Technical and anatomical factors affecting intra-arterial chemotherapy fluoroscopy time and radiation dose for intraocular retinoblastoma

2019 ◽  
Vol 11 (12) ◽  
pp. 1273-1276 ◽  
Author(s):  
Corey Area ◽  
Christopher J Yen ◽  
Patricia Chevez-Barrios ◽  
Cynthia Herzog ◽  
Peter Kan ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Anatomical Variation ◽  
Interventional Neuroradiology ◽  
Anatomical Variations ◽  
Fluoroscopy Time ◽  
P Value ◽  
Factors Affecting ◽  
Dose Area Product ◽  
Significant Difference ◽  
Intraocular Retinoblastoma

BackgroundIntra-arterial chemotherapy has an increasingly prominent role in the management of retinoblastoma. One concern regarding this technique is procedural radiation exposure.ObjectivesTo examine the effects of our institution’s procedural technique on fluoroscopy parameters for patients undergoing intra-arterial chemotherapy infusions for intraocular retinoblastoma. Secondary goals included describing the effect of anatomical variations of the carotid siphon and ophthalmic artery on radiation dose.MethodsA retrospective review of pediatric patients with retinoblastoma referred to interventional neuroradiology for chemosurgery was performed. Techniques were classified as: A (1.2 Fr or 1.5 Fr microcatheter with continuous verapamil flush, advanced without guide through a 2 Fr sheath) or B (1.5 Fr or 1.7 Fr microcatheter advanced within a 4 Fr base catheter, through a 4 Fr sheath). Statistical analysis was performed to determine if there was a significant difference in fluoroscopy parameters based on technique or due to anatomical variation.Results26 patients were treated with 94 intra-arterial chemotherapy infusions. 34 procedures were performed using technique A and 60 using technique B. Mean fluoroscopy time (4.75 min), fluoroscopy dose (23.3 mGy), and dose–area product (DAP; 85.2 μGy.m2) for technique A were significantly lower (p value <0.05) than for technique B, 14.0 min., 191 mGy, and 586 μGy.cm2, respectively.ConclusionsMicrocatheter-only technique with continuous verapamil infusion resulted in decreased fluoroscopy times, DAP, and radiation doses at our institution for the treatment of intraocular retinoblastoma. Furthermore, our fluoroscopy times using this technique are the lowest reported in the current literature. Additionally, our anatomical analysis has demonstrated a positive correlation between increasing vessel tortuosity and fluoroscopy times.

scholarly journals What factors affect fluoroscopy use during Bernese periacetabular osteotomy for acetabular dysplasia?

2019 ◽  
Vol 6 (3) ◽  
pp. 259-264
Author(s):  
James D Wylie ◽  
Michael P McClincy ◽  
Evan K Stieler ◽  
Michael B Millis ◽  
Young-Jo Kim ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Male Gender ◽  
Fluoroscopy Time ◽  
Linear Modeling ◽  
Factors Affecting ◽  
Dose Area Product ◽  
Area Product ◽  
Open Arthrotomy

Abstract Periacetabular osteotomy (PAO) is the treatment of choice for acetabular dysplasia in the skeletally mature. Little is known about factors affecting fluoroscopy use in PAO. Therefore, we strived to determine patient and surgery factors are associated with the amount of fluoroscopy time and radiation dose during PAO. We performed a retrospective review of 378 patients who underwent PAO between January 2012 and August 2017. The mean age was 21.7 years and 326 (86%) were females. A total of 85 patients underwent concomitant arthroscopy and 60 underwent open arthrotomy. We recorded fluoroscopy time in minutes and radiation dose area product (DAP) in mGy·m2. Multivariate general linear modeling identified independent predictors of fluoroscopy time and radiation dose. Mean fluoroscopy time was 1.21 minutes and mean fluoroscopy DAP was 0.71 mGy·m2. Multivariate predictors of increased fluoroscopy time were male gender (P = 0.001), surgeon (P < 0.001) and whether an arthroscopy was performed (P < 0.001). Multivariate predictors of increased fluoroscopy DAP were increased body mass index (BMI) (P = 0.001), surgeon (P < 0.001) and whether an arthroscopy was performed (P < 0.001). Patients undergoing hip arthroscopy concomitant to PAO are at higher risk of longer fluoroscopy time and higher radiation dose. Other factors affecting fluoroscopy time included male gender and surgeon, while radiation dose was further affected by surgeon and BMI. Our findings can facilitate discussion about the risk of radiation exposure during PAO.

