Level 1 Evidence-Based Medicine

Effect of the CT Table Strap on Radiation Exposure and Image Quality during Cervical Spine CT

This article was accepted as part of our Level 1 Evidence-Based Medicine Expedited Review Program.

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Authors

P.G. Kranz, J.D. Wylie, J.K. Hoang and A.S. Kosinski

From the Departments of Radiology (P.G.K., J.D.W., J.K.H.), Radiation Oncology (J.K.H.), and Biostatistics and Bioinformatics (A.S.K.), Duke University Medical Center, Durham, North Carolina.

Abstract

Background and Purpose

The CT table strap may impair shoulder lowering during cervical spine CT. The purpose of this investigation was to evaluate the effect of the CT table strap on radiation exposure and image quality during CT of the cervical spine.

Materials and Methods

Patients undergoing cervical spine CT were prospectively randomized to having the CT table strap placed around the torso and arms (control group) or around the torso only (intervention group). Radiation exposure, shoulder position, and image quality were evaluated. Potential confounders, including neck diameter and scan length, were also assessed.

Results

Fifty-eight patients were enrolled and randomized, and 51 subjects were included in the final study population. There was a 21% decrease in radiation exposure in the intervention group compared with the control group (mean dose-length product, 540 ± 152 versus 686 ± 200 mGy × cm, <emP = .005). Subjects in the intervention group achieved shoulder lowering of an average of >1 vertebral body lower than the control group (mean shoulder level, 7.7 ± 1.3 versus 6.5 ± 1.3, P = .001). Subjective image quality, determined by the lowest level of spinal cord visibility, was also better in the intervention group (mean cord visibility level, 6.9 ± 1.3 versus 5.9 ± 1.3, P = .006). No differences in neck diameter (P = .28) or scan length (P = .55) were observed between groups.

Conclusions

The CT table strap inhibits shoulder lowering during CT of the cervical spine. Placement of the patient’s arms outside …

Patients Prone to Recurrence after Endovascular Treatment: Periprocedural Results of the PRET Randomized Trial on Large and Recurrent Aneurysms

This article was accepted as part of our Level 1 Evidence-Based Medicine Expedited Review Program.

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Authors

J. Raymond, R. Klink, M. Chagnon, S.L. Barnwell, A.J. Evans, J. Mocco, B.L. Hoh, A.S. Turk, R.D. Turner, H. Desal, D. Fiorella, S. Bracard, A. Weill, F. Guilbert and D. Roy on behalf of the PRET Collaborative Group

From the Department of Radiology (J.R., A.W., F.G., D.R.), Centre Hospitalier de l’Université de Montréal and Laboratory of Interventional Neuroradiology (J.R., R.K.), Centre de recherche du Centre Hospitalier de l’Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada; Département de mathématiques et de statistique (M.C.), Université de Montréal, Montreal, Quebec, Canada; Department of Neurological Surgery (S.L.B.), Oregon Health & Science University, Portland, Oregon; Department of Radiology and Medical Imaging (A.J.E.), University of Virginia Health System, Charlottesville, Virginia; Department of Neurosurgery (J.M., B.L.H.), University of Florida, Gainesville, Florida; Departments of Radiology and Neurosurgery (A.S.T., R.D.T.), Medical University of South Carolina, Charleston, South Carolina; Service de Neuroradiologie Diagnostique et Interventionnelle (H.D.), Centre Hospitalier Universitaire de Nantes, Nantes, France; Department of Neurological Surgery (D.F.), Stony Brook University Medical Center, Stony Brook, New York; and Département de Neuroradiologie Diagnostique et Interventionnelle (S.B.), Centre Hospitalier Universitaire de Nancy, Nancy, France.

Abstract

Background and Purpose

Some patients with large or recurrent aneurysms may be at increased risk of recurrence postcoiling. The Patients Prone to Recurrence after Endovascular Treatment (PRET) trial was designed to assess whether hydrogel coils were superior to platinum coils in these high-risk patients. This article reports periprocedural safety and operator-assessed angiographic results from the PRET trial.

Materials and Methods

PRET was a pragmatic, multicenter, randomized controlled trial. Patients had ≥10-mm aneurysms (PRET-1) or a major recurrence after coiling of an aneurysm of any size (PRET-2). Patients were randomly allocated to hydrogel or control arms (any platinum coil) by using …

Transforaminal versus Intra-Articular Facet Corticosteroid Injections for the Treatment of Cervical Radiculopathy: A Randomized, Double-Blind, Controlled Study

This article was accepted as part of our Level 1 Evidence-Based Medicine Expedited Review Program.

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Authors

N.J. Bureau, T. Moser, J.H. Dagher, D. Shedid, M. Li, P. Brassard and B.E. Leduc

From the Department of Radiology (N.J.B., T.M.), Research Center (N.J.B., T.M.), Department of Surgery (D.S.), Division of Neurosurgery, and Department of Medicine (B.E.L.), Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada; Institut de réadaptation Gingras-Lindsay-de-Montréal (J.H.D.), Université de Montréal, Montreal, Quebec, Canada; Department of Surgery (M.L.), Division of Neurosurgery, Hôopital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada; and Division of Clinical Epidemiology (P.B.), McGill University Health Center, Montreal, Quebec, Canada.

Abstract

Background and Purpose

Transforaminal corticosteroid injections can be performed in the management of cervical radiculopathy but carry the risk of catastrophic complications. This study compares the efficacy of transforaminal and facet corticosteroid injections at 4 weeks’ follow-up.

Materials and Methods

We randomly assigned 56 subjects to receive CT-guided transforaminal (15 men, 13 women; mean age, 52 years; range, 28–72 years) or facet (8 men, 20 women; mean, 44 years; range, 26–60 years) injections. The primary outcome was pain severity rated on a Visual Analog Scale (0–100). Secondary outcomes were the Neck Disability Index and the Medication Quantitative Scale.

Results

In the intention-to-treat and as-treated analyses, for a mean baseline score, facet injections demonstrated a significant pain score reduction of 45.3% (95% CI, 21.4–69.2) and 37.0% (95% CI, 9.2–64.7), while transforaminal injections showed a nonsignificant pain score reduction of 9.8% (95% CI, +11.5–31.2) and 17.8% (95% CI, +6.6–42.2). While facet injections demonstrated an improvement in the Neck Disability Index score of 24.3% (95% CI, +2.9–51.5) and 20.7% (95% CI, +6.2–47.6) as opposed to transforaminal injections of 9.6% (95% CI, +15.2–34.4) and 12.8% (95% CI, +11.2–36.7), the results were not statistically significant. Noninferiority of facet to transforaminal injections …