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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Comparison of Radiation Doses of Computed Tomography Brain and Pulmonary Angiography with International Commission on Radiological Protection Guidelines: A Descriptive Study
Correspondence Address :
Miss. Amita Digambar Dabholkar,
Assistant Professor, Department of Medical Imaging Technology, Yenepoya School of Allied Health Sciences, Yenepoya (Deemed to be University), Mangaluru-575018, Karnataka, India.
E-mail: dabholkaramita99@gmail.com
Introduction: Computed Tomography Angiography (CTA) is useful for evaluating and diagnosing conditions related to blood vessels, such as aneurysms, stenosis (narrowing of vessels), vascular malformations, and blockages. It provides valuable information for planning and guiding interventions or surgeries. It is also important to measure patient doses during CTA operations to evaluate and optimise the technique and balance the benefits compared to radiation hazards.
Aim: To calculate the CT Dose Index (CTDI), Dose Length Product (DLP), and effective dose for CT brain angiography and CT pulmonary angiography, and also to compare whether the measured values are within the International Commission on Radiological Protection (ICRP) recommended levels.
Materials and Methods: A retrospective descriptive study was conducted in the Department of Radiodiagnosis at Yenepoya Medical College Hospital Mangaluru, Karnataka, India, from September 2022 to September 2023. A total of 52 data points were collected for CT brain and CT pulmonary angiography examinations, which were acquired before October 2022. Information on CTDI and DLP was collected, and the effective dose was calculated using the conversion factor. The values were then compared with the ICRP reference level. Descriptive statistics, mean, and standard deviation for continuous variables, and frequency and percentage for categorical variables were used.
Results: There was a significantly lower value of CTDI, DLP, and effective dose for CT brain angiography and CT pulmonary angiography compared to the ICRP recommended reference levels. The mean CTDI and DLP for CT brain angiography were 111.56 mGy and 1153.31 mGy•cm, and the mean CTDI and DLP for CT pulmonary angiography were 24.56 mGy and 713.74 mGy•cm, respectively. The mean effective dose for CT brain and CT pulmonary angiography was 2.46 mSv and 9.94 mSv, respectively.
Conclusion: The measured values were within the recommended values of ICRP regulations. It is recommended that CT brain angiography and CT pulmonary angiography examinations are safer for diagnostic purposes. Optimising scanning protocols, utilising low-dose techniques, and implementing dose monitoring and control are important clinical aspects. Compliance with the guidelines helps to enhance patient care and reduce the risk of radiation-related complications.
Brain angiography, Computed tomography dose index, Dose-length-product, Effective dose
Computed Tomography (CT) is an imaging technology that generates cross-sectional images depicting the X-ray attenuation characteristics of anatomical structures (1). CT is currently one of the most significant radiological techniques in the world, and due to its increasing usage in clinical practice, the radiation dosage from CT is rising as a component of the overall radiation dose received by patients and the general public (2). Compared to other radiological treatments, CT has been extremely significant in identifying illnesses, even though it exposes patients to high radiation doses. Despite the well-established advantages of CT, the radiation danger should be far outweighed by these advantages in diagnosing illnesses (3). The literature states that the Weighted CTDI (CTDIw) and DLP are acceptable dose-related quantities for establishing Diagnostic Reference Levels (DRLs) to optimise radiation exposure for patients (4). The Volumetric CTDI and Weighted CTDI quantify the amount of exposure per tissue slice, while the DLP calculates the overall exposure for a sequence of scans (5),(6). The most accurate way to determine a patient’s radiation exposure during any radiographic examination is to use the effective dose, which is correlated with the risk of carcinogenesis and the production of genetic consequences.
CT Angiography (CTA) is a non invasive procedure using an intravenous injection of contrast media to investigate vascular anatomy-related diseases and illnesses (5). CT Brain angiography is a non invasive technique for detecting cerebral aneurysms (7), and the diagnosis of pulmonary embolism increasingly uses Computed Tomographic Pulmonary Angiography (CTPA). The advantage of CTPA is its ability to image the entire thorax, making it an easier and non invasive technique for diagnosing pulmonary embolisms (8).
The IRCP has recommended DRLs as a means of dose optimisation (9). ICRP recommends an effective dose of 3.2 mSv for CT brain angiography and 12.1 mSv for CTPA, respectively (10). The effective dose for radiological procedures varies depending on the patient’s size and the type of procedure (10),(11). Hence, the study aims to calculate the CTDI, DLP, and effective dose and to check whether the measured dose is within the reference level of the ICRP recommendation.
A retrospective descriptive study was conducted in the Department of Radiodiagnosis at Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, from September 2022 to September 2023. The study was approved by the Yenepoya Ethical Committee after approval from the scientific review board (YEC2/1174), and a permission letter was obtained from the head of the department to collect data from the CT console. A total of 52 data points were collected for CT brain angiography and CT pulmonary angiography, with each examination consisting of 26 samples.
Inclusion criteria: CT brain angiography and CT pulmonary angiography studies with individuals aged 18 years and above were included in the study.
Exclusion criteria: Incomplete CT data, such as missing images or information, were excluded from the study.
Data collection and analysis: The cases of CT brain angiography and pulmonary angiography were selected from the CT console, which had been examined by the 128-slice GE Revolution CT (Table/Fig 1). The dose was calculated for each CT brain angiography and CT pulmonary angiography examination (dose report obtained from the screen saver of the CT console, (Table/Fig 2),(Table/Fig 3). Information on volume-averaged CTDI and DLP was collected, and the Effective dose was then calculated from DLP using conversion factors, termed k-coefficients. K-coefficients represent the relationship between the absorbed dose in a specific organ or tissue and the resulting effective dose to the whole body. The measured effective dose of CT brain and pulmonary angiography was compared with the ICRP recommended dose.
