Assessment of the safety climate in outpatient diagnostic services: Development and psychometric evaluation of a questionnaire.

INTRODUCTION: Safe practice and safety culture are important issues in outpatient diagnostic imaging services. As questionnaires assessing safety culture through the measurement of safety climate in this setting are not yet available, the present study aimed to develop and validate such an instrument. MATERIALS AND METHODS: After adaptation of an existing questionnaire and qualitative pretesting, the instrument was tested by collaborators from three outpatient imaging services in Switzerland. Results were first assessed using descriptive statistics. Scores of individual services were compared using a Wilcoxon test assessing differences between rank distributions. The final instrument was tested for validity using inter-rater agreement measures, such as reliability within groups (rWG), and an intraclass correlation coefficient measure (ICC(1)). These measures allowed the assessment of validity of aggregation into a total score (rWG(j)) and validated the instrument for its capacity to distinguish various safety climates of different groups by comparing inter-rater agreement in the overall sample to inter-rater agreement of individual services (rWG) and by measuring group effects (ICC(1)). Furthermore, the final instrument was tested for internal consistency and reliability using Cronbach's Alpha. RESULTS: Safety climate scores vary significantly between services. Inter-rater agreement measures show that item aggregation is justified and that the instrument distinguishes various patterns of safety climate. The final instrument proves to be valid, consistent and reliable. CONCLUSIONS: The final instrument presents a valid, consistent and reliable option to measure safety climate in outpatient diagnostic imaging services. Results can be used as a basis for quality improvement. KEY POINTS: • An adapted questionnaire that assesses safety climate in outpatient diagnostic imaging services was developed and tested in Switzerland. • Psychometric evaluation showed the questionnaire to be a valid, consistent and reliable instrument. • Results are of interest for imaging services as well as for stakeholders interested more globally in monitoring and quality improvement.

Correction to: National survey on dose data analysis in computed tomography.

The original version of this article, published on 28 May 2018, unfortunately contained a mistake.

National survey on dose data analysis in computed tomography.

OBJECTIVES: A nationwide survey was performed assessing current practice of dose data analysis in computed tomography (CT). MATERIAL AND METHODS: All radiological departments in Switzerland were asked to participate in the on-line survey composed of 19 questions (16 multiple choice, 3 free text). It consisted of four sections: (1) general information on the department, (2) dose data analysis, (3) use of a dose management software (DMS) and (4) radiation protection activities. RESULTS: In total, 152 out of 241 Swiss radiological departments filled in the whole questionnaire (return rate, 63%). Seventy-nine per cent of the departments (n = 120/152) analyse dose data on a regular basis with considerable heterogeneity in the frequency (1-2 times per year, 45%, n = 54/120; every month, 35%, n = 42/120) and method of analysis. Manual analysis is carried out by 58% (n = 70/120) compared with 42% (n = 50/120) of departments using a DMS. Purchase of a DMS is planned by 43% (n = 30/70) of the departments with manual analysis. Real-time analysis of dose data is performed by 42% (n = 21/50) of the departments with a DMS; however, residents can access the DMS in clinical routine only in 20% (n = 10/50) of the departments. An interdisciplinary dose team, which among other things communicates dose data internally (63%, n = 76/120) and externally, is already implemented in 57% (n = 68/120) departments. CONCLUSION: Swiss radiological departments are committed to radiation safety. However, there is high heterogeneity among them regarding the frequency and method of dose data analysis as well as the use of DMS and radiation protection activities. KEY POINTS: • Swiss radiological departments are committed to and interest in radiation safety as proven by a 63% return rate of the survey. • Seventy-nine per cent of departments analyse dose data on a regular basis with differences in the frequency and method of analysis: 42% use a dose management software, while 58% currently perform manual dose data analysis. Of the latter, 43% plan to buy a dose management software. • Currently, only 25% of the departments add radiation exposure data to the final CT report.

Implementation of a patient dose monitoring system in conventional digital X-ray imaging: initial experiences.

