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Munir, M., T. Shouter, and H. S. Tay. "63 Quality Improvement Project: Should We be Doing More or Less Ct Head Scans in the Health Care of Older People Department?" Age and Ageing 49, Supplement_1 (2020): i18—i20. http://dx.doi.org/10.1093/ageing/afz187.04.
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Abstract Introduction Older people are likely to have more CT head scans given their multiple co- morbidities, being on anticoagulants, and increased falls. The aims of this quality improvement project (QIP) were to identify the number of patients who had CT head scan, the reason/indication of it, the number of patients who had new finding/s on it, actions taken on new findings, and whether the management plan was altered because of the CT scan. Methods Medical notes and CT head scan reports of all patients admitted to the Health Care of Older People department from April to September 2018 were reviewed to evaluate the indications of CT head scans, new findings, and management plans following the findings. Results 461 (10.7%) out of the 4323 patients discharged from the healthcare of older people department during April to September 2018 had CT head scans during admission. Frequent indications for CT head scans included delirium, falls and head injury. Only 46 (9.9%) patients had new finding/s on the CT head scan, and action was taken on 26 (56.5%) of these patients. The CT head scan changed the management plan of only 17 (3.6%) patients. Please see Table for more details. Conclusions By using our clinical judgement, following NICE guidelines on head injuries, educating our colleagues on the criteria for requesting a CT head scan, taking collateral histories about patients’ cognition and ascertaining the mechanism of fall, we can lessen the financial burden on the NHS and minimise the radiation exposure to our patients.
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Tsao, Shao-Lun, Yin-Yang Chen, Liang-Tsai Yeh, et al. "Impact of Computed Tomography Scans on the Risk of Thyroid Disease in Minor Head Injury Patients: A Population-Based Retrospective Cohort Study." International Journal of Environmental Research and Public Health 17, no. 11 (2020): 3873. http://dx.doi.org/10.3390/ijerph17113873.
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We investigated the association between head computed tomography (CT) scans and the risk of noncancer thyroid diseases in patients with minor head injury in a Taiwanese healthcare setting. For this retrospective population-based cohort study, the 2009–2013 Longitudinal Health Insurance Database was used to include patients with a minor head injury at admission or emergency visit between 2009 and 2013. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. According to whether a CT scan was conducted within 14 days of admission, patients were divided into a CT scan group (n = 14,041) or a non-CT scan group (n = 34,684). No increased incidence of thyroid diseases was observed in the CT scan group regardless of the number of CT scans performed. The incidence rate ratio for one scan was 1.10 (95% confidence interval: 0.94–1.29) and for two or more scans was 1.09 (95% confidence interval: 0.93–1.28). In conclusion, this population-based cohort study showed that a head CT scan is not associated with increased risk of thyroid disease in patients with minor head injury. The short-term adverse effects on the thyroid could be mild when a regular CT scan is appropriately performed.
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Yuana, Firdi, Kusharto Kusno, and Achmad Hidayat. "Determining Effective Dose on Computed Tomography Scan (CT SCAN) in Head Scanning." Natural-B 1, no. 1 (2011): 81–86. http://dx.doi.org/10.21776/ub.natural-b.2011.001.01.11.
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Rieke-Zapp, D. H., and E. Trinkl. "Face to face - close range inspection of head vases." ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XLII-2/W5 (August 21, 2017): 601–4. http://dx.doi.org/10.5194/isprs-archives-xlii-2-w5-601-2017.
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Several hundred attic head vases are known worldwide and stored in museums and collections. In 1929, Beazley has categorized twenty groups (A-W) based on stylistic properties and historic methodology. Head vases are assembled in several steps, most important for our comparison is the moulding of the head area. While the other parts of head vases like the size of the handle and the painting can differ significantly from each other, one can notice similarities in the head shapes of the same group. Since molds were used to shape the heads, our initial hypothesis was to perform a quantitative comparison of head shapes based on digital scan data. Comparison of scan data is straight forward and is very similar to quality control and inspection processes in industrial applications. Nonetheless, quality control of approximately 2,500-year-old artefacts that are distributed among several different places is not straight forward. Initial analysis was performed on older scan data. In addition, a high-resolution fringe projection scanner was employed to scan further head vases in additional museums in Germany and Italy. Scan resolution and accuracy of approximately 0.1 mm in all dimensions were required to reveal differences below 1 mm. All new scans were performed with an AICON SmartScan-HE C8. This scanner captures not only shape, but at the same time records color textures which can be employed for presentation or future analyses. Shape analysis results of the head areas do not only confirm that it is likely that the same mold was used for shaping some of the head vases. According to these results, it is also not unlikely that a first generation of larger head vases was used to prepare molds for consecutive generations of head vases that are slightly smaller by 10-15%. This volume loss resembles closely the volume loss observed after oven-burning of pottery. Scanning will continue to increase the data set for further analyses.
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Morton, Ryan P., Renee M. Reynolds, Rohan Ramakrishna, et al. "Low-dose head computed tomography in children: a single institutional experience in pediatric radiation risk reduction." Journal of Neurosurgery: Pediatrics 12, no. 4 (2013): 406–10. http://dx.doi.org/10.3171/2013.7.peds12631.
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Object In this study, the authors describe their experience with a low-dose head CT protocol for a preselected neurosurgical population at a dedicated pediatric hospital (Seattle Children's Hospital), the largest number of patients with this protocol reported to date. Methods All low-dose head CT scans between October 2011 and November 2012 were reviewed. Two different low-dose radiation dosages were used, at one-half or one-quarter the dose of a standard head CT scan, based on patient characteristics agreed upon by the neurosurgery and radiology departments. Patient information was also recorded, including diagnosis and indication for CT scan. Results Six hundred twenty-four low-dose head CT procedures were performed within the 12-month study period. Although indications for the CT scans varied, the most common reason was to evaluate the ventricles and catheter placement in hydrocephalic patients with shunts (70%), followed by postoperative craniosynostosis imaging (12%). These scans provided adequate diagnostic imaging, and no patient required a follow-up full-dose CT scan as a result of poor image quality on a low-dose CT scan. Overall physician comfort and satisfaction with interpretation of the images was high. An additional 2150 full-dose head CT scans were performed during the same 12-month time period, making the total number of CT scans 2774. This value compares to 3730 full-dose head CT scans obtained during the year prior to the study when low-dose CT and rapid-sequence MRI was not a reliable option at Seattle Children's Hospital. Thus, over a 1-year period, 22% of the total CT scans were able to be converted to low-dose scans, and full-dose CT scans were able to be reduced by 42%. Conclusions The implementation of a low-dose head CT protocol substantially reduced the amount of ionizing radiation exposure in a preselected population of pediatric neurosurgical patients. Image quality and diagnostic utility were not significantly compromised.
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Siregar, Elshaday S. B., Gusti Ngurah Sutapa, and I. Wayan Balik Sudarsana. "Analysis of Radiation Dose of Patients on CT Scan Examination using Si-INTAN Application." BULETIN FISIKA 21, no. 2 (2020): 53. http://dx.doi.org/10.24843/bf.2020.v21.i02.p03.
