Exploiting endovascular aortic repair as a minimally invasive method - Nine years of experience in a non-university hospital.

Background: At the introduction of endovascular aortic repair (EVAR) in 2013 in our non-university hospital, we established a quality registry to monitor our EVAR activity. Purpose: To observe if we over time were able to exploit EVAR as a minimally invasive method in an elective as well as emergency setting, and to monitor our treatment quality in terms of complications, secondary interventions and mortality. Material and methods: From November 2013 to March 2022, we treated 207 patients with EVAR, including six patients with rupture. Follow-up regimen was partly based on contrast-enhanced computer tomography, and partly on contrast-enhanced ultrasound in combination with plain radiography. Results: During the observation period, the method of anesthesia changed from general, via spinal, to local anesthesia. The groin access changed from surgical cut down to percutaneous and the median length of postoperative stay decreased from 3 days to 1 day. EVAR on ruptured aneurysm was done for the first time in 2019. Endoleak was detected in 85 patients (42%) and 37 patients (18%) had one or more secondary interventions, of which 85% were endovascular. Estimated five-year survival was 72% in patients below 80 years of age and 45% in patients 80 years or older. Conclusion: Nine years of experience enabled us to exploit EVAR's advantages as a minimally invasive method in an elective as well as emergency setting. Complications, secondary interventions and survival rates in our low volume non-university hospital matches results from larger vascular centers.

Application of adaptive non-linear 2D and 3D postprocessing filters for reduced dose abdominal CT.

BACKGROUND: Abdominal computed tomography (CT) is a frequently performed imaging procedure, resulting in considerable radiation doses to the patient population. Postprocessing filters are one of several dose reduction measures that might help to reduce radiation doses without loss of image quality. PURPOSE: To assess and compare the effect of two- and three-dimensional (2D, 3D) non-linear adaptive filters on reduced dose abdominal CT images. MATERIAL AND METHODS: Two baseline abdominal CT image series with a volume computer tomography dose index (CTDI (vol)) of 12 mGy and 6 mGy were acquired for 12 patients. Reduced dose images were postprocessed with 2D and 3D filters. Six radiologists performed blinded randomized, side-by-side image quality assessments. Objective noise was measured. Data were analyzed using visual grading regression and mixed linear models. RESULTS: All image quality criteria were rated as superior for 3D filtered images compared to reduced dose baseline and 2D filtered images (P < 0.01). Standard dose images had better image quality than reduced dose 3D filtered images (P < 0.01), but similar image noise. For patients with body mass index (BMI) < 30 kg/m(2) however, 3D filtered images were rated significantly better than normal dose images for two image criteria (P < 0.05), while no significant difference was found for the remaining three image criteria (P > 0.05). There were no significant variations of objective noise between standard dose and 2D or 3D filtered images. CONCLUSION: The quality of 3D filtered reduced dose abdominal CT images is superior compared to reduced dose unfiltered and 2D filtered images. For patients with BMI < 30 kg/m(2), 3D filtered images are comparable to standard dose images.

Shift in imaging modalities of gastrointestinal tract through 25 years and its impact on patient ionizing radiation doses.

We wanted to explore the shift in modalities when diagnosing the gastrointestinal tract through the last three decades and see how this has influenced on the radiation doses given to this patient population. Activity reports from a central hospital in the years of 1979-2003 have been reviewed. The x-ray based modalities have decreased, while there has been a marked increase in colonoscopies, gastroscopies, ultrasound, and magnetic resonance cholangiopancreatography. This has caused a reduction in collective effective radiation dose of 54%.

Shift in imaging modalities of the spine through 25 years and its impact on patient ionizing radiation doses.

STUDY DESIGN: Retrospective. OBJECTIVE: To explore the shift in modalities when diagnosing the spine in the years 1979-2003. To see how this shift, together with a radiation protective policy, have influenced on the ionizing radiation doses. SUMMARY OF BACKGROUND DATA: The shift from CT/myelography to MR when diagnosing the spine is well known. To what extent this has changed the radiation doses has to our knowledge not yet been published. METHODS: Activity reports from a department of radiology have been reviewed. Relevant radiation doses estimates have been obtained from the Norwegian Radiation Protection Authority. RESULTS: MRI was introduced in 1992 and has been used increasingly since then. Conventional X-ray to the spine has been practically unchanged. Myelography and CT decreased markedly after the introduction of MRI. The total number of examinations of the spine has increased, but the radiation doses given have decreased since 1993. CONCLUSIONS: The introduction of MRI together with a radiation protective policy have reduced the ionizing radiation doses given to this population, in spite of an increase in the total number of examinations of the spine.

