Radiologists are increasingly recommending follow-up of chest radiographs: a 10-year review.

PURPOSE: To assess for changes in trends of GP chest radiograph reporting over a 10-year period and to assess if there has been a change in recommendations for follow-up. METHODS: Retrospective study of an Irish tertiary referral center. The total number of GP-referred chest x-rays performed per year from 2007 to 2017 are recorded. One-hundred male/100 female GP-referred chest x-rays are chosen at random from NIMIS data for each of 2007, 2010, 2013, and 2017. Reports are analyzed with regard to abnormal findings, recommendation for follow-up, and yield of follow-up imaging. RESULTS: There were 4917 GP CXRs performed in 2007, 4856 in 2010, 5561 in 2013, and 6492 in 2017. Follow-up was recommended in 17 studies(8.5%) in 2007, 19 studies(9.5%) in 2010, 22 studies(11%) in 2013, and 27 studies(13.5%) in 2017. Indications for follow-up recommendation were largely to ensure resolution of infection (52%) or for nodule surveillance (43%). There has been a notable increase in lung nodule follow-up, with suggested follow-ups increasing from 6 in 2007, to 7 in 2010, 9 in 2013, and 14 in 2017, an increase of 58%. CONCLUSION: Along with the increase in the quantity of GP-referred chest radiographs over the past 10 years, suggestions for follow-up have increased, particularly for nodule surveillance. Reasons for this increase may include lack of availability of CT to GPs for lung cancer screening, insensitivity of plain radiographs to early cancer detection, and possible fear of litigation for missing lesions, making radiologists more cautious.

Enteritis and Severe Abdominal Pain as the First Presentation of Covid-19.

Presentation A male patient with no significant past medical history presented to emergency department with progressive in severity abdominal pain, associated with mild nausea and diarrhea. No other significant symptoms were reported. Diagnosis On investigation with CT, duodenojejunitis was diagnosed as the cause of abdominal pain. Lung basal changes were also visualized and subsequently proven to be secondary to Covid-19 infection. Treatment After few days of hospitalization and supportive treatment, the patient improved clinically and was discharged. Conclusion Covid-19 infection typically presents with respiratory symptoms associated with fever and myalgia. Anorexia, diarrhea and nausea have been reported. Severe abdominal pain is rare, particularly as the initial presenting compliant. It is important to be aware of the varied clinical presentations that may occur in Covid-19, including isolated gastrointestinal symptoms. This will allow to increase the timely detectability of infected patients and more effective contact control measures.

Are we Over-Imaging the Obese Patient with Suspected Pulmonary Embolus in Ireland

Aims To assess if there was a significant difference in the number of positive studies for pulmonary embolism between obese and non obese patients. Methods A retrospective analysis of all CTPAs performed in our institution over one year in patients aged 18-50 was performed. Data regarding the diagnosis of pulmonary embolism, the presence of airways disease, other significant chest findings, D dimer values and demographic data including a BMI surrogate was obtained. Results Two hundred and thirty CTPAs were performed in our institution over 12 months. Two hundred and twenty-one were included for analysis, of which 129 were male and 92 were female. Sixty-nine (31%) patients were classified as obese. Eleven (16%) of these had positive studies. One hundred and fifty-two patients were in the non obese category, of which 24 (15%) had positive studies. Conclusions We are not over imaging the obese patient, but are over imaging patients in general with suspected PE, but are exposing a significant number overall, to unnecessary radiation.

Peripherally Inserted Central Catheters (PICCs) and Potential Cost Savings and Shortened Bed Stays In an Acute Hospital Setting.

Peripheral inserted central catheters (PICCs) have increasingly become the mainstay of patients requiring prolonged treatment with antibiotics, transfusions, oncologic IV therapy and total parental nutrition. They may also be used in delivering a number of other medications to patients. In recent years, bed occupancy rates have become hugely pressurized in many hospitals and any potential solutions to free up beds is welcome. Recent introductions of doctor or nurse led intravenous (IV) outpatient based treatment teams has been having a direct effect on early discharge of patients and in some cases avoiding admission completely. The ability to deliver outpatient intravenous treatment is facilitated by the placement of PICCs allowing safe and targeted treatment of patients over a prolonged period of time. We carried out a retrospective study of 2,404 patients referred for PICCs from 2009 to 2015 in a university teaching hospital. There was an exponential increase in the number of PICCs requested from 2011 to 2015 with a 64% increase from 2012 to 2013. The clear increase in demand for PICCs in our institution is directly linked to the advent of outpatient intravenous antibiotic services. In this paper, we assess the impact that the use of PICCs combined with intravenous outpatient treatment may have on cost and hospital bed demand. We advocate that a more widespread implementation of this service throughout Ireland may result in significant cost savings as well as decreasing the number of patients on hospital trollies.