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CT scan is widely used to diagnose the inside of the human body, so supervision is needed to ensure the health and safety of workers, patients and the public. One surveillance that can be done is to analyze the radiation dose of the patient on CT scan with the application of Si-INTAN. Data processing of the results of CT scan of the head, thorax and abdomen for ages 0-4 years, 5-14 years and ? 15 years using the Si-INTAN application. From the results of the data processing, the highest DRL DLP value and CTDIVOL values were obtained, for CT scan heads were 1732,8 mGycm and 31,92 mGy, the CT scan of the thorax was 2450,78 mGycm and 19,36 mGy, and for CT Abdominal Scans were 3968,85 mGycm and 19,35 mGy.
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Elmoheen, Amr, Waleed Salem, and Khalid Bashir. "Reducing unnecessary CT scan of the head for minor paediatric head injuries at the emergency department." BMJ Open Quality 10, no. 1 (2021): e000973. http://dx.doi.org/10.1136/bmjoq-2020-000973.
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The CT scan is a determining imaging study in the diagnosis and treatment of head trauma; however, its indiscriminate application can have serious consequences for patients and the health system. More than 45% of CT scans of the head requested for minor head injuries in the paediatric age group in the emergency department were not correctly indicated according to international guidelines. The root of such a high percentage was misinformation and lack of knowledge about the ideal parameters for requesting a CT scan for minor head injuries. To achieve this, survey-based interventions and educational programmes were conducted to improve understanding of international guidelines and access to this information, which was the most important parameter during this project. A decreasing rate of CT scans for paediatric minor head injuries was demonstrated at the rate of 17%, achieving a reduction by more than 47% after the implementation of the interventions. Besides, misinformation and documentation deficits improved by more than 30%. Quality improvement methods decreased misinformation and improved access to information, which reduced errors in the indication of CT scans of the head in the paediatric age group and increased efficiency of patient care.
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Bordignon, Kelly C., and Walter Oleschko Arruda. "CT scan findings in mild head trauma: a series of 2,000 patients." Arquivos de Neuro-Psiquiatria 60, no. 2A (2002): 204–10. http://dx.doi.org/10.1590/s0004-282x2002000200004.
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The present study describes the cranial computed tomography (CT) scan findings of 2,000 cases of mild head trauma (HT) in Curitiba, Southern Brazil. The mean age of the entire series was 30.8 <FONT FACE=Symbol>±</FONT>19 years. The overall male to female ratio was 2:1. The most common causes of head injury were interpersonal aggression (17.9%), falls (17.4%), automobile accidents (16.2%), falls to the ground (13.1%) and pedestrian injuries (13 %). Alcohol intoxication was associated with HT in 158 cases (7.9%). A normal CT scan was seen in 60.75% (1215) and an abnormal CT scan in 39.25% (785) of patients. Out of 785 abnormal CT scan, 518(65.9%) lesions were related to HT. The most common CT scan HT related findings were: soft tissue swelling (8.9 %), skull fractures (4.3 %), intracranial and subgaleal hematomas (3.4% and 2.4 %), brain swelling (2 %) and brain contusion (1.2%). Out of 785 abnormal CT scans, 267 (34.1%) lesions were not related to head trauma. Incidental CT scan findings included brain atrophy (5.9%), one calcification (5.2%) several calcifications (2.4%) (probably neurocysticercosis in most cases), ischemic infarct (1.9%) and leukoaraiosis (1.3%). These findings showed the importance of CT scan examination in mild head injuries. Further studies to identify mild HT patients at higher risk of significant brain injury are warranted in order to optimize its use.
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Yunus, Muhamad, Alfi Wahyudi, Arti Febriyani H, and Rona Asla Romiza. "Karakteristik Hasil CT-Scan Kepala pada Penderita Cedera Kepala di Rumah Sakit Dr.H.Abdul Moeloek periode Januari – Desember Tahun 2018." ARTERI : Jurnal Ilmu Kesehatan 1, no. 3 (2020): 177–83. http://dx.doi.org/10.37148/arteri.v1i3.56.
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Computerized Tomography (CT) -Scans examination are the main choice modalities in patients with acute head injuries because they are able to view the entire brain tissues and accurately distinguish the nature and presence of intracranial lesions and Extracranial. This study aim to determine the characteristics of results CT-Scan head on the patient's head injury at Dr.H.Abdul Moeloek Hospital January to December Period 2018. The research is a descriptive study with a crosssectional approach. The samples in this study were all records of medical head injury patients at Dr.H.Abdul Moeloek Hospital in January – December 2018 based on the formula Slovin as many as 182 respondents. The sampling techniques in the study used purposive sampling techniques. Data analysis using univariate analysis. From 182 respondents known prevalence of the age of the patient's head injury is 16-25 years as many as 82 respondents (45.1%), male gender 119 respondents (65.4%), a mild head injury of 105 respondents (57.7%). A normal CT-Scan overview of 99 respondents (54.4%) With a valid description (subarachnoid hemorrhage) as much as 25 respondents (13.7%). Characteristics of results CT-Scan head at the head injury sufferer of most ages 16-25 years, most male gender, most dominant mild head injuries and CT-Scan results most commonly present normal results with description SAH (subarachnoid hemorrhage).
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Foote, Robert L. "Oncology Scan – Head and Neck Cancers." International Journal of Radiation Oncology*Biology*Physics 83, no. 2 (2012): 477–79. http://dx.doi.org/10.1016/s0360-3016(12)00529-9.
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Yom, Sue S. "Oncology Scan—Head and Neck Cancers." International Journal of Radiation Oncology*Biology*Physics 85, no. 1 (2013): 3–5. http://dx.doi.org/10.1016/j.ijrobp.2012.08.022.
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Danielson, Kris, Teresa Hall, Terrence Endres, Clifford Jones, and Deb Sietsema. "Clinical Indications of Computed Tomography (CT) of the Head in Patients With Low-Energy Geriatric Hip Fractures: A Follow-Up Study at a Community Hospital." Geriatric Orthopaedic Surgery & Rehabilitation 10 (January 1, 2019): 215145931986156. http://dx.doi.org/10.1177/2151459319861562.
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Introduction: A seemingly large percentage of geriatric patients with isolated low-energy femur fractures undergo a head computed tomography (CT) scans during initial work up in the emergency department. This study aimed to evaluate the pertinent clinical variables that are associated with positive CT findings with the objective to decrease the number of unnecessary CT scans performed. Methods: A retrospective review performed at a level II trauma center including 713 patients over the age of 65 sustaining a femur fracture following a low-energy fall. The main outcome measure was pertinent clinical variables that are associated with CT scans that yielded positive findings. Results: A total of 713 patients over the age of 65 were included, with a low-energy fall, of which 76.2% (543/713) underwent a head CT scan as part of their evaluation. The most common presenting symptom reported was the patient hitting their head, 13% (93/713), and 1.8% (13/713) were unsure if they had hit their head. Of those evaluated with a head CT scan, only 3 (0.4%) had acute findings and none required acute neurosurgical intervention. All three patients with acute changes on the head CT scan had an Injury Severity Score (ISS) greater than 9, Glasgow Coma Scale (GCS) less than 15, and evidence of trauma above the clavicles. Discussion: None of the patients with a traumatic injury required a neurosurgical intervention after sustaining a low-energy fall (0/713). Conclusion: Head CT scans should have a limited role in the workup of this patient population and should be reserved for patients with a history and physical exam findings that support head trauma, an ISS > 9 and GCS < 15.
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Oertel, Matthias, Daniel F. Kelly, David McArthur, et al. "Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury." Journal of Neurosurgery 96, no. 1 (2002): 109–16. http://dx.doi.org/10.3171/jns.2002.96.1.0109.