OBJECTIVES: The purpose was to report on the initial experience after implementation of a patient dose-monitoring system in conventional X-ray imaging. METHODS: A dose-monitoring system collected dose data relating to different radiographs (one projection) and studies (two or more projections). Images were acquired on digital X-ray systems equipped with flat-panel detectors. During period 1, examinations were performed in a routine fashion in 12,614 patients. After period 1, technical modifications were performed and radiographers underwent training in radiation protection. During period 2, examinations were performed in 14,514 patients, and the radiographers were advised to read dose data after each radiograph/study. Dose data were compared by means of kerma area product (KAP, gray × centimetre squared) and entrance surface air kerma (ESAK, milligray). RESULTS: During period 1, 13,955 radiographs and 8,466 studies were performed, and in period 2 16,090 radiographs and 10,389 studies. In period 2, KAP values for radiographs were an average of 25 % lower and for studies 7 % lower, and ESAK values for radiographs were 24 % lower and for studies 5 % lower. The reduction in KAP was significant in 8/13 radiographs and in 6/14 studies, and the reduction in ESAK was significant in 6/13 radiographs and 5/14 studies. CONCLUSIONS: Implementation of a patient dose-monitoring system in conventional X-ray imaging allows easy data collection, supports dose reduction efforts, and may increase radiographers' dose awareness. KEY POINTS: • A dose-monitoring system enables easy dose data collection in X-ray imaging. • The system facilitates dose reduction efforts and may increase radiographers' radiation awareness. • Mean kerma-area-product significantly declined in period 2 in 8/13 radiographs and 6/14 studies. • In ESAK a significant decline was evident in 6/13 radiographs and 5/14 studies.

Establishing Local Diagnostic Reference Levels in IR Procedures with Dose Management Software.

PURPOSE: To obtain local diagnostic reference levels (DRLs) in diagnostic and therapeutic IR procedures with dose management software to improve radiation protection. MATERIALS AND METHODS: Dose data of various vascular and nonvascular IR procedures performed within 18 months were collected and analyzed with dose management software. To account for different levels of complexity, procedures were subdivided into simple, standard, and difficult procedures as graded by interventional radiologists. Based on these analyses, local DRLs (given as kerma-area product [KAP]) were proposed. Comparison with dose data of others was conducted, and Spearman correlation coefficients were calculated to evaluate relationships between dose metrics. RESULTS: Analysis included 1,403 IR procedures (simple/standard/difficult, n = 346/702/355). Within the same procedure, KAP tended to increase with level of complexity. Overall, very strong correlation between KAP (Gy ∙ cm2) and cumulative air kerma (KA,R; Gy) was observed, and moderate to strong correlation between KAP and time and KA,R and time was observed. For simple procedures, strong correlation was seen between KAP and time and KA,R and time; for standard and difficult procedures, only moderate correlation was seen. Correlation between KAP and time and KA,R and time was strong in nonvascular procedures but only moderate in vascular procedures. CONCLUSIONS: Dose management software can be used to derive local DRLs for various IR procedures, taking into consideration different levels of complexity. Proposed local DRLs can contribute to obtaining detailed national DRLs as part of efforts to improve patients' radiation protection further.

Combined Use of a Patient Dose Monitoring System and a Real-Time Occupational Dose Monitoring System for Fluoroscopically Guided Interventions.

PURPOSE: To determine the effect on patient radiation exposure of the combined use of a patient dose monitoring system and real-time occupational dose monitoring during fluoroscopically guided interventions (FGIs). MATERIALS AND METHODS: Patient radiation exposure, in terms of the kerma area product (KAP; Gy ∙ cm(2)), was measured in period 1 with a patient dose monitoring system, and a real-time occupational dose monitoring system was additionally applied in period 2. Mean/median KAP in 19 different types of FGIs was analyzed in both periods for two experienced interventional radiologists combined as well as individually. Patient dose and occupational dose were correlated, applying Pearson and Spearman correlation coefficients. RESULTS: Although FGIs were similar in numbers and types over both periods, a substantial decrease was found for period 2 in total mean ± SD/median KAP for both operators together (period 1, 47 Gy ∙ cm(2) ± 67/41 Gy ∙ cm(2); period 2, 37 Gy ∙ cm(2) ± 69/34 Gy ∙ cm(2)) as well as for each individual operator (for all, P < .05). Overall, KAP declined considerably in 15 of 19 types of FGIs in period 2. Mean accumulated dose per intervention was 4.6 µSv, and mean dose rate was 0.24 mSv/h. There was a strong positive correlation between patient and occupational dose (r = 0.88). CONCLUSIONS: Combined use of a patient dose monitoring system and a real-time occupational dose monitoring system in FGIs significantly lessens patient and operator doses.

