Establishment of a local diagnostic reference level for computed tomography chest and abdomen in two different cities in Saudi Arabia.

BACKGROUND AND AIM: Spiral computed tomography (CT) scans, which are considered a high-contrast resolution, quick and cross-sectional imaging technique, have grown in popularity as a result of technological advancements. However, these advancements have brought with them the potential for significantly increased radiation doses to the patient. Consequently, many organizations recommended optimization and establishing diagnostic reference levels. The aim of the current study was to assess CT radiation dose and propose a local diagnostic reference level (LDRL) for the adult trunk [chest and abdomen] using CT dose parameters such as CT dose index volume (CTDIvol) and dose length product (DLP) as well as to compare the practices for aforementioned examinations between two hospitals in Taif and Abha cities in Saudi Arabia. MATERIALS AND METHODS: Data from 428 patients (216 for abdomen and 212 for chest) who were examined in two hospitals in Taif and Abha City in Saudi Arabia from December 2022 to March 2023, are used in this study. The data for hospitals in Taif and Abha are presented as 'T' and 'A' throughout this manuscript. The parameters of exposure and slice thickness were recorded in a specially designed data sheet together with the gender, age and patients morphometric. Microsoft Excel version 2010 was used to analyze results and plot the figures. The LDRL was achieved from the third quartile of CTDIvol and DLP for each hospital and examination. RESULTS: The average DLP (mGy-cm) and CTDIvol (mGy) for the chest and abdomen were 243 mGy cm, 5.8 mGy and 549 mGy cm, 8.6 mGy respectively. The average effective dose (ED) for chest and abdomen were 5.10 and 21.10 mSv, respectively. The proposed LDRL for the chest and abdomen were 6.9 mGy (CTDIvol), 375 mGy-cm (DLP), 7.8 mGy (CTDIvol), and 747 (DLP) mGy-cm, respectively. CONCLUSION: Hospital 'A' irradiated patients with a higher dose for the abdomen exam than Hospital 'T', but both hospitals agreed on the amount of radiation dose received by patients for chest imaging. The proposed LDRL for two examinations was less than the DRL obtained from the literature.

The Actual Role of Iterative Reconstruction Algorithm Methods in Several Saudi Hospitals As A Tool For Radiation Dose Minimization of Ct Scan Examinations.

Background: Iterative reconstruction algorithm (IR) techniques were developed to maintain a lower radiation dose for patients as much as possible while achieving the required image quality and medical benefits. The main purpose of the current research was to assess the level and usage extent of IR techniques in computed tomographic (CT) scan exams. Also, the obligation of practitioners in several hospitals in Saudi Arabia to implement IR in CT exams was assessed. Material and Methodology: The recent research was based on two studies: data collection and a survey study. Data on the CT scan examinations were retrospectively collected from CT scanners. The survey was conducted using a questionnaire to evaluate radiographers' and radiologists' perceptions about IR and their practices with IR techniques. The statistical analysis results were performed to measure the usage strength level of IR methods. Results and Discussions: The IR strength level of 50% was selected for nearly 80% of different CT examinations and patients of different ages and weights. About 46% of the participants had not learned about IR methods during their college studies, and 54% had not received formal training in applying IR techniques. Only 32% of the participants had adequate experience with IR. Half of the participants were not involved in the updating process of the CT protocol. Conclusion: The results indicate that the majority of radiographer and radiologist at four different hospitals in Saudi Arabia have no explicit or understandable knowledge of selecting IR strength levels during the CT examination of patients. There is a need for more training in IR applications for both radiologists and radiographers. Training sessions were suggested to support radiographers and radiologists to efficiently utilize IR techniques to optimize image quality. Further studies are required to adjust CT exam protocols effectively to utilize the IR technique.

Dental Undergraduates and Interns' Awareness, Attitudes, and Perception of Radiological Protection.