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Object. Progressive intracranial hemorrhage after head injury is often observed on serial computerized tomography (CT) scans but its significance is uncertain. In this study, patients in whom two CT scans were obtained within 24 hours of injury were analyzed to determine the incidence, risk factors, and clinical significance of progressive hemorrhagic injury (PHI). Methods. The diagnosis of PHI was determined by comparing the first and second CT scans and was categorized as epidural hematoma (EDH), subdural hematoma (SDH), intraparenchymal contusion or hematoma (IPCH), or subarachnoid hemorrhage (SAH). Potential risk factors, the daily mean intracranial pressure (ICP), and cerebral perfusion pressure were analyzed. In a cohort of 142 patients (mean age 34 ± 14 years; median Glasgow Coma Scale score of 8, range 3–15; male/female ratio 4.3:1), the mean time from injury to first CT scan was 2 ± 1.6 hours and between first and second CT scans was 6.9 ± 3.6 hours. A PHI was found in 42.3% of patients overall and in 48.6% of patients who underwent scanning within 2 hours of injury. Of the 60 patients with PHI, 87% underwent their first CT scan within 2 hours of injury and in only one with PHI was the first CT scan obtained more than 6 hours postinjury. The likelihood of PHI for a given lesion was 51% for IPCH, 22% for EDH, 17% for SAH, and 11% for SDH. Of the 46 patients who underwent craniotomy for hematoma evacuation, 24% did so after the second CT scan because of findings of PHI. Logistic regression was used to identify male sex (p = 0.01), older age (p = 0.01), time from injury to first CT scan (p = 0.02), and initial partial thromboplastin time (PTT) (p = 0.02) as the best predictors of PHI. The percentage of patients with mean daily ICP greater than 20 mm Hg was higher in those with PHI compared with those without PHI. The 6-month postinjury outcome was similar in the two patient groups. Conclusions. Early progressive hemorrhage occurs in almost 50% of head-injured patients who undergo CT scanning within 2 hours of injury, it occurs most frequently in cerebral contusions, and it is associated with ICP elevations. Male sex, older age, time from injury to first CT scan, and PTT appear to be key determinants of PHI. Early repeated CT scanning is indicated in patients with nonsurgically treated hemorrhage revealed on the first CT scan.
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Masood, Sameer, Victoria Woolner, Joo Hyung Yoon, and Lucas B. Chartier. "Checklist for Head Injury Management Evaluation Study (CHIMES): a quality improvement initiative to reduce imaging utilisation for head injuries in the emergency department." BMJ Open Quality 9, no. 1 (2020): e000811. http://dx.doi.org/10.1136/bmjoq-2019-000811.
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Over 90% of patients with head trauma seen in emergency departments (EDs) are diagnosed with minor head injuries. Over-utilisation of CT scans results in unnecessary exposure to radiation and increases healthcare utilisation. Using recommendations from the Choosing Wisely Canada (CWC) campaign and quality improvement (QI) methodology, we aimed to reduce the CT scan rate for head injuries by 10% over a 6-month period.Baseline CT scan rates were determined through a 27-month retrospective cohort review. We used stakeholder engagement and provider surveys to develop our driver diagram and Plan-Do-Study-Act (PDSA) cycles, which included (1) improving provider knowledge about the CWC campaign recommendations; (2) testing, refining and implementing a modified Canadian CT Head Rule checklist; (3) developing CWC-themed head injury–specific patient handouts; and (4) feedback on CT scan group ordering rates to providers. Our primary outcome measure was the number of CT scans performed for patients with head injuries. Process measures included the number of checklists completed and ED length of stay (LOS). Our balancing measure was return ED visits within 72 hours (with or without admission).Baseline CT scan rates prior to our interventions was 46.1%. Our QI initiative resulted in a ‘shift’ in the Statistical Process Control chart of the weekly CT scan rates, associated with the first and second PDSA cycles, resulting in a 13.9% reduction in CT rates during the initial 3 months, and a sustained reduction of 8% at 16 months (p<0.05). Mean ED LOS for all patients with head injuries decreased by 1.5 min (p=0.74). 33% of checklists were completed. 72-hour return visits did not change significantly (p=0.68).Through provider and patient education, and the creation of a user-friendly evidence-based tool, our local QI initiative was successful in achieving long-term reduction in CT rates for patients presenting to EDs with head injuries.
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MacDonald, S., É. Mercier, T. O'Brien, M. Mercuri, and K. de Wit. "P088: Emergency physicians’ approach to head CT scanning for elderly patients who fall: A survey of Canadian, American, British, and Australian emergency physicians." CJEM 21, S1 (2019): S95. http://dx.doi.org/10.1017/cem.2019.279.
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Introduction: The number of seniors presenting to emergency departments after a fall is increasing. Head injury concerns in this population often leads to a head CT scan. The CT rate among physicians is variable and the reasons for this are unknown. This study examined the role of patient characteristics and country of practice in the decision to order a CT. Methods: This study used a case-based survey of physicians across multiple countries. Each survey included 9 cases pertaining to an 82-year old man who falls. Each case varied in one aspect compared to a base case (aspirin, warfarin, or rivaroxaban use, occipital hematoma, amnesia, dementia, and fall with no head trauma). For each case, participants indicated how “likely” they were to order a head CT scan, measured on a 100-point scale. A response of 80 or more was defined a priori as ‘likely to order a CT scan’. The survey was piloted among emergency residents for feedback on design and comprehension, and was published in French and English. Recruitment was through the Canadian Association of Emergency Physicians, Twitter and CanadiEM. For each case we compared the proportion of physicians who were ‘likely to scan’ with relative to the base case. We also compared the proportion of participants who were ‘likely to scan’ each case in the USA, UK and Australia, relative to Canada. Results: Data was collected from 484 respondents (Canada-308, USA-64, UK-67, Australia-27, and 18 from other countries). Social media distribution limited our ability to estimate of the response rate. Physicians were most likely to scan in the anticoagulation cases (90% likely to order a scan compared to 36% for the base case (p = &lt;0.001)). Other features associated with increased scans were occipital hematoma (48%), multiple falls (68%), and amnesia (68%) (all p &lt; 0.005). Compared to Canada, US physicians were more likely to order CT scans for all cases (p = &lt;0.05). Compared to Canada, UK physicians were significantly less likely to order CT for patients in every case except in the patient with amnesia. Finally, Australian physicians differed from Canada only for the occipital hematoma case where they were significantly more likely to order CT scan. Conclusion: Anticoagulation, amnesia and a history of multiple falls appear to drive the ordering a head CT scan in elderly patients who had fallen. We observed variations in practice between countries. Future clinical decision rules will likely have variable impact on head CT scan rates depending on baseline practice variation.
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Lobato, Ramiro D., Rosario Sarabia, Juan J. Rivas, et al. "Normal computerized tomography scans in severe head injury." Journal of Neurosurgery 65, no. 6 (1986): 784–89. http://dx.doi.org/10.3171/jns.1986.65.6.0784.