Does Real-Time Monitoring of Patient Dose With Dose Management Software Increase CT Technologists' Radiation Awareness?

OBJECTIVE: Dose management software can be used to increase patient safety. The purpose of the current study was to evaluate whether real-time monitoring of patient dose in CT examinations increases CT technologists' dose awareness. MATERIALS AND METHODS: Dose data of two scanners (clinical routine CT scanner, mainly outpatients; emergency CT scanner, predominantly emergency department and ICU patients) were analyzed before (period 1) and after (period 2) dose management software was implemented in clinical routine and technologists were advised to check for dose notifications (dose values above reference levels) after each examination (i.e., real-time monitoring). To assess statistically significant differences between both the scanners and the study periods, we used chi-square tests. RESULTS: A total of 6413 examinations were performed (period 1 = 3214 examinations, period 2 = 3199 examinations). Dose notifications were mainly because of patient miscentering (period 1 = 45% of examinations, period 2 = 23%), overweight patients (period 1 = 35%, period 2 = 49%), and scanning repetition (period 1 = 10%, period 2 = 15%). Overall, the number of dose notifications significantly declined in period 2 (period 1, n = 210; period 2, n = 120; p < 0.001). Miscentering was more often seen on the clinical routine CT examinations (period 1 = 46%, period 2 = 23%) than on the emergency CT examinations (period 1 = 44%, period 2 = 22%) and occurred significantly less frequently on both scanners in period 2 (period 1: n = 94; period 2: n = 27; p < 0.001). The relative values of dose notifications due to overweight patients or scanning repetition were higher in period 2, but these differences did not reach statistical significance (p > 0.05). CONCLUSION: Real-time monitoring of patient dose with dose management software increases CT technologists' dose awareness and leads to a reduced number of dose notifications due to human error.

Improving Patient Safety: Implementing Dose Monitoring Software in Fluoroscopically Guided Interventions.

PURPOSE: To assess whether dose monitoring software can be successfully implemented in fluoroscopically guided interventions and to provide dose data based on levels of complexity. MATERIALS AND METHODS: After launching the software (DoseWatch; GE Healthcare Systems, Buc, France), data were collected for 6 months and analyzed by means of kerma-area product (KAP; Gy/cm(2)), cumulative air kerma (KA,R; Gy), and fluoroscopic time (minutes). Data analysis was executed by level of complexity as graded by the operators. Complexity grading was based on factors such as tortuosity and calcification of vessel, variant anatomy, and patient cooperation. RESULTS: The software successfully transferred dose data of 357 fluoroscopically guided procedures. KAP was 0.238-400 Gy/cm(2) with mean, median, and 75th percentile values of 46.0 Gy/cm(2), 163.2 Gy/cm(2), and 541.1 Gy/cm(2) (KA,R, 0.013-4.1 Gy; mean, median, 75th percentile, 0.48 Gy, 0.97 Gy, 3.98 Gy). Highest dose values were seen in transarterial chemoembolization (KAP mean, median, 75th percentile, 229.5 Gy/cm(2), 216.4 Gy/cm(2), 299.9 Gy/cm(2); KA,R mean, median, 75th percentile, 1.9 Gy, 1.2 Gy, 1.7 Gy). Analysis revealed that the level of complexity strongly correlated with KAP (r = 0.88; P < .001) whereas there was no direct correlation of KAP and fluoroscopy time. During the same intervention, KA,R and fluoroscopy time increased with level of complexity, but the correlation was not statistically significant. CONCLUSIONS: Implementation of dose monitoring software in fluoroscopically guided interventions can be successfully accomplished, and it facilitates data comparison.

Association of time-to-levodopa with initial Parkinsonian medication: a retrospective cohort study.

