Complication Rates and Risk of Recurrence After Percutaneous Radiofrequency Ablation and Microwave Ablation for the Treatment of Liver Tumors: a Meta-analysis.

RATIONALE AND OBJECTIVES: The rate of complications and risk of local recurrence following percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for liver tumors varies significantly between investigations. This meta-analysis aimed to assess complication rates and risk of local recurrence after percutaneous RFA and MWA. MATERIALS AND METHODS: PubMed, Medline, Web of Science, the Cochrane Library, Embase, Google Scholar, and CINAHL were systematically searched from database inception until August 2022 to retrieve articles reporting the complication rates and risk of recurrence after percutaneous RFA and MWA for the treatment of liver tumors. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated and displayed by forest plots. To measure heterogeneity, Cochran Q and I2 statistics were also applied. Egger's test and funnel plots were also performed to assess any potential publication bias. Additionally, subgroup analysis was done to investigate the source of heterogeneity. RESULTS: 26 studies including 2026 and 1974 patients for RFA and MWA, respectively, were included. The rate of minor complications was significantly higher after MWA compared to RFA, yielding an overall OR of 0.688 (95% CI: 0.549-0.862, P = 0.001). Similarly, the rate of major complications was significantly higher after MWA than RFA (P = 0.012), yielding an overall OR of 0.639 (95% CI: 0.450-0.907). No significant difference was found between RFA and MWA in terms of local recurrence after ablation (P > 0.05). In addition, there was no statistical evidence of publication bias. CONCLUSION: When most factors are considered equally, percutaneous RFA and MWA can be considered safe modalities for the treatment of liver tumors, with RFA superior in terms of the incidence of minor and major complications.

Assessment of Nursing Students' Awareness toward Ionizing Radiation: Cross-Sectional Study.

Among healthcare workers, nurses are considered the core of healthcare auth-info services in healthcare facilities because of their responsibilities and duties toward patients. All healthcare professionals, especially nurses, must be completely knowledgeable about the hazards of ionizing radiation, and the most effective radiation protection techniques. This study assessed the attitude and awareness toward radiation protection among final-year nursing students in the Fatima College of Health Sciences (FCHS) campuses. An online cross-sectional survey was conducted between March and April 2022. A total of 200 out of 224 female participants ranging from 18 to 30 years old agreed to participate in the study. The highest percentage of final-year nursing students did not attend any radiation protection course (52%). The results of the last section of the survey indicate a lack of awareness of basic radiation protection knowledge among final-year nursing students in FCHS campuses (less than 80%). The results showed a lack of knowledge and poor attitude toward radiation hazards and radiation protection from final-year nursing students in the FCHS. Formal education about basic radiation and radiation is recommended in the nursing program for safe clinical practice.

Establishing language laterality: does resting-state functional MRI help?

OBJECTIVE: Task-based functional MRI (tb-fMRI) is now considered the standard, noninvasive technique in establishing language laterality in children for surgical planning. The evaluation can be limited due to several factors such as age, language barriers, and developmental and cognitive delays. Resting-state functional MRI (rs-fMRI) offers a potential path to establish language dominance without active task participation. The authors sought to compare the ability of rs-fMRI for language lateralization in the pediatric population with conventional tb-fMRI used as the gold standard. METHODS: The authors performed a retrospective evaluation of all pediatric patients at a dedicated quaternary pediatric hospital who underwent tb-fMRI and rs-fMRI from 2019 to 2021 as part of the surgical workup for patients with seizures and brain tumors. Task-based fMRI language laterality was based on a patient's adequate performance on one or more of the following: sentence completion, verb generation, antonym generation, or passive listening tasks. Resting-state fMRI data were postprocessed using statistical parametric mapping, FMRIB Software Library, and FreeSurfer as described in the literature. The laterality index (LI) was calculated from the independent component (IC) with the highest Jaccard Index (JI) for the language mask. Additionally, the authors visually inspected the activation maps for two ICs with the highest JIs. The rs-fMRI LI of IC1 and the authors' image-based subjective interpretation of language lateralization were compared with tb-fMRI, which was considered the gold standard for this study. RESULTS: A retrospective search yielded 33 patients with language fMRI data. Eight patients were excluded (5 with suboptimal tb-fMRI and 3 with suboptimal rs-fMRI data). Twenty-five patients (age range 7-19 years, male/female ratio 15:10) were included in the study. The language laterality concordance between tb-fMRI and rs-fMRI ranged from 68% to 80% for assessment based on LI of independent component analysis with highest JI and for subjective evaluation by visual inspection of activation maps, respectively. CONCLUSIONS: The concordance rates between tb-fMRI and rs-fMRI of 68% to 80% show the limitation of rs-fMRI in determining language dominance. Resting-state fMRI should not be used as the sole method for language lateralization in clinical practice.