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✓ The authors analyze the clinical course of 46 severely head-injured patients who had completely normal computerized tomography (CT) scans through the immediate posttraumatic period (1 to 7 days after trauma). These patients represent 10.2% of a consecutive series of 448 cases of severe head injuries and two-thirds of the cases showing a normal CT scan on admission (the other one-third of the cases developed new pathology). The usual course in these 46 patients after the initial coma was toward progressive neurological improvement, and 35 patients (76%) achieved a functional level of survival. Nine patients (19.5%) remained comatose for several weeks and developed severe disability. There were two fatalities due to medical complications. The final outcome was more closely related to the duration of coma (the longer the duration the worse the result) than to the initial Glasgow Coma Scale (GCS) score. In fact, 26% of the patients in the lower GCS score ranges (3 to 4 points) made a good recovery and 46% developed moderate disability only. These findings indicate that the grim prognostic significance of deep posttraumatic coma is tempered in the presence of a normal scan. However, the absence of CT abnormalities in severely head-injured patients cannot be equated with a good prognosis because in one-fifth of the cases serious permanent disability develops. Sustained elevation of the intracranial pressure (ICP) was not seen in these patients, indicating that ICP monitoring may be omitted in cases with a normal scan. However, since one-third of the patients with a normal admission scan developed new pathology within the first few days of injury, a strategy for control scanning is recommended. Control CT scans performed more than 6 months after injury showed a significantly higher incidence of brain atrophy in patients developing permanent disability than in those who made a good recovery.
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Öğrenci, Ahmet, Orkun Koban, Murat Ekşi, Onur Yaman, and Sedat Dalbayrak. "The Necessity of Follow-Up Brain Computed-Tomography Scans: Is It the Pathology Itself Or Our Fear that We Should Overcome?" Open Access Macedonian Journal of Medical Sciences 5, no. 6 (2017): 740–43. http://dx.doi.org/10.3889/oamjms.2017.157.
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AIM: This study aimed to make a retrospective analysis of pediatric patients with head traumas that were admitted to one hospital setting and to make an analysis of the patients for whom follow-up CT scans were obtained.METHODS: Pediatric head trauma cases were retrospectively retrieved from the hospital’s electronic database. Patients’ charts, CT scans and surgical notes were evaluated by one of the authors. Repeat CT scans for operated patients were excluded from the total number of repeat CT scans.RESULTS: One thousand one hundred and thirty-eight pediatric patients were admitted to the clinic due to head traumas. Brain CT scan was requested in 863 patients (76%) in the cohort. Follow-up brain CT scans were obtained in 102 patients. Additional abnormal finding requiring surgical intervention was observed in only one patient (isolated 4th ventricle hematoma) on the control CTs (1% of repeat CT scans), who developed obstructive hydrocephalus. None of the patients with no more than 1 cm epidural hematoma in its widest dimension and repeat CT scans obtained 1.5 hours after the trauma necessitated surgery.CONCLUSION: Follow-up CT scans changed clinical approach in only one patient in the present series. When ordering CT scan in the follow-up of pediatric traumas, benefits and harms should be weighted based upon time interval from trauma onset to initial CT scan and underlying pathology.
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Zhao, Zhenhua, Yiming Lyu, Tim Leschinger, Kilian Wegmann, Lars Peter Müller, and Michael Hackl. "Imaging diagnosis of radial head fractures—evaluation of plain radiography vs. CT scans." Obere Extremität 16, no. 3 (2021): 198–202. http://dx.doi.org/10.1007/s11678-021-00642-z.
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Abstract Background Radial head fractures represent a common pathology that can cause permanent disability, especially if not treated correctly. Plain radiographs as well as computed tomography (CT) scans represent important diagnostic measures. The specific differences between these two imaging modalities with regard to diagnosis of radial head fractures have not been evaluated to date. Objective This study aimed to compare estimations of fracture classification, percentage of articular fracture involvement, and fragment sizes through plain radiography with CT scan evaluations. Methods A total of 52 consecutive cases of isolated radial head fractures with plain radiographs and CT scans were evaluated retrospectively. Two observers analyzed the fracture classification according to Mason, the percentage of articular fracture involvement, and the size of the largest fracture fragment by means of CT. Three trauma surgeons estimated these parameters through blinded plain radiographs. Intra- and inter-observer reliability were evaluated. Results The CT scan evaluations showed high intra- and inter-observer reliability without significant differences between the two observers. X‑ray estimations of fracture classifications showed only fair agreements. Moreover, the estimations of articular fracture involvement and fragment sizes differed significantly from the CT scan evaluations. While the fragment size tended to be underrated, the articular involvement tended to be overrated. Conclusion This study shows that plain radiographs often provide unreliable information regarding classification, articular involvement, and fragment sizes of radial head fractures. When in doubt, an additional CT scan should be carried out to assess the injury in greater detail.
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Mishra, Rakesh Kumar, Ashok Munivenkatappa, Vasuki Prathyusha, Dhaval P. Shukla, and Bhagavatula Indira Devi. "Clinical predictors of abnormal head computed tomography scan in patients who are conscious after head injury." Journal of Neurosciences in Rural Practice 08, no. 01 (2017): 064–67. http://dx.doi.org/10.4103/0976-3147.193538.
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ABSTRACT Background: Indication of a head computed tomography (CT) scan in a patient who remains conscious after head injury is controversial. We aimed to determine the clinical features that are most likely to be associated with abnormal CT scan in patients with a history of head injury, and who are conscious at the time of presentation to casualty. Materials and Methods: This is a prospective observation study of patients presented to casualty with history of head injury, and who were conscious, i.e., Glasgow Coma Scale (GCS) 15 at the time of evaluation. All patients underwent head CT scan. The CT scan was reported as abnormal if it showed any pathology ascribed to trauma. The following variables were used: age, gender, mode of injury (road traffic accident, fall, assault, and others), duration since injury, and history of transient loss of consciousness, headache, vomiting, ear/nose bleeding, and seizures. Logistic regression analysis was used to identify the clinical features that predicted an abnormal CT scan. Results: During the observation period, a total of 1629 patients with head injury were evaluated, out of which 453 were in GCS 15. Abnormal CT scan was present in 195 (43%) patients. Among all the variables, the following were found significantly associated with abnormal CT scan: duration since injury (>12 h) P < 0.001; vomiting odds, ratio (OR) 1.89 (1.23, 2.80), P < 0.001; and presence of any symptom, OR 2.36 (1.52, 3.71), P < 0.001. Conclusion: A patient with GCS 15 presenting after 12 hours of injury with vomiting or combination of symptoms has a significant risk of abnormal head CT scan.
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Wu, Dan, Gang Wang, Bingyang Bian, Zhuohang Liu, and Dan Li. "Benefits of Low-Dose CT Scan of Head for Patients With Intracranial Hemorrhage." Dose-Response 19, no. 1 (2020): 155932582090977. http://dx.doi.org/10.1177/1559325820909778.
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Objectives: For patients with intracranial hemorrhage (ICH), routine follow-up computed tomography (CT) scans are typically required to monitor the progression of intracranial pathology. Remarkable levels of radiation exposure are accumulated during repeated CT scan. However, the effects and associated risks have still remained elusive. This study presented an effective approach to quantify organ-specific radiation dose of repeated CT scans of head for patients with ICH. We also indicated whether a low-dose CT scan may reduce radiation exposure and keep the image quality highly acceptable for diagnosis. Methods: Herein, 72 patients with a history of ICH were recruited. The patients were divided into 4 groups and underwent CT scan of head with different tube current–time products (250, 200, 150, and 100 mAs). Two experienced radiologists visually rated scores of quality of images according to objective image noise, sharpness, diagnostic acceptability, and artifacts due to physiological noise on the same workstation. Organ-/tissue-specific radiation doses were analyzed using Radimetrics. Results: In conventional CT scan group, signal to noise ratio (SNR) and contrast to noise ratio (CNR) of ICH images were significantly higher than those in normal brain structures. Reducing the tube current–time product may decrease the image quality. However, the predilection sites for ICH could be clearly identified. The SNR and CNR in the predilection sites for ICH were notably higher than other areas. The brain, eye lenses, and salivary glands received the highest radiation dose. Reducing tube current–time product from 250 to 100 mA can significantly reduce the radiation dose. Discussion: We demonstrated that low-dose CT scan of head can still provide reasonable images for diagnosing ICH. The radiation dose can be reduced to ∼45% of the conventional CT scan group.
