Road to RSNA 2014: CT Preview

By Eric Barnes, staff writer
November 4, 2014

The 100th meeting of RSNA just happens to be spiral CT's 25th anniversary, and in 2014 both are in fine shape. CT's star wasn't always rising, of course. Twenty-five years ago, the modality was all but left for dead as MRI was rising to prominence.

It was the invention and application of spiral CT, first presented in clinical studies at the 1989 RSNA meeting, that turned things around and put CT on track for today's extraordinary achievements, according to medical physicist and CT pioneer Willi Kalender, PhD.

Today, innovation remains at the heart of every advance in CT imaging, and at RSNA 2014 it shows up at every step in the imaging process, from acquisition to reconstruction to analysis.

There are discussions of conebeam CT, high-efficiency direct conversion detectors, and new, more efficient detector materials. This year you'll find presentations on spectral and multienergy imaging, which continue to break ground in new applications, making tumors, soft tissue, blood, and bone more conspicuous.

Cardiac imaging is progressing in its quest to stop motion in the fast-beating heart via new scanners and acquisition methods. New techniques compete to best assess the hemodynamic significance of coronary artery stenosis, opening a window on a blind spot in coronary CT angiography.

Assessment of the myocardium, ventricles, and aorta keeps improving, and radiation doses keep dropping amid improving image quality, thanks to a new generation of iterative reconstruction tools. Plaque analysis is no longer limited to the measurement of calcium, as the prognostic value of noncalcified plaque is tested and incorporated into individual risk profiles. Researchers are fusing CT images with electroanatomic mapping to tackle complex ventricular fibrillation ablation procedures.

In the brain, perfusion and CT angiography are melding into a single, dose-efficient exam to look at cerebral vasculature and blood flow. In the lungs, screening for cancer is being tried in new populations, and new techniques are honing in on treatment response measurement, key to patient management and better outcomes. The same advanced techniques are revealing new information about the gastrointestinal tract.

Even beyond the realm of medicine, CT is taking center stage in revealing the secrets of antiquities from Peruvian mummies to Judaic tabernacles. We invite you to scroll through the links below to create your own CT adventure at this year's RSNA meeting.

For detailed listings of scientific abstracts and other presentations straight from RSNA, click here.