Radiation dose reduction during neurointerventional procedures by modification of default settings on biplane angiography equipment

2015 ◽  
Vol 8 (8) ◽  
pp. 819-823 ◽  
Author(s):  
Elyne N Kahn ◽  
Joseph J Gemmete ◽  
Neeraj Chaudhary ◽  
Byron Gregory Thompson ◽  
Kevin Chen ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Frame Rate ◽  
Fluoroscopy Time ◽  
P Value ◽  
Dose Cohort ◽  
Dose Area Product ◽  
Reduced Dose ◽  
Cine Frame ◽  
Area Product ◽  
Neurointerventional Procedures

BackgroundNeurointerventional procedures represent a significant source of ionizing radiation. We sought to assess the effect during neurointerventional procedures of varying default rates of radiation dose in fluoroscopy (F) and image acquisition (IA) modes, and frame rates during cine acquisition (CINE) on total X-ray dose, acquisition exposures, fluoroscopy time, and complications.MethodsWe retrospectively reviewed procedures performed with two radiation dose and CINE settings: a factory setting dose cohort (30 patients, F 45 nGy/pulse, IA 3.6 μGy/pulse, factory CINE frame rate) and a reduced dose cohort (30 patients, F 32 nGy/pulse, IA 1.2 μGy/pulse, with a decreased CINE frame rate). Total radiation dose, dose area product, number of acquisition exposures, fluoroscopy time, and complications were compared between the groups. Means comparisons (t tests) were employed to evaluate differences in the outcome variables between the two groups. p Value <0.05 was considered significant.ResultsThe reduced dose cohort had a significant reduction in mean radiation dose (factory, 3650 mGy; reduced, 1650 mGy; p=0.005) and dose area product (factory, 34 700 μGy×m2; reduced, 15 000 μGy×m2; p=0.02). There were no significant differences between cohorts in acquisition exposure (p=0.73), fluoroscopy time (p=0.45), or complications.ConclusionsSignificant reductions in radiation dose delivered by neurointerventional procedures can be achieved through simple modifications of default radiation dose in F and IA and frame rate during CINE without an increase in procedural complexity (fluoroscopy time) or rate of complications.

scholarly journals Inappropriate maternal perception of child’s weight status: a potential threat to nutrition

2019 ◽  
Vol 6 (5) ◽  
pp. 2091
Author(s):  
Parima Dalal ◽  
Rekha Thaddanee ◽  
Arun Parikh ◽  
Hasmukh Chauhan ◽  
Shamim Morbiwala
Keyword(s):  
Weight Status ◽  
Tertiary Care ◽  
P Value ◽  
Potential Threat ◽  
Factors Affecting ◽  
Actual Weight ◽  
Maternal Perception ◽  
Significant Difference ◽  
Correct Weight ◽  
Child’S Weight

Background: This study was done to know the maternal perception of weight of their children and correlate it with exact weights. We also studied various factors affecting ability of a mother to perceive her child’s weight status.Method: This prospective study was done in Pediatric Department of a tertiary care teaching hospital of Western Gujarat, India, from January 2018 to September 2018. 897 mothers of children < 5 years of age were included. Socio-demographic and anthropometric details of child and mother were recorded. Maternal perception of their child’s weight status was enquired. A correlation between perceived and actual child weight status was estimated.Results: 897 patients <5 years of age had mean (SD) age of 28.66 (±17.04) months, weight 10.17 (±3.5) kg, height 0.81 (±0.15) meters and BMI 15.74 (±15.26) kg/m2. 34.7% of mothers perceived underweight erroneously as compared to actual weight status being normal (p value=0.00001). Misperception (under or over) of the mothers for their children weight status was significant for girls (p=0.011). Significant difference between perceived and actual weight status was seen in birth orders 1 to 4. 34. 6% actual UW children were perceived as NW by < 40 years age mothers (p=0.0018). 78.2% uneducated and 81% of primary or secondary educated mothers from lower SES felt their children were of NW status whereas actually 43.4% and 50.3% children were of NW status respectively (p=0.00001). Surprisingly, 91.3% of graduate or postgraduate mothers of middle SES perceived their children as NW status while actually only 39.1% were of NW and 52.1% of UW (p=0.00001).Conclusion: Half of the mothers were not able to perceive correct weight status of their children. Misperception was significant for girls. Significant difference between perceived and actual weight status was seen for birth orders 1 to 4. Mothers <40 years of age significantly failed to perceive actual UW status of the children. Both educated and uneducated mothers misclassified their children’s weight status significantly.

