Health & Medical First Aid & Hospitals & Surgery

LODOX Statscan in Detecting Adult Ingested Foreign Bodies

LODOX Statscan in Detecting Adult Ingested Foreign Bodies

Abstract and Introduction

Abstract


Objective Foreign body ingestion is common and potentially lethal. This study evaluates the use of low-dose Statscans (LODOX) in emergency departments.

Design This comparative cross-sectional study retrospectively assessed 28 289 digital chest x-rays and 2301 LODOX scans performed between 2006 and 2010 at a tertiary emergency centre. The radiographic appearance, image quality and location of ingested foreign bodies were evaluated in standard digital chest and LODOX radiography. The mean irradiation (μSv) and cumulative mean radiation dose per patient with the ingested foreign body were calculated according to literature-based data, together with the sensitivity and specificity for each modality.

Results A total of 62 foreign bodies were detected in 39 patients, of whom 19 were investigated with LODOX and 20 with conventional digital chest radiography. Thirty-three foreign bodies were located in the two upper abdominal quadrants, 21 in the lower quadrants—which are not visible on conventional digital chest radiography—seven in the oesophagus and one in the bronchial system. The sensitivity and specificity of digital chest radiography were 44.4% and 94.1%, respectively, and for the LODOX Statscan 90% and 100%, respectively. The calculated mean radiation dose for LODOX investigations was 184 μS, compared with 524 μS for digital chest radiography.

Conclusions LODOX Statscan is superior to digital chest radiography in the diagnostic work-up of ingested foreign bodies because it makes it possible to enlarge the field of view to the entire body, has higher sensitivity and specificity, and reduces the radiation dose by 65%.

Introduction


Patients are frequently admitted to emergency departments after foreign body ingestion. In over 90% of the cases, foreign bodies are spontaneously eliminated from the body without the need for intervention. However, foreign bodies can also lead to lethal complications. It is estimated that over 1500 people die secondarily to foreign body ingestion in the USA alone every year. Accurate diagnosis and treatment are, therefore, crucial to avoiding severe complications in the airway, oesophagus or gastrointestinal organs, such as perforation, obstruction and infection.

Most of the foreign body ingestions are found in children. In adults, ingestions predominantly occur in patients with psychiatric disorders or mental handicap, alcoholics, prisoners or body packers (narcotic packet ingestion). Plain x-ray films are frequently used in emergency departments for the detection and assessment of ingested foreign bodies, and for planning the appropriate therapy. Viewing x-rays in two planes can be helpful for the exact localisation of the foreign body. In addition, indirect signs for complications, such as the presence of free air in the mediastinum or peritoneum, can be visualised. If the foreign body or a local complication can be visualised, x-ray imaging is undoubtedly very helpful. On the other hand, foreign bodies like fish or chicken bones, wood, plastic and glass, are difficult to detect on routine x-rays. In the absence of direct or indirect signs of a foreign body, the responsible doctors may be prompted to repeat the x-ray acquisition or to extend the investigation to the neck, abdomen and pelvis. The cumulative radiation dose in these cases with multiple x-ray investigations is very high and should best be avoided, because direct endoscopy will most likely be performed anyway, as this remains the gold standard in cases with negative radiographic evaluation and persistent symptoms. Additionally, patients have become aware of the negative effects of radiation exposure, as this has been repeatedly covered in the daily press.

To reduce radiation exposure, conventional x-ray investigations should be reduced or replaced by techniques that deliver lower doses, particularly if multiple investigations are required. In our emergency department, a linear slot-scanning system (LODOX Statscan, figure 1) has been installed for full-body radiography of polytrauma patients. This technology was originally developed for mining applications and uses low radiation doses for full-body imaging. In theory, this system should offer substantial advantages for the assessment of ingested foreign bodies in comparison with conventional x-ray investigations, because the whole body can be visualised with lower radiation doses. However, there is no literature on this topic, and the accuracy, image quality and radiation dose reduction relative to conventional x-ray investigations are unknown.



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Figure 1.



Emergency room with LODOX Statscan. For a full-body screening, the patient lies on the LODOX table while the C-arm moves along the patient's length axis for scanning.





The present comparative cross-sectional study aims at filling this gap by retrospectively evaluating the clinical use of a full-body scanner (LODOX Statscan) in adult patients with ingested foreign bodies, and by comparing image quality, sensitivity, specificity, ease-of-use and dose exposure with conventional x-ray investigations.



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