Imaging and Demographic Risk Factors in the Diagnosis of Pediatric Nonaccidental Trauma.

BACKGROUND: The patient described in this case received a diagnosis of severe head trauma that resulted in death. Imaging findings, along with discrepancies in the parental explanation of the incident, aided the forensic investigators to identify the case as nonaccidental trauma (NAT). DISCUSSION: Identifying demographic risk factors and performing proper clinical evaluations can serve an important role in the diagnosis of pediatric NAT. Imaging modalities such as radiography, computed tomography, and magnetic resonance imaging can help determine the extent of trauma. CONCLUSION: Abuse is frequent in the pediatric population. To help prevent future cases of abuse, medical professionals should be fluent in identifying differences between accidental and NAT. Using multiple imaging modalities, NAT in pediatric patients can be identified and treated adequately.

Workplace Violence in Imaging Departments.

PURPOSE: To investigate the types and frequency of workplace violence experienced by radiologic technologists and to identify which technologists using specific imaging modalities are at increased risk. METHODS: A mixed-methods approach was employed using a research electronic data capture (REDCap; Vanderbilt University) survey designed to establish information on radiologic technologists' self-reported experiences with workplace violence. The survey was distributed to a random sample of 10 000 radiologic technologists working with various imaging disciplines. Participants (N = 193) were asked questions regarding personal and employment demographics, experiences with violence, and reporting and education practices. RESULTS: Radiologic technologists were shown to have experienced most workplace violence from patients or visitors. Among those surveyed, 50% or more reported being hit, bitten, called names, harassed, threatened, or having hair pulled by a patient. Verbal intimidation by patients, visitors, and others also was reported, with more than 50% experienced from visitors and more than 40% from patients, coworkers, radiologists, other physicians, or other health care providers. Statistical tests to evaluate a relationship between types of workplace violence and imaging modalities showed an association between name-calling by visitors and modality (P < .001). Results indicated that technologists performing computed tomography imaging, adult diagnostic imaging in the emergency department, and magnetic resonance imaging experienced the most frequent occurrences of name-calling by visitors. DISCUSSION: Workplace violence, which can affect a person mentally, physically, and emotionally, might occur in any work environment. In the health care setting, radiologic technologists might experience workplace violence originating from coworkers, other health care professionals, patients, visitors, or a combination of these sources. Therefore, a health care organization's acknowledgment of workplace violence and their resolve to prevent or reduce its occurrence is important. Providing sufficient human resources and adequate workplace violence education courses might be the first steps in eliminating workplace violence in the health care environment. CONCLUSION: Workplace violence creates an undesirable working environment, leading to negative implications for the health care worker and the patient. Education that details possible types of workplace violence and best practices for handling each type is key to protecting employees. This study provides a foundation for future quality improvement studies aimed at protecting the mental and physical health of imaging professionals.

Radiologic Sciences Student Perceptions of Advisement.

PURPOSE: To investigate student perceptions of a structured advisement program. METHODS: Using a mixed-methods approach, 24 radiologic sciences students were surveyed in the initial and final semesters of the program to capture their perceptions of advisement practices. Quantitative data were analyzed for percentages and descriptive statistics, and qualitative responses were analyzed for emergent themes. RESULTS: Qualitative data analyses identified 3 themes: building relationships, strengthening student performance, and determining best practices for advisement. Quantitative data demonstrated that students appreciated the advisement process and acknowledged improvements in communication skills and the feedback loop. DISCUSSION: Advisement sessions can serve an important role in identifying areas where students can improve their performance. To grow and develop, students must understand their own strengths and weaknesses. Structured forms of advisement can serve as important tools to guide advisement conversations toward specific topics. CONCLUSION: The results of this study indicate that student advising is a vital component of radiologic sciences programs. Participants indicated that the advisement process helped them build relationships with faculty members and improved their overall performance.

Imaging Advancements in Nuclear Medicine: Pancreatic Neuroendocrine Tumor Localization and Treatment.

BACKGROUND: This case report details a 57-year-old African American man with pancreatic neuroendocrine tumors (NETs). The patient underwent positron emission tomography (PET) imaging using gallium Ga 68 dotatate, which localized the tumors. Selected tumors were treated with 4 doses of 200 mCi of lutetium Lu 177 dotatate during a period of 8 months. At the conclusion of treatment, the patient demonstrated improvement, progressing from bedbound and confused to ambulatory and coherent. In addition, the patient stated he felt no adverse effects. DISCUSSION: Pancreatic NETs are rare tumors affecting 0.001% of the population. These tumors are associated with various symptoms and are classified as functional or nonfunctional. Imaging modalities, such as computed tomography (CT), magnetic resonance (MR) imaging, and gallium Ga 68-labeled PET, are essential in detecting and evaluating pancreatic NETs. For patients with localized NETs, the primary treatment is surgery; however, the radiopharmaceuticals yttrium Y 90 microspheres and lutetium Lu 177 dotatate are used as therapy to treat nonresectable tumors. CONCLUSION: Lutetium Lu 177 dotatate is used in NET cases that are deemed inoperable and for patients who are not responding to treatment. This case study demonstrates the effectiveness of combining imaging with Ga 68-labeled PET and treatment with lutetium Lu 177 dotatate. This treatment is not a cure but has been shown to improve a patient's quality of life.

An Investigation of MR Imaging Scanner Noise and its Effect on Technologists.

