Assessment of image quality and establishment of local acceptable quality dose for computed tomography based on patient effective diameter.

Purpose: We aim to develop modified clinical indication (CI)-based image quality scoring criteria (IQSC) for assessing image quality (IQ) and establishing acceptable quality doses (AQDs) in adult computed tomography (CT) examinations, based on CIs and patient sizes. Approach: CT images, volume CT dose index ( CTDI vol ), and dose length product (DLP) were collected retrospectively between September 2020 and September 2021 for eight common CIs from two CT scanners at a central hospital in the Kingdom of Bahrain. Using the modified CI-based IQSC and a Likert scale (0 to 4), three radiologists assessed the IQ of each examination. AQDs were then established as the median value of CTDI vol and DLP for images with an average score of 3 and compared to national diagnostic reference levels (NDRLs). Results: Out of 581 examinations, 60 were excluded from the study due to average scores above or below 3. The established AQDs were lower than the NDRLs for all CIs, except AQDs / CTDI vol for oncologic follow-up for large patients (28 versus 26 mGy) in scanner A, besides abdominal pain for medium patients (16 versus 15 mGy) and large patients (34 versus 27 mGy), and diverticulitis/appendicitis for medium patients (15 versus 12 mGy) and large patients (33 versus 30 mGy) in scanner B, indicating the need for optimization. Conclusions: CI-based IQSC is crucial for IQ assessment and establishing AQDs according to patient size. It identifies stations requiring optimization of patient radiation exposure.

Ribbing disease of the femur: a rare entity.

Ribbing disease is a rare benign bone dysplasia characterized by progressive cortical thickening of the diaphyses of long bones in adult patients. The literature provides limited insight into its natural radiological progression and anatomical distribution. Single-bone involvement is particularly uncommon, with prior cases exclusively affecting the tibia. This case report outlines the unique presentation of Ribbing disease in a 20-year-old male, localized to the left femur. The patient's history revealed intermittent left thigh pain persisting for more than 2 years, with no identifiable triggers or relief factors. Early radiographic imaging revealed no significant abnormalities, but subsequent imaging, conducted 1 year after the initial presentation, revealed focal fusiform widening and cortical thickening of the mid-diaphysis of the left femur. MRI further revealed circumferential cortical thickening with bone marrow edema, corroborated by CT, which revealed cortical thickening with near-complete obliteration of the intramedullary cavity. The patient was managed with nonsteroidal anti-inflammatory drugs and activity modifications. Misinterpretation of the radiographic findings of the osteoid osteoma led the patient to undergo radiofrequency ablation. This case highlights the challenges in diagnosing Ribbing disease and emphasizes the importance of considering it in the differential diagnosis of chronic limb pain. Continued reporting of cases contributes to enhancing our understanding and management of this rare skeletal dysplasia.

"Hot Cord" Sign on 18F-FDG PET/CT in a Patient With Acute Myelitis Due to Neuromyelitis Optica Spectrum Disorder.

A 44-year-old woman presented with prolonged low-grade fever, bilateral upper limb weakness, and hyperesthesia. MRI showed hyperintense T2 signal and enhancement of the cervicothoracic spinal cord. F-FDG PET/CT was requested to investigate pyrexia of unknown origin. It demonstrated diffusely increased FDG uptake along the entire spinal cord, suggestive of extensive acute myelitis. Initial blood work was positive for antinuclear antibodies and anti-Ro/SSA antibodies. Cerebrospinal fluid analysis revealed lymphocytosis and detected the presence of neuromyelitis optica aquaporin-4-immunoglobulin G antibodies, fulfilling the criteria for diagnosis of neuromyelitis optica spectrum disorder.

Prevalence and Prognostic Impact of Hypernatremia in Sepsis and Septic Shock Patients in the Intensive Care Unit: A Single Centre Experience.

INTRODUCTION: Hypernatremia is a commonly associated electrolyte disturbance in sepsis and septic shock patients in the ICU. The objective of this study was to identify the prognostic value of hypernatremia in sepsis and septic shock. MATERIAL AND METHODS: A prospective study conducted on sepsis and septic shock patients diagnosed prior to admission in the ICU in King Hamad University Hospital, Bahrain from January 1st 2017 to February 28th 2019. Data including age, sex, comorbidities, source of sepsis, sodium levels on days one, three, and seven. Data was correlated with the outcome (survival/death and the length of ICU stay). RESULTS: Patients included were 168, 110 survived, and 58 died. Hypernatraemia at day seven was associated with significantly higher mortality (P= 0.03). Hypernatraemia at Day1was associated with a significantly prolonged stay in the ICU (p= 0.039).Multivariate analysis to identify the independent predictors of mortality revealed that immunosuppression and hypernatraemia at Day7 proved to be independent predictors of mortality (P= 0.026 and 0.039 respectively). CONCLUSION: Hypernatremia can be an independent predictor of poor outcome in septic and septic shock patients in the ICU.