OBJECTIVES: To determine the initial distribution of medication in patients with de novo Parkinson's disease (PD), to estimate the share of patients who not receive a recommended initial therapy according to current German guidelines, and to compare the time-to-levodopa. METHODS: We used the Disease Analyzer database (IMS HEALTH), containing basic medical data from ~20 million patients in Germany. The primary outcome was the therapy change rate from initial treatment to levodopa estimated by Kaplan-Meier analyses. A Cox proportional hazards model was used to estimate the relationship between time-to-levodopa and confounders for a maximum follow-up of 10 years (between January 2002 and December 2011). Adjusted hazard ratios (HR) and 95% confidence intervals (CI) are presented for change-to-levodopa rate. RESULTS: A representative sample of de-novo patients diagnosed with PD was drawn (n=108,885). 71.8% of patients received levodopa as a first line treatment. 29,708 patients started with other anti-PD substances: 13.3% with dopamine agonists (DA), 3.6% with amantadine, 5.9% with anticholinergics, and 0.8% with monoamine oxidase B (MAO-B) inhibitors. Therefore, the proportion of patients who not receive a recommended initial therapy according to current German guidelines was ~10%. 29.0% of patients not starting with levodopa switched to levodopa within 5 years. After 5 years, more than 80% of PD patients using anticholinergics as their initial treatment remained levodopa-free. MAOB- inhibitors and DAs showed significantly lower proportions of levodopa-free patients after 5 years (35% and 55%, respectively). Compared to MAO-B inhibitors, the HR for switching to levodopa was 0.38 (CI 0.34-0.43; p<0.001) for anticholinergics and 0.85 (CI 0.75-0.97; p=0.017) for nonergot DA. CONCLUSIONS: Surprisingly, initial treatment with anticholinergics is correlated with the longest delay of levodopa treatment among all monotherapies. Our results suggest re-evaluating the comparative effectiveness of all initial PD treatments in head-tohead comparisons.

Use of antidiabetic agents in the treatment of gestational diabetes mellitus in Germany, 2008-2012.

AIM: Adequate blood glucose control during pregnancy is important because gestational diabetes mellitus (GDM) is known to have adverse effects on the mother and child. Due to an increasing prevalence of GDM in recent years, more information on the use of different antidiabetic agents is required, which was the aim of the present study. MATERIAL AND METHODS: Data from 32 diabetic practices in Germany were collected from January 2008 to December 2012 and analyzed using the Disease Analyzer Database. All women with International Classification of Diseases diagnosis O24 (that is, GDM) participated, except for patients with known type I or II diabetes mellitus, who were excluded. Analysis focused on the proportion of women requiring drug treatment in general. Thereafter, subanalysis was performed with a focus on the administration of different antidiabetic agents, namely insulin, metformin, and sulfonylurea. RESULTS: Within the given timeframe, medication-based treatment for GDM significantly rose to reach 30.8% of all women with GDM. Both the administration of insulin and metformin grew considerably within the 5-year period with metformin being increasingly used without supplemental insulin and at lower dosages. Within the insulin treatment arm, insulin analogues became increasingly important. The proportion of sulfonylurea remained stable (0.2%). CONCLUSIONS: GDM is more often treated with antidiabetic agents and, due to the fact that metformin is more frequently prescribed, it can be assumed that it is increasingly regarded as a safe and effective alternative to insulin.

Abdominal aortic calcification and its distribution in normal-sized and aneurysmatic abdominal aortas.

