Computed tomography is one of the most evolving fields of modern radiology. The current CT applications permit among other things angiography, 3D image reconstructions, material decomposition and tissue characterization. CT is an important tool in the assessment of specific patient populations prior to an invasive or surgical procedure. The aim of this dissertation was to demonstrate the decisive role of CT with 3D-image reconstructions in haemodialysis patients scheduled to undergo fistulography, in patients undergoing surgical breast reconstructions with a perforator flap and in patients with complicated renal calculi scheduled to undergo percutaneous nephrolithotomy. CT Angiography with 3D image reconstructions was performed in 31 patients with failing arteriovenous fistulas and grafts, illustrating the vascular anatomy in a comprehensive manner in 93.5% of the evaluated segments and demonstrating a sensitivity of 95% compared to fistulography. In 59 mastectomy patients scheduled to undergo reconstructive breast surgery with a deep inferior epigastric perforator flap, the preoperative planning with CT Angiography with 3D image reconstructions of the anterior abdominal wall providing details of its vascular supply, reduced surgery time significantly (p< 0.001) and resulted in fewer complications. Dual Energy CT Urography with advanced image reconstructions in 31 patients with complicated renal calculi scheduled to undergo PNL, resulted in a new method of material characterisation (depicting renal calculi within excreted contrast) and in the possibility of reducing radiation dose by 28% by omitting the nonenhanced scanning phase. Detailed analysis of the changes renal calculi undergo when virtually reconstructed was performed and a comparison of renal calculi number, volume, height and attenuation between virtual nonenhanced and true nonenhanced images was undertaken. All parameters were significantly underestimated in the virtual nonenhanced images. CT with 3D-reconstructions is more than just “flashy images”. It is crucial in preoperative planning, optimizes various procedures and can reduce radiation dose.

Le cancer du sein est le diagnostic de cancer le plus fréquent chez la femme, et la chirurgie de reconstruction mammaire post-mastectomie est une procédure couramment pratiquée pour améliorer la satisfaction personnelle et la qualité de vie des patientes atteintes de cancer du sein [1-3]. Le lambeau abdominal de DIEP (Deep Inferior Epigastric Artery Perforator) est considéré comme la référence en reconstruction mammaire autologue, mais le long séjour hospitalier, les coûts élevés et les complications postopératoires associées à cette chirurgie représentent des défis pour les patientes [4, 5]. La mise en place d'un programme de récupération rapide, tel que ERAS (Enhanced Recovery After Surgery), qui utilise une approche globale multidisciplinaire des soins péri-opératoires, s'est avérée être une stratégie efficace pour réduire les complications chirurgicales et est largement acceptée dans diverses disciplines chirurgicales [6-8]. Dans cette étude menée au Centre hospitalier de l’Université de Montréal, nous avons évalué l'efficacité du protocole ERAS pour la reconstruction par lambeau de DIEP. Nous avons comparé une cohorte après la mise en œuvre d'ERAS à un groupe témoin utilisant un protocole standard (pré-ERAS) de manière rétrospective pour déterminer l'impact du protocole ERAS sur la durée de séjour à l'hôpital, l'utilisation d'opioïdes chez les patients hospitalisés et les complications postopératoires. Les résultats ont montré que les patients suivant le protocole ERAS ont eu des séjours hospitaliers plus courts (2,8 vs 4,5 jours ; p<0,001) et une utilisation totale d'opioïdes plus faible (50,6 mg vs 136,3 mg ; p<0,001), ainsi que moins de complications postopératoires. L'implémentation du protocole ERAS pour la reconstruction mammaire par lambeau DIEP peut significativement réduire la durée du séjour à l'hôpital, les besoins postopératoires en opioïdes et les complications postopératoires. / Breast cancer is one of the most common cancer diagnoses among women, and post mastectomy breast reconstruction surgery is a commonly performed procedure to improve personal satisfaction and quality of life for breast cancer patients [1][2][3]. The DIEP (Deep Inferior Epigastric Artery Perforator) flap is the gold standard in autologous breast reconstruction, but the lengthy hospital stay, high costs, and postoperative complications associated with this surgery present challenges for patients [4][5]. Implementing a rapid recovery program, such as ERAS (Enhanced Recovery After Surgery), which utilizes a comprehensive, multidisciplinary approach to perioperative care, has been shown to be an effective strategy for reducing surgical complications and is widely accepted in various surgical disciplines [6][7][8]. In this study, we aimed to examine the effectiveness of the ERAS protocol for DIEP flap reconstruction at the Centre hospitalier de l’Université de Montréal. We compared a cohort after the implementation of ERAS with a control group using a standard protocol (pre-ERAS) retrospectively to determine the impact of the ERAS protocol on hospital length of stay, opioid use among hospitalized patients, and postoperative complications. This study included patients with 80% undergoing immediate reconstruction, while the remainder had delayed immediate or delayed reconstruction. Patients in the ERAS group experienced shorter hospital stays (2.8 vs. 4.5 days; p<0.001) and lower total opioid use (50.6 mg vs. 136.3 mg; p<0.001). This reduction was evident in opiates per day of hospitalization (18.2 mg vs. 30.2 mg; p<0.001) and within the first 24 postoperative hours (35.7 mg vs. 67.6 mg; p<0.001). The control group had a higher incidence of postoperative complications. Implementing the ERAS protocol for DIEP flap breast reconstruction can significantly reduce hospital length of stay, postoperative opioid requirements, and postoperative complications without increasing adverse events, particularly for immediate reconstructions with DIEP flaps.