Evaluation of clinicians' knowledge and practices regarding medical radiological exposure: findings from a mixed-methods investigation (survey and qualitative study).

OBJECTIVES: To assess the impact of initiatives aiming to increase clinician awareness of radiation exposure; to explore the challenges they face when communicating with patients; to study what they think is the most appropriate way of communicating the long-term potential risks of medical radiological exposure to patients. DESIGN: A quantitative and qualitative evaluation through a survey and focal groups. SETTING: San Juan Hospital and Dr Peset Hospital (Southeast Spain) and clinicians from Spanish scientific societies. PARTICIPANTS: The surveys were answered (a) in person (216: all the radiologists (30), urologists (14) and surgeons (44) working at both participant hospitals; a sample of general practitioners from the catchment area of one hospital (45), and a consecutive sample of radiologists attending a scientific meeting (60)) or (b) electronically through Spanish scientific societies (299: radiologists (45), pneumologists (123), haematologists (75) and surgeons (40)). Clinicians were not randomly selected and thus the results are limited by the diligence of the individuals filling out the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinicians' knowledge and practices regarding medical radiological exposure, and what they considered most appropriate for communicating information to patients. RESULTS: Nearly 80% of the clinicians surveyed had never heard of the European recommendations. Fewer than 20% of the clinicians surveyed identified correctly the radiation equivalence dose of intravenous urography or barium enema. It was reported by 31.7% that they inform patients about the long-term potential risks of ionising radiation. All participants agreed that the most appropriate way to present information is a table with a list of imaging tests and their corresponding radiation equivalence dose in terms of chest X-rays and background radiation exposure. CONCLUSIONS: Medical radiological exposure is frequently underestimated and rarely explained to patients. With a clear understanding of medical radiological exposure and proper communication tools, clinicians will be able to accurately inform patients.

Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study.

OBJECTIVE: To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient's features associated with malignancy in a non-high-risk clinical population. METHODS: Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. RESULTS: 25,529 patients were included: 23,102 (90.5%) underwent chest radiograph and 2,497 (9.5%) a CT. The prevalence of SPN was 2.1% (95% CI 1.9 - 2.3) in radiographs and 17.0% (95% CI 15.5 - 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. CONCLUSIONS: The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. KEY POINTS: There is a lower SPN prevalence in the clinical population than in screening studies. SPN prevalence is associated with some patient characteristics: sex, age, imaging test. Nodule characteristics related to malignancy were associated with some patient characteristics.

[Smoking-related interstitial lung diseases: findings at high-resolution CT]. / Enfermedades intersticiales relacionadas con el tabaco: hallazgos en TC de alta resolución.

OBJECTIVE: To describe the anatomic and radiologic characteristics common to smoking-related interstitial lung diseases use and to evaluate the association between smoking and these diseases. MATERIAL AND METHODS: We reviewed the clinical histories of patients with suspected smoking-related interstitial lung diseases from 2001 to 2005 who underwent high-resolution computed tomography and had radiologic findings of desquamative interstitial pneumonia, respiratory bronchiolitis, histiocytosis X, or pulmonary fibrosis. We analyzed the presence of emphysema, ground glass, centrilobar nodules, cysts, honey combing, and overlap among these findings. RESULTS: Fourteen patients were included. In desquamative interstitial pneumonia, the most common finding was ground glass (100%); in respiratory bronchiolitis, it was centrilobar nodules (100%); cysts were the most common finding in histiocytosis (85.7%) and honey combing was the most common finding in fibrosis (100%). Furthermore, over 75% of the patients had emphysema, which supported the relation with tobacco use. The patients with bronchiolitis also had signs common to the other three diseases (ground glass, honey combing, and cysts). CONCLUSIONS: There is a relation between smoking and these interstitial diseases, as well as overlapping in their clinical and radiological manifestations.

[Lobar emphysema due to bronchial atresia associated with a bronchogenic cyst]. / Enfisema lobar por atresia bronquial asociada a quiste broncogénico.

We report a case of bronchial atresia in the apical segment of right down lobule associated to subcarinal bronchogenic cyst in an eighteen years old patient who consults by long time bronchitis. The thorax X-ray shows an image suggested of mucoid impaction. The respiratory function tests are not essential for the diagnostic. The fiber bronchoscopy is normal and the diagnostic is established by mean image technics (thoracic HR-TC and MR).

Interobserver agreement in the diagnosis of pulmonary embolism with helical CT.