Medical ionizing radiation is widely used in hospitals, in particular dental clinics, and in medical research to facilitate the diagnosis and treatment of patients. The awareness, attitude, and perception of ionizing radiation exposure among dental undergraduate students and interns in radiological investigations and dental care clinics were investigated. A cross-sectional study was conducted; 17 questions were designed online using the software "QuestionPro," which was licensed to the University of Imam Abdulrahman Bin Faisal. Participants included senior medical dental students from Imam Abdulrahman Bin Faisal University in their third to fifth years, as well as interns from King Fahad University Hospital and private dental care clinics. A total of 855 participants viewed, 360 started the questionnaire, and 258 (72%) completed it online. Overall, knowledge was lacking; 32% of respondents incorrectly believed that magnetic resonance imaging and ultrasound used ionizing radiation, while 38% were unsure. Dental X-rays were deemed harmful by 40% (n = 104) of respondents. According to 33% (n = 85) of participants, there is no radiation scatter during an X-ray or CT scan, while 30% (n = 76) are unsure. Respondents (44%; n = 104) were unaware of the radiation dose from a chest radiograph and (45%; n = 116) overestimated the radiation dose. The effects of ionizing radiation on healthy tissue are known to more than half of the participants (54%). According to 39% of respondents, digital radiography exposes them to less radiation than traditional radiography. In terms of radiation protection and hazard, 46% said personal monitoring badges should be always worn and 58% (n = 150) said lead aprons should be used on a regular basis. 63% of the subjects had received radiation protection education, such as formal lectures, tutorials, or workshops, while 37% (n = 95) had not. 53% of the respondents were not aware of the international recommendations from the International Commission on Radiological Protection. When asked if they would follow radiation protection protocols if they opened a private dental clinical practice in the future, 50% (n = 129) said they would.

Evaluation of Pediatric Imaging Modalities Practices of Radiologists and Technologists: A Survey-Based Study.

Introduction: Radiation protection for pediatric patients is the main concern in pediatric computed tomography (CT) due to their sensitive organs, such as the brain and the thyroid glands. Accordingly, an optimization of pediatric CT practices is vital to minimize the radiation dose for this population. Aim: To assess the pediatric CT practices of radiologists and technologists in a CT unit. Materials and Methods: The study was conducted among 26 hospitals, located in various regions in Saudi Arabia. A total of 200 hard copies of the questionnaire were distributed manually and were collected for analysis. In total, 117 completed surveys were gathered from technologies, while 49 were gathered from radiologists. Results: In the case of infants with hydrocephalus, 65% of the radiologists ordered an ultrasound (US), 24% ordered a head CT scan, and 10% ordered a magnetic resonance imaging (MRI) and general X-ray for diagnosis. For pediatric patients complaining of persistent headache, 59% and 27% of the radiologists recommended CT and MRI, respectively, for diagnosis. Conclusion: Most of the radiologists utilize CT head scan to diagnose persistent headache (by 59%) and ventriculoperitoneal shunt (VPS) malfunction (by 41%) in pediatric patients compared with the other modalities. The use of CT can increase the risk of later malignancy among pediatric patients due to radiation exposure. Alternative imaging modalities such as US and MRI (non-ionized radiation) should be considered to reduce the ionizing radiation hazards and optimize the current practices of radiologists. Most of the technologists follow radiation protection protocols in this study as 63% of the technologists used lead apron for pediatric patient's protection. Radiation awareness training for the technologists could improve the knowledge about the benefits of using lead apron and reduce the radiation risks in pediatric patients.

Chest Radiological Findings and Clinical Characteristics of Laboratory-Confirmed COVID-19 Patients from Saudi Arabia.