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Chen, Xu, Tengfei Guo, Yubin Hou, Jing Zhang, Wenjie Meng, and Qingyou Lu. "A High Rigidity and Precision Scanning Tunneling Microscope with Decoupled XY and Z Scans." Scanning 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/1020476.
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A new scan-head structure for the scanning tunneling microscope (STM) is proposed, featuring high scan precision and rigidity. The core structure consists of a piezoelectric tube scanner of quadrant type (for XY scans) coaxially housed in a piezoelectric tube with single inner and outer electrodes (for Z scan). They are fixed at one end (called common end). A hollow tantalum shaft is coaxially housed in the XY-scan tube and they are mutually fixed at both ends. When the XY scanner scans, its free end will bring the shaft to scan and the tip which is coaxially inserted in the shaft at the common end will scan a smaller area if the tip protrudes short enough from the common end. The decoupled XY and Z scans are desired for less image distortion and the mechanically reduced scan range has the superiority of reducing the impact of the background electronic noise on the scanner and enhancing the tip positioning precision. High quality atomic resolution images are also shown.
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Osborn, A. G. "Repeat CT Scan in Closed Head Injury." Yearbook of Diagnostic Radiology 2006 (January 2006): 363–64. http://dx.doi.org/10.1016/s0098-1672(08)70483-1.
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Scott-Jupp, Robert. "Who should we scan after head injury?" Archives of Disease in Childhood 102, no. 7 (2017): 667. http://dx.doi.org/10.1136/archdischild-2017-313422.
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Dharap, S. B., A. A. Khandkar, A. Pandey, and A. K. Sharma. "Repeat CT scan in closed head injury." Injury 36, no. 3 (2005): 412–16. http://dx.doi.org/10.1016/j.injury.2004.06.020.
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Mitchell, Joellene R., Paul Jefferson, David R. Ball, et al. "Head computed tomography scan following cardiac arrest." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 52, no. 8 (2005): 892–93. http://dx.doi.org/10.1007/bf03021797.
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Radulovic, Danilo, Vesna Janosevic, Miodrag Rakic, Branko Djurovic, Eugen Slavik, and Novak Lakicevic. "Delayed epidural hematoma after mild head injury." Vojnosanitetski pregled 62, no. 9 (2005): 679–82. http://dx.doi.org/10.2298/vsp0509679r.
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Background. Traumatic delayed epidural hematoma (DEH) can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a ?massive? epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.
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Sidipratomo, Prijo, Trijono Karmawan Sukana Prija, Bachtiar Murtala, Agus Purwadianto, and Gatot Susilo Lawrence. "Role of Postmortem Multislice Computed Tomography Scan in Close Blunt Head Injury." Indonesian Biomedical Journal 6, no. 2 (2014): 101. http://dx.doi.org/10.18585/inabj.v6i2.36.
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BACKGROUND: Conventional autopsy in Indonesia is not well accepted as it is contrary to religion and culture. New radiological imaging method such as multislice computed tomography (MSCT) scan has potential to be a diagnostic tool in forensic pathology. The purpose of this study is to determine the ability of MSCT scan in finding abnormalities in close blunt head injury compared with autopsy.METHODS: This study used descriptive qualitative method. Postmortem cases in Department of Forensic Medicine and Radiology of Dr. Cipto Mangunkusumo Hospital were selected based on inclusion criteria. Then MSCT scan and autopsy were conducted. MSCT scan and autopsy results were compared and analyzed.RESULTS: There were 491 postmortem cases of blunt head injury. However, only 10 cases fulfilled inclusion criteria. Subarachnoid haemorrhages were identified 100% with MSCT scan and 80% with autopsy. Cerebral oedemas were identified 100% either with MSCT scan and autopsy. Subdural haemorrhages were identified 100% with MSCT scan, while 50% with autopsy. Multiple fractures were identified 80% with MSCT scan, while 40% with auto.CONCLUSION: MSCT scan showed a sensitive detection in finding abnormalities in close blunt head injury. Therefore it could be as an alternative choice of examination in close blunt head injury cases.KEYWORDS: multislice computed tomography scan, postmortem, blunt head injury, autopsy
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Matias, Joana, Sofia Almeida, Sofia Ferrito, et al. "A Experiência duma Norma de Atuação no Traumatismo Crânio-Encefálico Ligeiro em Idade Pediátrica: Estudo Longitudinal de Três Anos." Acta Médica Portuguesa 30, no. 10 (2017): 704. http://dx.doi.org/10.20344/amp.8795.
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Introduction: Head injury is common in children, with mostly being minor and not resulting in intracranial injury. Computerized tomography head scan is the preferred exam, but implies exposure to radiation; the indications for computerized tomography head scan in minor injuries are not consensual. An expectant approach is a good option in most cases. The aim was to compare the patients hospitalized and subjected to computerized tomography head scan with patients hospitalized but not subjected to computerized tomography head scan in order to assess the safety of our institution’s practice protocol.Material and Methods: Analytical longitudinal retrospective study, during three years, including patients younger than 15 years of age with minor head injury, admitted for in hospital surveillance through a paediatric emergency room. We defined two study groups: group A (hospitalized with computerized tomography head scan) and group B (hospitalized without computerized tomography head scan).Results: Study sample consisting of 206 patients: 81 (39%) group A and 125 (61%) group B. Symptoms, including vomiting, were more frequent in group B (91% and 61% vs 75% and 35%, p < 0.05); large scalp hematoma and palpable fracture in group A (11% and 12% vs 0%, p < 0.05). We performed computerized tomography head scan in 39% of the study patients (children with red flags in the physical examination or unfavourable course during hospitalization); 43% had traumatic brain injury (29 patients had fracture, 18 patients had intracranial injury). Three patients underwent neurosurgery. We did not register deaths, readmissions or neurologic sequelae.Discussion: Significant intracranial injury was infrequent. The hospitalization and surveillance of children and adolescents with symptomatic minor head injury, without red flags in the physical examination, did not seem to result in additional risks.Conclusion: The careful selection of patients for computerized tomography head scan enabled a decrease in the number of these exams and the exposure to ionizing radiation.
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Ginat, Daniel. "Implementation of Machine Learning Software on the Radiology Worklist Decreases Scan View Delay for the Detection of Intracranial Hemorrhage on CT." Brain Sciences 11, no. 7 (2021): 832. http://dx.doi.org/10.3390/brainsci11070832.
