Valg av modalitet ved karundersøkelser: CTA vs. MRA

Keywords: MRA, CTA, Modality choice, Angiographic imaging, Mixed method Sammendrag Hensikt Hensikten med denne studien var å undersøke hva som legges til grunn for radiologens valg av modalitet ved karundersøkelser. Dette med hensyn til at radiografen, med ansvar for berettigelse og selvstendig utførelse på CTA og MRA, bør kjenne til begrunnelsen for valgt modalitet. Metode Denne mixed method-studien bestod av en spørreundersøkelse med et nasjonalt perspektiv og et litteratursøk med et globalt perspektiv. Spørreundersøkelsen ble sendt til radiologer på offentlige sykehus i Norge. Litteratursøk ble gjennomført i databasene PubMed, Web of Science og Scopus, med søkeordene “MRA and CTA”, “MRA vs CTA” og “MRA and CTA and decision”. Resultat 38 respondenter deltok i undersøkelsen, og 21 studier ble inkludert fra litteratursøket. I resultatet kom det frem flere viktige faktorer som påvirker valg av modalitet, blant annet tilgjengelighet, pasientens situasjon, bildekvalitet og diagnostisk verdi. Noen viktig funn er at modalitetsvalg avhenger av patologi og dens lokalisasjon, samt at det i stor grad tas hensyn til ønske fra den som henviser. Konklusjon Valg av modalitet er hovedsakelig basert på klinisk problemstilling og pasientrelaterte faktorer. Faktorer knyttet til selve modaliteten som strålingsbelastning, undersøkelseshastighet, tilgjengelighet, er også tatt i betraktning, men foretrukken modalitet vil endres i takt med teknologiutvikling. Det kan sess et behov for retningslinjer for å øke radiografens kompetanse.

Erfaring med bruk av video i praksisundervisningen for radiografstudenter

Sammendrag Artikkelen beskriver erfaringer med utvikling og gjennomføring av et seminar i praksisundervisningen for 1.års studenter ved bachelorstudiet i Radiografi ved OsloMet – storbyuniversitetet. Hensikten var å få studentene til å systematisere teoretisk og praktisk kunnskap knyttet til prosedyren for røntgen thorax. Studentene vurderte først gruppevis en video av prosedyren relatert til læringsutbyttene i emnet, og diskuterte den så i plenum. Studentenes opplevelser av undervisningsformen ble innhentet i en kvalitativ, elektronisk spørreundersøkelse. Seminaret ble oppfattet som lærerikt og skapte fruktbare diskusjoner og refleksjon. Dette gjaldt særlig de studentene som allerede hadde gjennomført praksis og hadde tilegnet seg egne erfaringer. Struktur og samarbeid i grupper og i plenum opplevdes som viktig for resultatet. Resultater fra evaluering av undervisningen kan tyde på at video av røntgenprosedyrer har gunstig betydning for studentenes fagforståelse i praksisundervisningen når den benyttes i en studentaktiv læringssituasjon.

The sonographer dilemma: Ultrasound follow-up in patients with small gallbladder polyps

What should sonographers recommend to patients diagnosed with small gallbladder polyps? Is follow-up always the solution? And for how many years should we encourage patients to participate in a follow-up ultrasound program? This tutorial discusses current research and guidelines.

Analysis of the iodine distribution map in patients with diagnosis of pulmonary embolism: Initial results

Objectives: Analysing the iodine map distribution in patients with pulmonary embolism diagnosis by Dual Energy Computed Tomography. Materials and methods: Twenty-four images of pulmonary angiotomography by dual energy computed tomography were used to determinate the presence of pulmonary thrombi and identify the perfusion defects (PDs) in the Iodine Maps. Moreover, the iodine density (mg/ml) were measured in normal lung parenchyma and lung parenchyma with PDs areas. The documentary analysis was used thought the data collection sheet and the Likert scale questionnaire. The statistic software SPSS v.25 was used. Results: Thirty-four thrombi were found (21 occlusive and 13 partials occlusive) at monochromatic images. Forty-one perfusion defects (PD) were found at Iodine Maps, these have multiple origins: pulmonary thrombi (69.23%), artifacts (17.95%) and other alterations (12.82%). Furthermore, two new thrombi (5.56%) were identified, both were occlusive and segmental level. Mean Iodine density showed statistically significant differences among normal lung parenchyma (1.65 ± 0.66 mg/ml; [0.77-2.79 mg/ ml]) and parenchyma with PD areas (0.51 ± 0.26 mg/ml; [0.12-1.02 mg/ml])(p=0.000). Mean iodine density also had statistically significant differences between parenchyma with occlusive PD and partial occlusive PD (p=0.000). Iodine Map diagnostic quality was excellent (54.17%), good (33.33%), moderate (12.50%). Conclusion: The Iodine distribution Map offers a benefit greater than 5% in the diagnosis of pulmonary embolism by Dual-Energy Computed Tomography.