BACKGROUND Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that first emerged in China in December 2019 and quickly spread worldwide. As the prevalence of COVID-19 increases, radiological examination is becoming an essential diagnostic tool for identifying and managing the disease's progression. Therefore, we aimed to identify the chest imaging features and clinical characteristics of patients with laboratory-confirmed COVID-19 in Saudi Arabia. MATERIAL AND METHODS In this retrospective study, data of laboratory-confirmed COVID-19 patients were collected from 4 hospitals in Jeddah, Saudi Arabia. Their common clinical characteristics, as well as imaging features of chest X-rays and computed tomography (CT) images, were analyzed. RESULTS A total of 297 patients with laboratory-confirmed COVID-19 who underwent chest imaging were investigated in this study. Of these patients, 77.9% were male and 22.2% were female. Their mean age was 48 years old. The most common clinical symptoms were fever (187 patients; 63%) and cough (174 patients; 58.6%). The predominant descriptive chest imaging findings were ground-glass opacities and consolidation. Locations of abnormalities were bilateral, mainly distributed peripherally, in the lower lung zones, and in the middle lung zones. CONCLUSIONS This study provides an understanding of the most common clinical and radiological features of patients with laboratory-confirmed COVID-19 in Saudi Arabia. The majority of COVID-19 patients in our study cohort had either stable or worse progression of lung lesions during follow-ups; thus, they presented moderate disease cases. Elderly males were more affected by COVID-19 than females, with fever and cough being the most common clinical symptoms.

Artery of Percheron Infarction: A Characteristic Pattern of Ischemia and Variable Clinical Presentation: A Literature Review.

The Artery of Percheron (AOP) is an uncommon anatomic variant that provides arterial supply to the paramedian region of the thalami and bilaterally to the rostral part of the midbrain; it is a solitary arterial trunk that branches from a proximal segment of the posterior cerebral artery (PCA). Although AOP infarction results in a characteristic pattern of ischemia-namely bilateral paramedian thalamic infarct with or without midbrain involvement-it may cause diagnostic difficulties due to the variety of its clinical presentations and wide differentials, as well as its small diameter and the difficulty of obtaining visualization through diagnostic imaging. Early neuroimaging of AOP infarction and correct diagnosis are mandatory for early initiation of the appropriate treatment and better patient outcomes. In this study, we discuss imaging the patterns of AOP infarction and its differentials and clinical presentation.

Imaging differences between coronavirus disease 2019, severe acute respiratory syndrome, and Middle East respiratory syndrome.

Since the outbreak of Coronavirus Disease-19 (COVID-19) infection in December 2019 in Wuhan, the capital Hubei province, central of China, more than 4 million people have contracted the virus worldwide. Despite the imposed precautions, coronavirus disease-19 is rapidly spreading with human-to-human transmission resulting in more than 290,000 death as of May 13, 2020 according to World Health Organization (WHO). The aim of this study was to revise the characteristic imaging features of Sever Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) during their outbreak, and to compare them with that of COVID-19, to familiarize radiologists with the imaging spectrum of corona-virus syndromes. This study will help in more understanding and characterisation of COVID-19 to support the global efforts in combating its worldwide outbreak.

Evaluation of radiologist's knowledge about the Artificial Intelligence in diagnostic radiology: a survey-based study.

BACKGROUND: Advanced developments in diagnostic radiology have provided a rapid increase in the number of radiological investigations worldwide. Recently, Artificial Intelligence (AI) has been applied in diagnostic radiology. The purpose of developing such applications is to clinically validate and make them feasible for the current practice of diagnostic radiology, in which there is less time for diagnosis. PURPOSE: To assess radiologists' knowledge about AI's role and establish a baseline to help in providing educational activities on AI in diagnostic radiology in Saudi Arabia. MATERIAL AND METHODS: An online questionnaire was designed using QuestionPro software. The study was conducted in large hospitals located in different regions in Saudi Arabia. A total of 93 participants completed the questionnaire, of which 32 (34%) were trainee radiologists from year 1 to year 4 (R1-R4) of the residency programme, 33 (36%) were radiologists and fellows, and 28 (30%) were consultants. RESULTS: The responses to the question related to the use of AI on a daily basis illustrated that 76 (82%) of the participants were not using any AI software at all during daily interpretation of diagnostic images. Only 17 (18%) reported that they used AI software for diagnostic radiology. CONCLUSION: There is a significant lack of knowledge about AI in our residency programme and radiology departments at hospitals. Due to the rapid development of AI and its application in diagnostic radiology, there is an urgent need to enhance awareness about its role in different diagnostic fields.