Scientific and Educational Presentations
Physics session on innovation in CT
Sunday, November 30 | 10:45 a.m.-12:15 p.m. | SSA19 | Room S403B
New CT techniques and instrumentation are the focus of a Sunday scientific session that kicks off with a 20-minute physics keynote talk by CT pioneer Willi Kalender, PhD, and continues with presentations of other new technological innovations in CT.
Can the lumen area of stenosis predict coronary lesion significance?
Sunday, November 30 | 10:45 a.m.-10:55 a.m. | SSA03-01 | Room S504AB
This study looked at the value of mean lumen area quantification by CT angiography to predict the hemodynamic significance of coronary stenosis at invasive angiography severe enough to require revascularization.
Do positive NLST results persist in a poor, nonwhite, overweight urban population?
Sunday, November 30 | 10:45 a.m.-10:55 a.m. | SSA04-01 | Room S404CD
A new study looked at lung cancer screening in a population that bears little resemblance to the relatively affluent cohort in the National Lung Screening Trial (NLST), which produced a minimum 20% mortality reduction from screening. Does the successful NLST model still hold true?
Is epicardial fat linked to atrial fibrillation?
Sunday, November 30 | 10:55 a.m.-11:05 a.m. | SSA03-02 | Room S504AB
Quantifying epicardial fat on preprocedural CT scans may help identify patients with atrial fibrillation (AF) who will benefit from catheter ablation as a treatment for AF, according to a study to be presented on Sunday.
Single- vs. dual-energy abdominal CT: Which has the lowest dose?
Sunday, November 30 | 11:45 a.m.-11:55 a.m. | SSA06-07 | Room E353A
Triple-phase liver exams are a good way to evaluate CT dose. But which generates the lowest doses: single- or dual-source scanning? This study compared dose levels in 45 patients who had undergone the exam on different occasions with different scanners.
3D CT fused with electroanatomic mapping for VT ablation
Sunday, November 30 | 11:55 a.m.-12:05 p.m. | SSA02-08 | Room S502AB
A new technique that fuses cardiac CT and electroanatomic mapping could boost the success rate for ventricular tachycardia (VT) mapping and ablation procedures, a more complex process than ablation for atrial fibrillation and related conditions.
Advanced imaging unveils secrets of ancient artifacts
Sunday, November 30 | 2:00 p.m.-3:30 p.m. | RC124 | Room N226
A review course taught by Dr. Barry Daly from the University of Maryland will cover a wide range of artifacts, including Egyptian and Peruvian mummies, Mesoamerican and Chinese ceramics, Mesopotamian stucco art, Judaic tabernacles, and European medieval religious artifacts.
Effective assessment of lung cancer treatment response
Monday, December 1 | 8:30 a.m.-10:00 a.m. | RC218 | Room N226
A multispeaker course on treatment response for several kinds of cancer begins at 8:30 a.m. with a talk by Dr. Elena Korngold on a practical perspective of reporting treatment response. Arrive by 9:30 a.m. for the last talk in the series by Dr. Jeremy Erasmus from MD Anderson Cancer Center, who will focus on lung cancer.
Organ-dose software results are highly variable
Monday, December 1 | 10:30 a.m.-10:40 a.m. | SSC12-01 | Room S403B
Concerns over radiation dose in CT have led to the development of dose tracking software that estimates organ doses, replacing tedious manual processes. How well do they work? Dr. Atul Padole and colleagues evaluated two software packages.
Monoenergetic reconstruction tool boosts pancreatic tumor conspicuity
Monday, December 1 | 10:30 a.m.-10:40 a.m. | SSC04-01 | Room E353A
In pancreatic cancer imaging, conventional methods produce only very faint enhancement differences. Researchers from Germany are finding pancreatic lesions much easier to see using a monoenergetic reconstruction algorithm plus dual-source CT.
Increasing difference in x-ray spectra boosts image quality
Monday, December 1 | 10:50 a.m.-11:00 a.m. | SSC12-03 | Room S403B
This study from the Mayo Clinic in Rochester, MN, showed that increasing the difference in the x-ray spectra in dual-energy CT increases image quality, and that this improvement can be translated into reductions in dose.
Calcium boosts heart attack risk. How about noncalcified plaque?
Monday, December 1 | 11:10 a.m.-11:20 a.m. | SSC02-05 | Room S504AB
The role of coronary artery calcium in myocardial infarction risk is well-established, but the role of noncalcified plaque is still evolving. In this study, researchers aimed to determine how total plaque burden corresponds to traditional risk factors for cardiovascular disease.
Motion correction green-lights CCTA in faster hearts
Monday, December 1 | 11:50 a.m.-12:00 p.m. | SSC02-09 | Room S504AB
Stopping motion in the fast-beating heart is, of course, one of the toughest challenges in radiology, but new methods such as high-pitch CT and motion correction techniques are fueling new levels of image quality, even in patients with the highest heart rates.
How often do pancreatic cysts become ductal adenocarcinomas?
Monday, December 1 | 11:50 a.m.-12:00 p.m. | SSC04-09 | Room E353A
This study evaluated the relationship between pancreatic cysts and pancreatic ductal adenocarcinoma (PDAC), comparing imaging features of the cysts in subjects who subsequently developed PDAC versus those who did not.
Imaging vulnerable populations -- the geriatric patient
Tuesday, December 2 | 8:30 a.m.-10:00 a.m. | RC308 | Room S502AB
