Navigating Challenges in Teleradiology Implementation: A Case Study from Saudi Arabia's Healthcare System.

Background and Aims: Teleradiology is the practice of interpreting medical images acquired in an off-site location. Teleradiology has been utilized widely around the world to address the needs for subspecialty coverage, workload balancing, and as a solution for understaffing. This study aims to assess the perceptions of teleradiology among radiologists in Saudi Arabia, investigate any challenges they might face, and explore strategies that would help mitigate those challenges. Methods: A cross-sectional study using a self-administered electronic questionnaire was conducted to collect responses from radiologists practicing or having practiced teleradiology in Saudi Arabia. The questionnaire was conducted from January to June 2023, and 105 responses were included in the analysis. The responses were analyzed using chi-squared testing to investigate factors affecting the radiologists' perceptions. Results: The most common challenges for teleradiology were access to patients' health records, access to prior imaging exams, and concerns about image quality assurance. Around 74% of participants perceived teleradiology to be beneficial for geographic, after-hour, and subspecialties coverage. Teleradiology was also perceived to help reduce the turn-around time of radiology interpretations. Better communication with referring physicians and technologists was seen as a way to help improve teleradiology services. Conclusion: The findings suggest that the perception of teleradiology's challenges and benefits may not be influenced by experience, workplace, or subspecialty. Emphasis should be placed on the importance of quality assurance of images acquired remotely. Addressing the concerns and challenges related to access to patients' health records is also crucial to ensuring the successful implementation of teleradiology in the country.

Estimation of organ and effective doses of CBCT scans of radiotherapy using size-specific field of view (FOV): a Monte Carlo study.

The kV cone beam computed tomography (CBCT) is one of the most common imaging modalities used for image-guided radiation therapy (IGRT) procedures. Additional doses are delivered to patients, thus assessment and optimization of the imaging doses should be taken into consideration. This study aimed to investigate the influence of using fixed and patient-specific FOVs on the patient dose. Monte Carlo simulations were performed to simulate kV beams of the imaging system integrated into Truebeam linear accelerator using BEAMnrc code. Organ and size-specific effective doses resulting from chest and pelvis scanning protocols were estimated with DOSXYZnrc code using a phantom library developed by the National Cancer Institute (NCI) of the US. The library contains 193 (100 male and 93 female) mesh-type computational human adult phantoms, and it covers a large ratio of patient sizes with heights and weights ranging from 150 to 190 cm and 40 to 125 kg. The imaging doses were assessed using variable FOV of three sizes, small (S), medium (M), and large (L) for each scan region. The results show that the FOV and the patient size played a major role in the scan dose. The average percentage differences (PDs) for doses of organs that were fully inside the different FOVs were relatively low, all within 11% for both protocols. However, doses to organs that were scanned partially or near the FOVs were affected significantly. For the chest protocol, the inclusion of the thyroid in the scan field could give a dose of 1-7 mGy/100 mAs to the thyroid, compared to 0.4-1 mGy/100 mAs when it was excluded. Similarly, on average, testes doses could be 6 mGy/100 mAs for the male pelvis protocol compared to 3 mGy/100 mAs when it did not lie in the field irradiated. These dose differences resulted in an average increase of up to 27% in the size-specific effective dose of the protocols. Since changing the field size is possible for CBCT scans, the results suggest that patient-specific scanning protocols could be applied for each scan area in a manner similar to that used for CT scans. Adjustment of the FOV size should be subject to the clinical needs, and assist in improving the treatment accuracy. The patient's height and weight might be considered as the main factors upon which, the selection of the appropriate patient-specific protocol is based. This approach should optimize the imaging doses used for IGRT procedures by minimizing doses of a large ratio of patients.

National Early Warning Score (NEWS) as Prognostic Triage Tool for Septic Patients.

PURPOSE: We assessed the National Early Warning Score (NEWS) in emergency triage for predicting sepsis-related outcomes. METHODS: A retrospective chart review of all cases enrolled in the sepsis management protocol for a one-year duration. The protocol utilized the NEWS as a screening tool for sepsis in the triage area. Primary outcomes of interest were hyperlactatemia, admission to ICU and intrahospital mortality. Sensitivity, specificity, and area under the curve (AUC) were calculated for a given NEWS. RESULTS: A total of 444 patients were reviewed from July 2018 to June 2019, with a mean age of 58.7 years. A NEWS ≥5 was more than 88% sensitive in predicting hyperlactatemia, ICU admission, and/or mortality. Specificity, on the other hand, was as low as 12%. The AUC for the NEWS was 0.667 for predicting hyperlactatemia and 0.602 for predicting ICU admission or mortality. CONCLUSION: The NEWS was a sensitive screening tool for predicting sepsis-related outcomes. However, it was not specific, and further studies are recommended to assess the integration of other factors to improve specificity.

Identification, Quantification, and Toxicity of PCDDs and PCDFs in Soils from Industrial Areas in the Central and Eastern Regions of Saudi Arabia.

This study was conducted to identify and quantify polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) in soil samples collected from selected industrial areas in the central and eastern regions of Saudi Arabia. All the investigated compounds of PCDDs/PCDFs were identified in the studied locations. The average concentrations of PCDDs (sum of seven congeners measured) ranged from 11.5 to 59.6 pg g(-1), with a maximum concentration of 125.7 pg g(-1) at an oil refinery station followed by 100.9 pg g(-1) at a cement factory. The average concentrations of PCDFs (sum of 10 congeners measured) accounted for 11.68-19.35 pg g(-1), with a maximum concentration of 38.67 pg g(-1) at the cement factory. It was generally observed that the soil samples collected from industrial areas have substantially high toxicity equivalence (TEQ) values of PCDDs/PCDFs compared to soils of remote areas. Principal component analysis revealed that the cement factories and oil refineries were the primary sources of PCDDs and PCDFs.