BACKGROUND: Multi-detector computed tomography (MDCT) is more and more used for evaluation and quantification of coronary artery calcification, but correlation between the degree of calcification and occurrence of clinical events is also known for other vascular beds such as the aorta. PURPOSE: To assess possible differences in amount and pattern of calcification in aneurysmatic and non-aneurysmatic abdominal aortas. PATIENTS AND METHODS: Thirty-four subjects displayed infrarenal abdominal aneurysm (AAA) and were compared to 33 patients with normal-sized aortas using MDCT. Quantitative and qualitative analysis was performed by two radiologists. Calcium scores were assessed for the whole abdominal aorta as well as separately for the supra- and infrarenal segments. Moreover, plaque patterns were evaluated and classified according to their thickness and size. Furthermore, calcium scores were correlated with a number of cardiovascular risk factors. RESULTS: Total calcium scores were comparable in patients with and without AAA (1,213 ± 1,351 and 1,211 ± 1,535, respectively), but significant differences were found regarding plaque density that was considerably higher both in the supra- and infrarenal segments in the non-aneurysmatic group (AAA: suprarenal, 0.01, infrarenal, 0.07; non-AAA: suprarenal, 0.06, infrarenal, 0.16). Plaque pattern were considerably different in the infrarenal segments in aneurysmatic aortas: they were thinner (1 and 2 mm) and smaller (< 100 mm2) than in normal-sized aortas (mainly > 3mm and > 100 mm2). Distribution of risk factors was similar in both groups with the highest mean calcium score being present in patients with 4 risk factors. Pearson's correlation coefficient indicating correlation between total calcium score and number of risk factors was almost the same in both groups: AAA, r = 0.67; non-AAA, r = 0.65. CONCLUSIONS: Compared to normal-sized aortas thinner and smaller plaques are present in AAA, which may be due to degenerative processes.

A large-scale study on subjective perception of discomfort during 7 and 1.5 T MRI examinations.

A study on subjective perception has been carried out in order to gain further insight into subjective discomfort and sensations experienced during 7 T magnetic resonance imaging (MRI). This study provides information about subjective acceptance, which is essential if 7 T MRI is to become a clinical diagnostic tool. Of 573 subjects who underwent 7 T MRI, 166 were also examined at 1.5 T, providing a means of discriminating field-dependent discomfort. All subjects judged sources of discomfort and physiological sensations on an 11-point scale (0 = no side effects, 10 = intolerable side effects) and scores were analyzed separately for exam phases, with and without table movement at each field strength. Results revealed that 7 T MRI was, in general, judged more uncomfortable than 1.5 T; however, most subjects rated the effects as being non-critical (mean scores between 0.5 and 3.5). Significant differences were detected regarding vertigo and sweating between subjects positioned "head-first" and "feet-first" at 7 T (worse in "head-first") and between 7 and 1.5 T (worse at 7 T), with the effects being more pronounced in the moving compared to the stationary table position. The most unpleasant factor at 7 T was the extensive examination duration, while potentially field-dependent sensations were rated less bothersome. In summary, our study indicates that although certain sensations increase at 7 T compared to 1.5 T, they are unlikely to hinder the use of 7 T MRI as a clinical diagnostic tool.

Single breath-hold magnetic resonance cine imaging for fast assessment of global and regional left ventricular function in clinical routine.

OBJECTIVE: To evaluate a TGRAPPA (temporal parallel acquisition technique)-accelerated, single breath-hold multi-slice cine imaging approach for the assessment of left ventricular (LV) function. METHODS: One hundred eleven patients were examined at 1.5 T. Cine imaging was performed with single-slice breath-hold acquisitions in short-axis orientation using a SSFP (TR 2.63 ms, TE 1.12 ms, FA 72°) sequence and a TGRAPPA SSFP (TR 2.66 ms, TE 1.11 ms, FA 72°, AF 3) sequence, which covered the entire LV in multiple short-axis slices during a single breath-hold. End-diastolic (EDV), end-systolic (ESV), stroke volumes (SV), ejection fraction (EF), muscle mass (MM) and regional wall motion were assessed for both data sets. RESULTS: Single breath-hold imaging was feasible in 108 patients. Excellent correlations were observed for all volumetric parameters derived from both data sets (all r > 0.97). While EDV and ESV showed marginally lower values for single breath-hold imaging (EDV: -1.6 ± 7.9 ml; ESV: -1.8 ± 6.0 ml, p < 0.05), no differences were observed for SV, EF, MM and regional wall motion assessment. Single breath-hold imaging required significant shorter acquisition times (28 ± 6 s vs. 335 ± 87 s). CONCLUSION: TGRAPPA-accelerated multi-slice SSPF imaging allows for fast and accurate assessment of regional and global LV function within a single breath-hold.

Focal liver lesions: detection and characterization at double-contrast liver MR Imaging with ferucarbotran and gadobutrol versus single-contrast liver MR imaging.