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Background and Purpose: Prompt identification of acute intracranial hemorrhage on CT is important. The goal of this study was to assess the impact of artificial intelligence software for prioritizing positive cases. Materials and Methods: Cases analyzed by Aidoc (Tel Aviv, Israel) software for triaging acute intracranial hemorrhage cases on non-contrast head CT were retrospectively reviewed. The scan view delay time was calculated as the difference between the time the study was completed on PACS and the time the study was first opened by a radiologist. The scan view delay was stratified by scan location, including emergency, inpatient, and outpatient. The scan view delay times for cases flagged as positive by the software were compared to those that were not flagged. Results: A total of 8723 scans were assessed by the software, including 6894 cases that were not flagged and 1829 cases that were flagged as positive. Although there was no statistically significant difference in the scan view time for emergency cases, there was a significantly lower scan view time for positive outpatient and inpatient cases flagged by the software versus negative cases, with a reduction of 604 min on average, 90% in the scan view delay (p-value < 0.0001) for outpatients, and a reduction of 38 min on average, and 10% in the scan view delay (p-value <= 0.01) for inpatients. Conclusion: The use of artificial intelligence triage software for acute intracranial hemorrhage on head CT scans is associated with a significantly shorter scan view delay for cases flagged as positive than cases not flagged among outpatients and inpatients at an academic medical center.
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Sorour, Mohammad, Khaled M. Krisht, and William T. Couldwell. "Intraventricular Hemorrhage after Epidural Blood Patching: An Unusual Complication." Case Reports in Neurological Medicine 2014 (2014): 1–3. http://dx.doi.org/10.1155/2014/406289.
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The authors present two cases of intraventricular hemorrhage (IVH) believed to be a result of epidural blood patching. The first was a 71-year-old woman who had new onset of nontraumatic IVH on computed tomography (CT) scan after undergoing an epidural blood patch (EBP). This amount of intraventricular blood was deemed an incidental finding since it was of very small volume to account for her overall symptoms. The second patient, a 29-year-old woman, was found to have nontraumatic IVH three days after undergoing an EBP. This was seen on CT scan of the head for workup of pressure-like headaches, nausea, vomiting, and absence seizures. Conservative management was followed in both instances. Serial CT scan of the head in our first patient displayed complete resolution of her IVH. The second patient did not have follow-up CT scans because her overall clinical picture had improved significantly. This highlights a potential sequel of EBP that may be observed on CT scan of the head. In the event that IVH is detected, signs and symptoms of hydrocephalus should be closely monitored with the consideration for a future workup if warranted by the clinical picture.
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Yogi, Nikunj, Balgopal Karmacharya, and Amrit Gurung. "Clinical Predictors of Abnormal Computed Tomography Findings in Mild Head Injury." Nepalese Journal of Radiology 8, no. 2 (2018): 20–25. http://dx.doi.org/10.3126/njr.v8i2.22978.
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Introduction: Whether to scan a minor head injury with Glasgow Coma Scale (GCS) 15 who appears well and has a normal physical and neurological exam or not is an issue commonly faced in all emergency departments. In this study, we tried to assess the predictability of clinical parameters in predicting traumatic intracranial lesions in Computed Tomography (CT) scans of patients with minor head injuries with GCS 15.Methods: A prospective observational study was carried out in between January to December 2016 in Manipal Teaching Hospital, Pokhara, Nepal. Various clinical predictors of 415 cases of minor head injury with GCS 15 were assessed to see if they could predict the abnormal CT scans in these cases. Clinical variables found significant in bivariate analyses were further analyzed using logistic regression to calculate the odds of each variable to detect abnormal CT scans.Results: There were 119 (28.7%) abnormal CT scans in the study. Vomiting, LOC (Loss of Consciousness), seizure and headache were the significant predictors of abnormal CT scans with an odds of 4.254 (95% CI: 2.373-7.627), 2.396 (95% CI: 1.258-4.562), 5.803 (95% CI: 1.110-30.336) and 1.967 (95% CI: 1.008-3.839) respectivelyConclusion: Vomiting, LOC, seizure and headache are important clinical predictors of abnormal CT scan in cases of minor head injuries with GCS 15.
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Zygourakis, Corinna C., Ethan Winkler, Lawrence Pitts, Lisa Hannegan, Benjamin Franc, and Michael T. Lawton. "Clinical utility and cost analysis of routine postoperative head CT in elective aneurysm clippings." Journal of Neurosurgery 126, no. 2 (2017): 558–63. http://dx.doi.org/10.3171/2016.1.jns152242.
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OBJECTIVE Postoperative head CT scanning is performed routinely at the authors' institution on all neurosurgical patients after elective aneurysm clippings. The goal of this study was to determine how often these scans influence medical management and to quantify the associated imaging costs. METHODS The authors reviewed the medical records and accounting database of 304 patients who underwent elective (i.e., nonruptured) aneurysm clipping performed by 1 surgeon (M.T.L.) from 2010 to 2014 at the University of California, San Francisco. Specifically, the total number of postoperative head CT scans, radiographic findings, and the effect of these studies on patient management were determined. The authors obtained the total hospital costs for these patients, including the cost of imaging studies, from the hospital accounting database. RESULTS Overall, postoperative CT findings influenced clinical management in 3.6% of cases; specifically, they led to permissive hypertension in 4 patients for possible ischemia, administration of mannitol for edema and high-flow oxygen for pneumocephalus in 2 patients each, seizure prophylaxis in 1 patient, Plavix readjustment in 1 patient, and return to the operating room for an asymptomatic epidural hematoma evacuation in 1 patient. When patients were stratified on the basis of postoperative neurological examination, findings on CT scans altered management in 1.1%, 4.8%, and 9.0% of patients with no new neurological deficits, a nonfocal examination, and focal deficits, respectively. The mean total hospital cost for treating patients who undergo elective aneurysm clipping was $72,227 (± $53,966) (all values are US dollars), and the cost of obtaining a noncontrast head CT scan was $292. Neurologically intact patients required 99 head CT scans, at a cost of $28,908, to obtain 1 head CT scan that influenced medical management. In contrast, patients with a focal neurological deficit required only 11 head CT scans, at a cost of $3212, to obtain 1 head CT scan that changed clinical management. CONCLUSIONS Although there are no clear guidelines, the large number and high cost of CT scans needed to treat neurologically intact elective aneurysm patients suggest that careful neurological monitoring may be more clinically useful and a better use of hospital resources than routine postoperative CT.
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Phatak, Ashwin, and Markus Gruber. "Keep Your Head Up—Correlation between Visual Exploration Frequency, Passing Percentage and Turnover Rate in Elite Football Midfielders." Sports 7, no. 6 (2019): 139. http://dx.doi.org/10.3390/sports7060139.
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Statistical analysis of real in-game situations plays an increasing role in talent identification and player recruitment across team sports. Recently, visual exploration frequency (VEF) in football has been discussed as being one of the important performance-determining parameters. However, until now, VEF has been studied almost exclusively in laboratory settings. Moreover, the VEF of individuals has not been correlated with performance parameters in a statistically significant number of top-level players. Thus, the objective of the present study was to examine the relationship between VEF and individual performance parameters in elite football midfielders. Thirty-five midfielders participating in the Euro 2016 championship were analyzed using game video. Their VEF was categorized into scans, transition scans, and total scans. Linear regression analysis was used to correlate the three different VEF parameters with the passing percentage and the turnover rate for individual players. The linear regression showed significant positive correlations between scan rate (p = 0.033, R 2 = 3.0%) and total scan rate (p = 0.015, R 2 = 4.0%) and passing percentage but not between transition scan rate and passing percentage (p = 0.074). There was a significant negative correlation between transition scan rate and turnover rate (p = 0.023, R 2 = 3.5%) but not between total scan rate (p = 0.857) or scan rate (p = 0.817) and turnover rate. In conclusion, the present study shows that players with a higher VEF may complete more passes and cause fewer turnovers. VEF explains up to 4% of variance in pass completion and turnover rate and thus should be considered as one of the factors that can help to evaluate players and identify talents as well as to tailor training interventions to the needs of midfielders up to the highest level of professional football.