Clinical Examination of the Extensor Pollicis Brevis: Anatomical Study and Description of a Novel Clinical Sign

2018 ◽  
Vol 23 (03) ◽  
pp. 330-335 ◽  
Author(s):  
Michael Lonne ◽  
David S. Sparks ◽  
Carl Stephan ◽  
Michael Wagels ◽  
Anthony Berger
Keyword(s):  
Clinical Examination ◽  
Anatomical Variation ◽  
Proximal Phalanx ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Clinical Test ◽  
Main Function ◽  
Extensor Pollicis Longus ◽  
Extensor Pollicis Brevis ◽  
Significant Difference

Background: The Extensor Pollicis Brevis (EPB) is an extrinsic thumb muscle whose main function is extension of the first metacarpophalangeal joint (MCPJ). It is subject to significant anatomical variation and may be absent, vestigial or have an anomalous distal attachment. Clinical examination of EPB is notoriously difficult and no reliable test has yet been described. We propose a novel test for the accurate examination of EPB. We sought to clarify the anatomical variations of EPB and to validate our clinical test using human cadaveric anatomical tests. Methods: A structured literature review of all human cadaveric anatomical studies describing the attachments of EPB was performed using MEDLINE and Embase with the key words “Extensor Pollicis Brevis”. A cadaveric anatomical study was performed using 18 unembalmed upper limbs. Positive and negative tests were simulated by manipulating the tendons of EPB, Extensor Pollicis Longus (EPL) and Flexor Pollicis Longus (FPL). Changes in tendon tension and joint position were measured and recorded. The EPB anatomy was then determined by dissection. Results: Anatomical variations were present in the majority of wrists, with only 35% of EPB tendons having a distal attachment to the proximal phalanx alone. EPB was absent in 5% of specimens. There was a significant difference between the change in MCPJ position between a positive (36 degrees; 95% CI 25 to 47 degrees) and negative (19 degrees; 95% CI 14 to 25 degrees) clinical test (p = 0.002). Conclusions: The functional importance of EPB depends on its congenital architecture in addition to the functional demands of the patient. We report a novel clinical test which is effective in demonstrating the integrity of the EPB. A positive test result is observed when a change in MCPJ position that occurs while the interphalangeal joint is brought into flexion from full thumb extension is 25 degrees or more.

scholarly journals Pull-Type Radiologically Inserted Gastrostomy: An Improvised Technique Using a Frugal Innovation

2019 ◽  
Vol 03 (01) ◽  
pp. 007-011
Author(s):  
Anurag Chahal ◽  
Sundeep Malla ◽  
Chinmaya Dash ◽  
Deepak Gupta ◽  
Shivanand Gamanagatti
Keyword(s):  
Radiation Dose ◽  
Safety Profile ◽  
Conventional Technique ◽  
New Technique ◽  
Fluoroscopy Time ◽  
P Value ◽  
Complication Rates ◽  
Nasogastric Feeding ◽  
Group A ◽  
Group B

Abstract Purpose To describe a new technique for “pull type” radiologically inserted gastrostomy (RIG) and prospectively compare it with conventional (described) technique in terms of technical ease (fluoroscopy time, radiation dose) and safety profile. Materials and Methods Adult patients with head injury with Glasgow coma scale (GCS) (M score) < 5, one week after decompression or those requiring nutritional support for > 4 weeks, or patients with recurrent aspiration pneumonitis on nasogastric feeding were included. Hemodynamically unstable patients or those with uncorrectable coagulopathy were excluded. Patients underwent pull-type RIG with alternate patient getting allocated to groups A (conventional technique) and B (new technique). The authors compared the technical success, complication rate, fluoroscopy time, radiation dose, and cost of hardware in these two groups. Results The average fluoroscopy time for group A (9 patients) was 498.7 ± 145.3 seconds, whereas for group B (16 patients), it was 302.8 ± 54.1 seconds with p-value = 0.06. The mean radiation dose of group A was 74.7 ± 15.7 mGy, whereas for group B, it was 56.7 ± 14.1 mGy (p-value = 0.004). The minor complication rates were 11.1% in both the groups. Conclusion The authors’ innovative technique using a customized snare has the potential to increase the technical ease of pull-type RIG with reduced fluoroscopy time, radiation dose, and cost with a similar safety profile.

scholarly journals Factors Affecting Patient Perceptions and Satisfaction with Telemedicine in Outpatient Clinics