PURPOSE: Our objective was to asses the interobserver agreement in the detection of pulmonary embolism (PE) with contrast-enhanced helical CT at the main pulmonary, lobar and segmental arteries. A prospective study was carried out in 51 patients with suspected PE. Finally, 29 patients were diagnosed of PE. SUBJECTS AND METHODS: All patients were studied with helical CT. Images (5 mm collimation, 1.5 pitch factor, 3 mm reconstruction interval) were obtained after bolus contrast injection (120 ml, 4 ml/s, 15 s delay time). All cases were blinded and independently interpreted in three ways: two radiologists with different level of expertise and two expert radiologists reading by consensus. Agreement was evaluated by means of the kappa test. RESULTS: Kappa values for thrombi detection expressed an excellent agreement at the main (between 0.802 and 0. 946), lobar (between 0.915 and 0.958) and segmental (between 0.879 and 0.718) levels. For all vessels, mean kappa values were similar and excellent for all three combinations of readers. Arteries with more discrepancies were located mainly at the anterior and posterior areas of the upper lobes. CONCLUSIONS: The high degree of agreement shown in this study indicates that helical CT is a reproducible test in the diagnosis of PE to the segmental level. Isolated readings and levels of expertise do not influence agreement.

Diagnosis of pulmonary sequestration by spiral CT angiography.

The diagnosis of pulmonary sequestration traditionally requires arteriography to identify abnormal systemic vessels feeding the abnormal portion of the lung. Non-invasive imaging techniques have recently been used to replace arteriography. Conventional computed tomographic (CT) scanning is, however, at a disadvantage because of its inability to obtain multiplanar images. The combination of slip ring CT scanning and computerised three-dimensional reconstruction (spiral CT angiography) can be used to visualise the anatomical detail of a wide range of vessels within the lung. Four cases of pulmonary sequestration are reported which were successfully diagnosed using spiral CT angiography. Spiral CT scanning allows simultaneous imaging of anomalous vessels and lung parenchyma in a single examination and is particularly useful in the diagnosis and assessment of pulmonary sequestration.

Intracranial abnormalities and ventricular patterns associated with meningoencephaloceles.

Twenty-eight patients with meningoencephalocoeles with a mean age of 11 months were studied. CT scans showed abnormal ventricular patterns and other intracranial abnormalities in 78%, about 2 3 of whom had multiple defects. There was a direct relationship between the number of intracranial abnormalities and the amount of herniated brain and not with the size of the meningocele sac per se. We believe that traction on the intracranial contents by progressive brain herniation is a primary mechanism leading to the development of multiple abnormalities. It is therefore recommended that early closure of the bone and dural defects is necessary to prevent further brain herniation. We have utilized multiple stage operations including cerebrospinal fluid shunting for hydrocephalus, when present, transcranial extradural closure of the bone and dural defects, and cosmetic repair of the mengingocoele sac at a much later date.

[Percutaneous nephrostomy as a technic for emergency drainage: review of cases]. / La nefrostomía percutánea como técnica de derivación de urgencia: revisión de casos.

Percutaneous nephrostomy (PCN) is currently one of the procedures of choice for emergency drainage of the upper urinary tract. Moreover, it permits morphologic and functional diagnostic possibilities as well as a wide variety of new and frequently definitive therapeutic procedures. We report on 58 PCN procedures performed in 55 patients from May 1983 to February 1989. PCN was indicated for complicated or uncomplicated uni- or bilateral supravesical obstruction, with infection and/or azotemia. All patients submitted to PCN for complicated obstruction with infection and/or azotemia showed a marked clinical and analytical improvement. Apart from resolving this emergency, it reduced the morbidity and mortality rate of subsequent surgical treatment of the underlying cause of obstruction because patient status was markedly improved. The major complications, retroperitoneal hematoma and sepsis, were rare. We frequently observed that the catheter had come out or become obstructed in our series. PCN affords the following advantages: it can be performed with local anesthesia; it is a simple technique; there are no absolute contraindications; its morbidity and mortality rates are low; and, it can be easily converted into a permanent procedure. In our view, all the foregoing advantages, as well as its therapeutic and morphologic and functional diagnostic possibilities, make PCN one of the procedures of choice in emergency treatment of upper urinary tract obstruction.

Massive thyroxine intoxication: evaluation of plasma extraction.

Six patients were admitted after erroneous massive intake of levothyroxine (70-1200 mg over an interval of 2-12 days). All patients developed classical symptoms of thyrotoxicosis within 3 days of the first dose; five patients presented grade II-III coma and one became stuporous (days 7-10). Two patients developed left ventricular failure and three had arrhythmias (days 8-11). Total thyroid hormone levels in serum on admission ranged 935-7728 nmol/l for T4 (TT4) and 23-399 nmol/l for T3 (TT3). All patients received treatment with hydrocortisone and Propranolol. Propylthiouracil was also given in 3 cases. Extractive techniques (charcoal haemoperfusion and/or plasmapheresis) were initiated 8-14 days after the first dose of L-T4. The plasma disappearance rate (K) of TT4 with plasmapheresis was 30 times higher, on average, than under standard medical treatment (M). Also, K of TT4 under haemoperfusion was about five times higher than K under M. K changes for TT3 were higher under haemoperfusion than under plasmapheresis. Furthermore, extractive procedures shortened the average half life of TT4, (from 106.5 +/- 44.6 to 59.7 +/- 20.2 h, p less than 0.05).