Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80kV versus 100kV

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A preliminary study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "533" "paginaFinal" => "540" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparación de una secuencia en 3D con eco de gradiente potenciada en T1 con 3 factores de reducción de imagen en paralelo diferentes, en apnea y respiración libre, utilizando una bobina de 32 canales a 1,5T. Estudio preliminar" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2139 "Ancho" => 1001 "Tamanyo" => 165047 ] ] "descripcion" => array:1 [ "en" => "Free breathing T1 weighted 3D GRE images with RF=2 (A), RF=4 (B) and RF=6 (C) of the same subject. All images were considered non-diagnostic. Notice the presence of motion artifacts with all RFs. In (C) pixel graininess and aliasing artifacts are also clearly evident in the center of the image contributing furthermore for image degradation." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Herédia, B. Dale, R. Op de Campos, M. Ramalho, L.B. Burke, C. Sams, M. de Toni, R.C. Semelka" "autores" => array:8 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Herédia" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Dale" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Op de Campos" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Ramalho" ] 4 => array:2 [ "nombre" => "L.B." "apellidos" => "Burke" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Sams" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "de Toni" ] 7 => array:2 [ "nombre" => "R.C." "apellidos" => "Semelka" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833812002342" "doi" => "10.1016/j.rx.2012.06.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833812002342?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510713000049?idApp=UINPBA00004N" "url" => "/21735107/0000005600000006/v1_201412120104/S2173510713000049/v1_201412120104/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80kV versus 100kV" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "541" "paginaFinal" => "547" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Oca Pernas, C. Delgado Sánchez-Gracián, G. Tardáguila de la Fuente, A. Fernández del Valle, N. Silva Priegue, M. González Vázquez, C. Trinidad López" "autores" => array:7 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Oca Pernas" "email" => array:2 [ 0 => "roqueoca@hotmail.com" 1 => "roqueoca@povisa.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Delgado Sánchez-Gracián" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Tardáguila de la Fuente" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Fernández del Valle" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Silva Priegue" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "González Vázquez" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Trinidad López" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparación de la calidad de imagen y dosis de radiación en angio-tomografía computarizada de arterias periféricas con 80 y 100kV" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2423 "Ancho" => 2168 "Tamanyo" => 419491 ] ] "descripcion" => array:1 [ "en" => "Volume rendering reconstructions with the identical algorithm to that of angio-CT of peripheral arteries of two (2) different patients of 82kg of weight both. The patient who underwent the 80kV protocol shows occlusion of the right external iliac artery (hollow arrow) and bilateral femoropopliteal artery recanalizing through collaterals distally. The patient studied with 100kV shows the occlusion of the left popliteal artery (arrow). See the optimal quality of the image obtained with both protocols." ] ] ] "textoCompleto" => "IntroductionPeripheral artery disease (PAD) whose etiopathological factor is arterosclerosis is a serious health condition. Its prevalence is high: it affects 12% of adult population and 20% of people <70 years old.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Its diagnosis is based on clinical criteria and image modalities that help us plan the appropriate therapy. Traditionally the assessment of pretreatment has been performed through conventional angiographies yet this modality is not free from complications.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Angio-CT has proven to be an efficient exploratory tool to diagnose PAD in lower limbs. Several studies confirm the high diagnostic security of this modality when exploring the peripheral arterial system as easier less bloody more widely available test than digital angiography. For all these reasons angio-CT is more and more used to diagnose PAD while accounting for 5% of all planned explorations and 0.1% of scanning emergencies.<a class="elsevierStyleCrossRefs" href="#bib0020">4–12</a>Recently it has been proven that 64-detector row angio-CT equals conventional angiography both for the diagnosis and planning of therapy in patients with PAD.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Yet angio-CT has several drawbacks like its poor diagnostic capacity when in the presence of calcification, its low profitability in stenoses <50% and above all due its radiation dose up to 12–13mSv due to large anatomical volumes included and acquisitions that performed through thinner cuts.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> The idea of reducing the radiation dose of CT up to reasonable limits still stands today.<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a> There are studies on other vascular territories showing that it is possible to reduce the dose of radiation with protocols of fewer kV without affecting the quality of the diagnostic images acquired<a class="elsevierStyleCrossRef" href="#bib0085">17</a> yet there are few studies showing how to optimize the radiation dose when studying lower limbs through angio-CT<a class="elsevierStyleCrossRef" href="#bib0090">18</a>–none of them just by reducing kV. Reducing kV not only reduces the radiation dose but also increases vascular enhancement. This is due to the fact that the level of maximum iodine attenuation (K-edge) is 33kV, i.e. with energies of 80kV the attenuation is >100kV.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a>Hence our goal is to check if there are differences in the diagnostic quality of angio-CT of lower limbs and in radiation dose while reducing kV.Materials and methodsPatientsWe did a prospective observational study where 60 randomized patients in two (2) groups during a period of five (5) months were analyzed. The study was approved by the hospital ethical committee and all patients signed prior written informed consent.The criterion to do the test was the request of one angio-CT of lower limbs due to suspicion of acute or chronic peripheral artery disease. Exclusion criteria were contrast allergies, pregnancy, hyperthyroidism or renal failure (glomerular filtration rate below 35ml/min/m2), age <18 years old and not signing the aforementioned informed consent. Patients were randomized in two (2) groups through a computed generated list with the program Excel® 2007 (Microsoft®) that randomly assigned kilovoltage to every patient. In group A the 100kV protocol was used and in group B the 80kV protocol was used. In group A 32 males and 7 women of an average 65.9±16.5 years of age were included. In group B 23 males and 7 women of an average 65.8±12.6 years of age were included.Computed angio-tomography of lower limbsAll studies were done through a 64-detector row angio-CT (Somatom Sensation 64®; Siemens Medical Systems, Erlangen, Germany). Patients were examined in the decubitus supinus position with their arms above their heads. Frontal topogram with 100kV and 35mA was acquired. The study was done in cranial-caudal direction with a coverage spanning from the diaphragm to the heels. The CT parameters were 64mm×0.6mm collimation, gantry rotation speed 0.33s, table speed 40mm/s, pitch factor 0.9, reference tube current 170mAS with tube modulation modality in a 170–230mAs range (Care Dose® Siemens Medical Systems, Erlangen, Germany). Based on the group a different kilovoltage was used (100kV for group A and 80kV for group B) while the remaining parameters remained stable including the reference tube current. For the administration of contrast the antecubital vein was canalized to introduce 120ml of iopromide (Ultravist 300® Bayer Schering Pharma, Berlin, Germany) followed by 40ml of saline solution at a constant flow of 4ml/s using a Stellant Dual® injector (Medrad Inc., PA, USA).For an adequate vascular enhancement the contrast optimization technique “bolus tracking” was used by placing one ROI in the abdominal aorta at the level of renal arteries and with a trigger threshold of 150HU. A 15s additional delay was added to guarantee the stain of the more distal arteries. In an effort to homogenize the technique this protocol was applied in the same way in all patients regardless of their clinical manifestations. During post-processing 1.5mm thick cuts were done with reconstruction increase of 1mm and soft tissue filter B20f. Final analysis was done with axial images with V reconstructions–volume rendering.Image analysisMeasurements of vascular density (VD) were acquired in w Leonardo® working station (Siemens Medical Systems; Erlangen, Germany) along the arteries of lower limbs including 11 different levels (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>): aorta at the level of renal arteries, external left and right iliac arteries, proximal left and right superficial femoral arteries, proximal left and right deep femoral arteries, left and right popliteal arteries, posterior left and right tibial arteries. To that end one ROI was freehand drawn of a diameter as big as the vascular lumen area and the HU density was measured. The vascular lumen area was considered exclusively as the visible surface with contrast of which wall thrombi or plaques calcified at wall level were excluded.