PURPOSE: To retrospectively compare, in a multiobserver study, double-contrast-material (sequential administration of ferucarbotran and gadobutrol) magnetic resonance (MR) imaging with single-contrast-material ferucarbotran-enhanced and dynamic postferucarbotran gadobutrol-enhanced MR imaging for the detection and characterization of benign and malignant focal liver lesions. MATERIALS AND METHODS: This study was institutional review board approved, and the requirement for informed patient consent was waived. Eighty-nine patients with a total of 128 focal liver lesions underwent double-contrast liver MR imaging (nonenhanced, ferucarbotran-enhanced, and dynamic postferucarbotran gadobutrol-enhanced MR imaging performed during one session). Four readers independently reviewed the data sets during three reading sessions focused on focal liver lesion detection and characterization: In session 1, the nonenhanced and dynamic postferucarbotran gadobutrol-enhanced images obtained at double-contrast MR imaging were analyzed. In session 2, the nonenhanced and ferucarbotran-enhanced images were analyzed. In session 3, all MR images were analyzed together. The diagnostic performance of each MR technique and each reader was evaluated by using receiver operating characteristic (ROC) analysis; differences between postferucarbotran gadobutrol-enhanced, ferucarbotran-enhanced, and double-contrast MR imaging were assessed at Wilcoxon signed rank testing; and interreader agreement was assessed at Cohen kappa analysis. Histopathologic confirmation or an unchanged clinical course or MR finding was the reference standard. RESULTS: The four readers' detection of the benign and malignant lesions was not significantly different (P > or = .11) between the three MR techniques. The benign and malignant focal liver lesions were differentiated with significantly higher confidence (P < or = .01) on the double-contrast (area under ROC curve [A(z)] = 0.988) and ferucarbotran-enhanced (A(z) = 0.985) MR images than on the dynamic gadobutrol-enhanced images (A(z) = 0.963). Accuracy in the diagnosis of hepatocellular carcinoma (HCC) was highest (P = .02) and confidence in the final diagnosis of HCC (P = .001) or metastasis (P = .049) was significantly higher with double-contrast imaging. CONCLUSION: In select cases, double-contrast MR imaging can improve diagnostic accuracy and increase confidence in characterizing focal liver lesions as HCC or metastasis.

MR angiography with parallel acquisition for assessment of the visceral arteries: comparison with conventional MR angiography and 64-detector-row computed tomography.

The purpose of the study was to retrospectively compare three-dimensional gadolinium-enhanced magnetic resonance angiography (conventional MRA) with MRA accelerated by a parallel acquisition technique (fast MRA) for the assessment of visceral arteries, using 64-detector-row computed tomography angiography (MDCTA) as the reference standard. Eighteen patients underwent fast MRA (imaging time 17 s), conventional MRA (29 s) and MDCTA of the abdomen and pelvis. Two independent readers assessed subjective image quality and the presence of arterial stenosis. Data were analysed on per-patient and per-segment bases. Fast MRA yielded better subjective image quality in all segments compared with conventional MRA (P = 0.012 for reader 1, P = 0.055 for reader 2) because of fewer motion-induced artefacts. Sensitivity and specificity of fast MRA for the detection of arterial stenosis were 100% for both readers. Sensitivity of conventional MRA was 89% for both readers, and specificity was 100% (reader 1) and 99% (reader 2). Differences in sensitivity between the two types of MRA were not significant for either reader. Interobserver agreement for the detection of arterial stenosis was excellent for fast (kappa = 1.00) and good for conventional MRA (kappa = 0.76). Thus, subjective image quality of visceral arteries remains good on fast MRA compared with conventional MRA, and the two techniques do not differ substantially in the grading of arterial stenosis, despite the markedly reduced acquisition time of fast MRA.

Referring Physicians Assess the Quality of Outpatient Diagnostic Imaging Services: Development and Psychometric Evaluation of a Questionnaire.

