title: Body packers on your examination table: How helpful are plain x-ray images? A definitive low-dose CT protocol as a diagnosis tool for body packers.
abstract: OBJECTIVE
  To analyze the clinical value and radiation dose of plain x-rays and CT in examining patients suspected of ingesting drug-filled packets.
  
  
  METHODS
  Thirty-eight patients with suspected internal concealment of drug-filled packets who were examined with plain x-rays or CT or both were included in the study. CT studies were performed using low-dose and standard-dose techniques. All radiographic images were analysed by two radiologists regarding identification of the packets and estimating the effective radiation dose from standard- and low-dose CT versus conventional x-ray examinations. Descriptive calculations were made regarding the number and density of packs and radiation dosage. The diagnostic performance of both radiologists with standard- and low-dose CT was calculated by analysing differences in the mean number of packs found.
  
  
  RESULTS
  Thirty-one patients were positively identified as body packers with an average of 13 packs (min: n = 1, max: n = 58, total: n = 390); seven patients were not concealing drug packets. X-ray images were taken of 24 patients prior to CT, thus allowing a direct comparison between the two methods. The correct diagnosis was made in 42%, in 33% the radiologists were uncertain, and in 25% of drug packets were either not or wrongly identified. X-ray imaging had a positive predictive value of 20% with a negative predictive value of 81%. A total of 55 CT examinations were performed on all patients with a mean effective dose of 2 mSv (low dose) versus 9.3 mSv (standard dose). The visibility of packets on low-dose CT images compared to high-dose CT was not reduced: the radiologists identified 385 and 381 of the packets, respectively, with no difference regarding the examination technique (p = 0.24 and p = 0.253, respectively). The radiodensity of all drug-filled packets at CT ranged from 26-292 HU (mean 181.2 HU).
  
  
  CONCLUSIONS
  X-ray imaging of supposed body packers leads to a significant risk of diagnostic errors and additional need for CT. Instead, a single abdominal low-dose CT examination will deliver the correct diagnoses in most cases, leading to safe clinical management of the suspects.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schulz
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Grossbach
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Gruber-Rouh
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Zangos
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
authors.forename: Th J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany. Electronic address: k.eichler@em.uni-frankfurt.de.
authors.forename: K
authors.initials: K
authors.lastname: Eichler
mesh_terms: D000328:Adult; D064423:Drug Trafficking; D004632:Emergency Medical Services / Q000379:methods; D004636:Emergency Service, Hospital; D058637:Examination Tables; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D005554:Forensic Medicine / Q000379:methods; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011829:Radiation Dosage; D011860:Radiography, Abdominal / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013270:Stomach / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D013287:Illicit Drugs