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Based on these measurements the average VD was obtained. In those cases where we could not measure all segments–occlusion, prosthesis or amputation the average VD was limited to the assessed vessels.The average muscle density (MD) was estimated by measuring density with a 0.25in.-ROI in the central region of the right paraspinal muscle and the anterior rectum of left quadriceps from which the measurement was obtained.Measurement of the average noise (N) was estimated through the standard deviation of a 0.25in.-ROI in the surrounding air of three (3) regions in front of the patient's body (right, central and left) at the level of the belly button. The average values were used to estimate the final noise.Based on these measurements the vascular density-noise ratio (VDNR) and the contrast-noise ratio (CNR) were estimated according to the following equations: VDNR=VD/N and CNR=(VD−MD)/N.Also the subjective quality of image was assessed by two (2) explorers (CDS and CTL) with 12 and 11 years of experience in CT respectively by using axial cuts and volume rendering reconstructions (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). To that end a five (5) point-scale was used: 5 excellent; optimal homogeneous vascular enhancement allowing us to evaluate all possible vascular lesions with high diagnostic safety and without any artifacts; 4: good; good vascular nearly homogeneous enhancement allowing us to evaluate all possible vascular lesions with high diagnostic safety and without any significant artifacts; 3: moderate; good; heterogeneous vascular enhancement allowing us to evaluate all possible vascular lesions with moderate diagnostic safety or artifacts affecting the interpretation of images; 2: poor quality but diagnostic; heterogeneous vascular enhancement allowing us to evaluate all possible vascular lesions with low diagnostic safety or artifacts affecting the interpretation of images; 1: non-diagnostic; poor diagnostic information that does not allow us to find or discard vascular lesions with artifacts definitely affecting the interpretation of images.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Evaluation of the estimated effective radiation doseThe effective radiation dose (ERD) was estimated by multiplying the longitudinal product dose (LPD) by a conversion factor for the studied anatomical region. This conversion factor in abdomen and pelvis is 0.01mSv/mGycm.LPD was obtained according to the proportionate figure in the exploration protocol given by the equipment.Statistical analysisThe outcomes of the measurements of VD, VDNR, CNR, subjective image quality, LPD and ERD are expressed according to the average±standard deviation with ranges between brackets.Normalcy in the distribution of the sample could be confirmed through the Kolmogorov–Smirnov test. The characteristics of both groups–age, sex, body mass index [BMI] could be compared by using Student's t test for separate samples as well as the Chi-square test. The variables exploration length and measurements of VD, VDNR, CNR, subjective image quality, LPD and ERD were compared between both groups by using Student's t test for unpaired samples as well as the Chi-square test. Statistical significance was considered to be a value of P<0.05. The Kappa coefficient was used to measure the inter-observer concordance while assessing the subjective quality of images. All estimates were done through a standard PC with the SPSS® software for Windows® v. 15.0 (SPSS® Chicago, IL, USA).ResultsSubjectsThe demographic variables of both groups showed normal distribution and the comparison between both groups of patients did not show statistically significant differences in age, sex, BMI or length of acquisition (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Image parametersAll variables followed normal distribution. The average VD in subjects from group B was greater than that in subjects from group A (462.5±95.6 vs 372.3±100.9; P<0.001). Also a detailed analysis for each and every vessel showed a greater VD in all vessels of patients from group B than in patients from group A without exemption and with significant differences too. There were no statistically significant differences in the average MD (50.1±11.2 vs 51.3±8.8; P=0.54). The average N was greater in patients from group B (21.3±13.4) than in patients from group A (16.3±3.5) with no statistically significant differences (P=0.098). There were statistically significant differences between patients from group A and B when it comes to the VDNR (194.3±49.6 vs 241.9±48.1; P<0.001) yet no statistically significant differences in CNR (21.4±12.1 vs 22.9±9.1; P=0.15). The assessment of the subjective quality of images showed an average value in patients from group A of 4.27±0.82 (CDS) and 4.37±0.71 (CTL) and for patients from group B of 4.0±0.91 (CDS) and 4±0.87 (CTL) P=0.3, with a K-correlation of 0.93±0.075 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Radiation doseThere were statistically significant differences both in the longitudinal product dose (LPD) (570.1mGycm±131.5 vs 278.6mGycm±64.9; P<0.001) and in the effective radiation dose (ERD) (9.6mSv±2.2 vs 4.7mSv±1.1; P<0.001) between the two groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).DiscussionThe results of this study confirm that it is feasible to reduce the radiation dose in studies of angio-CT of lower limbs using a low dose-protocol of 80kV without affecting the quality of image.Recently it has been confirmed that 64-detector row angio-CT endows a great diagnostic safety similar to that of conventional arteriography for the diagnosis and planning of therapy in patients with PAD.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> However, the most important limitation in this type of studies is the radiation dose. Some authors claim that the radiation dose is not a major issue in patients with PAD since the radiation dose does not increase the possibility of developing neoplasms or other conditions when life expectancy is shorter than the latency period needed to develop such conditions.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> Yet despite this several official bodies following the ALARA (as low as reasonably achievable) criterion insist in the need for reducing the radiation in all radiologic tests to the reasonable minimum and patients to levels of unnecessary exposure.<a class="elsevierStyleCrossRefs" href="#bib0075">15,16</a> In the attempt to constantly reduce the radiation dose modifications in the acquisition parameters of equipments are planned. Modifying the tube current, varying the pitch factor, the angle between the tube and the table or the distance of the tube with respect to the patient have been proceedings used to achieve the aforementioned optimization.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> The most significant setback in the strategies aimed at diminishing the dose is the reduction of the diagnostic ability due to an increase in image noise and worsening of the quality of the very test.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> In the study of Fraioli et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> when the tube current was reduced from 130 to 100mAs and to 50mAs in the artery studies of lower limbs the radiation dose was reduced 40–74% respectively without affectation on the diagnostic safety of the test. In another study–Heyer et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> only by modifying the tube kilovoltage from 120 to 100kV they achieved a reduction of up to 40% in the radiation dose without affectation of the image quality in angio-CT for the diagnosis of lung thromboembolism. Similarly Wintersperger et al.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> showed that the reduction of kilovoltage from 120 to 100kV did not influence the relation between VD and N or the overall quality of image in angio-CT of the aortoiliac region. In our study we tried to show that by reducing kilovoltage to 80kV we still can acquire arterial maps of lower limbs with enough quality to perform diagnostic explorations.One of the reasons is due to the fact that the iodine attenuation (K-edge) is maximum at 33kV which means it is closer to 80 than 100kV so it presents a greater enhancement in the studies performed at 80kV.<a class="elsevierStyleCrossRefs" href="#bib0095">19,20</a> Indeed our results were consistent with the studies published to date in other anatomical regions and with the recent study by Lezzi et al.