A comparison of erect weight-bearing and non-weight-bearing radiography of the cervical spine in non-trauma patients

Introduction: Various positioning techniques are utilized to enhance the visualization of lower cervical vertebrae on lateral radiographs. However, the effectiveness of these techniques still remains unclear. This study was conducted to determine the effect of the weight-bearing (WB) technique in visualizing lower cervical vertebrae and cervicothoracic junction (C7-T1) on standing lateral cervical radiographs of adult non-trauma patients. The study was conducted using both computed radiography (CR) and digital radiography (DR) systems.Methods: Forty-four CR (29 WB and 15 non-WB – NWB) and 61 DR (26 WB and 35 NWB) lateral C-spine radiographs were prospectively evaluated to assess the visible number of cervical vertebral bodies and C7-T1 junction. The instructions given by the radiographer to the patient for the imaging procedure were also assessed on the Likert scale (very good, good, fair, poor, very poor).Results: There was no significant difference (p > 0.05) in the visualization of the number of vertebral bodies between the two techniques of WB and NWB for CR or DR. Further, no significant relationship (p > 0.05) was observed between the WB technique and the visualization of C7-T1 junction in DR systems. However, a significant difference was identified for CR (p = 0.012). The instruction given to the patient significantly correlated with the visibility of the lower C-spine region within each group of WB and NWB in both imaging systems.Conclusions: The visibility of the number of vertebral bodies in the lower C-spine region in either CR or DR systems did not demonstrate any enhancement with the WB technique. Regardless of the imaging system or techniques used, adequate instructions given to the patient before and during the imaging procedure of C-spine lateral radiography demonstrated a significant improvement in visualizing the lower C-spine region. In this preliminary study, the application of erect WB radiography technique in evaluating the lower cervical region of adult non-trauma patients gives limited advantage.

Consensus Procedures in Oncological Imaging: The Case of Prostate Cancer

Recently, there has been increasing interest in methodological aspects of advanced imaging, including the role of guidelines, recommendations, and experts’ consensus, the practice of self-referral, and the risk of diagnostic procedure overuse. In a recent Delphi study of the European Association for Nuclear Medicine (EANM), panelists were asked to give their opinion on 47 scientific questions about imaging in prostate cancer. Nine additional questions exploring the experts’ attitudes and opinions relating to the procedure of consensus building itself were also included. The purpose was to provide insights into the mechanism of recommendation choice and consensus building as seen from the experts’ point of view. Results: Regarding the factors likely to influence the willingness to refer a patient for imaging, the most voted were incorporation into guidelines and data from scientific literature, while personal experience and personal relationship were chosen by a small minority. Regarding the recommendations more relevant to prescribe an imaging procedure, it resulted the incorporation into guidelines promoted by scientific societies (59% of votes); these guidelines also resulted the more trusted. With respect to patients’ preferences considered when prescribing an imaging procedure, the most voted was accuracy, resulted more important than easy access and time to access to the procedure. The majority of the experts expressed the opinion that there is a scarce use of imaging procedures in prostate cancer. With respect to the most relevant factor to build consensus, it resulted the transparency of the process (52% of votes), followed by multidisciplinarity of contributors. The main obstacle to incorporation of modern imaging procedures into guidelines resulted the lack of primary literature on clinical impact. Conclusions: Firstly, the panelists portray themselves as having Evidence-Based Medicine oriented and scientifically inclined attitudes and preferences. Secondly, guidelines and recommendations from scientific societies, especially clinical ones, are positively taken into account as factors influencing decisions, but panelists tend to consider their own appraisal of the scientific literature as more relevant. Thirdly, in respect of overuse, panelists do not think that advanced diagnostic procedures are overutilized in the specific case of Prostate Cancer, but rather they are underutilized.