Impact of extended pre-scan written instructions on motion artifacts during head magnetic resonance imaging.

This study aimed to assess the effect of extending pre-scan written instructions to patients undergoing head magnetic resonance imaging (MRI) examinations on motion artifacts. A controlled study was conducted in King Fahad Hospital at the Department of Radiology. A total of 100 patients were involved: 50 received only routine oral hospital instructions (control group), and another 50 received pre-scan extended written instructions besides routine oral hospital instructions (intervention group). The head MRI images were assessed regarding motion artifacts. Informed consent was obtained from all patients included in the study. The incidence of motion artifacts was significantly less in the intervention group than in the control group, 10% and 58%, respectively (p-value=0.001). The motion artifacts decreased significantly in the intervention group compared to the control group. Extending written information before an MRI scan could significantly reduce motion artifacts and improve image quality.

Medical Radiation Safety and COVID-19 Knowledge and Awareness among UAE Residents: A Cross-Sectional Study.

Radiologic examinations are valuable tools in the evaluation of COVID-19. A patient-centered care approach encourages patient involvement in decision-making related to their health management. Therefore, patients should have basic knowledge about their disease and its evaluation tools. Therefore, the purpose of this prospective study is to evaluate the public level of knowledge and awareness regarding COVID-19 and radiation safety in the UAE. Methods: A cross-sectional survey study was conducted using an online questionnaire (Google platform). The data collection instrument contained close-ended questions in both Arabic and English. The questions aimed to collect demographic information and to measure the level of knowledge and awareness of COVID-19 and radiation safety. The questionnaire was distributed online using different social media platforms. Results: A total of 1548 participants have completed the questionnaire; 84% were females and 16% were males. The participants' average age was 24 years. Sixty-eight percent of the participants showed a high level of awareness of the COVID-19 pandemic, while most of the participants (51%) only showed a low level in the radiation safety awareness section. Factors such as Emirates of residence and passively receiving awareness information were shown to predict knowledge and awareness level. Conclusions: The UAE public was found to have a high level of knowledge and awareness about the COVID-19 disease. However, the same could not be said about radiation safety. More effort should be put towards raising the public's knowledge and awareness about the risk of radiation in order to enable them to participate actively in decisions regarding the radiologic management of their disease.

Spindle Cell/Sclerosing Rhabdomyosarcoma With PAX8::PPARG Fusion.

The spindle cell/sclerosing subtype of rhabdomyosarcoma is classified based on genetic features into the three categories of MYOD1-mutated, gene fusion-driven, and a subset without a currently identified genetic driver event. The gene fusion-driven spindle cell/sclerosing rhabdomyosarcomas are heterogenous and characterized by increasing numbers of gene fusions, the most common gene partners being VGLL2, NCOA2, and TFCP2. Here we report a spindle cell/sclerosing rhabdomyosarcoma that arose in the orbit of a 4-year-old male. This tumor harbored a unique PAX8::PPARG fusion. PAX8::PPARG fusions have previously only been described in follicular thyroid carcinoma and follicular variant of papillary thyroid carcinoma. Our report adds to the growing number of gene fusions in spindle cell/sclerosing rhabdomyosarcomas.

