✓ Test de restitution active des
consignes
Le patient tient
l’apnée ?
PROTOCOLE RAPIDE
PROTOCOLE USUEL
PAS D’EXAMEN
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Département diagnostique
Service de radiologie
Analyse for the 1° semester 2018
68%
32%
Distribution 1° semester 2018 (493 exams)
Normal
Rapide
5457
66
4649
63
2825
28
24
29
24
Janvier 2018 Février 2018 Mars 2018 Avril 2018 Mai 2018 Juin 2018
Normal Rapide
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Département diagnostique
Service de radiologie
Analyse for the 1° semester 2018, 2nd reading
0
10
20
30
40
50
60
70
80
90
100
Jan.18 Feb.18 Mrz.18 Apr.18 Mai.18 Jun.18
Protocole Rapide
On a dû recommencer en modeRapide
Le patient a respiré
Protocole Standard réussi
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Département diagnostique
Service de radiologie
Protocol Rapide : Centering,Always in sight
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Département diagnostique
Service de radiologie
Protocol Rapide : Centering,Always in sight
1. The Centring and the dose
Reference Dose
+ 13.5%*
+ 33.3%*
+ 51.1%*
* : Fantôme CTDI 32 cm
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Département diagnostique
Service de radiologie
Protocol Rapide : Centering,Always in sightCentering et dose gradient +
+
-
-
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Département diagnostique
Service de radiologie
Protocol Rapide : Centering,Always in sight
2. Dose Gradient dose and posterior noise
bruit de référence
+ 1.8%*
+ 5.4%*
+ 13.4%*
*: Fantôme W23
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Département diagnostique
Service de radiologie
Protocol Rapide : Arms, Centering, Dose, Time
+ +
8
7
6
5
4
3
2
1
0
-1
-2
-3
-4
-5
-6
-7
-8
BMI PATIENT CENTRAGE BRASPERCEPTION
INFORMATIQUE DOSERESOLUTIONTEMPORELLE
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Département diagnostique
Service de radiologie
Any question?
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Département diagnostique
Service de radiologie
A last call?
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Département diagnostique
Service de radiologie
Thanks for your attention
Remerciements particuliers: DR. Max Scheffler, Méd Adjoint, Service de radiologie, HUG Professeur ZAIDI, Physicien, HUG.Mme JEHL, Siemens HealthCareL’équipe TRM , Hôpital des Trois –Chênes, HUG.Mr et Mme HENNEQUIN, Montreuil,France,informatique.Mr S.RICHARD, Manipulateur radio, CHBM, France
Auteurs:David Delarbre, TRMAitor Bonneau, TRMEnrique Maturana, Chef TRM adjoint,