Multidetector-row CT: high performance but still many questions

European Journal of Radiology 45 (2003) S1 www.elsevier.com/locate/ejrad

Editorial

Multidetector-row CT: high performance but still many questions

The report of my death was an exaggeration

Mark Twain The advent of multidetector-row CT (MDCT) in 1998 was a major technological breakthrough as it generated new clinical applications as well as new work management and a new concept of equipment update. Although MR Imaging seemed to have more potential for some years, the steady evolution of CT-scan in the last decade has given it a new life of its own. The overall improved image quality has led to greater diagnostic accuracy; however, many questions remain to be answered. One of the major issues deals with the radiation dose to the patient. Established guidelines for radiation limitation (Council directive 97/43/Euratom) recommend the use of non-ionizing techniques whenever possible, so what could justify the use of MDCT as a diagnostic tool in 2002? What are the technical advances to reduce radiation dose? Are ‘as low as reasonably achievable’ (ALARA) protocols available in all diagnostic applications and for all types of equipment? Another important question regarding MDCT concerns its integration in today’s complex radiological apparatus. How can we best organize the equipment update and what is the most productive way when faced

with various and somewhat competing techniques such as Ultra-sound, MDCT, MRI, angiography, and PETscan? What type of equipment (number and type of workstations, PACS. . .) is best suited for optimal performance of MDCT? Will workflow improvements be sufficient to face the ever increasing demand resulting from new applications? How will we cope with data explosion? Finally, is this technique cost-effective? On a more practical level, what are the most efficient protocols for various suspected pathologies, including contrast media injection modalities? What minimal dose of iodinated contrast media is necessary without compromising the diagnostic outcome? Lastly, some clinical aspects should be considered. Will the overall improved image quality lead to an early and more accurate diagnosis with therapeutic consequences and significant prognostic impact? Is MDCT a pertinent screening device? What conditions are required for this technique to compete with lower limb angiography or coronary angiography? Will perfusion CT be a useful tool in therapeutic planning for acute stroke patients? The following articles relating future trends in MDCT applications, published in this supplement of the European Journal of Radiology, were compiled following the Bracco-Byk symposium which took place in Paris, in June 2002. Its primary purpose was to answer some of the above questions. The high level of professionalism of this informative meeting and the high quality of the speakers made it very successful. We are looking forward to new and exciting, practical symposia in the future that will highlight the steady development of imaging techniques and, in particular of MDCT. Pr Alain Blum Service d’Imagerie Guilloz, Teaching Hospital, Nancy Hospital Central, 29 Ave. Marechal de Lattre, de Tassigny, CHU Nancy 543035, France

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