1. Brain angiography:
- The mean CTDI and DLP were calculated.
- Effective dose=k value×DLP.
- k value for the brain: 0.0021.
2. Pulmonary angiography:
- The mean CTDI and DLP were calculated.
- Effective dose=k value×DLP.
- k value for the chest: 0.014.
Statistical Analysis
For statistical analysis, the data were analysed in Statistical Package for Social Sciences (SPSS) version 21.0. In descriptive statistics, mean and standard deviation were used for continuous variables, and frequency and percentage were used for categorical variables.
In CT brain angiography, the mean CTDIvol was found to be 111.56±29.65 mGy, with a minimum of 67.39 mGy and a maximum of 206.70 mGy. The mean DLP was 1153.31±216.73 mGy.cm, with a minimum of 746.07 mGy.cm and a maximum of 1423.43 mGy.cm. The mean effective dose was 2.46±0.42 mSv, with a minimum of 1.6 mSv and a maximum of 2.9 mSv (Table/Fig 4).
(Table/Fig 5) shows that in CT pulmonary angiography, the mean CTDIvol was found to be 24.55±4.27 mGy, with a minimum of 16.98 mGy and a maximum of 37.16 mGy. The mean effective dose was 9.94±1.96 mSv, with a minimum of 6.22 mSv and a maximum of 12 mSv.
(Table/Fig 6) shows the comparison between the observed values and the ICRP recommended values of effective dose. The results show a lower value for CT brain angiography (2.46 mSv) and CT pulmonary angiography (9.94 mSv) compared to the ICRP regulations of 3.2 mSv and 12.1 mSv, respectively.
Computed Tomography (CT) is currently one of the most significant radiological techniques globally, and due to its increasing utilisation in clinical practice, the radiation dosage from CT is becoming a larger component of the overall radiation dose received by patients and the general public. Present study revealed that the mean effective dose for CT brain angiography was 2.46 mSv, which was lower than the ICRP reference value of 3.2 mSv. Additionally, a lower mean effective dose of 9.94 mSv for CT pulmonary angiography compared to the ICRP recommendation of 12.1 mSv was observed.
Netwong Y and Krisanachinda A measured the effective dose from CTA of the brain, which ranged from 2.82 to 5.19 mSv, with an average of 3.7 mSv. This average value was twice the result of present study. They revealed that the higher dose was attributed to factors such as effective mAs, kVp, and scan length. They also correlated patient characteristics with the effective dose and found that an increase in effective dose is associated with an increase in patient height and weight (12). The present study demonstrates a lower radiation dose of 2.46 mSv for CT brain angiography examination compared to the reference recommended levels of ICRP, which were performed using a 128-slice CT scanner. A study by Cohnen M et al., found that the average effective dose in brain CT following an acute stroke was 3.6 mSv, using four different protocols, including a standard head CT and intracranial and cervical vessels CTA, with a Somatom Sensation Cardiac 64 machine, which was higher compared to the ICRP recommendation (13). Chen GZ et al., measured the radiation dose and image quality of cerebral CTA at 70 kVp with Sinogram-Affirmed Iterative Reconstruction (SAFIRE) and at 120 kVp prospectively. They compared both groups and concluded that the effective dose was 0.2 mSv at 70 kVp, resulting in an 85% reduction in radiation dose compared to the 120 kVp acquisition (14).
In present study, a lower effective dose was observed in CT pulmonary angiography. A retrospective study similar to present study was conducted by Takahashi EA and Yoon HC over a four-year period, which concluded that the average effective radiation dose provided by pulmonary CTA was 10.7 mSv, with a 6.3% incidence of pulmonary embolism (15). Another study by Noël PB et al., reported a similar range of effective dose of 9.7 mSv for CTPA and also indicated that the use of iterative reconstruction significantly reduces the radiation dose (16).
Sauter A et al., conducted a prospective study on 19 patients (7 males, 9 females) for the detection of pulmonary embolism in ultra-low dose CTPA with the evaluation of an iterative reconstruction algorithm and procedure, including Body Mass Index (BMI) changes in tube current. This study enables the detection of pulmonary embolism in images with ultra-low doses, with a suggested mean effective dose of about 0.9 mSv. In present study, a retrospective method was used to collect data from the CT console of 26 patients who underwent pulmonary angiography, without consideration of gender comparison and BMI (17). Deevband MR et al., conducted a study on BMI-based effective dose determination in a total of 550 adult patients who underwent abdomen-pelvis and chest CT examinations. They found a higher radiation dose with higher values of BMI (18).
The study recommends the use of an iterative reconstruction technique, which in the future can significantly reduce the radiation dose to patients without compromising image quality.
Limitation(s)
The small number of samples included in the current study was one potential limitation. Additionally, in the present study, information regarding age, sex, height, weight, and BMI was not included as it was a retrospective study. Therefore, further studies should be conducted using such parameters to evaluate the changes.
As patients are exposed to substantial radiation doses during CTA examinations, it is important to keep the radiation dose as low as reasonably achievable. The present study concluded that the radiation doses for CT brain angiography and CT pulmonary angiography are lower than the ICRP reference levels, which makes it safer and reduces the radiation risk to patients.
DOI: 10.7860/JCDR/2024/69156.19417
Date of Submission: Dec 18, 2023
Date of Peer Review: Feb 03, 2024
Date of Acceptance: Mar 12, 2024
Date of Publishing: May 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 18, 2023
• Manual Googling: Mar 05, 2024
• iThenticate Software: Mar 09, 2024 (12%)
ETYMOLOGY: Author Origin
EMENDATIONS: 7
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