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Objectives: Accurate collimation helps to reduce unnecessary irradiation and improves radiographic image quality, which is especially important in the radiosensitive paediatric population. For AP/PA chest radiographs in children, a minimal field size (MinFS) from "just above the lung apices" to "T12/L1" with age-dependent tolerance is suggested by the 1996 European Commission (EC) guidelines, which were examined qualitatively and quantitatively at a paediatric radiology division., Methods: Five hundred ninety-eight unprocessed chest X-rays (45% boys, 55% girls; mean age 3.9 years, range 0-18 years) were analysed with a self-developed tool. Qualitative standards were assessed based on the EC guidelines, as well as the overexposed field size and needlessly irradiated tissue compared to the MinFS., Results: While qualitative guideline recommendations were satisfied, mean overexposure of +45.1 ± 18.9% (range +10.2% to +107.9%) and tissue overexposure of +33.3 ± 13.3% were found. Only 4% (26/598) of the examined X-rays completely fulfilled the EC guidelines., Conclusions: This study presents a new chest radiography quality control tool which allows assessment of field sizes, distances, overexposures and quality parameters based on the EC guidelines. Utilising this tool, we detected inadequate field sizes, inspiration depths, and patient positioning. Furthermore, some debatable EC guideline aspects were revealed., Key Points: • European Guidelines on X-ray quality recommend exposed field sizes for common examinations. • The major failing in paediatric radiographic imaging techniques is inappropriate field size. • Optimal handling of radiographic units can reduce radiation exposure to paediatric patients. • Constant quality control helps ensure optimal chest radiographic image acquisition in children.

Purpose: To compare the image quality and radiation dose between iterative reconstruction (IR) and standard filtered back projection (FBP) in CT of the chest and abdomen., Materials and Methods: Thoracic CT was performed in 50 patients (38 male, 12 female; mean age, 51 ± 23 yrs; range, 7-85 yrs) and abdominal CT was performed in 50 patients (36 male, 14 female; mean age, 62 ± 13 yrs; range, 20-85 yrs), using IR as well as FBP for image reconstruction. Image noise was quantitatively assessed measuring standard deviation of Hounsfield Units (HU) in defined regions of interest in subcutaneous tissue. Scan length and Computed Tomography Dose Index (CTDI) were documented. Scan length, image noise, and CTDI of both reconstruction techniques were compared by using paired tests according to the nature of variables (McNemar test or Student t test). Overall subjective image quality and subjective image noise were compared., Results: There was no significant difference between the protocols in terms of mean scan length (p>0.05). Image noise was statistically significantly higher with IR, although the difference was clinically insignificant (13.3 ± 3.0 HU and 13.6 ± 3.0 HU for thoracic CT and 11.5 ± 3.1 HU and 11.7 ± 3.0 HU for abdominal CT, p<0.05). There was no significant difference in overall subjective image quality and subjective image noise. The radiation dose was significantly lower with IR. Volume-weighted CTDI decreased by 64% (6.2 ± 2.5 mGy versus 17.1 ± 9.5 mGy, p<0.001) for thoracic CT and by 58% (7.8 ± 4.6 mGy versus 18.5 ± 8.6 mGy, p<0.001) for abdominal CT., Conclusions: Our study shows that in thoracic and abdominal CT with IR, there is no clinically significant impact on image quality, yet a significant radiation dose reduction compared to FBP., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To assess the correlation of relative hepatic enhancement (RHE), relative renal enhancement (RRE) and liver to kidneys enhancement ratio (LKR) with serum hepatic enzyme levels and eGFR in Gd-EOB-DTPA enhanced MRI of the liver and to assess threshold levels for predicting enhancement of the liver parenchyma., Methods: Data of 75 patients who underwent Gd-EOB-DTPA enhanced MRI of the liver were collected. Images were obtained before contrast injection, during the early arterial phase, late arterial phase, venous phase, delayed phase, and hepatobiliary phase which was 20 min after Gd-EOB-DTPA administration. Signal intensity of the liver and the kidneys in all phases was defined using region-of-interest measurements for relative enhancement calculation. Serum hepatic enzyme levels and eGFR were available in all patients. Spearman correlation test was used to test the correlation of RHE, RRE and LKR with serum hepatic enzyme levels and eGFR., Results: In the hepatobiliary phase all serum hepatic enzymes were significantly correlated with RHE; total bilirubin (TBIL) and cholin esterase (CHE) showed strongest correlations. TBIL and CHE were significantly correlated with RRE in the arterial phases. TBIL and CHE were significantly correlated with LKR in the arterial phase and hepatobiliary phase. eGFR showed no correlation., Conclusions: In Gd-EOB-DTPA enhanced MRI, TBIL and CHE levels may predict RHE, RRE and LKR., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Nocardiosis is an infrequent but serious pulmonary infection caused by Gram-positive aerobic actinomycetes. In this paper, we report on a 48-year-old patient with pleuropulmonary nocardiosis and cirrhosis due to chronic hepatitis C virus infection treated with triple antiviral treatment complicated by prolonged neutropenia.

Rationale and Objectives: To assess the value of additional fine needle aspiration (FNA) to core needle biopsy (CNB) in computed tomography-guided biopsy of lesions of the lung, liver, pancreas, or of enlarged lymph nodes in an offsite cytopathologist setting., Materials and Methods: This retrospective Health Insurance Portability and Accountability Act-compliant study was approved by the Institutional Review Board (IRB); informed consent (IC) was waived. Data of 377 patients who underwent computed tomography-guided FNA and CNB of lesions of the lung, liver, pancreas, or enlarged lymph nodes were enrolled. An onsite cytopathologist was not available. Sensitivity and specificity were calculated for FNA, CNB, and combined FNA/CNB. For the purpose of our study, positive diagnoses from CNB specimens or subsequent biopsy or surgical resection specimens or clinical follow-up data were considered as the standard of reference., Results: CNB yielded a significantly higher sensitivity than FNA in all sites, except the pancreas, where the difference did not reach statistical significance. Additional FNA to CNB did not significantly increase the sensitivity. Specificity did not significantly differ between FNA, CNB, and combined FNA/CNB in all sites. Malignancies of 1.7% were detected only with FNA, without evidence of malignancy in CNB; for the remaining malignancies, CNB was positive or indeterminate., Conclusion: Additional FNA to CNB without an onsite cytopathologist does not yield higher sensitivity or specificity compared to CNB alone., (Copyright © 2010 AUR. Published by Elsevier Inc. All rights reserved.)