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> in the lower limbs. Studies performed at 80kV proved that the VD is significantly greater than studies done at 100kV. However there were not significant differences in MD or N even though the latter showed a certain growing trend toward significance. N was greater in studies at 80kV yet the VDNR image quality gauge showed a significantly greater result in the 80kV group. This indicates that VD increase is proportionately greater than N allowing us to analyze the arterial system adequately in studies at 80kV. However, the CNR–that also assesses the MD too not only arterial enhancement did not show a significant difference between both groups. This fact can be interpreted by the greater amount of N in the 80kV series images meaning that we need to be cautious when assessing other structures different from arteries in those studies.Also it is also possible that a greater sample size conditions a significant increase of N that in turn could also condition a reduction of CNR. In any case in the sample a non-diagnostic study was found only that could be explained by the patient's abnormal cardiac output that conditioned one insufficient vascular perfusion in the time of acquisition rather than the reduction of kV per se. Despite the systematic use of bolus tracking modality the variability among patients of hemodynamic features can explain the sporadic cases of inconclusive images above all in the more distal territories and the more stenosed-vessels. As a matter of fact this is one of the limitations of our study since trying to homogenize the modality to all patients the same amount of iodinated contrast was administered and the same 15s-delay was used when the 150HU threshold was achieved in the abdominal aorta without paying attention to the physical characteristics of each subject. However, with this protocol we did not find any other cases without stain of distal arteries due to delays in the arrival of contrast. The reasons why the distal arteries could not be assessed were occlusions, artifacts due to metallic prostheses or amputations of limbs.This study has other limitations. We did not assess the radiation dose through direct method using phantoms yet the formula allowed us to obtain the dose through a protocol supplied by the team has proven to have a high concordance with the real doses in adult patients.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> On the other hand the exploration of abdomen with 80kV can underestimate the extravascular findings that with 100kV would be seen with greater reliability which limits its use to the strict vascular evaluation above all in patients with high BMI. Yet despite these drawbacks this study opens the door to new researches with the use of kilovoltage for the assessment of vascular territories through CT.In sum we can say that using 80kV in angio-CT studies of lower limbs reduces the radiation dose without affecting the diagnostic efficacy of the study with respect to the use of 100kV.Ethical responsibilitiesProtection of human and animal subjectsAuthors confirm that all proceedings and experiments followed relate to the committee of responsible human experimentation ethical rules and regulations in compliance with the World Medical Association and the Declaration of Helsinki.Confidentiality of dataAuthors confirm that in this report there are no personal data of patients.Right to privacy and informed consentAuthors confirm that in this report there are no personal data of patients.Authors<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1.Manager of the integrity of the study: CDS, ROP and CTL.</li><li class="elsevierStyleListItem" id="lsti0010">2.Original Idea of the Study: CDS and GTF.</li><li class="elsevierStyleListItem" id="lsti0015">3.Study Design: CDS and GTF.</li><li class="elsevierStyleListItem" id="lsti0020">4.Data Mining: CDS, ROP, AFV, NSP, MGV and CTL.</li><li class="elsevierStyleListItem" id="lsti0025">5.Data Analysis and Interpretation: ROP, CDS and GTF.</li><li class="elsevierStyleListItem" id="lsti0030">6.Statistical Analysis: CDS and GTF.</li><li class="elsevierStyleListItem" id="lsti0035">7.Reference Search: ROP, CDS, AFV, MGV and NSP.</li><li class="elsevierStyleListItem" id="lsti0040">8.Writing: ROP and CDS.</li><li class="elsevierStyleListItem" id="lsti0045">9.Manuscript critical review with intellectually relevant contributions: CTL, GTF, CTL, AFV, MGV and NSP.</li><li class="elsevierStyleListItem" id="lsti0050">10.Final Version Approval: ROP, CDS, AFV, NSP, MGV, CTL and GTF.</li></ul>Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres389413" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec367702" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres389414" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec367703" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Computed angio-tomography of lower limbs" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Image analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Evaluation of the estimated effective radiation dose" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Subjects" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Image parameters" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Radiation dose" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0065" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0080" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0085" "titulo" => "Authors" ] 10 => array:2 [ "identificador" => "sec0140" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-03-24" "fechaAceptado" => "2012-06-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec367702" "palabras" => array:3 [ 0 => "Peripheral arterial disease" 1 => "Multidetector computed tomography" 2 => "Dose of radiation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec367703" "palabras" => array:3 [ 0 => "Enfermedad arterial periférica" 1 => "Tomografía computarizada multidetector" 2 => "Dosis de radiación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo compare the image quality and dose of radiation in two groups of patients undergoing CT angiography of the lower limbs, one with tube voltage of 80kV and the other with tube voltage of 100kV. Materials and methodsWe performed CT angiography of the lower limbs in 60 patients with suspected peripheral arterial disease. Patients were randomly assigned to one of the two groups; in one group, CT angiography was performed using a tube voltage of 80kV, whereas in the other it was performed using 100kV. The remaining acquisition parameters were the same in both groups. The images were analyzed by quantifying vascular density (VD) and noise (N) and by calculating the quotients density/noise (QVDN) and contrast/noise (QCN). Two radiologists working independently evaluated the subjective quality of the images. We calculated the estimated effective dose (EED) based on the dose-length product (DLP). ResultsIn the group studied at 80kV, VD was significantly higher (462.5UH±95.6 vs 372UH±100.9; P<.001), QVDN was significantly higher (241.9±48.1 vs 194.3±49.6; P<.001), and there were trends toward higher N (21.3UH±13 vs 16.3UH±3.5; P=.098) and toward higher QCN (21.4±12.1 vs 22.9±9.1; P=.15). No significant differences were found in the subjective quality of the images. The EED was significantly lower in the group studied at 80kV (4.73mSv±1.1 vs 9.6mSv±2.2; P<.001). ConclusionUsing 80kV instead of 100kV for CT angiography of the lower limbs reduces the dose of radiation without affecting the diagnostic efficacy of the study." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoComparar la calidad de imagen y la dosis de radiación en 2 grupos de pacientes a los que se realiza angio-TC de extremidades inferiores con 80 y 100kV. Material y métodosSe realizó angio-TC de miembros inferiores a 60 pacientes con sospecha de enfermedad arterial periférica aleatorizados en 2 grupos, en uno la TC se realizó con 80kV y en el otro con 100kV. Los demás parámetros de adquisición se mantuvieron constantes. Se analizaron las imágenes cuantificando la densidad vascular (DV) y el ruido (R), y se calcularon los cocientes densidad vascular/ruido (CDVR) y contraste/ruido (CCR). Dos radiólogos evaluaron independientemente la calidad subjetiva de las imágenes. Se calculó la dosis efectiva estimada (DEE) basada en el producto dosis-longitud (DLP). ResultadosEl grupo de 80kV presentó valores significativamente más elevados de la DV (462,5UH±95,6 vs. 372UH±100,9; p<0,001) y del CDVR (241,9±48,1 vs. 194,3±49,6; p<0,001) y diferencias no significativas del R (21,3UH±13 vs. 16,3UH±3,5; p=0,098) y el CCR (21,4±12,1 vs. 22,9±9,1; p=0,15). No hubo diferencias significativas en la calidad subjetiva de la imagen y la dosis efectiva fue significativamente menor en el grupo de 80kV (4,73mSv±1,1 vs. 9,6mSv±2,2; p<0,001). ConclusiónLa utilización de 80kV en el estudio de angio-TC de miembros inferiores disminuye la dosis de radiación sin afectar a la eficacia diagnóstica del estudio respecto a la utilización de 100kV." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Oca Pernas R, Delgado Sánchez-Gracián C, Tardáguila de la Fuente G, Fernández del Valle A, Silva Priegue N, González Vázquez M, et al. Comparación de la calidad de imagen y dosis de radiación en angio-tomografía computarizada de arterias periféricas con 80 y 100kV. Radiología. 2014;56:541–547." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1767 "Ancho" => 1660 "Tamanyo" => 360507 ] ] "descripcion" => array:1 [ "en" => "Angio-CT of peripheral arteries showing how vascular density was freehand measured with a ROI in the external iliac arteries (upper image) and the popliteal arteries (lower image)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2423 "Ancho" => 2168 "Tamanyo" => 419491 ] ] "descripcion" => array:1 [ "en" => "Volume rendering reconstructions with the identical algorithm to that of angio-CT of peripheral arteries of two (2) different patients of 82kg of weight both. The patient who underwent the 80kV protocol shows occlusion of the right external iliac artery (hollow arrow) and bilateral femoropopliteal artery recanalizing through collaterals distally. The patient studied with 100kV shows the occlusion of the left popliteal artery (arrow). See the optimal quality of the image obtained with both protocols." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "BMI, body mass index; NA, non applicable value." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients from group A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients from group B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65±12 (27–92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66±16 (41–86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ratiomen:women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23:7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23:7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28±4 (19–35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28±5 (20–47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Length of scan (mm)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.320±100 (1.184–1.594) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.278±99 (1.039–1.536) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Collimation (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rotation speed (s) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pitch \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tube current (mA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">170 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">170 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kilovoltage (kVp) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab599937.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "The data are the average±standard deviation with ranges between brackets." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients and parameters of acquisition." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "CNR, contrast-noise ratio; VDNR, vascular density-noise ratio; ERD, effective radiation dose; LPD, longitudinal product dose; MD, muscular density; VD, vascular density; HU, Hounsfield units." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Parameters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients from group A 100kV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients from group B 80kV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Difference percentage between protocol A and B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VD (HU) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">372.3±100.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">462.5±95.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">±0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MD (HU) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51.3±8.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.1±11.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Background noise (HU) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.3±3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.3±13.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">±0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.098 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VDNR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">194.3±49.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">241.9±48.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">±0.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CNR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.4±12.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.9±9.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">±0.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.152 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subjective quality of image</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reader#1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.27±0.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4±0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reader#2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.37±0.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4±0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LPD (mGycm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">570.1±131.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">278.6±64.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ERD (mSv) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.6±2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7±1.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−0.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab599938.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Measurements of vascular density, subjective quality of image and radiation dose." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" 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Comparación de la calidad de imagen y dosis de radiación en angio-tomografía computarizada de arterias periféricas con 80 y 100kV

R. Oca Pernas

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roqueoca@hotmail.com
roqueoca@povisa.es

Corresponding author.

, C. Delgado Sánchez-Gracián, G. Tardáguila de la Fuente, A. Fernández del Valle, N. Silva Priegue, M. González Vázquez, C. Trinidad López

Servicio de Radiodiagnóstico, Hospital POVISA, Vigo, Pontevedra, Spain

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    "titulo" => "Comparison of image quality and radiation dose in computed tomography angiography of the peripheral arteries using tube voltage of 80<span class="elsevierStyleHsp" style=""></span>kV versus 100<span class="elsevierStyleHsp" style=""></span>kV"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Volume rendering reconstructions with the identical algorithm to that of angio-CT of peripheral arteries of two &#40;2&#41; different patients of 82<span class="elsevierStyleHsp" style=""></span>kg of weight both&#46; The patient who underwent the 80<span class="elsevierStyleHsp" style=""></span>kV protocol shows occlusion of the right external iliac artery &#40;hollow arrow&#41; and bilateral femoropopliteal artery recanalizing through collaterals distally&#46; The patient studied with 100<span class="elsevierStyleHsp" style=""></span>kV shows the occlusion of the left popliteal artery &#40;arrow&#41;&#46; See the optimal quality of the image obtained with both protocols&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Peripheral artery disease &#40;PAD&#41; whose etiopathological factor is arterosclerosis is a serious health condition&#46; Its prevalence is high&#58; it affects 12&#37; of adult population and 20&#37; of people &#60;70 years old&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Its diagnosis is based on clinical criteria and image modalities that help us plan the appropriate therapy&#46; Traditionally the assessment of pretreatment has been performed through conventional angiographies yet this modality is not free from complications&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Angio-CT has proven to be an efficient exploratory tool to diagnose PAD in lower limbs&#46; Several studies confirm the high diagnostic security of this modality when exploring the peripheral arterial system as easier less bloody more widely available test than digital angiography&#46; For all these reasons angio-CT is more and more used to diagnose PAD while accounting for 5&#37; of all planned explorations and 0&#46;1&#37; of scanning emergencies&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Recently it has been proven that 64-detector row angio-CT equals conventional angiography both for the diagnosis and planning of therapy in patients with PAD&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Yet angio-CT has several drawbacks like its poor diagnostic capacity when in the presence of calcification&#44; its low profitability in stenoses &#60;50&#37; and above all due its radiation dose up to 12&#8211;13<span class="elsevierStyleHsp" style=""></span>mSv due to large anatomical volumes included and acquisitions that performed through thinner cuts&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The idea of reducing the radiation dose of CT up to reasonable limits still stands today&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> There