Acute haemorrhage rate in 28,000 Out-of-Hours CT heads

Objectives: The aim of this paper is to assess the acute haemorrhage rate in patients who had CT head investigation out-of-hours with and without trauma and compare the rates of haemorrhage between warfarin and DOACs, at a busy teritary teaching hospital. Methods: All CT heads performed between January 2008 and December 2019 were identified from the radiology information system (RIS) at Sheffield Teaching Hospitals (STH), with the requesting information being available from January 2015. The clinical information was assessed for the mention of trauma or anticoagulation and the reports were categorised into acute and non-acute findings. Results: Between 2008 and 2019 the number of scans increased by 63%, with scans performed out of hours increasing by 278%. Between 2015 and 2019, the incidence of acute ICH was similar over the 5 year period, averaging at 6.9% and ranging from 6.1 to 7.6%. The rate of detection of acute haemorrhage following trauma was greater in those not anticoagulated (6.8%), compared with patients on anticoagulants such as warfarin (5.2%) or DOACs (2.8%). Conclusions: Over 12 years, there has been a significant increase in the number of CT heads performed at STH. The rate of ICH has remained steady over the last 5 years indicating a justified increase in imaging demand. However the incidence of ICH in patients prescribed DOACs is lower than the general population and those on warfarin. Advances in knowledge: : This finding in a large centre should prompt discussion of the risk of bleeding with DOACs in relation to CT head imaging guidelines.

MRI for paediatric flatfoot: Is it necessary?

Objective: To determine the additional benefit of MRI for children with flatfoot deformity assessed with weight-bearing radiographs in a specialist paediatric orthopaedic unit. Methods and materials: Patient cohort was obtained by searching the Radiology Information System for children referred for investigation of flatfoot. All patients with flatfoot on weight bearing radiographs who had undergone MRI were included. Radiographs were classified by a consultant musculoskeletal radiologist as showing no underlying abnormality, talo-calcaneal coalition, calcaneo-navicular coalition, accessory navicular or other abnormality. MRI studies were classified similarly by a different consultant musculoskeletal radiologist blinded to the radiographic findings. Results: 33 males and 24 females were included (mean age 12.5 years; range 3–18 years). Twenty-four had bilateral abnormality, so 81 feet were assessed. Radiographs showed no specific abnormality (n = 51), talo-calcaneal coalition (n = 6), calcaneo-navicular coalition (n = 3), os naviculare (n = 12) or other abnormality (n = 9). MRI showed no specific abnormality (n = 40), talo-calcaneal coalition (n = 10), calcaneo-navicular coalition (n = 5), os naviculare (n = 12) or other abnormality (n = 14). Assuming MRI as the diagnostic gold standard, additional relevant diagnostic information was identified in 19 (23.5%) cases, while in the 51 cases for which radiographs provided no specific diagnosis MRI confirmed no underlying abnormality in 31 (60.8%). Conclusion: MRI is a valuable adjunct to weight bearing radiography for investigating paediatric flatfoot deformity. Advances in knowledge: MRI is of value in the assessment of paediatric flatfoot, additional diagnostic information to radiography being identified in 23.5% cases, while in 60.8% of cases for which radiographs provided no specific diagnosis MRI confirmed no underlying abnormality.

Management reorganization of a Radiology ward during the Covid-19 pandemic in a University Hospital structured inpavilions.

Objective: The aim of the recent management reorganization of the Emergency Room and Radiology ward was to face the recent Coronavirus pandemic in the most rational way possible, to preserve the essential role of these Units in the complex context of a pavillions structured Hospital. Methods: The most challenging management criticalities posed by the recent Coronavirus pandemic were individually analyzed and dealt with. The pavilions structure of our Hospital, biohazard management, shortage of personnel and shortage or temporary inadequacy of personal protective equipment were addressed as the most urgent and important problems.Results: A strategic use of the Radiology Information System and Picture Archiving And Communication System (RIS-PACS), dedicated ambulances with specific disinfection procedures, the institution of dedicated pavilions, wards, checkpoints and different paths for COVID-19 (Coronavirs Disease 2019) and non COVID-19 patients, frequent sanification procedures, serological screening for employees and emergency dedicated staff recruitment were put to place as a result of said analysis.Nevertheless, all of these goals couldn’t have been achieved without a constant sense of responsibility of the employees involved.Conclusions: A rational analysis of the most critical problems associated with a pandemic is vital to provide a fast and effective response, and represents a valuable wealth of experience in case of future pandemics.