Corynebacterium pseudotuberculosis Pneumonia in a Veterinary Student Infected During Laboratory Work.

We present a case of Corynebacterium pseudotuberculosis pneumonia in a veterinary student, with molecular genetic evidence of acquisition during laboratory work, an observation relevant for laboratory personnel working with C pseudotuberculosis isolates. The patient was clinically cured with 14 months trimethoprim/sulfamethoxazole and rifampicin combination treatment.

Radiation knowledge and perception of referral practice among radiologists and radiographers compared with referring clinicians.

OBJECTIVES: To explore if the perception of radiologists and radiographers on referral practice differs from that of referring clinicians, and to see if knowledge of radiation issues and referral guidelines differ between these groups. METHODS: A questionnaire was handed out to 46 radiologists and 36 radiographers in Norway. Findings were compared to corresponding results from a similar already published study on clinicians. Questions dealt with referrals unlikely to affect treatment as well as respondents' radiation and referral guideline knowledge. RESULTS: Radiographers estimated the highest proportion of referrals most unlikely to affect treatment (median 20 %) in comparison to radiologists (10 %) and clinicians (5 %). Lack of time, compensating for limited clinical examination and patient expectations were rated as more important reasons for such referrals by radiologists than by clinicians. Radiologists and radiographers possessed significantly better radiation knowledge than clinicians, and were more familiar with referral guidelines. CONCLUSIONS: The perception of radiologists and radiographers differs from that of clinicians, concerning the use of imaging most unlikely to affect treatment, and the reasons for such referrals. Radiologists and radiographers possess better radiation knowledge than referring clinicians, but all groups have a potential in improving their radiation protection knowledge. MAIN MESSAGES: • Radiographers estimated the highest proportion of referrals most unlikely to affect treatment. • Radiologists rated "getting the patient discharged" as an important reason for such referrals. • Radiologists and radiographers possess significantly better radiation knowledge than clinicians.

Clinicians' justification of imaging: do radiation issues play a role?

OBJECTIVE: To explore clinicians' knowledge and consideration of radiation, in relation to their referral practice and use of referral guidelines for imaging. METHODS: A questionnaire was handed out to 213 clinicians in Norway; all responded: 77 general practitioners, 71 hospital physicians and 65 non-physicians (55 manual physiotherapists, 10 chiropractors). Questions concerned weighting of radiation dose, guideline use, referrals unlikely to affect treatment, doses from imaging procedures, ranking of imaging as radiation source, and deterministic and stochastic effects. For radiation knowledge, a total score was aggregated. RESULTS: The mean radiation knowledge score was 30.4/71. Most respondents underestimated doses from high-dose imaging, e.g., barium enema (94.7%), chest CT (57.7%) and abdominal CT (52.7%). Limited radiation knowledge was not compensated by using guidelines. Only 20% of physicians and 72% of non-physicians used referral guidelines. Non-physicians weighted radiation dose as being more important than physicians when referring; they also reported fewer referrals as being unlikely to affect treatment. Such referrals and not using guidelines were related to lower weighting of radiation dose but not to radiation knowledge. CONCLUSION: Limited radiation knowledge and guideline use indicate suboptimal justification of referrals. When justifying imaging, weighting of radiation dose may play a larger role than detailed radiation knowledge.

Shift in imaging modalities of the urinary tract over a 25-year period and its impact on ionizing radiation doses given to patients.

OBJECTIVES: To explore the shift in imaging modalities used when examining the urinary tract over the period 1979-2003 and to see how this shift, together with a radiation protection policy, have influenced the doses of ionizing radiation used. MATERIAL AND METHODS: Activity reports from a department of radiology were reviewed. Relevant radiation dose estimates were obtained from the Norwegian Radiation Protection Authority. RESULTS: Ultrasound (US) was introduced in 1983 and has been increasingly used since then. MRI was introduced in 1992 and has been used to some extent when examining the urinary tract. The use of i.v. pyelography decreased by 50% during the review period and the use of plain radiographs remained practically unchanged. The number of CT examinations increased until 1983, but decreased thereafter. The total number of examinations of the urinary tract has increased during the review period, but the radiation doses given have decreased. CONCLUSIONS: The introduction of US and MRI, together with a radiation protection policy, have reduced the ionizing radiation doses given to this population, in spite of an increase in the total number of examinations of the urinary tract.