On the use of AAA and AcurosXB algorithms for three different stereotactic ablative body radiotherapy (SABR) techniques: Volumetric modulated arc therapy (VMAT), intensity modulated radiation therapy (IMRT) and 3D conformal radiotherapy (3D-CRT).

AIM: The purpose of this study was to investigate the dosimetric characteristics of three stereotactic ablative body radiotherapy (SABR) techniques using the anisotropic analytical algorithm (AAA) and Acuros XB algorithm. The SABR techniques include coplanar volumetric modulated arc therapy (C-VMAT), non-coplanar intensity modulated radiation therapy (NC-IMRT) and non-coplanar three-dimensional conformal radiotherapy (NC-3D CRT). BACKGROUND: SABR is a special type of radiotherapy where a high dose of radiation is delivered over a short time. The treatment outcome and accuracy of the dose delivered to cancer patients highly depend on the dose calculation algorithm and treatment technique. MATERIALS AND METHODS: Twelve lung cancer patients underwent 4D CT scanning, and three different treatment plans were generated: C-VMAT, NC-IMRT, NC-3D CRT. Dose calculation was performed using the AAA and Acuros XB algorithm. The dosimetric indices, such as conformity index (CI), homogeneity index, dose fall-off index, doses received by organs at risk and planning target volume, were used to compare the plans. The accuracy of AAA and Acuros XB (AXB) algorithms for the lung was validated against measured dose on a CIRS thorax phantom. RESULTS: The CIs for C-VMAT, NC-IMRT and NC-3D CRT were 1.21, 1.28 and 1.38 for the AAA, respectively, and 1.17, 1.26 and 1.36 for the Acuros XB algorithm, respectively. The overall dose computed by AcurosXB algorithm was close to the measured dose when compared to the AAA algorithm. The overall dose computed by the AcurosXB algorithm was close to the measured dose when compared to the AAA algorithm. CONCLUSION: This study showed that the treatment planning results obtained using the Acuros XB algorithm was better than those using the AAA algorithm in SABR lung radiotherapy.

Evaluation and Performance of ArcCheck and Film using Gamma Criteria in Pre-treatment Quality Assurance of Stereotactic Ablative Radiotherapy.

AIM: The aim of this study is to assess the use of ArcCHECK (AC) as an alternative method to replace film dosimetry for pre-treatment quality assurance (QA) of three-dimensional conformal radiation therapy, intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) stereotactic ablative radiotherapy (SABR) treatment plans. MATERIALS AND METHODS: Twenty-five patients with a varied diagnosis of lung, spine, sacrum, sternum, ribs, scapula, and femur undergoing SABR were selected for this study. Pre-treatment QA was performed for all the patients using ionization chamber and film dosimetry. Measurements were also carried out on an AC phantom. The planned and measured doses from the AC device and EBT3 films were compared using four different gamma criteria: 2%/2 mm, 3%/2 mm, 3%/1 mm, and 3%/3 mm. RESULTS: The mean gamma passing rates at 3%/3 mm for all non-spine SABR cases were 98.79 ± 0.96 and 99.27 ± 1.03 with AC and films, respectively. The mean passing rates at 3%/2 mm for AC and films were 98.76 ± 0.42 and 99.43 ± 0.27 respectively for spine VMAT SABR, and 87.15 ± 2.45 and 99.79 ± 0.14 respectively for spine IMRT SABR. In the case of spine tumors, the gamma criterion was tightened due to the proximity of spinal cord to the planning target volume. Our results show that AC provides good results for all VMAT SABR plans. CONCLUSION: The AC results at 3%/3 mm were in good agreement with film dosimetry for most cases. We observed a significant reduction in QA time on using AC for SABR QA. This study showed that AC results are comparable to film dosimetry for all studied sites except for spine IMRT SABR.