are studies on other vascular territories showing that it is possible to reduce the dose of radiation with protocols of fewer kV without affecting the quality of the diagnostic images acquired<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> yet there are few studies showing how to optimize the radiation dose when studying lower limbs through angio-CT<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#8211;none of them just by reducing kV&#46; Reducing kV not only reduces the radiation dose but also increases vascular enhancement&#46; This is due to the fact that the level of maximum iodine attenuation &#40;K-edge&#41; is 33<span class="elsevierStyleHsp" style=""></span>kV&#44; i&#46;e&#46; with energies of 80<span class="elsevierStyleHsp" style=""></span>kV the attenuation is &#62;100<span class="elsevierStyleHsp" style=""></span>kV&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Hence our goal is to check if there are differences in the diagnostic quality of angio-CT of lower limbs and in radiation dose while reducing kV&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">We did a prospective observational study where 60 randomized patients in two &#40;2&#41; groups during a period of five &#40;5&#41; months were analyzed&#46; The study was approved by the hospital ethical committee and all patients signed prior written informed consent&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The criterion to do the test was the request of one angio-CT of lower limbs due to suspicion of acute or chronic peripheral artery disease&#46; Exclusion criteria were contrast allergies&#44; pregnancy&#44; hyperthyroidism or renal failure &#40;glomerular filtration rate below 35<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; age &#60;18 years old and not signing the aforementioned informed consent&#46; Patients were randomized in two &#40;2&#41; groups through a computed generated list with the program Excel<span class="elsevierStyleSup">&#174;</span> 2007 &#40;Microsoft<span class="elsevierStyleSup">&#174;</span>&#41; that randomly assigned kilovoltage to every patient&#46; In group A the 100<span class="elsevierStyleHsp" style=""></span>kV protocol was used and in group B the 80<span class="elsevierStyleHsp" style=""></span>kV protocol was used&#46; In group A 32 males and 7 women of an average 65&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;5 years of age were included&#46; In group B 23 males and 7 women of an average 65&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;6 years of age were included&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Computed angio-tomography of lower limbs</span><p id="par0030" class="elsevierStylePara elsevierViewall">All studies were done through a 64-detector row angio-CT &#40;Somatom Sensation 64<span class="elsevierStyleSup">&#174;</span>&#59; Siemens Medical Systems&#44; Erlangen&#44; Germany&#41;&#46; Patients were examined in the decubitus supinus position with their arms above their heads&#46; Frontal topogram with 100<span class="elsevierStyleHsp" style=""></span>kV and 35<span class="elsevierStyleHsp" style=""></span>mA was acquired&#46; The study was done in cranial-caudal direction with a coverage spanning from the diaphragm to the heels&#46; The CT parameters were 64<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>0&#46;6<span class="elsevierStyleHsp" style=""></span>mm collimation&#44; gantry rotation speed 0&#46;33<span class="elsevierStyleHsp" style=""></span>s&#44; table speed 40<span class="elsevierStyleHsp" style=""></span>mm&#47;s&#44; pitch factor 0&#46;9&#44; reference tube current 170mAS with tube modulation modality in a 170&#8211;230<span class="elsevierStyleHsp" style=""></span>mAs range &#40;Care Dose<span class="elsevierStyleSup">&#174;</span> Siemens Medical Systems&#44; Erlangen&#44; Germany&#41;&#46; Based on the group a different kilovoltage was used &#40;100<span class="elsevierStyleHsp" style=""></span>kV for group A and 80<span class="elsevierStyleHsp" style=""></span>kV for group B&#41; while the remaining parameters remained stable including the reference tube current&#46; For the administration of contrast the antecubital vein was canalized to introduce 120<span class="elsevierStyleHsp" style=""></span>ml of iopromide &#40;Ultravist 300<span class="elsevierStyleSup">&#174;</span> Bayer Schering Pharma&#44; Berlin&#44; Germany&#41; followed by 40<span class="elsevierStyleHsp" style=""></span>ml of saline solution at a constant flow of 4<span class="elsevierStyleHsp" style=""></span>ml&#47;s using a Stellant Dual<span class="elsevierStyleSup">&#174;</span> injector &#40;Medrad Inc&#46;&#44; PA&#44; USA&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For an adequate vascular enhancement the contrast optimization technique &#8220;<span class="elsevierStyleItalic">bolus tracking</span>&#8221; was used by placing one ROI in the abdominal aorta at the level of renal arteries and with a trigger threshold of 150<span class="elsevierStyleHsp" style=""></span>HU&#46; A 15<span class="elsevierStyleHsp" style=""></span>s additional delay was added to guarantee the stain of the more distal arteries&#46; In an effort to homogenize the technique this protocol was applied in the same way in all patients regardless of their clinical manifestations&#46; During post-processing 1&#46;5<span class="elsevierStyleHsp" style=""></span>mm thick cuts were done with reconstruction increase of 1<span class="elsevierStyleHsp" style=""></span>mm and soft tissue filter B20f&#46; Final analysis was done with axial images with V reconstructions&#8211;volume rendering&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Image analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Measurements of vascular density &#40;VD&#41; were acquired in w Leonardo<span class="elsevierStyleSup">&#174;</span> working station &#40;Siemens Medical Systems&#59; Erlangen&#44; Germany&#41; along the arteries of lower limbs including 11 different levels &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#58; aorta at the level of renal arteries&#44; external left and right iliac arteries&#44; proximal left and right superficial femoral arteries&#44; proximal left and right deep femoral arteries&#44; left and right popliteal arteries&#44; posterior left and right tibial arteries&#46; To that end one ROI was freehand drawn of a diameter as big as the vascular lumen area and the HU density was measured&#46; The vascular lumen area was considered exclusively as the visible surface with contrast of which wall thrombi or plaques calcified at wall level were excluded&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Based on these measurements the average VD was obtained&#46; In those cases where we could not measure all segments&#8211;occlusion&#44; prosthesis or amputation the average VD was limited to the assessed vessels&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The average muscle density &#40;MD&#41; was estimated by measuring density with a 0&#46;25<span class="elsevierStyleHsp" style=""></span>in&#46;-ROI in the central region of the right paraspinal muscle and the anterior rectum of left quadriceps from which the measurement was obtained&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Measurement of the average noise &#40;N&#41; was estimated through the standard deviation of a 0&#46;25<span class="elsevierStyleHsp" style=""></span>in&#46;-ROI in the surrounding air of three &#40;3&#41; regions in front of the patient&#39;s body &#40;right&#44; central and left&#41; at the level of the belly button&#46; The average values were used to estimate the final noise&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Based on these measurements the vascular density-noise ratio &#40;VDNR&#41; and the contrast-noise ratio &#40;CNR&#41; were estimated according to the following equations&#58; VDNR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>VD&#47;N and CNR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#40;VD<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>MD&#41;&#47;N&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Also the subjective quality of image was assessed by two &#40;2&#41; explorers &#40;CDS and CTL&#41; with 12 and 11 years of experience in CT respectively by using axial cuts and volume rendering reconstructions &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; To that end a five &#40;5&#41; point-scale was used&#58; 5 excellent&#59; optimal homogeneous vascular enhancement allowing us to evaluate all possible vascular lesions with high diagnostic safety and without any artifacts&#59; 4&#58; good&#59; good vascular nearly homogeneous enhancement allowing us to evaluate all possible vascular lesions with high diagnostic safety and without any significant artifacts&#59; 3&#58; moderate&#59; good&#59; heterogeneous vascular enhancement allowing us to evaluate all possible vascular lesions with moderate diagnostic safety or artifacts affecting the interpretation of images&#59; 2&#58; poor quality but diagnostic&#59; heterogeneous vascular enhancement allowing us to evaluate all possible vascular lesions with low diagnostic safety or artifacts affecting the interpretation of