Preferred characterization of orbital infection (cellulitis) with exposure dose and relative medication
Keywords:Cellulitis, CT-Exposure, Orbital, Spectrometry
Background: A retrospective study presenting the endemic orbital infection (cellulitis) that breakout during dusty storm season; aiming to ascertain and showing the precedence of MRI for diagnosis of orbital infection rather than CT and revealing the diagnostic abilities of cross-sectional matrices spectrum.
Methods: Based on retrospective collection of diagnostics (CT and MRI) information for randomly selected patients with cellulitis and the targeting the relevant data (image interpretation, exposure dose (DLP and CTDIvol), age, BMI and matrix cross-section spectrum findings).
Results: The exposure dose of orbital CT exam was 59.4 (mGy) as CT dose index (CTDIvol) and 917.3 (mGy/cm) as dose length product (DLP) that increase by increment of age and BMI. The obese patients only exposed to dose exceeding the National Diagnostic Reference by 2.8%. MRI confirmed the inflammation around the optic nerve and extension to posterio-inferior portion of the globe and affecting the optic nerve with left sided proptosis (0.5cm) better than CT. The cross-sectional matrix successfully revealed that: the Lt optic nerve’s gray value (density) increases by a factor of 17.7 (a u) and enlarged by 5 pixels greater than the Rt optic nerve. Thickening, rough surface increased gray value by 30.5 (a u), muco-thickening and choncheal enlargement at the medial boarder of Lt orbit as 10.0 pixel and Lt eye ball enlarged by a factor of 10.9 pixels.Conclusions: MRI wisely diagnose orbital infection with more details and overcoming patient radiation exposure and usage of image spectrum gives detailed characterization of lesion morphology.
Murphy C, Livingstone I, Foot B, Murgatroyd H, MacEwen CJ. Orbital cellulitis in Scotland: current incidence, aetiology, management and outcomes. Br J. Ophthalmol. 2014;98(11):1575-8.
Negus VE. Orbital cellulitis due to sinus infection, and its treatment: (section of laryngology and section of otology), Proc R Soc Med. 1937;30(11):1397-407.
Bedwell J, Bauman NM. Management of pediatric orbital cellulitis and abscess. Curr Opin Otolaryngol. Head Neck Surg. 2011;19(6):467-73.
Kayhan FT, Sayin I, Yazici ZM, Erdur O. Management of orbital subperiosteal abscess. J Craniofac Surg. 2010;21(4):1114-7.
Yen MT, Johnson TE, editors. Orbital Cellulitis and Periorbital Infections. Springer; 2017 Oct 6.
Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80(9):1414-28.
Ikeda K, Oshima T, Suzuki H, Kikuchi T, Suzuki M, Kobayashi T. Surgical treatment of subperiosteal abscess of the orbit: Sendai’s ten-year experience. Auris Nasus Larynx. 2003;30(3):259-62.
Harris GJ. Age as a factor in the bacteriology and response to treatment of subperiosteal abscess of the orbit. Trans Am Ophthalmol Soc. 1993;91:441-516.
Thakar A, Tandon DA, Thakar MD, Nivsarkar S. Orbital cellulitis revisited. Indian J. Otolaryngol Head Neck Surg. 2000;52(3):235-42.
Siegel JA, Welsh JS. Does imaging technology cause cancer? Debunking the linear no-threshold model of radiation carcinogenesis. Technol Cancer Res Treat. 2016;15:249-56.
Cohen MD. CT radiation dose reduction: can we do harm by doing good? Pediatr Radiol. 2012;42:397-8.
Pandharipande PV, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, et al. CT in the emergency department: a real-time study of changes in physician decision making. Radiol. 2015 Sep 24;278(3):812-21.
Boos J, Lanzman RS, Meineke A, Heusch P, Sawicki LM, Antoch G, Kröpil P. Dose monitoring using the DICOM structured report: assessment of the relationship between cumulative radiation exposure and BMI in abdominal CT. Clin Radiol. 2015;70(2):176-82.
Australian Radiation Protection and Nuclear Safety Agency. Code of practice “Radiation Protection in the Medical Applications of Ionizing Radiation” Radiation Protection Series Publication. 2008;14.
Zarb F, Rainford L, McEntee MF. AP diameter shows the strongest correlation with CTDI and DLP in abdominal and chest CT. Radiation protection dosimetry. 2010 Mar 23;140(3):266-73.
Siegel JA, McCollough CH, Orton CG. Advocating for use of the ALARA principle in the context of medical imaging fails to recognize that the risk is hypothetical and so serves to reinforce patients' fears of radiation. Medical physics. 2017 Jan 1;44(1):3-6.
Pushker N, Tejwani LK, Bajaj MS, Khurana S, Velpandian T, Chandra M. Role of oral corticosteroids in orbital cellulitis. Am J Ophthalmol. 2013;156(1):178-83.