GOAL: In order to ensure high-quality cooperation between referring physicians and imaging services, it is important to assess the quality of imaging services as perceived by referring physicians. The present study aimed to develop and validate a questionnaire for referring physicians to assess the quality of outpatient diagnostic imaging services. MATERIALS & METHODS: The questionnaire was developed by discussing and modifying an existing instrument by the German Association of Surgeons. After qualitative pretesting, the instrument was tested with physicians referring to four outpatient diagnostic imaging services in Switzerland. The results were first assessed using descriptive statistics. The final instrument was tested for validity using the concept of known-groups validity. The hypothesis underlying this procedure was that physicians referring frequently to services estimated the quality of these services to be higher than physicians who referred less often to services. The differences in ratings were assessed using a one-sided two-sample Wilcoxon test. The final questionnaire was tested for internal consistency and reliability using Cronbach's Alpha. RESULTS: Results show a high level of satisfaction of referring physicians with the relevant services but also potential for quality improvement initiatives. The psychometric evaluation of the final questionnaire shows that it is a valid instrument, showing significant differences between the ratings of physicians referring with high and low frequency. Furthermore, the instrument proves to be consistent and reliable. CONCLUSION: The final instrument presents a valid, consistent and reliable option for assess the quality of outpatient diagnostic imaging services as perceived by referring physicians. Results can be used as a basis for quality improvement. KEY POINTS: · A newly developed questionnaire assesses the quality of outpatient diagnostic imaging services as perceived by referring physicians. The questionnaire was developed and tested in Switzerland.. · Psychometric evaluation showed the questionnaire to be a valid, consistent and reliable instrument.. · Results are of interest for imaging services as well as for initiatives encompassing several services.. CITATION FORMAT: · Jossen M, Valeri F, Heilmaier C et al. Referring Physicians Assess the Quality of Outpatient Diagnostic Imaging Services: Development and Psychometric Evaluation of a Questionnaire. Fortschr Röntgenstr 2019; 191: 725 - 731.

Accuracy of myocardial viability imaging by cardiac MRI and PET depending on left ventricular function.

AIM: To compare myocardial viability assessment accuracy of cardiac magnetic resonance imaging (CMR) compared to [18F]-fluorodeoxyglucose (FDG)- positron emission tomography (PET) depending on left ventricular (LV) function. METHODS: One-hundred-five patients with known obstructive coronary artery disease (CAD) and anticipated coronary revascularization were included in the study and examined by CMR on a 1.5T scanner. The CMR protocol consisted of cine-sequences for function analysis and late gadolinium enhancement (LGE) imaging for viability assessment in 8 mm long and contiguous short axis slices. All patients underwent PET using [18F]-FDG. Myocardial scars were rated in both CMR and PET on a segmental basis by a 4-point-scale: Score 1 = no LGE, normal FDG-uptake; score 2 = LGE enhancement < 50% of wall thickness, reduced FDG-uptake ( ≥ 50% of maximum); score 3 = LGE ≥ 50%, reduced FDG-uptake (< 50% of maximum); score 4 = transmural LGE, no FDG-uptake. Segments with score 1 and 2 were categorized "viable", scores 3 and 4 were categorized as "non-viable". Patients were divided into three groups based on LV function as determined by CMR: Ejection fraction (EF), < 30%: n = 45; EF: 30%-50%: n = 44; EF > 50%: n = 16). On a segmental basis, the accuracy of CMR in detecting myocardial scar was compared to PET in the total collective and in the three different patient groups. RESULTS: CMR and PET data of all 105 patients were sufficient for evaluation and 5508 segments were compared in total. In all patients, CMR detected significantly more scars (score 2-4) than PET: 45% vs 40% of all segments (P < 0.0001). In the different LV function groups, CMR found more scar segments than PET in subjects with EF< 30% (55% vs 46%; P < 0.0001) and EF 30%-50% (44% vs 40%; P < 0.005). However, CMR revealed less scars than PET in patients with EF > 50% (15% vs 23%; P < 0.0001). In terms of functional improvement estimation, i.e., expected improvement after revascularization, CMR identified "viable" segments (score 1 and 2) in 72% of segments across all groups, PET in 80% (P < 0.0001). Also in all LV function subgroups, CMR judged less segments viable than PET: EF < 30%, 66% vs 75%; EF = 30%-50%, 72% vs 80%; EF > 50%, 91% vs 94%. CONCLUSION: CMR and PET reveal different diagnostic accuracy in myocardial viability assessment depending on LV function state. CMR, in general, is less optimistic in functional recovery prediction.

