The Emergence of Ultra-Low–Dose Computed Tomography and the Impending Obsolescence of the Plain Radiograph? Patrick D. McLaughlin, FFR RCSI, Hugue A.

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The Emergence of Ultra-Low–Dose Computed Tomography and the Impending Obsolescence of the Plain Radiograph? Patrick D. McLaughlin, FFR RCSI, Hugue A. Ouellette, FRCPC, Luck J. Louis, FRCPC, Paul I. Mallinson, FRCR, Timothy O'Connell, FRCPC, John R. Mayo, FRCPC, Peter L. Munk, FRCPC, Savvas Nicolaou, FRCPC Canadian Association of Radiologists Journal Volume 64, Issue 4, Pages 314-318 (November 2013) DOI: 10.1016/j.carj.2013.09.004 Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 1 A 28-year-old pregnant female patient with acute cervical spine tenderness after a motor vehicle collision. Axial (A) and sagittal (B) T2 short-tau inversion recovery magnetic resonance images, demonstrating increased bone and soft tissue signal in the region of the left lateral mass of C3 (arrow) and traumatic extrusion of the C3 disk (arrowhead). Ultra-low–dose computed tomography (CT) (dose-length product = 56 mGy.cm, effective dose = 0.6 mSv) was performed to better characterize the suspected fractures. Axial (C) and sagittal (D) reformatted images clearly demonstrate an acute left C3 transverse process (arrow) and the extruded disk (arrowhead). (The average C-spine radiograph and CT C-spine effective dose in 2008 was 0.2 mSv and 6 mSv, respectively [1]). Canadian Association of Radiologists Journal 2013 64, 314-318DOI: (10.1016/j.carj.2013.09.004) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 2 Coronal (A) and axial (B) reformatted ultra-low–dose chest computed tomography (CT) (dose-length product = 26 mGy.cm, effective dose = 0.52 mSv) images performed on a 24-year-old male patient to investigate a suspected nodular opacity at the lung base found, but incompletely imaged, during an abdominal CT investigation (B, arrow). (The average chest radiograph and CT chest effective dose in 2008 was 0.1 mSv and 7 mSv, respectively [1]). Canadian Association of Radiologists Journal 2013 64, 314-318DOI: (10.1016/j.carj.2013.09.004) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 3 A 30-year-old female patient with chest pain and atrial fibrillation was referred for coronary artery CTA. An ultra-low–dose functional coronary CTA (dose-length product = 50 mGy.cm, effective dose = 1 mSv) was performed to allow reconstruction of the coronary vessels throughout the cardiac cycle. Curved planar reformatted images, demonstrating no plaque in the right (A) and left anterior descending (B) coronary arteries. (The average coronary angiography and computed tomography chest effective dose in 2008 was 16 mSv and 7 mSv, respectively [1]). Canadian Association of Radiologists Journal 2013 64, 314-318DOI: (10.1016/j.carj.2013.09.004) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 4 A 22-year-old female patient scheduled to undergo shock wave lithotripsy for a known left intrarenal calculus. Abdominal radiograph did not demonstrate the stone. Axial (A) and coronal (B) images from an ultra-low–dose, noncontrast, abdominal computed tomography (CT) (dose-length product = 27 mGy.cm, effective dose = 0.4 mSv) was performed and clearly demonstrated the nonobstructing calculus (arrows). (The average abdominal radiograph and CT abdomen effective dose in 2008 was 0.7 mSv and 8 mSv, respectively [1]). Canadian Association of Radiologists Journal 2013 64, 314-318DOI: (10.1016/j.carj.2013.09.004) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions

Figure 5 A 24-year-old female patient with suspected appendicitis. Ultra-low–dose abdominal computed tomography (CT) (dose-length product = 35 mGy.cm, effective dose = 0.56 mSv) with oral contrast was performed. (A) Coronal image, demonstrating a normal appendix (arrow). Sagittal reconstructions, showing that the osseous and soft tissue structures of the lumbar spine are extremely well depicted despite the ultra-low–dose technique. (The average abdominal radiograph and CT abdomen effective dose in 2008 was 0.7 mSv and 8 mSv, respectively [1]). Canadian Association of Radiologists Journal 2013 64, 314-318DOI: (10.1016/j.carj.2013.09.004) Copyright © 2013 Canadian Association of Radiologists Terms and Conditions