Prevalence and Seasonal Variation of Incidental MRI Paranasal Inflammatory Changes in an Asymptomatic Irish Population.

Inflammatory changes in the paranasal sinuses are a common incidental finding on magnetic resonance imaging (MRI) of the head and neck. This study aimed to assess the prevalence and seasonal variation of inflammatory paranasal sinus changes in an asymptomatic Irish population. Retrospective analysis was performed on 221 patients who underwent brain MRI at the time points of winter and summer. T2-weighted sequences were evaluated for paranasal sinus disease. Nearly half the patients in the study exhibited morphological paranasal sinus changes on imaging suggesting that these could be considered a normal variant. Correlation of imaging findings with clinical symptoms and signs remain crucial to the diagnosis of sinusitis.

Frequency and analysis of non-clinical errors made in radiology reports using the National Integrated Medical Imaging System voice recognition dictation software.

BACKGROUND: Voice recognition (VR) dictation of radiology reports has become the mainstay of reporting in many institutions worldwide. Despite benefit, such software is not without limitations, and transcription errors have been widely reported. AIM: Evaluate the frequency and nature of non-clinical transcription error using VR dictation software. METHODS: Retrospective audit of 378 finalised radiology reports. Errors were counted and categorised by significance, error type and sub-type. Data regarding imaging modality, report length and dictation time was collected. RESULTS: 67 (17.72 %) reports contained ≥1 errors, with 7 (1.85 %) containing 'significant' and 9 (2.38 %) containing 'very significant' errors. A total of 90 errors were identified from the 378 reports analysed, with 74 (82.22 %) classified as 'insignificant', 7 (7.78 %) as 'significant', 9 (10 %) as 'very significant'. 68 (75.56 %) errors were 'spelling and grammar', 20 (22.22 %) 'missense' and 2 (2.22 %) 'nonsense'. 'Punctuation' error was most common sub-type, accounting for 27 errors (30 %). Complex imaging modalities had higher error rates per report and sentence. Computed tomography contained 0.040 errors per sentence compared to plain film with 0.030. Longer reports had a higher error rate, with reports >25 sentences containing an average of 1.23 errors per report compared to 0-5 sentences containing 0.09. CONCLUSION: These findings highlight the limitations of VR dictation software. While most error was deemed insignificant, there were occurrences of error with potential to alter report interpretation and patient management. Longer reports and reports on more complex imaging had higher error rates and this should be taken into account by the reporting radiologist.

Examining the End-User Experience of the National Integrated Medical Imaging System (NIMIS).

The National Integrated Medical Imaging System (NIMIS) is used to store and retrieve medical imaging studies in Ireland. The purpose of this audit was to obtain feedback from its end-users in relation to key NIMIS functionality and to understand their perception of its existing interface while identifying potential improvements. The results showed that, while the majority of respondents are satisfied with NIMIS, they identified a number of areas of concern. These included difficulty in identifying the appropriate code for a study, 88 (34%); dissatisfaction with ordering and viewing scans, 82 (32%); and a need for improved communication between end-users and local Radiology departments, with 104 (40%) unsure when to contact the department and 137 (53%) dissatisfied with the feedback they received in relation to requests. Respondents indicated that addressing these issues would improve the NIMIS end-user experience while allowing it to continue to meet current and future clinical needs.

Imaging features of poorly controlled congenital adrenal hyperplasia in adults.

Congenital adrenal hyperplasia (CAH) is a genetic autosomal recessive condition most frequently as a result of a mutation in the 21-hydroxylase enzyme gene. Patients with poorly controlled CAH can manifest characteristic imaging findings as a result of adrenocorticotrophic hormone stimulation or the effects of cortisol precursor excess on various target organs. We present a spectrum of imaging findings encountered in adult patients with poorly treated CAH, with an emphasis on radiological features and their clinical relevance.

