Author
Marcel van Straten
Bio: Marcel van Straten is an academic researcher from Erasmus University Rotterdam. The author has contributed to research in topics: Cystic fibrosis & Agatston score. The author has an hindex of 14, co-authored 27 publications receiving 734 citations.
Papers
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TL;DR: Evidence is found that CT-related radiation exposure increases brain tumor risk following exposure to low-dose ionizing radiation from CT scans in childhood, and incidence of brain tumors was higher in the cohort of children with CT scans, requiring cautious interpretation of the findings.
Abstract: Background: Computed tomography (CT), a strong diagnostic tool, delivers higher radiation doses than most imaging modalities. As CT use has increased rapidly, radiation protection is important, particularly among children. We evaluate leukemia and brain tumor risk following exposure to low-dose ionizing radiation from CT scans in childhood. Methods: For a nationwide retrospective cohort of 168 394 children who received one or more CT scans in a Dutch hospital between 1979 and 2012 who were younger than age 18 years, we obtained cancer incidence, vital status, and confounder information by record linkage with external registries. Standardized incidence ratios were calculated using cancer incidence rates from the general Dutch population. Excess relative risks (ERRs) per 100 mGy organ dose were calculated with Poisson regression. All statistical tests were two-sided. Results: Standardized incidence ratios were elevated for all cancer sites. Mean cumulative bone marrow doses were 9.5 mGy at the end of follow-up, and leukemia risk (excluding myelodysplastic syndrome) was not associated with cumulative bone marrow dose (44 cases). Cumulative brain dose was on average 38.5 mGy and was statistically significantly associated with risk for malignant and nonmalignant brain tumors combined (ERR/100 mGy: 0.86, 95% confidence interval = 0.20 to 2.22, P = .002, 84 cases). Excluding tuberous sclerosis complex patients did not substantially change the risk. Conclusions: We found evidence that CT-related radiation exposure increases brain tumor risk. No association was observed for leukemia. Compared with the general population, incidence of brain tumors was higher in the cohort of children with CT scans, requiring cautious interpretation of the findings.
197 citations
TL;DR: The risk related to routine usage of CT in clinical care is small and a life-limiting disease, such as CF, lowers the risk of radiation-induced cancer, so the use of CT should always be justified and the radiation dose should be kept as low as reasonably achievable.
Abstract: Computed tomography (CT) is a sensitive technique to monitor structural changes related to cystic fibrosis (CF) lung disease. It detects structural pulmonary abnormalities such as bronchiectasis and trapped air, at an early stage, before they become apparent with other diagnostic tests. Clinical decisions may be influenced by knowledge of these abnormalities. CT imaging, however, comes with risk related to ionizing radiation exposure. The aim of this review is to discuss the risk of routine CT imaging in patients with CF, using current models of radiation-induced cancer, and to put this risk in perspective with other medical and nonmedical risks. The magnitude of the risk is a complex, controversial matter. Risk analyses have largely been based on a linear no-threshold model, and excess relative and excess absolute risk estimates have been derived mainly from atomic bomb survivors. The estimates have large confidence intervals. Our risk estimates are in concordance with previously reported estimates. A la...
113 citations
TL;DR: CT scores from end-expiratory and end-inspiratory CT alone may be sufficient for monitoring CF-related lung disease, suggesting that radiation dose reduction by up to 75% may be necessary for a single investigation.
Abstract: CT scores from inspiratory and expiratory scans match closely, suggesting that end-expiratory CT alone may suffice for assessing cystic fibrosis–related structural abnormalities, thus helping to reduce radiation dose by up to 75%.
88 citations
TL;DR: DS spiral CT coronary angiography performed with adaptive ECG pulsing results in preserved diagnostic image quality and performance independent of HRF or HRV at the cost of limited dose reduction in arrhythmic patients.
Abstract: Adaptive electrocardiographic pulsing at dual-source spiral CT coronary angiography provides diagnostic image quality and reliable detection of obstructive coronary artery disease independent of heart rate frequency or variability at the cost of a limited dose reduction in arrhythmic patients.
86 citations
TL;DR: A high-pitch spiral CT coronary angiographic protocol should be applied in patients with regular and low (<55 beats per minute) heart rates; a sequential protocol is preferred in all others.
Abstract: A prospective electrocardiogram-triggered sequential CT coronary angiographic scan protocol is the preferred scan protocol in most patients with a stable heart rate and provides optimal image quality at a low radiation dose.