2021 ◽  
Vol 8 ◽  
pp. 237437352110637
Author(s):  
SA Abdulwahab ◽  
HS Zedan
Keyword(s):  
Healthcare Providers ◽  
Patient Perceptions ◽  
Outpatient Clinics ◽  
P Value ◽  
Telemedicine Service ◽  
Factors Affecting ◽  
Internet Connection ◽  
Significant Difference ◽  
Medical Specialities ◽  
Satisfaction Rates

Despite the increasing use of telemedicine, patients’ views on telemedicine remain unclear. This study aimed to understand factors affecting patient perceptions and satisfaction with telemedicine services. 235 patients were surveyed on accessibility to telemedicine clinics, medical specialities and satisfaction with the services. 58.3% confirmed having a stable internet connection, 24.3% used telemedicine services in internal medicine clinics, and only 5.1% accessed the telemedicine services in psychiatry clinics. 68.5% used the telephone to access telemedicine service, while only 6.4% used the hotline. Over half of patients confirmed their ability to hear clearly and speak easily with their healthcare providers during their consultations. 55.7% confirmed they were satisfied with their telemedicine experience, while 23.4% were neutral and 8.9% were unsatisfied. There was a significant difference in the rates of satisfaction between female and male respondents (p-value<0.001). Those with stable internet connection had significantly higher satisfaction rates with telemedicine services (p-value<0.001). The rates of satisfaction with telemedicine services were significantly higher in Cardiology and Orthopaedic clinics. Larger multi-center studies examining other factors affecting patients’ satisfaction are recommended.

scholarly journals New patient-controlled abdominal compression method in radiography: radiation dose and image quality

2018 ◽  
Vol 7 (5) ◽  
pp. 205846011877286 ◽  
Author(s):  
Oili Piippo-Huotari ◽  
Eva Norrman ◽  
Agneta Anderzén-Carlsson ◽  
Håkan Geijer
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Prone Position ◽  
Quality Criteria ◽  
Abdominal Compression ◽  
Radiographic Images ◽  
Dose Area Product ◽  
Similar Dose ◽  
Significant Difference ◽  
Area Product

Background The radiation dose for patients can be reduced with many methods and one way is to use abdominal compression. In this study, the radiation dose and image quality for a new patient-controlled compression device were compared with conventional compression and compression in the prone position . Purpose To compare radiation dose and image quality of patient-controlled compression compared with conventional and prone compression in general radiography. Material and Methods An experimental design with quantitative approach. After obtaining the approval of the ethics committee, a consecutive sample of 48 patients was examined with the standard clinical urography protocol. The radiation doses were measured as dose-area product and analyzed with a paired t-test. The image quality was evaluated by visual grading analysis. Four radiologists evaluated each image individually by scoring nine criteria modified from the European quality criteria for diagnostic radiographic images. Results There was no significant difference in radiation dose or image quality between conventional and patient-controlled compression. Prone position resulted in both higher dose and inferior image quality. Conclusion Patient-controlled compression gave similar dose levels as conventional compression and lower than prone compression. Image quality was similar with both patient-controlled and conventional compression and was judged to be better than in the prone position.

scholarly journals Psychiatry as a career: A survey of factors affecting students’ interest in Psychiatry as a career

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Mubashir Aslam ◽  
Tahir Taj ◽  
Arif Ali ◽  
Nasira Badar ◽  
Farzan Saeed ◽  
...  
Keyword(s):  
Medical Students ◽  
Family History ◽  
Medical School ◽  
Psychiatric Illness ◽  
P Value ◽  
Factors Affecting ◽  
Medical Graduates ◽  
Significant Difference ◽  
History Of ◽  
Self Administered Questionnaire

The objectives of this study were to determine the characteristics of medical students and graduates interested in choosing psychiatry as a career and the obstacles in choosing this field of medicine. Two private and two public medical institutes were surveyed from June 2007 to August 2007. A self-administered questionnaire was distributed to third, fourth and final year students and to medical graduates doing their internship in these four medical institutes.A total of 909 medical students and graduates participated in the study. Seventeen percent of participants responded positively regarding their interest in psychiatry as a career. Significantly higher proportion belonged to private medical institutes (14% vs. 24%, P-value =0.001). There was no significant difference in reporting interest for psychiatry in regard to age, sex, year in medical school and whether or not the participant had done a psychiatry ward rotation. However significantly higher proportion of participants (22%, n=43) were reporting their interest in the field of psychiatry who had done more than a month long psychiatry ward rotation as compared to those participants (14%, n=54) with less than a month or no psychiatry rotation (P-value=0.01). More students were reporting their interest in psychiatry with a family history of psychiatric illness as compared to without family history (24% vs 16%, P-value=0.03). In conclusion, students and graduates with more than a month long rotation in psychiatry, studying in private medical colleges and with a family history of psychiatric illness were more interested in choosing psychiatry as a career.