Anatomical variations of posterior inferior cerebellar artery (PICA) on digital subtraction angiography (DSA)

Introduction: The posterior inferior cerebellar artery (PICA) often exhibits anatomical variations at the craniovertebral junction. Few studies investigated variations of the posterior inferior cerebellar artery, and the prevalence of other variations has not been reported. The study aimed to identify variations of the posterior inferior cerebral artery using cerebral Digital Subtraction Angiography (DSA). Method: 50 patients underwent 64-slice cerebral Digital Subtraction Angiography. Four types of variations were observed. Results: Out of a total of 50 patients, 23 (46%) were males and 27 (54%) females (all age groups). Our study has shown the utility of the 2 sequences - fluoroscopy and cine. All 2 sequences have their significance in evaluating anatomical variations in PICA. Only 20% of the 50 patients had all the posterior inferior cerebellar artery without anatomical variations. Anatomic variations commonly involve the distal segment of the vertebral artery (VA). Most of them are seen arising from the C1, C2, and both C1 and C2 origins. Anatomic variations involve arising from the C1 origin in 9 patients, C2 origin in 11 patients, C1 & C2 origin in 8 patients, and other variations observed in 12 patients. Conclusion: Variations of the posterior inferior cerebellar artery can be easily evaluated by cerebral Digital Subtraction Angiography (CDSA). Recognizing and reporting them at cerebral CDSA may be clinically important. Surgeons should be mindful of this variation during operations.

Projection radiography of the ankle; the views used for different indications vary between medical imaging departments

Plain radiographs are used for initial evaluation of many conditions of the ankle. Many different radiographic views are described in positioning textbooks but evidence on which views to use, in which case, is scarce. The aim of this study was to map imaging procedures related to four indications for ankle projection radiography. A questionnaire was sent to all medical imaging departments in Iceland with questions about acquisition technique for ankle radiography views and which views were used for selected indications. Answer was received from 14 of the 28 departments. All departments gave very similar descriptions of the four most common views. In the case of trauma, all but one department used four views but for control of trauma or operation, four different combinations of views were found using from two to four images. For detrition and osteomyelitis, four views were more common in the larger departments but there was not a statistically significant difference. Eight different combinations of the number of views for the four indications were found. The study indicates that there is a need for standardization in image acquisition protocols. More studies are needed to support decisions about how many views are necessary for the most common ankle radiography indications.

Pre-registration UK diagnostic radiography student ability and confidence in interpretation of chest X-rays

Introduction Chest X-rays are the most frequently requested X-ray imaging in English hospitals. This study aimed to assess final year UK radiography student’s confidence and ability in image interpretation of chest X-rays. Methods Thirty-three diagnostic radiography students were invited to assess their confidence and ability in interpreting chest x-rays from a bank of n=10 cases using multiple choice answers. Data analysis included 2x2 contingency tables, Kappa for inter-rater reliability, a Likert scale of confidence for each case, and questions to assess individual interpretation skills and ways to increase the learning of the subject. Results Twenty-three students participated in the study. The pooled accuracy achieved was 61% (95% CI 38.4-77.7; k=0.22). The degree of confidence and ability varied depending upon the student and the conditions observed. High confidence was noted with COVID-19 (n=12/23; 52%), lung metastasis (n=14/23; 61%), and pneumothorax (n=13/23; 57%). Low confidence was noted with conditions of consolidation (n=8/23; 35%), haemothorax (n=8/23; 35%), and surgical emphysema (n=8/23; 35%). From the sample n=11 (48%), participants stated they felt they had the knowledge to interpret chest X-rays required for a newly qualified radiographer. Conclusion The results demonstrated final year radiography student’s confidence and ability in image interpretation of chest X-rays. Student feedback indicated a preference for learning support through university lectures, online study resources, and time spent with reporting radiographers on clinical practice to improve ability and confidence in interpreting chest X-rays.