Mapping of hepatic vascular anatomy: dynamic contrast-enhanced parallel MR imaging compared with 64 detector row CT.

UNLABELLED: The study was approved by the institutional review board, and informed consent was obtained from all patients. The purpose of this study was to retrospectively evaluate the feasibility, reliability, and accuracy of breath-hold dynamic contrast material-enhanced parallel gradient-echo (GRE) magnetic resonance (MR) imaging for mapping the hepatic vascular anatomy, with contrast-enhanced 64-detector row computed tomography (CT) as the reference standard. The parallel GRE MR data sets of 100 patients acquired at 1.5 T were evaluated independently by two blinded readers with respect to (a) image quality for depiction of the hepatic arteries and the portal and hepatic veins and (b) presence of arterial stenosis and variant hepatic vasculature. The readers rated image quality to be good or excellent for 91.1%-100% of the vessels. At parallel GRE MR imaging, the readers diagnosed variant hepatic vessels and arterial stenosis with 94%-100% accuracy. They concluded that parallel GRE MR imaging, as compared with 64-detector row CT, is feasible for hepatic vascular mapping and enables reliable and accurate detection of variant hepatic vasculature and diagnosis of arterial stenosis. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/2453062103/DC1.

The proinflammatory cytokine interleukin 1beta and hypoxia cooperatively induce the expression of adrenomedullin in ovarian carcinoma cells through hypoxia inducible factor 1 activation.

Adrenomedullin (ADM) is a potent hypotensive peptide produced by macrophages and endothelial cells during ischemia and sepsis. The molecular mechanisms that control ADM gene expression in tumor cells are still poorly defined. It is known, however, that hypoxia potently increases ADM expression by activation of the transcription factor complex hypoxia inducible factor 1 (HIF-1). Proinflammatory cytokines produced by tumor invading macrophages likewise activate expression of ADM. Herein, we show that apart from hypoxia, the proinflammatory cytokine interleukin 1beta (IL-1beta) induced the expression of ADM mRNA through activation of HIF-1 under normoxic conditions and enhanced the hypoxia-induced expression in the human ovarian carcinoma cell line OVCAR-3. IL-1beta significantly increased accumulation and nuclear translocation of HIF-1alpha under normoxic conditions and amplified hypoxic HIF-1 activation. IL-1beta treatment affected neither HIF-1alpha mRNA levels nor the hydroxylation status of HIF-1alpha and, thus, stability of the protein. Instead cycloheximide effectively prevented the increase in HIF-1alpha protein, indicating a stimulatory effect of IL-1beta on HIF-1alpha translation. Finally, treatment of HIF-1alpha with short interfering RNA revealed a significant role for HIF-1 in the IL-1beta-dependent stimulation of ADM expression.

Effects of selected antidiabetics on weight loss--a retrospective database analysis.

AIMS: In published studies metformin was often associated with weight loss in type 2 diabetes patients. Until now, no epidemiological studies have directly compared the effects of DPP-4 and GLP-1 versus metformin on weight loss. Our study is a comparison of sulfonylurea, DPP-4 and GLP-1 with metformin regarding body weight in type 2 diabetes patients. METHODS: Data from 2641 patients initiated therapy with either metformin, sulfonylurea, DPP-inhibitors or GLP-1 with baseline BMI >30 were retrospectively analyzed (Disease Analyzer Germany: 11/2008-10/2012). Comparison was performed for the weight change after 1 year of therapy compared with the last value prior to therapy. Differences between SU, DPP-4, GLP-1 versus metformin were estimated using regression model adjusted for age, gender, health insurance status, defined co-diagnoses and body weight at baseline. RESULTS: In absolute values, metformin patients lost an average of 2.6 kg, subjects treated with SU gained 0.3 kg, body weight in the DPP-4 group decreased by 1.8 kg and GLP-1 patients lost 3.3 kg in body weight after 1 year. After adjustment for other variables, comparisons with metformin revealed the following results: SU +3.4 kg (p < 0.001), DPP-4 +1.0 kg (p = 0.003) and GLP-1 -0.4 kg (p = 0.589). CONCLUSION: Our study showed that GLP-1 treatment was comparable to metformin regarding the weight reduction, while sulfonylurea and DPP-4 are inferior in this regard.