A special course on imaging vulnerable populations will begin at 8:30 a.m. and feature studies on several vulnerable patient groups for which CT plays an important role. Arrive by 9:30 a.m. to hear our highlighted presentation on geriatric patients, presented by Dr. Claudia Sadro.
Calcium volume, distribution predict rupture risk for TAVR patients
Tuesday, December 2 | 10:30 a.m.-10:40 a.m. | SSG02-01 | Room S504AB
Balloon-expandable transcatheter aortic valve replacement (TAVR) procedures can lead to dangerous aortic root injury in the event of annular rupture. How do such ruptures happen and in which patients? Canadian researchers looked at the role of calcified plaque's location and distribution in these events.
Study compares 2nd, 3rd generations of iterative reconstruction
Tuesday, December 2 | 10:50 a.m.-11:00 a.m. | SSG04-03 | Room E350
Liver lesions are always a challenge to visualize with CT, and iterative reconstruction improves conspicuity in the liver and other regions. How does the latest algorithm stack up against an earlier iteration?
Refresher course examines imaging for traumatic brain injury
Tuesday, December 2 | 4:30 p.m.-6:00 p.m. | RC405 | Room E451A
A Tuesday refresher course on traumatic brain injury will present three speakers beginning at 4:30 p.m. First, Dr. Paul Parizel, PhD, will discuss the use of CT and MR for patients with head trauma.
CT colonography keynote: Present and future
Wednesday, December 3 | 10:30 a.m.-10:50 a.m. | SSK08-01 | Room E351
CT colonography (CTC) expert Dr. Abraham Dachman will start off this year's CTC scientific sessions with a talk on the present and future of the technique.
Is iterative reconstruction a fix for motion-altered calcium scores?
Wednesday, December 3 | 11:50 a.m.-12:00 p.m. | SSK03-09 | Room S502AB
Dr. Martin Willemink and colleagues from University Medical Center Utrecht in the Netherlands addressed this question with iterative model reconstruction, a calcium hydroxyapatite-containing phantom, and a 256-slice CT scanner.
Study finds ultralow-dose CTC equivalent to normal-dose scans
Wednesday, December 3 | 11:50 a.m.-12:00 p.m. | SSK08-09 | Room E351
The need for dose reduction is real in CT colonography (CTC), an exam that could be repeated several times between ages 50 and 80 years, when colorectal cancer screening is recommended. Fortunately, the University of Rome La Sapienza is on the case, working to reduce the dose for CTC to sub-mSv levels consistently.
Does 4D CTA outperform DSA for arteriovenous malformations?
Wednesday, December 3 | 3:00 p.m.-3:10 p.m.| SSM25-01 | Room E450B
Digital subtraction angiography (DSA) is the gold standard for evaluating arteriovenous malformations, but 4D CT angiography (CTA) outperforms it by visualizing the nidus.
Knee perfusion is key in limb salvage after trauma
Wednesday, December 3 | 3:50 p.m.-4:00 p.m. | SSM25-06 | Room E450B
Trauma patients are typically assessed for salvageability of lower limbs based on a clinical exam and perfusion assessment of the distal arteries. But a group from Texas found that flow in the geniculate artery on CT angiography studies is crucial in determining whether such patients will eventually need an amputation.
CTA dose and image quality: 3rd- vs. 2nd-generation DSCT
Thursday, December 4 | 9:35 a.m.-9:45 a.m. | VSVA51-06 | Room E352
How much can dose be reduced in CT angiography (CTA) while preserving image quality in the latest dual-source CT (DSCT) scanners? Dr. Florian Schwarz and colleagues from the University of Munich looked at the image quality and radiation dose-saving potential of advanced dual-source CT.
CT aims for takeover of scintigraphy in GI bleeding
Thursday, December 4 | 11:00 a.m.-11:10 a.m. | SSQ07-04 | Room E353A
Acute lower gastrointestinal bleeding (GI) is a medical and surgical emergency that can lead to significant morbidity and mortality. But how should physicians detect where it comes from? CT does it best, researchers from Pakistan will report in this presentation.
Chest size swings calcium scores on CT scans
Friday, December 5 | 10:50 a.m.-11:00 a.m. | SST03-03 | Room S504AB
Does chest size, since it is related to obesity, affect calcium scores? Dutch researchers aimed to find out, having previously found an association between obesity and coronary calcium scores, and shown that CT image quality deteriorates with increased body weight.
Low-dose, 1-step stroke protocol combines CTA and CTP
Friday, December 5 | 11:30 a.m.-11:40 a.m. | SST09-07 | Room N226
Researchers in the Netherlands are honing a new one-step stroke imaging protocol that promises to save dose and time, acquiring CT angiography (CTA) of the neck with head CT perfusion (CTP) during a single acquisition.
CT ownership growth among otolaryngologists and neurologists: Major trend?
Friday, December 5 | 11:00 a.m.-11:10 a.m. | SST10-04 | Room N227
Ear, nose, and throat (ENT) physicians and neurologists are among the physician groups increasingly putting CT scanners in their offices -- bypassing radiologists for in-office exams. How common is the trend?
Cerebral angiographic data reconstructed from time-resolved CTP
Friday, December 5 | 11:50 a.m.-12:00 p.m. | SST14-09 | Room S403B
Wavelet analysis is a powerful method of displaying angiographic data from CT perfusion (CTP) and for separating arterial and venous flow patterns. Can it be used to visualize the vascular tree from CTP data in stroke patients, eliminating the need for a separate angiography exam routinely performed for that purpose?