PURPOSE: To investigate the level of noise that magnetic resonance (MR) technologists are exposed to during daily tasks, and prevalence of hearing loss among MR technologists. METHODS: Decibel levels at the scanner control panel were measured and recorded at clinical facilities. A survey was distributed to MR technologists, which included questions about demographics, workplace habits, and self-reported hearing loss. RESULTS: Technologists are exposed to decibel levels higher than U.S. government recommended occupational limits; however, these are for very short periods, resulting in an average projected 8-hour noise dose of 1.68%. Statistical analysis of survey results showed no association between time spent working in an MR imaging department (P = .111); however, results did show an association between entering the scan room during image acquisition and hearing loss (P = .005). DISCUSSION: At times, technologists are exposed to decibel levels exceeding the U.S. Occupational Safety and Health Administration and the U.S. Food and Drug Administration recommended limits; however, the average findings indicate that there is a low risk of hearing damage from working at the control panel. Statistical analysis revealed an association between entering the scan room and hearing loss; therefore, individuals entering the scan room for any reason should be wearing hearing protection, even for short periods. CONCLUSION: Risks of exposure to high occupational decibel levels should be monitored continually. This study provides a foundation for future research studies, such as longitudinal analysis of hearing loss in MR technologists.

Familial Thoracic Aortic Dissection.

BACKGROUND: This case report details familial aortic dissection in 2 second-degree blood relatives who experienced sudden aortic dissections. One patient underwent emergency computed tomography angiography (CTA) and the other underwent magnetic resonance angiography (MRA). These imaging examinations were instrumental in revealing each patient's condition. One patient died of dissection rupture while being prepped for surgery. The other patient underwent surgery, recovered, and undergoes continual monitoring for the condition. DISCUSSION: A positive family history of aortic dissection should be considered in patients presenting with aortic emergencies. Many genes can contribute to this condition, with most genes relating to smooth muscle and connective tissue disorders. Imaging studies for evaluating and monitoring aortic dissection include transesophageal echocardiography, CTA, and MRA. Surgical treatment is possible for aortic dissection, with the goals being to stabilize the dissection and reduce the possibility of rupture. CONCLUSION: The mortality rate for aortic dissection is high, with the main cause of death being dissection rupture. Lifelong monitoring of survivors and first-degree relatives is recommended.

Rare Orbital Metastasis Originating From a Neuroendocrine Tumor.

BACKGROUND: This case study details a rare orbital metastasis originating from the gastrointestinal tract. A patient presented with proptosis of the right eye precipitated by a slow-growing orbital tumor. A biopsy confirmed a low-grade neuroendocrine tumor. Imaging studies were completed, with magnetic resonance (MR) imaging of the orbits providing the most detailed images of the mass. Fusion software images were created from the MR images and indium In 111 pentetreotide (octreoscan) studies, which confirmed the presence of the neuroendocrine carcinoid tumor. DISCUSSION: Orbital metastases are a rare condition associated with various symptoms, most commonly proptosis and diplopia. Imaging modalities, such as MR, computed tomography, and nuclear medicine technology, are instrumental in detecting and assessing these masses. Fusion imaging software can provide additional opportunities for facilities without hybrid scanners. The treatment of choice for orbital metastases is octreotide therapy; however, radiation therapy, partial or complete surgical removal of the tumor, and chemotherapy also are used. CONCLUSION: Traditional imaging techniques and fusion imaging techniques are essential for diagnosing and treating orbital metastases.

Safety Resources and Processes in MR Imaging Departments.

PURPOSE: To identify current standards of safety practices, common safety resources in use, and gaps in workflow practices in magnetic resonance (MR) imaging departments. METHODS: Qualitative observational research and visual assessments of safety resources available at clinical rotation sites were conducted with subsequent open coding analysis. RESULTS: The sample varied in terms of the strength of MR systems, types of facilities, patient populations, and safety resources available. Qualitative themes included carelessness of personnel, facility design flaws, and inconsistencies in safety practices and staffing. DISCUSSION: Proper screening of patients and other individuals, appropriate use of barriers, and ferromagnetic detection systems can be effective tools for ensuring patient and personnel safety. Although various safety resources were available at most MR imaging facilities, the resources proved to be only as effective as the safety practices of the MR technologists. CONCLUSION: Safety practices in MR imaging departments can be improved upon continually. This study provides a foundation for future research on MR safety practices.

GBCAs and Risk for Nephrogenic Systemic Fibrosis: A Literature Review.

PURPOSE: To examine the risks of using of gadolinium-based contrast agents (GBCAs) in magnetic resonance (MR) imaging and explore strategies to reduce the likeliness of adverse effects in patients who might be at risk for developing nephrogenic system fibrosis (NSF). METHODS: A search of 3 scholarly databases was performed to identify articles that discuss adverse reactions to GBCAs, specifically relating to kidney function, in MR examinations. A total of 20 peer-reviewed articles were analyzed. DISCUSSION: Safety of contrast media is related to the stability of the chelate bond (ie, macrocyclic or linear). Patients who have decreased kidney function or chronic kidney disease are at higher risk for an adverse reaction to GBCAs; typically, macrocyclic contrast agents are considered safer than linear contrast agents for patients at risk for developing NSF because of their higher kinetic stability. Recommended doses of gadolinium should be adhered to carefully for all patients in conjunction with the glomerular filtration rate guidelines for contrast administration defined by the American College of Radiology. CONCLUSION: Although there are advantages to contrast use in MR examinations, technologists should work closely with referring physicians and radiologists to minimize risks for developing NSF in patients who have decreased kidney function.