Students' perspective on the online delivery of radiography & medical imaging program during COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has led to significant changes to academic program delivery worldwide. Face to face (traditional teaching) lectures were replaced with online, recorded, or live sessions; however, online systems are not an efficient substitute for clinical or laboratory courses. The purpose of this study is to evaluate the imaging student's perspective on COVID-19 awareness to ensure they are prepared for clinical training and laboratory education, and to evaluate the teaching quality of the online radiography program delivery. METHODS: An online survey was conducted with radiography and medical imaging students of two female campuses in the United Arab Emirates (UAE). Knowledge and awareness level of COVID-19, such as symptoms and diagnostic tests, were evaluated using multiple choice questions. The Likert scale (1-5) was used to evaluate the teaching quality of the online learning of radiography, such as critical thinking and communication skills. Open-ended questions were included for students to provide comments and feedback. RESULTS: Out of 305 female students, 212 participants (71%) responded and were included in the study. The average age was 20 years, and respondents were from different study levels (year 1-year 5), with 47% and 53% of the participants from Al Ain campus and Abu Dhabi campus, respectively. Seventy percent of the respondents reported a Bachelor degree, while 30% were higher Diploma participants. The overall COVID-19 awareness level mean score was acceptable (70%). Senior students with a Bachelor degree and clinical experience scored higher than other students (72% vs. 65%, P<0.05). The mode value of the Likert scale for the teaching factors assessment (1-5) for most of the respondents showed average (mode=3) response value. However, the mode for the stress factor was high (mode=5). The overall online radiography teaching satisfaction for the teaching quality factors was less than 50%. However, more than half of the respondents (52%) recommended delivering the radiography program using the online learning system. DISCUSSION: COVID-19 imposed several challenges to the educational systems worldwide, requiring implementation of effective strategies to improve the current online teaching. Effective communication between instructors and students, engaging students with case studies discussion, and encouraging students to think critically and to be creative are important strategies. CONCLUSION: Online delivery of the radiography and medical imaging program imposes challenges for laboratory and clinical courses. It is recommended that academic institutions implement state of art technology to bridge the gap between traditional and online learning methods during the pandemic. Students are suggested to be mentally prepared to accept the shifting of the teaching mode to relieve stress and gain knowledge and practical skills more efficiently.

Digital imaging, technologies and artificial intelligence applications during COVID-19 pandemic.

The advancement of technology remained an immersive interest for humankind throughout the past decades. Tech enterprises offered a stream of innovation to address the universal healthcare concerns. The novel coronavirus holds a substantial foothold of planet earth which is combatted by digital interventions across afflicted geographical boundaries and territories. This study aims to explore the trends of modern healthcare technologies and Artificial Intelligence (AI) during COVID-19 crisis, define the concepts and clinical role of AI in the mitigation of COVID-19, investigate and correlate the efficacy of AI-enabled technology in medical imaging during COVID-19 and determine advantages, drawbacks, and challenges of artificial intelligence during COVID-19 pandemic. The paper applied systematic review approach using a deliberated research protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. Digital technologies can coordinate COVID-19 responses in a cascade fashion that extends from the clinical care facility to the exterior of the pending viral epicenter. With cases of healthcare robotics, aerial drones, and the internet of things as evidentiary examples. PCR tests and medical imaging are the frontier diagnostics of COVID-19. Computed tomography helped to correct the accuracy variation of PCR tests at a clinical sensitivity of 98 %. Artificial intelligence can enable autonomous COVID-19 responses using techniques like machine learning. Technology could be an endless system of innovation and opportunities when sourced effectively. Scientists can utilize technology to resolve global concerns challenging the history of tangible possibility. Digital interventions have enhanced the responses to COVID-19, magnified the role of medical imaging amid the COVID-19 crisis and have exposed healthcare professionals to the opportunity of contactless care.

Concurrent Persistent Cryptococcosis and Mycobacterium avium Complex Infections in a Patient With Human Immunodeficiency Virus.