images&#59; 1&#58; non-diagnostic&#59; poor diagnostic information that does not allow us to find or discard vascular lesions with artifacts definitely affecting the interpretation of images&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Evaluation of the estimated effective radiation dose</span><p id="par0070" class="elsevierStylePara elsevierViewall">The effective radiation dose &#40;ERD&#41; was estimated by multiplying the longitudinal product dose &#40;LPD&#41; by a conversion factor for the studied anatomical region&#46; This conversion factor in abdomen and pelvis is 0&#46;01<span class="elsevierStyleHsp" style=""></span>mSv&#47;mGy<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">LPD was obtained according to the proportionate figure in the exploration protocol given by the equipment&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">The outcomes of the measurements of VD&#44; VDNR&#44; CNR&#44; subjective image quality&#44; LPD and ERD are expressed according to the average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation with ranges between brackets&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Normalcy in the distribution of the sample could be confirmed through the Kolmogorov&#8211;Smirnov test&#46; The characteristics of both groups&#8211;age&#44; sex&#44; body mass index &#91;BMI&#93; could be compared by using Student&#39;s <span class="elsevierStyleItalic">t</span> test for separate samples as well as the Chi-square test&#46; The variables exploration length and measurements of VD&#44; VDNR&#44; CNR&#44; subjective image quality&#44; LPD and ERD were compared between both groups by using Student&#39;s <span class="elsevierStyleItalic">t</span> test for unpaired samples as well as the Chi-square test&#46; Statistical significance was considered to be a value of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The Kappa coefficient was used to measure the inter-observer concordance while assessing the subjective quality of images&#46; All estimates were done through a standard PC with the SPSS<span class="elsevierStyleSup">&#174;</span> software for Windows<span class="elsevierStyleSup">&#174;</span> v&#46; 15&#46;0 &#40;SPSS<span class="elsevierStyleSup">&#174;</span> Chicago&#44; IL&#44; USA&#41;&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Subjects</span><p id="par0090" class="elsevierStylePara elsevierViewall">The demographic variables of both groups showed normal distribution and the comparison between both groups of patients did not show statistically significant differences in age&#44; sex&#44; BMI or length of acquisition &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Image parameters</span><p id="par0095" class="elsevierStylePara elsevierViewall">All variables followed normal distribution&#46; The average VD in subjects from group B was greater than that in subjects from group A &#40;462&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>95&#46;6 vs 372&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>100&#46;9&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Also a detailed analysis for each and every vessel showed a greater VD in all vessels of patients from group B than in patients from group A without exemption and with significant differences too&#46; There were no statistically significant differences in the average MD &#40;50&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;2 vs 51&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;8&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54&#41;&#46; The average N was greater in patients from group B &#40;21&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;4&#41; than in patients from group A &#40;16&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#41; with no statistically significant differences &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;098&#41;&#46; There were statistically significant differences between patients from group A and B when it comes to the VDNR &#40;194&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&#46;6 vs 241&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48&#46;1&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; yet no statistically significant differences in CNR &#40;21&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;1 vs 22&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#41;&#46; The assessment of the subjective quality of images showed an average value in patients from group A of 4&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;82 &#40;CDS&#41; and 4&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;71 &#40;CTL&#41; and for patients from group B of 4&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;91 &#40;CDS&#41; and 4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;87 &#40;CTL&#41; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;3&#44; with a K-correlation of 0&#46;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;075 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Radiation dose</span><p id="par0100" class="elsevierStylePara elsevierViewall">There were statistically significant differences both in the longitudinal product dose &#40;LPD&#41; &#40;570&#46;1<span class="elsevierStyleHsp" style=""></span>mGy<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>131&#46;5 vs 278&#46;6<span class="elsevierStyleHsp" style=""></span>mGy<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>64&#46;9&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and in the effective radiation dose &#40;ERD&#41; &#40;9&#46;6<span class="elsevierStyleHsp" style=""></span>mSv<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2 vs 4&#46;7<span class="elsevierStyleHsp" style=""></span>mSv<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; between the two groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The results of this study confirm that it is feasible to reduce the radiation dose in studies of angio-CT of lower limbs using a low dose-protocol of 80<span class="elsevierStyleHsp" style=""></span>kV without affecting the quality of image&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Recently it has been confirmed that 64-detector row angio-CT endows a great diagnostic safety similar to that of conventional arteriography for the diagnosis and planning of therapy in patients with PAD&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However&#44; the most important limitation in this type of studies is the radiation dose&#46; Some authors claim that the radiation dose is not a major issue in patients with PAD since the radiation dose does not increase the possibility of developing neoplasms or other conditions when life expectancy is shorter than the latency period needed to develop such conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Yet despite this several official bodies following the ALARA &#40;as low as reasonably achievable&#41; criterion insist in the need for reducing the radiation in all radiologic tests to the reasonable minimum and patients to levels of unnecessary exposure&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> In the attempt to constantly reduce the radiation dose modifications in the acquisition parameters of equipments are planned&#46; Modifying the tube current&#44; varying the pitch factor&#44; the angle between the tube and the table or the distance of the tube with respect to the patient have been proceedings used to achieve the aforementioned optimization&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The most significant setback in the strategies aimed at diminishing the dose is the reduction of the diagnostic ability due to an increase in image noise and worsening of the quality of the very test&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In the study of Fraioli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> when the tube current was reduced from 130 to 100<span class="elsevierStyleHsp" style=""></span>mAs and to 50<span class="elsevierStyleHsp" style=""></span>mAs in the artery studies of lower limbs the radiation dose was reduced 40&#8211;74&#37; respectively without affectation on the diagnostic safety of the test&#46; In another study&#8211;Heyer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> only by modifying the tube kilovoltage from 120 to 100<span class="elsevierStyleHsp" style=""></span>kV they achieved a reduction of up to 40&#37; in the radiation dose without affectation of the image quality in angio-CT for the diagnosis of lung thromboembolism&#46; Similarly Wintersperger et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> showed that the reduction of kilovoltage from 120 to 100<span class="elsevierStyleHsp" style=""></span>kV did not influence the relation between VD and N or the overall quality of image in angio-CT of the aortoiliac region&#46; In our study we tried to show that by reducing kilovoltage to 80<span class="elsevierStyleHsp" style=""></span>kV we still can acquire arterial maps of lower limbs with enough quality to perform diagnostic explorations&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">One of the reasons is due to the fact that the iodine attenuation &#40;K-edge&#41; is maximum at 33<span class="elsevierStyleHsp" style=""></span>kV