Low-dose computed tomography (CT) protocol in the screening of patients with social exposure to asbestos Poster No.: C-3032 Congress: ECR 2010 Type: Scientific Exhibit Topic: Radiographers Authors: P. Caruso, M. Mencoboni, L. Migliazzi, C. Pastorino, T. Luminati, E. Tagliafico, E. Silvestri; Genoa/IT Keywords: Low Dose CT, Lung, Mesothelin DOI: 10.1594/ecr2010/C-3032 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 28
Purpose Purpose: our Institution is involved in a screening project to assess whether high concentrations of seric mesoteline in patients with social exposure to asbestos is predictive of a higher incidence of pleural mesothelioma. The purpose of our work is to evaluate the effectiveness of a low-dose CT protocol for the screening of such patients. Methods and Materials Methods and materials: 185 patients with a previous social exposure to asbestos were included in our screening (185 males, mean age 61,2±6,5 years range41-82 ). They underwent a non-contrast low-dose CT of the chest (2,5 mm x 4, pitch 7, 40 mas [50 ma x 0,8 s], 120 Kv) completed with coronal an sagittal MPR reconstruction. Page 2 of 28
Fig.: Normal lung: axial image References: P. Caruso; Unit of Radiology, Ospedale Evangelico Internazionale, Genoa, ITALY Page 3 of 28
Fig.: Normal lung: coronal MPR References: P. Caruso; Unit of Radiology, Ospedale Evangelico Internazionale, Genoa, ITALY Page 4 of 28
Fig.: Normal lung: sagittal MPR References: P. Caruso; Unit of Radiology, Ospedale Evangelico Internazionale, Genoa, ITALY Page 5 of 28
Images for this section: Fig. 1: Normal lung: coronal MPR Page 6 of 28
Fig. 2: Normal lung: axial image Page 7 of 28
Fig. 3: Normal lung: sagittal MPR Page 8 of 28
Results Results: 80/185 patients (43,2%) had no lung alterations, 90/185 (48,6%) showed the presence of a chronic lung disease, and 15/185 (8,1%) presented a acute lung disease that was evalued by a pneumologist finding also malignat lesion. Those latter underwent a conventional-dose contrasted CT of the chest that confirmed the previous finding (2,5 mm x 4, pitch 7, 180 mas [225 ma x 0,8 s], 120 Kv). The low-dose protocol administered a radiation dose of 2,2 mgy instead 9,8 mgy of the normal protocol. No lung alteration Chronic lung disease Acute lung disease Images for this section: Page 9 of 28
Fig. 1: Calcified pleural thickening - axial Page 10 of 28
Fig. 2: Calcified pleural thickening - coronal MPR Page 11 of 28
Fig. 3: Calcified pleural thickening - sagittal MPR Page 12 of 28
Fig. 4: Micronodule - 3 mm Page 13 of 28
Fig. 5: Inflammatory nodule Page 14 of 28
Fig. 6: Spiculate nodule - axial Page 15 of 28
Fig. 7: Spiculate nodule - coronal MPR Page 16 of 28
Fig. 8: Acute interstitial pneumonia Page 17 of 28
Fig. 9: micronodule 4 mm Page 18 of 28
Fig. 10: Thin-walled cysts Page 19 of 28
Conclusion Conclusions: our low-dose protocol was effective in the detection of malignancies in patients with a previous social exposure to asbestos. We think that this protocol could be used also in patients where a CT examination of the lung is needed on a short-term basis (pneumothorax, post-operative follow-up) and in young patients. Page 20 of 28
Fig.: Massive pneumothorax References: P. Caruso; Unit of Radiology, Ospedale Evangelico Internazionale, Genoa, ITALY Fig.: Bronchiectasis References: P. Caruso; Unit of Radiology, Ospedale Evangelico Internazionale, Genoa, ITALY Page 21 of 28
Fig.: Spiculate nodule References: P. Caruso; Unit of Radiology, Ospedale Evangelico Internazionale, Genoa, ITALY Page 22 of 28
Images for this section: Fig. 1: Massive pneumothorax Page 23 of 28
Fig. 2: Bronchiectasis Page 24 of 28
Fig. 3: Spiculate nodule Page 25 of 28
References,,,,,,,,,,,,,,,,. Lung cancer screening with low-dose computed tomography: Canadian experience. Can Assoc Radiol J. 2007 Oct;58(4):225-35,,,,,,,. Program of early detection of pulmonary neoplasms by the computed tomography - preliminary Szczecin experience. Pneumonol Alergol Pol. 2009;77(6):521-7,,,,. Multidetector computed tomography chest examinations with low-kilovoltage protocols in adults: effect on image quality and radiation dose. J Comput Assist Tomogr. 2009 May-Jun;33(3):416-21,,,,,,. Radiation dose reduction in chest CT: a review. AJR Am J Roentgenol. 2008 Feb;190(2):335-43.,,,,,,,,,,,,,,, Lung cancer screening using low-dose computed tomography in at-risk individuals: The Toronto experience. Lung Cancer. 2009 May 6,,,,. Low-kilovoltage multi-detector row chest CT in adults: feasibility and effect on image quality and iodine dose. Radiology. 2004 Apr;231(1):169-74. Epub 2004 Feb 27. Page 26 of 28
,,,,. Image quality and radiation exposure at pulmonary CT angiography with 100- or 120-kVp protocol: prospective randomized study. Radiology. 2007 Nov;245(2):577-83.,,,,,. Strategies for reducing radiation dose in CT. Radiol Clin North Am. 2009 Jan;47(1):27-40. Personal Information P. Caruso, E. Silvestri Radiologist Ospedale Evangelico Intrnazionale Genova Italy pietro.caruso@oeige.org M.Mencoboni M.D. Oncologia Osp. Villa Scassi Genova Italy L. Migliazzi M.D. Medicina del Lavoro - Osp S. Martino Genova Italy C. Pastorino Radiologist Page 27 of 28
Radiologia - Osp. Bordighera (IM) Italy T. Luminati, E. Tagliafico Radiographer Ospedale Evangelico Intrnazionale Genova Italy Page 28 of 28