Background: Fungal infections are known for their chronicity and latency and are difficult to eradicate. The pathophysiology of these invading pathogens and the resulting alteration of the immune system are not fully understood. Fungal meningitis is associated with significant rates of morbidity and mortality, especially among immunocompromised patients. Cryptococcosis, an infection secondary to the fungus Cryptococcus, is one of the most important opportunistic infections among patients with human immunodeficiency virus (HIV), and expediting treatment is crucial. Case Report: We report the case of a 28-year-old male with HIV who had a simultaneous co-infection with cryptococcal meningitis and Mycobacterium avium complex (MAC). The patient required a 2-week induction phase of antifungal medication with amphotericin B and flucytosine. Despite aggressive initial therapy and the patient's significant clinical improvement, his radiologic findings and lumbar puncture showed persistent cryptococcal infection. Conclusion: Concurrent infection with cryptococcosis and MAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis.

Compliance With Radiation Protection Practices Among Radiologists.

BACKGROUND: Radiologists are at higher risk of adverse health effects due to their occupational radiation exposure; therefore, applying protection techniques is imperative. Studies on radiologists' compliance in this regard are scarce. We aimed to assess compliance with radiation safety practices among radiologists. METHODS: Questionnaires were distributed to radiologists in tertiary hospitals. The questionnaire was designed to assess compliance in three domains: using personal protective devices, using exposure-reduction techniques during fluoroscopic exposures, and using personal dose-monitoring devices. Descriptive analysis of the compliance was performed. RESULTS: Sixty-two radiologists were included in the analysis. Use of leaded aprons and thyroid shields was commonplace, whereas only 3.2% ever use leaded eyeglasses. About half of the radiologists always considered reducing the time of exposure and avoided exposure by the primary beam, and the other half did that sometimes. Most of the radiologists (66.1%) always complied with reducing the number of unnecessary exposures, and the rest only complied sometimes. Most of the radiologists (93.5%) always used single personal dose-monitoring devices, most commonly at the neck level over the collar. There was no difference in compliance between different sexes, position descriptions, hospital types, hospital sizes, or years of experience. CONCLUSION: Future compliance improvement strategies for radiologists should focus on use of thyroid shields and leaded eyeglasses and use of exposure-reduction techniques during fluoroscopic operations.

Musculoskeletal pain symptoms among allied health professions' students: Prevalence rates and associated factors.

BACKGROUND: Very few articles, comprehensively, investigated musculoskeletal pain symptoms (MPS) among wide variety of allied health professions (AHP) students. OBJECTIVES: This study aimed to investigate the prevalence of MPS and their associated factors among different AHP majors' students. METHOD: A cross-sectional design was conducted. A sample of AHP students from nine majors (n= 838, Mean age = 21.3 years) completed a validated structured self-administrated questionnaires including Nordic Musculoskeletal Questionnaire, Depression Anxiety Stress Scale (DASS 21), and specific questions regarding demographics and life style. MPS prevalence rate were compared between males and females and between majors. Logistic regression was conducted to identify predictors of MPS. RESULTS: MPS in neck, lower back, and shoulder 12-month were the most prevalent (67.1%, and 61.4%, 58.8% respectively). MPS prevalence was significantly higher in females and statistically different among majors. MPS were significantly associated with increased clinical training load, mental stress symptoms, and smartphone average use time. CONCLUSIONS: MPS in AHP students are prevalent and statistically higher among females. Students are advised to adhere to different conservative precautions and follow prevention programs. Future studies are needed to assess actual mechanisms causing MPS among AHP students and designing effective prevention programs specific to AHP students.

Medical Radiation Knowledge among Patients in Local Hospitals.