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Kvam, Kathryn A., Vanja C. Douglas, William D. Whetstone, S. Andrew Josephson, and John P. Betjemann. "Yield of Emergent CT in Patients With Epilepsy Presenting With a Seizure." Neurohospitalist 9, no. 2 (2018): 71–78. http://dx.doi.org/10.1177/1941874418808676.
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Background: Studies of emergent neuroimaging in the management of patients presenting with a breakthrough seizure are lacking. We sought to determine how often emergent computed tomography (CT) scans are obtained in patients with known epilepsy presenting with a seizure and how often acute abnormalities are found. Methods: This multicenter retrospective cohort study was performed in the emergency department at 2 academic medical centers. The primary outcomes were percentage of visits where a CT scan was obtained, whether CT findings represented acute abnormalities, and whether these findings changed acute management. Results: Of the 396 visits included, CT scans were obtained in 39%, and 8% of these scans demonstrated acute abnormalities. Patients who were older, had status epilepticus, a brain tumor, head trauma, or an abnormal examination were all significantly more likely to undergo acute neuroimaging ( P < .05). In the multivariable model, only history of brain tumor (odds ratio [OR] 5.88, 95% confidence interval [CI], 1.33-26.1) and head trauma as a result of seizure (OR 3.92, 95% CI, 1.01-15.2) reached statistical significance in predicting an acutely abnormal scan. The likelihood of an acute imaging abnormality in visits for patients without a history of brain tumor or head trauma as a result of the seizure was 2.7% (2 visits). Both of these patients had abnormal neurological examinations. Conclusion: Obtaining an emergent CT scan for patients with epilepsy presenting with a seizure may be avoidable in most cases, but might be indicated for patients with a history of brain tumor or head trauma as a result of seizure.
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King, Brent R. "Special Report: To Scan or Not to Scan: Diagnosing Children with Head Injuries." Emergency Medicine News 32, no. 11 (2010): 20–21. http://dx.doi.org/10.1097/01.eem.0000390638.10085.dd.
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Tayal, A., and PK Chhetri. "Evaluation of acute head injury by computed tomography scan in College of Medical Sciences-Teaching Hospital, Chitwan." Journal of College of Medical Sciences-Nepal 7, no. 1 (2012): 36–39. http://dx.doi.org/10.3126/jcmsn.v7i1.5971.
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This study was conducted to evaluate the computed tomography findings in patient with acute head injury and to emphasize the importance of computed tomography scan in head injury. One hundred consecutive patients presenting to the emergency department with head injury were evaluated by computed tomography scan of the head. Seventy five patients (75%) were male and twenty five (25%) were females. The age of the patients ranged from three to seventy years and the most affected age group was between thirty and forty (40%). The common causes of head injury were motor vehicle accident (70%), fall injury (25% ) and physical assault (5%). The most common computed tomographic findings were: cerebral contusions (52%), skull fractures (41%), intracerebral hematomas (24%), diffuse cerebral edema (23%), midline shift (18%), subdural hematomas (15%), subarachnoid hemorrhage (13%), diffuse axonal injury (8%), intraventricular hemorrhage (6%), extradural hemotomas (4%), pnemocephalus (2%) and normal scans were found in (5%). In conclusion, computed tomography is the mainstay in the imaging of head injury and helps in the patient management. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5971 JCMSN 2011; 7(1): 36-39
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Masood, S., L. Chartier, and J. Yoon. "LO24: The checklist for head injury management evaluation study (CHIMES): a cQI initiative to reduce imaging utilization for head injuries in the emergency department." CJEM 20, S1 (2018): S15. http://dx.doi.org/10.1017/cem.2018.86.
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Introduction: Over 1 million patients with head injuries (HIs) are seen every year at emergency departments (EDs) in North America, with over 90% being minor HIs. Over-utilization of computed tomography (CT) scans in these patients results in unnecessary exposure to radiation and increases health-care resource utilization. Using recommendations from the Choosing Wisely Campaign (CWC) and quality improvement (QI) methodology, we developed a local initiative targeting this issue. Our aim was to reduce the CT scan rate for patients presenting with HIs by 10% over a 6-month period at two academic EDs. This was considered both achievable and meaningful by our stakeholders. Methods: Baseline CT scan rates for patients with HIs were determined through a 10-month retrospective cohort review. We used stakeholder engagement and provider surveys to develop our driver diagram and PDSA cycles, which included: 1) Assessing and improving provider knowledge about the CWC recommendations; 2) Testing, refining and implementing a modified Canadian CT Head Rule checklist in the ED; 3) Developing and giving patients CWC-themed handouts pertaining to HI best practice; 4) Bimonthly reporting of CT scan rates to providers. Our primary outcome measure was the number of CT scans performed for patients with HIs. Process measures included the number of checklists completed and ED length of stay (LOS). Our balance measure was return ED visits within 72 hours. Results: Baseline rate of CT scans prior to our interventions was 47.9%. Our QI initiative resulted in a significant shift in the run chart of the weekly CT scan rates, associated with the second PDSA cycle cluster. We observed a 16% relative decrease in CT scans at 3 months (47.9% to 40.5%, P=0.005) and 10.4% at 8 months (47.9% to 43.1%, P=0.02). Non-sustained trends and shifts were seen in the run chart of median ED LOS for HI patients, but overall before-and-after median times were not significantly different (237min to 225min, P=0.18). 33% of total checklists were completed. 72-hr return visits did not change during the 8-month study period (4.0% to 4.16%, P=0.85). Conclusion: Our local QI initiative was successful in decreasing CT rates for patients presenting with a HI. The decrease in effect at 8 months suggests the need for continued feedback and reminders to ensure long-term sustainability. Other centres could use similar QI methods, as well as the materials we developed, to achieve similar results of improved evidence-based utilization of diagnostic tests.
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Chen, Chao-Wen, Yun-Ting Lou, Chi-Ming Chu, et al. "Less Is More? The Impact of Trauma Volume on the Positive Rate of Head Computed Tomography Scans in Head Trauma Patients." Scientific World Journal 2012 (2012): 1–6. http://dx.doi.org/10.1100/2012/340317.
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Objective. Few studies have assessed the impact of trauma volume on the operational efficiency of emergency departments. Herein, we evaluate the association between trauma volume with the positive rate of head computed tomography scans in head trauma patients in a tertiary care hospital.Methods. This is a retrospective cohort review involving all head trauma patients presenting to a tertiary care hospital. Trauma census, head trauma patient volume, the number of emergent head CT scans, and the number of positive head CT scans were collected on a monthly basis. Comparison was primarily made between the trauma patient volume and the positive rate of head CT scans.Results. 25,549 trauma patients were reviewed. Of these, 5,168 (20.2%) sustained head trauma and 3,336 head CT scans were performed with mean 29.1% positive rate of substantial head injuries. The monthly data were analyzed and a statistically significant correlation between monthly trauma volume and decrease in positive rate of head CT scan was identified (Pearsonr=−0.51,P=0.02). With introducing different cut-point values of trauma volume, we identified the threshold of trauma census as approximately 4.9 and 8.8% higher than mean monthly trauma volume in discriminating significant decrease of positive rate of head CT scans.