scholarly journals Anatomical Variations of the Paranasal Sinuses and the Nasal Cavity

2019 ◽  
Vol 21 (1) ◽  
pp. 7-11
Author(s):  
Kundan Kumar Shrestha ◽  
K Acharya ◽  
RR Joshi ◽  
S Maharjan ◽  
D Adhikari
Keyword(s):  
Anatomical Variation ◽  
Anatomical Variations ◽  
P Value ◽  
Deviated Nasal Septum ◽  
Chi Square ◽  
Female Ratio ◽  
Chi Square Test ◽  
The Difference ◽  
The Right ◽  
Sinonasal Symptoms

Computed tomography (CT) of the para-nasal sinuses (PNS) has nowadays become the investigation of choice for the diagnosis of sinonasal diseases. Numerous sinonasal anatomic variants exist and are frequently seen on CT scans. A sound knowledge of these variations is important not only for diagnosis but also for planning surgery in order to avoid complications. The aim of this study is to investigate the frequency of these variations in patients with sinonasal symptoms and also to determine their relation to sinonasal disease if any. A total of 76 patients were included in the study from August 2017 to July 2018 of which 43 (56.6%) were males and while 33 (43.4%) were females with male to female ratio of 1.3:1. The ages of patients ranged from 14 to 72 years with a mean age of 33.2±14.2 years. Out of 76 patients, 68 (89.5%) had at least one type of anatomical variation while 8 (10.5%) had no variation. Only one variation was seen in 39 (51.3%) patients while 29 (38.2%) had two or more variations. The most common variant was deviated nasal septum (DNS), occurring in 49 (64.5%) patients followed by concha bullosa (CB) and agger nasi cell (AN) seen in 15 (19.7%) and 14 (18.4%) patients respectively. Genderwise, anatomical variations were seen more in males but the difference was not statistically significant. Some variations were seen more on the right side while others on the left. Some variations were present bilaterally. The difference was not statistically significant. The presence of DNS was statistically significant in the study population (p value 0.012 in nonparametric chi square test). The age group 14 to 30 years showed maximum variations though not significant statistically. Therefore, during management of patients with sinonasal symptoms, these variations need to be addressed, if required, surgically. Proper knowledge of both common and uncommon sinonasal variations in our community could help in better surgical planning and overall management of sinonasal disorders.

scholarly journals BREASTFEEDING TEMPORAL DISTRIBUTION TRENDS AMONG NEONATES IN TERTIARY CARE HOSPITAL IN LAHORE

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Hamid Mehmood ◽  
Zarmast Khan ◽  
Abdul Rauf ◽  
Ammara Waqar
Keyword(s):  
Tertiary Care ◽  
Mode Of Delivery ◽  
Temporal Distribution ◽  
P Value ◽  
Care Hospital ◽  
Chi Square ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Significant Difference ◽  
Initiation Of Breastfeeding

ABSTRACT  BACKGROUND & OBJECTIVE: Breastfeeding provides immunity against bacterial, viral, and other infectious diseases. More than four million new neonates die due to vaccine-related diseases in the first 28 days of their lives. It is therefore emphasized that breastfeeding in the first hours after delivery may save the neonate. The objective of this study was to determine the factors affecting the pattern of breastfeeding among the neonates and assess the frequency of early breastfeeding among neonates at Gulab Devi Hospital, Lahore. METHODOLOGY: It was a cross-sectional descriptive study. One hundred mothers were selected through convenient purposes sampling. Chi-square test applied for an association between mode of delivery and initiation of breastfeeding. RESULTS: The result of the study showed variability in the time of breastfeeding by the mothers from one hour to 24 hours after delivery. Pre-lacteal was given to 59 mothers, while 41 were not given with any pre-lacteal. A significant association was found between mode of delivery and initiation of breastfeeding with a p-value less than 0.001 CONCLUSION: The result of the study showed that variability in the time of breastfeeding by the mothers from one hour to 24 hours after delivery provided a significant difference in the production of the neonate in the first 28 days.

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