OBJECTIVE: Evaluation of patient knowledge regarding radiation and its associated risks can identify knowledge gaps, providing an opportunity to increase patient awareness and understanding of medical radiation. The aims of this study were to evaluate the awareness level of patients regarding medical radiation types used in medical diagnostic imaging and to correlate them with the availability of radiation information provided upon examination. METHODS: A qualified radiographer distributed a multiple choice questionnaire in four major Jordanian hospitals, including three governmental hospitals and one university hospital. The questionnaire included demographic and radiation awareness sections. The sample included 400 patients who were undergoing routine x-ray imaging, computed tomography, fluoroscopy, magnetic resonance imaging, ultrasound, or nuclear medicine. RESULTS: Less than 50% of the participants had received information on radiation awareness upon examination. The average scores of the radiation awareness questionnaire ranged from 56% to 70%. There was a significant correlation (r = 1.00, P < .05) between those who were provided radiation information upon examination and the radiation awareness questions score. CONCLUSIONS: Most of the patients did not receive the radiation awareness information upon examination, which reflected the low level of general radiation knowledge in most hospitals. Patient education and awareness should be improved to reduce unnecessary exposure from medical imaging examinations.

Work-related Stress, Musculoskeletal Disorder Complaints, and Stress Symptoms among Radiographers in the Northern Part of Jordan.

OBJECTIVE: The aims of this study were to report the variation in work-related stressor (WRS) and musculoskeletal disorder (MSD) complaints across three major hospitals in the northern part of Jordan and to examine the correlations between stressors, MSD complaints, and stress symptoms using a questionnaire. METHODS: A qualified radiographer distributed a questionnaire in the radiology department at three hospitals, including a governmental public hospital (GH), a university educational hospital (UH), and a private hospital (PH). The questionnaire included demographic, WRS, management and responsibility stressors, stress symptoms, stress relievers, and MSD complaints sections. A total of 74 radiographers (GH = 28, UH = 29, PH = 17) agreed to participate after signing a consent form. RESULTS: The average age ranged from 30.8 ± 3.3 to 33.6 ± 1.4 (P = .6), and the average experience ranged from 6.2 ± 2.5 to 8 ± 1.2 years (P = .7) in the hospitals. The number of men was higher than women only in the UH (ratio = 2.6). The number of diploma degree holders was higher than the number of bachelor's degree holders only in the GH (ratio = 3). Stress symptoms such as depression and MSD complaints such as low back pain in the GH were significantly higher than the other hospitals. There was a significant correlation (Spearman correlation coefficient = 0.61, P = .04) between WRS and MSD complaints. CONCLUSION: The GH had more MSD complaints and stress symptoms than the other hospitals. WRSs were correlated significantly with MSD complaints. Encouraging the radiographers to attend work stress management sessions may help in reducing the level of stress.

Comparison of optical and power Doppler ultrasound imaging for non-invasive evaluation of arsenic trioxide as a vascular disrupting agent in tumors.

Small animal imaging provides diverse methods for evaluating tumor growth and acute response to therapy. This study compared the utility of non-invasive optical and ultrasound imaging to monitor growth of three diverse human tumor xenografts (brain U87-luc-mCherry, mammary MCF7-luc-mCherry, and prostate PC3-luc) growing in nude mice. Bioluminescence imaging (BLI), fluorescence imaging (FLI), and Power Doppler ultrasound (PD US) were then applied to examine acute vascular disruption following administration of arsenic trioxide (ATO).During initial tumor growth, strong correlations were found between manual caliper measured tumor volume and FLI intensity, BLI intensity following luciferin injection, and traditional B-mode US. Administration of ATO to established U87 tumors caused significant vascular shutdown within 2 hrs at all doses in the range 5 to 10 mg/kg in a dose dependant manner, as revealed by depressed bioluminescent light emission. At lower doses substantial recovery was seen within 4 hrs. At 8 mg/kg there was >85% reduction in tumor vascular perfusion, which remained depressed after 6 hrs, but showed some recovery after 24 hrs. Similar response was observed in MCF7 and PC3 tumors. Dynamic BLI and PD US each showed similar duration and percent reductions in tumor blood flow, but FLI showed no significant changes during the first 24 hrs.The results provide further evidence for comparable utility of optical and ultrasound imaging for monitoring tumor growth, More specifically, they confirm the utility of BLI and ultrasound imaging as facile assays of the vascular disruption in solid tumors based on ATO as a model agent.