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Maharjan, Surendra, Sudil Prajapati, and Om Biju Panta. "Measurement of radiation dose in multi-slice computed tomography." Bangabandhu Sheikh Mujib Medical University Journal 9, no. 4 (2016): 196. http://dx.doi.org/10.3329/bsmmuj.v9i4.30143.
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<p>The aim of this study was to measure the radiation doses for computed tomography (CT) examinations of the head, chest and abdomen in adult patients in Nepal in comparison to international standard. Dose length products (DLP) and effective doses for standard patient sizes were calculated from the reported volume CT dose index (CTDI<sub>Vol</sub>). Details were obtained from approximately 90 CT examinations carried out in 128 slice CT scan. Effective dose was calculated for each examination using CT dose indices, exposure related parameters and CTDI-to-effective dose conversion factors. The CTDI and DLP were below the established international reference dose levels for head and chest while for the abdomen and pelvis, the CTDl and DLP were above the established international reference dose levels. The mean effective doses in this study for the head, chest, and abdomen were 1.7, 5.4 and 17.7 mGy respectively. In conclusion, for the routine head and chest protocol, CTDI, DLP and ED were found to be significantly lower compared to the recommendation of European Commission. However, abdomen CT scans showed higher dose values because of multiple phase scans and longer scan lengths.</p>
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Nagesh, Madhusudhan, Kautilya Rajendrakumar Patel, Ajit Mishra, Ujwal Yeole, Andiperumal R. Prabhuraj, and Dhaval Shukla. "Role of repeat CT in mild to moderate head injury: an institutional study." Neurosurgical Focus 47, no. 5 (2019): E2. http://dx.doi.org/10.3171/2019.8.focus19527.
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OBJECTIVEPatients with traumatic brain injury (TBI) often undergo repeat head CT scans to identify the possible progression of injury. The objective of this study is to evaluate the need for routine repeat head CT scans in patients with mild to moderate head injury and an initial positive abnormal CT scan.METHODSThis is a retrospective study of patients presenting to the emergency department from January 2016 to December 2017 with Glasgow Coma Scale (GCS) scores > 8 and an initial abnormal CT scan, who underwent repeat CT during their in-hospital medical management. Patients who underwent surgery after the first CT scan, had a GCS score < 9, or had a normal initial CT scan were excluded. Demographic, medical history, and physical examination details were collected, and CT scans were reviewed. Radiological deterioration, neurological deterioration, and/or the need for neurosurgical intervention were the primary outcome variables.RESULTSA total of 1033 patients were included in this study. These patients underwent at least two CT scans on an inpatient basis. Of these 1033 patients, 54.1% had mild head injury and 45.9% had moderate head injury based on GCS score at admission. The most common diagnosis was contusion (43.8%), followed by extradural hematoma (28.8%) and subdural hematoma (26.6%). A total of 2636 CT scans were performed for 1033 patients, with a mean of 2.55 per patient. Of these, 25 (2.4%) had neurological deterioration, 90 (8.7%) had a progression of an existing lesion or appearance of a new lesion on repeat CT, and 101 (9.8%) required neurosurgical intervention. Seventy-five patients underwent surgery due to worsening of repeat CT without neurological deterioration, so the average number of repeat CT scans required to identify one such patient was 21.3. On multiple logistic regression, GCS score at admission (p = 0.024), abnormal international normalized ratio (INR; p < 0.001), midline shift (p = 0.005), effaced basal cisterns (p < 0.001), and multiple hemorrhagic lesions (p = 0.010) were associated with worsening of repeat CT, neurological deterioration, and/or need for neurosurgical intervention.CONCLUSIONSThe role of routine repeat head CT in medically managed patients with head injury is controversial. The authors have tried to study the various factors that are associated with neurological deterioration, radiological deterioration, and/or need for neurosurgical intervention. In this study the authors found lower GCS score at admission, abnormal INR, presence of midline shift, effaced basal cisterns, and multiple lesions on initial CT to be significantly associated with the above outcomes.
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Hallamasek, K., M. Boots, F. Souchon, et al. "GMR head for helical-scan recording with a 5000-h head life." IEEE Transactions on Magnetics 39, no. 5 (2003): 2387–89. http://dx.doi.org/10.1109/tmag.2003.815458.
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Hor, Y. K., J. Alex, K. Y. Wong, D. Pai, and D. Arundel. "Adult traumatic head injury: compliance with NICE guideline for CT head scan." Clinical Radiology 75 (December 2020): e11. http://dx.doi.org/10.1016/j.crad.2020.11.047.
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Yamauchi-Kawaura, C., K. Fujii, M. Yamauchi, et al. "DEVELOPMENT OF A JAPANESE INFANT HEAD–CHEST PHANTOM AND INVESTIGATION OF THE CURRENT STATUS OF INFANT HEAD CT EXAMINATIONS IN JAPAN." Radiation Protection Dosimetry 188, no. 1 (2019): 65–72. http://dx.doi.org/10.1093/rpd/ncz261.
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Abstract The aim of this study was to develop a head–chest phantom that could mimic the physique of a Japanese 0.5-year-old child and to investigate the current status of exposure dose in infant head computed tomography examinations in Japan. The phantom was produced by machine processing, and radiophotoluminescence glass dosemeters were installed in the phantom for dose measurement. Organ doses were measured for seven different head scan protocols routinely used in three hospitals. In this study, the average dose of the brain and lens within the scan region was equivalent to that measured using infant phantoms in previous studies. In contrast, the doses of both salivary glands and thyroid glands adjacent to the scan region were 1.4–1.8 times higher than those in previous studies. Expansion of the scan area accompanied by a transition of the scan mode from non-helical to helical may have resulted in the differences in organ doses.
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Lawal, Yusuf, Garba Idris, Davidson Florence, Speelman Aladdin, TabariMusa Abdulkadir, and SuwaidMuhammad Abba. "Mild head injury: Criteria for computed tomography scan." Journal of Medicine in the Tropics 19, no. 1 (2017): 11. http://dx.doi.org/10.4103/2276-7096.207585.
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Prabhakaran, Vijay, Soo Kyung Kim, and Frank E. Talke. "Tribology of the helical scan head tape interface." Wear 215, no. 1-2 (1998): 91–97. http://dx.doi.org/10.1016/s0043-1648(97)00274-3.
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Moser, A., H. J. Hug, T. Jung, U. D. Schwarz, and H. J. Guntherodt. "A miniature fibre optic force microscope scan head." Measurement Science and Technology 4, no. 7 (1993): 769–75. http://dx.doi.org/10.1088/0957-0233/4/7/009.
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Hsieh, Bao-Yu, Sung-Liang Chen, Tao Ling, L. Jay Guo, and Pai-Chi Li. "Integrated intravascular ultrasound and photoacoustic imaging scan head." Optics Letters 35, no. 17 (2010): 2892. http://dx.doi.org/10.1364/ol.35.002892.
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Bullard, M. J. "Reliability of Emergency Department Head CT Scan Interpretation." Academic Emergency Medicine 11, no. 5 (2004): 578. http://dx.doi.org/10.1197/j.aem.2004.02.306.
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Garrett, Matthew, and Nader Pouratian. "Repeat Head CT Scan in Blunt Trauma Patients." Journal of the American College of Surgeons 215, no. 6 (2012): 897. http://dx.doi.org/10.1016/j.jamcollsurg.2012.08.020.
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