which means it is closer to 80 than 100<span class="elsevierStyleHsp" style=""></span>kV so it presents a greater enhancement in the studies performed at 80<span class="elsevierStyleHsp" style=""></span>kV&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> Indeed our results were consistent with the studies published to date in other anatomical regions and with the recent study by Lezzi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in the lower limbs&#46; Studies performed at 80<span class="elsevierStyleHsp" style=""></span>kV proved that the VD is significantly greater than studies done at 100<span class="elsevierStyleHsp" style=""></span>kV&#46; However there were not significant differences in MD or N even though the latter showed a certain growing trend toward significance&#46; N was greater in studies at 80<span class="elsevierStyleHsp" style=""></span>kV yet the VDNR image quality gauge showed a significantly greater result in the 80<span class="elsevierStyleHsp" style=""></span>kV group&#46; This indicates that VD increase is proportionately greater than N allowing us to analyze the arterial system adequately in studies at 80<span class="elsevierStyleHsp" style=""></span>kV&#46; However&#44; the CNR&#8211;that also assesses the MD too not only arterial enhancement did not show a significant difference between both groups&#46; This fact can be interpreted by the greater amount of N in the 80<span class="elsevierStyleHsp" style=""></span>kV series images meaning that we need to be cautious when assessing other structures different from arteries in those studies&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Also it is also possible that a greater sample size conditions a significant increase of N that in turn could also condition a reduction of CNR&#46; In any case in the sample a non-diagnostic study was found only that could be explained by the patient&#39;s abnormal cardiac output that conditioned one insufficient vascular perfusion in the time of acquisition rather than the reduction of kV per se&#46; Despite the systematic use of bolus tracking modality the variability among patients of hemodynamic features can explain the sporadic cases of inconclusive images above all in the more distal territories and the more stenosed-vessels&#46; As a matter of fact this is one of the limitations of our study since trying to homogenize the modality to all patients the same amount of iodinated contrast was administered and the same 15<span class="elsevierStyleHsp" style=""></span>s-delay was used when the 150<span class="elsevierStyleHsp" style=""></span>HU threshold was achieved in the abdominal aorta without paying attention to the physical characteristics of each subject&#46; However&#44; with this protocol we did not find any other cases without stain of distal arteries due to delays in the arrival of contrast&#46; The reasons why the distal arteries could not be assessed were occlusions&#44; artifacts due to metallic prostheses or amputations of limbs&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">This study has other limitations&#46; We did not assess the radiation dose through direct method using phantoms yet the formula allowed us to obtain the dose through a protocol supplied by the team has proven to have a high concordance with the real doses in adult patients&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> On the other hand the exploration of abdomen with 80<span class="elsevierStyleHsp" style=""></span>kV can underestimate the extravascular findings that with 100<span class="elsevierStyleHsp" style=""></span>kV would be seen with greater reliability which limits its use to the strict vascular evaluation above all in patients with high BMI&#46; Yet despite these drawbacks this study opens the door to new researches with the use of kilovoltage for the assessment of vascular territories through CT&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In sum we can say that using 80<span class="elsevierStyleHsp" style=""></span>kV in angio-CT studies of lower limbs reduces the radiation dose without affecting the diagnostic efficacy of the study with respect to the use of 100<span class="elsevierStyleHsp" style=""></span>kV&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ethical responsibilities</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Protection of human and animal subjects</span><p id="par0135" class="elsevierStylePara elsevierViewall">Authors confirm that all proceedings and experiments followed relate to the committee of responsible human experimentation ethical rules and regulations in compliance with the World Medical Association and the Declaration of Helsinki&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Confidentiality of data</span><p id="par0140" class="elsevierStylePara elsevierViewall">Authors confirm that in this report there are no personal data of patients&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Right to privacy and informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">Authors confirm that in this report there are no personal data of patients&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authors</span><p id="par0150" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study&#58; CDS&#44; ROP and CTL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Original Idea of the Study&#58; CDS and GTF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Study Design&#58; CDS and GTF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4&#46;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Data Mining&#58; CDS&#44; ROP&#44; AFV&#44; NSP&#44; MGV and CTL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Data Analysis and Interpretation&#58; ROP&#44; CDS and GTF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Statistical Analysis&#58; CDS and GTF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Reference Search&#58; ROP&#44; CDS&#44; AFV&#44; MGV and NSP&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8&#46;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Writing&#58; ROP and CDS&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9&#46;</span><p id="par0195" class="elsevierStylePara elsevierViewall">Manuscript critical review with intellectually relevant contributions&#58; CTL&#44; GTF&#44; CTL&#44; AFV&#44; MGV and NSP&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10&#46;</span><p id="par0200" class="elsevierStylePara elsevierViewall">Final Version Approval&#58; ROP&#44; CDS&#44; AFV&#44; NSP&#44; MGV&#44; CTL and GTF&#46;</p></li></ul></p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflict of interest</span><p id="par0305" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To compare the image quality and dose of radiation in two groups of patients undergoing CT angiography of the lower limbs&#44; one with tube voltage of 80<span class="elsevierStyleHsp" style=""></span>kV and the other with tube voltage of 100<span class="elsevierStyleHsp" style=""></span>kV&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed CT angiography of the lower limbs in 60 patients with suspected peripheral arterial disease&#46; Patients were randomly assigned to one of the two groups&#59; in one group&#44; CT angiography was performed using a tube voltage of 80<span class="elsevierStyleHsp" style=""></span>kV&#44; whereas in the other it was performed using 100<span class="elsevierStyleHsp" style=""></span>kV&#46; The remaining acquisition parameters were the same in both groups&#46; The images were analyzed by quantifying vascular density &#40;VD&#41; and noise &#40;N&#41; and by calculating the quotients density&#47;noise &#40;QVDN&#41; and contrast&#47;noise &#40;QCN&#41;&#46; Two radiologists working independently evaluated the subjective quality of the images&#46; We calculated the estimated effective dose &#40;EED&#41; based on the dose-length product &#40;DLP&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the group studied at 80<span class="elsevierStyleHsp" style=""></span>kV&#44; VD was significantly higher &#40;462&#46;5<span class="elsevierStyleHsp" style=""></span>UH<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>95&#46;6 vs 372<span class="elsevierStyleHsp" style=""></span>UH<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>100&#46;9&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; QVDN was significantly higher &#40;241&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48&#46;1 vs 194&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&#46;6&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and there were trends toward higher N &#40;21&#46;3<span class="elsevierStyleHsp" style=""></span>UH<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 vs 16&#46;3<span class="elsevierStyleHsp" style=""></span>UH<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;098&#41; and toward higher QCN &#40;21&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;1 vs 22&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;15&#41;&#46; No significant differences were found in the subjective quality of the images&#46; The EED was significantly lower in the group studied at 80<span class="elsevierStyleHsp" style=""></span>kV &#40;4&#46;73<span