71 citations
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TL;DR: This review paper covers the entire pipeline of medical imaging and analysis techniques involved with COVID-19, including image acquisition, segmentation, diagnosis, and follow-up, and particularly focuses on the integration of AI with X-ray and CT, both of which are widely used in the frontline hospitals.
Abstract: The pandemic of coronavirus disease 2019 (COVID-19) is spreading all over the world. Medical imaging such as X-ray and computed tomography (CT) plays an essential role in the global fight against COVID-19, whereas the recently emerging artificial intelligence (AI) technologies further strengthen the power of the imaging tools and help medical specialists. We hereby review the rapid responses in the community of medical imaging (empowered by AI) toward COVID-19. For example, AI-empowered image acquisition can significantly help automate the scanning procedure and also reshape the workflow with minimal contact to patients, providing the best protection to the imaging technicians. Also, AI can improve work efficiency by accurate delineation of infections in X-ray and CT images, facilitating subsequent quantification. Moreover, the computer-aided platforms help radiologists make clinical decisions, i.e., for disease diagnosis, tracking, and prognosis. In this review paper, we thus cover the entire pipeline of medical imaging and analysis techniques involved with COVID-19, including image acquisition, segmentation, diagnosis, and follow-up. We particularly focus on the integration of AI with X-ray and CT, both of which are widely used in the frontline hospitals, in order to depict the latest progress of medical imaging and radiology fighting against COVID-19.
916 citations
TL;DR: The Society of Cardiovascular Computed Tomography has produced a guideline document to review available data and provide recommendations regarding interpretation of radiation dose indices and predictors of risk, appropriate use of scanner acquisition modes and settings, development of algorithms for dose optimization, and establishment of procedures for dose monitoring.
424 citations
TL;DR: This review explores the methodologies and the emerging value of imaging techniques in the assessment of body composition, focusing on the value of lean soft tissue (LST) to predict nutrition status.
Abstract: Body composition refers to the amount of fat and lean tissues in our body; it is a science that looks beyond a unit of body weight, accounting for the proportion of different tissues and its relationship to health. Although body weight and body mass index are well-known indexes of health status, most researchers agree that they are rather inaccurate measures, especially for elderly individuals and those patients with specific clinical conditions. The emerging use of imaging techniques such as dual energy x-ray absorptiometry, computerized tomography, magnetic resonance imaging, and ultrasound imaging in the clinical setting have highlighted the importance of lean soft tissue (LST) as an independent predictor of morbidity and mortality. It is clear from emerging studies that body composition health will be vital in treatment decisions, prognostic outcomes, and quality of life in several nonclinical and clinical states. This review explores the methodologies and the emerging value of imaging techniques in the assessment of body composition, focusing on the value of LST to predict nutrition status.
402 citations
TL;DR: Acceptable image quality can be obtained for chest CT images acquired at 40 mAs by using ASIR without any substantial artifacts affecting diagnostic confidence.
Abstract: CT radiation dose reduction down to 3.5 mGy is achievable for adaptive statistical iterative reconstructed chest CT while maintaining acceptable image noise and diagnostic confidence.
328 citations
TL;DR: The authors in this paper summarized epidemiologic data on cancer risks associated with diagnostic procedures, described how exposures from recent diagnostic procedures relate to radiation levels linked with cancer occurrence, and proposed a framework of strategies to reduce radiation from diagnostic imaging in patients.
Abstract: The 600% increase in medical radiation exposure to the US population since 1980 has provided immense benefit, but increased potential future cancer risks to patients. Most of the increase is from diagnostic radiologic pro cedures. The objectives of this review are to summarize epidemiologic data on cancer risks associated with diagnostic procedures, describe how exposures from recent diagnostic procedures relate to radiation levels linked with cancer occurrence, and propose a framework of strategies to reduce radiation from diagnostic imaging in patients. We briefly review radiation dose definitions, mechanisms of radiation carcinogenesis, key epidemiologic studies of medical and other radiation sources and cancer risks, and dose trends from diagnostic procedures. We describe cancer risks from experimental studies, future projected risks from current imaging procedures, and the potential for higher risks in genetically susceptible populations. To reduce future projected cancers from diagnostic procedures, we advocate the widespread use of evidencebased appropriateness criteria for decisions about imaging procedures; oversight of equipment to deliver reliably the minimum radiation required to attain clinical objectives; development of electronic lifetime records of imaging procedures for patients and their physicians; and commitment by medical training programs, professional societies, and radiation protection organizations to educate all stakeholders in reducing radiation from diagnostic procedures. CA Cancer J Clin 2012;62:75-100. Publis hed 2012 American Cancer Society. †
321 citations