A comparison of manually populated radiology information system digital radiographic data with electronic dose management systems

Objective: To assess the accuracy and agreement of radiology information system (RIS) kerma–area product (KAP) data with respect to automatically populated dose management system (DMS) data for digital radiography (DR). Methods: All adult radiographic examinations over 12 months were exported from the RIS and DMS at three centres. Examinations were matched by unique identifier fields, and grouped by examination type. Each centre’s RIS sample completeness was calculated, as was the percentage of the RIS examination KAP values within 5% of their DMS counterparts (used as an accuracy metric). For each centre, the percentage agreement between the RIS and DMS examination median KAP values was computed using a Bland–Altman analysis. At two centres, up to 42.5% of the RIS KAP units entries were blank or invalid; corrections were attempted to improve data quality in these cases. Results: Statistically significant intersite variation was seen in RIS data accuracy and the agreement between the uncorrected RIS and DMS median KAP data, with a Bland–Altman bias of up to 11.1% (with a −31.7% to 53.9% 95% confidence interval) at one centre. Attempts to correct invalid KAP units increased accuracy but produced worse agreement at one centre, a slight improvement at another and no significant change in the third. Conclusion: The RIS data poorly represented the DMS data. Advances in knowledge: RIS KAP data are a poor surrogate for DMS data in DR. RIS data should only be used in patient dose surveys with an understanding of its limitations and potential inaccuracies.

Can the examination time in CT and conventional x-ray be reduced in an emergency department with integrated radiology unit? A retrospective study

Quick radiological diagnosis is often needed in order to allow the clinicians to make a diagnosis. The purpose of this study was to measure examination time for radiology procedures before and after physical integration of a radiology unit in the ED. We retrospectively acquired data from the radiology information system and compared time from referral to end of radiological examination before and after physical integration of the radiology unit in the ED for 19,897 X-ray and 6,940 CT examinations. After integration examination time for X-ray examinations was reduced by 5 to 14 minutes (p<0.001). For CT head and chest examination time was reduced by 7 to 15 minutes (p<0.003) while examination time for CT abdomen was prolonged by 4 minutes (p=0.78).

Effectiveness of Material Using CT Scan and MRI After Use of Picture Archiving and Commucating System and Radiology Information System at Radiological Installation of Bukit Tinggi National Hospital, West Sumatra

ABSTRACT Background: Efficiency while paying attention to service quality is the top priority of the hospital. The efficiency in radiology installations has also not gone unnoticed. The implementation of Picture Archiving and Commucating System (PACS) and Radiology Information System (RIS) is one of the efforts to control costs in radiology installations, especially in consumables’ efficiency (BHP). Bukittinggi National Stroke Hospital (RSSN), as one of the vertical hospitals located in the City of Bukittinggi, West Sumatra, has become a precursor to the implementation of PACS and RIS in this province. This study aimed to determine effect of material using ct scan and mri after use of picture archiving and communicating system and radiology information system at radiological installation of Bukittinggi national hospital, West Sumatra. Subjects and Method: This was a descriptive study conducted at Radiological Installation Of Bukittinggi National Hospital, West Sumatra from July 2020. The data were collected by observation and monthly report data. Results: The results of the analysis of the use of PACS and RIS had a significant impact on the cost efficiency of BHP CT scans and MRIs in the RSSN radiology installation reaching 97.9%. Conclusion: Transfer of CT scan and MRI results from film to DVD-R for internal RSSN patients with considerable efficiency. Keyword: PACS, RIS, cost control, BHP Correspondence: Widya. Postgraduate Administrative Studies, Faculty of Public Health, Universitas Indonesia. Pondok Cina, Kecamatan Beji, Kota Depok, Jawa Barat 12345. Email: [email protected]. Mobile: (021) 7864975 DOI: https://doi.org/10.26911/the7thicph.05.23