class="elsevierStyleHsp" style=""></span>mSv<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1 vs 9&#46;6<span class="elsevierStyleHsp" style=""></span>mSv<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Using 80<span class="elsevierStyleHsp" style=""></span>kV instead of 100<span class="elsevierStyleHsp" style=""></span>kV for CT angiography of the lower limbs reduces the dose of radiation without affecting the diagnostic efficacy of the study&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar la calidad de imagen y la dosis de radiaci&#243;n en 2 grupos de pacientes a los que se realiza angio-TC de extremidades inferiores con 80 y 100<span class="elsevierStyleHsp" style=""></span>kV&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; angio-TC de miembros inferiores a 60 pacientes con sospecha de enfermedad arterial perif&#233;rica aleatorizados en 2 grupos&#44; en uno la TC se realiz&#243; con 80<span class="elsevierStyleHsp" style=""></span>kV y en el otro con 100<span class="elsevierStyleHsp" style=""></span>kV&#46; Los dem&#225;s par&#225;metros de adquisici&#243;n se mantuvieron constantes&#46; Se analizaron las im&#225;genes cuantificando la densidad vascular &#40;DV&#41; y el ruido &#40;R&#41;&#44; y se calcularon los cocientes densidad vascular&#47;ruido &#40;CDVR&#41; y contraste&#47;ruido &#40;CCR&#41;&#46; Dos radi&#243;logos evaluaron independientemente la calidad subjetiva de las im&#225;genes&#46; Se calcul&#243; la dosis efectiva estimada &#40;DEE&#41; basada en el producto dosis-longitud &#40;DLP&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El grupo de 80<span class="elsevierStyleHsp" style=""></span>kV present&#243; valores significativamente m&#225;s elevados de la DV &#40;462&#44;5<span class="elsevierStyleHsp" style=""></span>UH<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>95&#44;6 vs&#46; 372<span class="elsevierStyleHsp" style=""></span>UH<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>100&#44;9&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y del CDVR &#40;241&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48&#44;1 vs&#46; 194&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>49&#44;6&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y diferencias no significativas del R &#40;21&#44;3<span class="elsevierStyleHsp" style=""></span>UH<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13 vs&#46; 16&#44;3<span class="elsevierStyleHsp" style=""></span>UH<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;5&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;098&#41; y el CCR &#40;21&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;1 vs&#46; 22&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;1&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;15&#41;&#46; No hubo diferencias significativas en la calidad subjetiva de la imagen y la dosis efectiva fue significativamente menor en el grupo de 80<span class="elsevierStyleHsp" style=""></span>kV &#40;4&#44;73<span class="elsevierStyleHsp" style=""></span>mSv<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;1 vs&#46; 9&#44;6<span class="elsevierStyleHsp" style=""></span>mSv<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La utilizaci&#243;n de 80<span class="elsevierStyleHsp" style=""></span>kV en el estudio de angio-TC de miembros inferiores disminuye la dosis de radiaci&#243;n sin afectar a la eficacia diagn&#243;stica del estudio respecto a la utilizaci&#243;n de 100<span class="elsevierStyleHsp" style=""></span>kV&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Oca Pernas R&#44; Delgado S&#225;nchez-Graci&#225;n C&#44; Tard&#225;guila de la Fuente G&#44; Fern&#225;ndez del Valle A&#44; Silva Priegue N&#44; Gonz&#225;lez V&#225;zquez M&#44; et al&#46; Comparaci&#243;n de la calidad de imagen y dosis de radiaci&#243;n en angio-tomograf&#237;a computarizada de arterias perif&#233;ricas con 80 y 100<span class="elsevierStyleHsp" style=""></span>kV&#46; Radiolog&#237;a&#46; 2014&#59;56&#58;541&#8211;547&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1767
            "Ancho" => 1660
            "Tamanyo" => 360507
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Angio-CT of peripheral arteries showing how vascular density was freehand measured with a ROI in the external iliac arteries &#40;upper image&#41; and the popliteal arteries &#40;lower image&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2423
            "Ancho" => 2168
            "Tamanyo" => 419491
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Volume rendering reconstructions with the identical algorithm to that of angio-CT of peripheral arteries of two &#40;2&#41; different patients of 82<span class="elsevierStyleHsp" style=""></span>kg of weight both&#46; The patient who underwent the 80<span class="elsevierStyleHsp" style=""></span>kV protocol shows occlusion of the right external iliac artery &#40;hollow arrow&#41; and bilateral femoropopliteal artery recanalizing through collaterals distally&#46; The patient studied with 100<span class="elsevierStyleHsp" style=""></span>kV shows the occlusion of the left popliteal artery &#40;arrow&#41;&#46; See the optimal quality of the image obtained with both protocols&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; NA&#44; non applicable value&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients from group A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients from group B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Age &#40;years&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 &#40;27&#8211;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16 &#40;41&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ratiomen&#58;women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#58;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#58;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4 &#40;19&#8211;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5 &#40;20&#8211;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Length of scan &#40;mm&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;320<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>100 &#40;1&#46;184&#8211;1&#46;594&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;278<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>99 &#40;1&#46;039&#8211;1&#46;536&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Collimation &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rotation speed &#40;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pitch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tube current &#40;mA&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">170&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Kilovoltage &#40;kVp&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab599937.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
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            ]
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        "descripcion" => array:1 [
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        ]
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      3 => array:7 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CNR&#44; contrast-noise ratio&#59; VDNR&#44; vascular density-noise ratio&#59; ERD&#44; effective radiation dose&#59; LPD&#44; longitudinal product dose&#59; MD&#44; muscular density&#59; VD&#44; vascular density&#59; HU&#44; Hounsfield units&#46;</p>"
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            0 => array:2 [
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                  \t\t\t\t" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">MD &#40;HU&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">50&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;54&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#177;0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">VDNR</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">21&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;152&nbsp;\t\t\t\t\t\t\n
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                  """
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2012.06.006

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Year/Month	Html	Pdf	Total

2024 May	10	7	17
2024 March	4	1	5
2024 February	1	0	1
2024 January	1	0	1
2023 October	1	0	1
2023 August	1	0	1
2023 January	2	0	2
2018 May	7	0	7
2018 April	24	5	29
2018 March	29	3	32
2018 February	21	4	25
2018 January	23	1	24
2017 December	24	8	32
2017 November	25	0	25
2017 October	35	2	37
2017 September	46	15	61
2017 August	52	11	63
2017 July	53	5	58
2017 June	94	10	104
2017 May	97	6	103
2017 April	45	9	54
2017 March	53	21	74
2017 February	188	3	191
2017 January	56	2	58
2016 December	18	10	28
2016 November	17	4	21
2016 October	65	13	78
2016 September	95	20	115
2016 August	22	9	31
2016 July	22	2	24
2016 June	38	6	44
2016 May	24	20	44
2016 April	26	9	35
2016 March	26	24	50
2016 February	26	19	45
2016 January	27	17	44
2015 December	31	17	48
2015 November	17	13	30
2015 October	22	16	38
2015 September	28	10	38
2015 August	18	9	27
2015 July	23	9	32
2015 June	11	6	17
2015 May	15	6	21
2015 February	1	1	2
2015 January	1	1	2

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