Pasienters evaluering av informasjonsskrivet til CT abdomen

SammendragInnledning: Flere pasienter møter opp til CT-time uten å ha fått med seg tilstrekkeliginformasjon om undersøkelsen de skal gjennomføre, informasjon som skal være gitt dem iinformasjonsskrivet i forkant av undersøkelsen.Målsetning: Målet med denne studien var å avdekke om informasjonsskrivet bidro tiltilstrekkelig kunnskap om CT-undersøkelsen. I tillegg ønsket vi å kartlegge om det var behovfor forbedring av informasjonsskrivet, eventuelt avdekke pasientens syn på hva som kunneforbedres.Metode: I denne studien ble det benyttet et spørreskjema i papirform somdatainnsamlingsmetode. Spørreskjema ble gitt ut til pasienter som fikk innkallingsbrev oggjennomførte en av de utvalgte CT-undersøkelser på St. Olavs Hospital.Resultat: Det totale antallet respondenter var 25. De fleste var fornøyde medinformasjonsskrivet både med tanke på innhold og utseende, og de følte at skrivet inneholdtall informasjon som var nødvendig for å bli forberedt til CT-undersøkelsen. Allerespondentene svarte at innholdet i informasjonsskrivet var lett å forstå. Respondenter medhelsefaglig bakgrunn var mer kritiske til innholdet av informasjonsskrivet enn de utenarbeidserfaring fra helsevesenet. Et fåtall respondenter ønsket mer informasjon om bl.a.kontrastmiddel.Konklusjon: Selv om pasientene i denne undersøkelsen stort sett var fornøyde med dagensinformasjonsskriv, er er det likevel rom for forbedring med tanke på innholdet.

Quality of radiation protection aprons and quality control routines at different diagnostic imaging modalities

Keywords: Radiation protection apron, Quality control, Routines, Radiation protection, Radiation doses Abstract Introduction: The purpose of this project was to assess the quality of lead aprons at different departments at two hospitals and to investigate whether there was a connection between routines for controlling lead aprons and the actual condition of the lead aprons. Methods: Lead aprons were tested in several diagnostic modalities in two hospitals. The lead aprons were inspected visually and by palpation. Furthermore, the lead aprons were scanned with a fluoroscopy unit and the size of the defect was recorded. The radiation dose was measured behind defects exceeding 0,4 cm in length. Radiation protection officers at the two hospitals were contacted for a review of the procedures. Results: Defects were detected in 19% of the tested aprons. Most findings were discovered in emergency room 1, where 62,5% of the lead aprons had one or more defects. The measured radiation doses behind the defects ranged from 3.996 nGy to 83.370 nGy. No defects were detected on nuclear medicine 1, emergency room 2, CT 2 and intervention 2. Both hospitals' routines were based on the Norwegian Radiation Protection Regulations. Hospital 2 controlled most of the lead aprons one month prior to this project. Conclusion: A possible connection between the hospitals’ routines and the quality of the lead aprons is indicated by the fact that the hospital with the most defective lead aprons also had the least follow-up of the routines.

Estimation of effective dose from CT scanning using dose length product in a Nepalese hospital

Keywords: Effective dose, Dose Length Product, Computed Tomography Dose Indexvolume, Dose Reference Level AbstractAim: The aim of this study was to estimate the effective doses from CT scans using DoseLength Product (DLP) in a Nepalese hospital.Materials and methods: This prospective study was conducted in 150 patients above 18years of age who were referred for CT scan of head, chest and abdomen. The CT scan wasperformed on a 128 slice multi detector scanner. All the subjects who met the inclusioncriteria were included in the study. Following the non-contrast imaging phases of the head,chest and abdomen CTDIvol, DLP, kVp and pitch were recorded for each patient from theconsole display of the scanner. The effective dose was calculated for each examination usingDLP which were graphically analyzed and correlated with the age of the patient.Results: The study showed the mean CTDIvol for head, chest and abdomen to be 53.95±4.83mGy, 5.28±1.17 mGy and 11.15±2.71 mGy respectively along with mean DLP to be923.52±71.11 mGycm, 229.32±48.70 mGycm and 517.02±148.32 mGycm respectively. Usingthese values, the mean effective doses were calculated and found to be 1.93±0.14 mSv,3.20±0.68 mSv and 7.75±2.19 mSv respectively.Conclusion: The calculated effective dose values were lower than in other studies for CTexaminations of chest and abdomen while higher or similar for CT examination of head. Theresults of this survey could motivate other researchers to investigate the radiation doses inother hospitals and help establish national diagnostic reference levels.