Inferior vena cava filter insertion and retrieval patterns in a tertiary referral centre in Ireland.

BACKGROUND: Inferior vena cava (IVC) filters are widely used in clinical practice to prevent large, clinically significant pulmonary emboli. Modern filters are designed to be retrievable within a specific time window; however, many become lost to follow-up. AIM: To examine the insertion and retrieval patterns of IVC filters in a tertiary referral teaching hospital in Ireland. METHODS: A retrospective review of all IVC filter insertions and retrievals was performed in a tertiary referral university teaching hospital which incorporates the national referral centre for pelvic and acetabular trauma, over a 22-month period. RESULTS: Fifty-seven patients underwent IVC filter insertion with 100% technical success. The most common indication was prophylaxis in patients at high risk of deep venous thrombosis or pulmonary emboli (64.9%), followed by patients with contra-indication to anticoagulation (24.6%) and breakthrough thromboembolic events despite anticoagulation (10.5%). IVC filter retrievals were attempted in 48.9% of patients with a success rate of 86.9%. The mean dwell time for retrieved IVC filters was 159.4 days. CONCLUSION: Inferior vena cava filter insertion and retrieval patterns in our centre were comparable to trends reported internationally with scope for improvement in terms of filter retrieval rates and minimising filter dwell time. Particular vigilance is required in younger patients where the indication for filter insertion was prophylactic.

Multimodality imaging features of hereditary multiple exostoses.

Hereditary multiple exostoses (HME) or diaphyseal aclasis is an inherited disorder characterised by the formation of multiple osteochondromas, which are cartilage-capped osseous outgrowths, and the development of associated osseous deformities. Individuals with HME may be asymptomatic or develop clinical symptoms, which prompt imaging studies. Different modalities ranging from plain radiographs to cross-sectional and nuclear medicine imaging studies can be helpful in the diagnosis and detection of complications in HME, including chondrosarcomatous transformation. We review the role and imaging features of these different modalities in HME.

Percutaneous nephrolithotomy in adult patients with spina bifida, severe spinal deformity and large renal stones.

AIMS: To present our experience in patients with spina bifida with severe spinal abnormality undergoing percutaneous nephrolithotomy (PCNL) for large stone burden. PATIENTS AND METHODS: A retrospective review identified five spina bifida patients with abnormal spinal curvature who had a PCNL for large kidney stones. The mean age was 28 years. In two patients, stones were on the concave side of the scoliotic spine further limiting percutaneous access. Mean stone burden was 940 mm2. All patients were paraplegic, three patients had symptomatic stone disease. We performed initial percutaneous renal access in radiology department and staged nephrolithotomy in operating room. Tract dilatation was accomplished using Amplatz dilators and a 24 Ch or 26 Ch nephroscope was used. Fragmentation and stone removal were accomplished in all patients using pneumatic and or ultrasound lithotripter and a retrieval grasper. RESULTS: No anaesthetic complications were recorded. One patient required multiple percutaneous tracts, four had single tract to access stones. Three patients were stone free after PCNL. One required second PCNL through the same tract and another patient had multiple adjunctive ESWL. All five patients were stone clear after the final procedure. Two patients required blood transfusion. No patient had major complication or admission to intensive care unit. CONCLUSIONS: Percutaneous nephrolithotomy in patients with spina bifida is challenging but safe. Detailed pre-operative anaesthetic assessment and precise uroradiological evaluation of renal anatomy is essential. Second-look PCNL and additional ESWL/URS treatment may be required to completely clear stones.

Percutaneous renal artery angioplasty and stenting: indications, technique and results.

BACKGROUND: Percutaneous interventions for renal arterial disease can be used to treat a variety of conditions including both atherosclerotic and non-atherosclerotic renal artery stenosis (RAS) as well as endovascular management of renal artery aneurysms (RAA). AIM: We sought to examine the indications, techniques and results of percutaneous renal angioplasty and stenting in our institution over a 6-year period and review the current evidence for practice. METHODS: Patient demographics, procedure indications, technical procedural details, complications, baseline and follow-up renal profile indices were analysed. RESULTS: The most common indication for intervention was atherosclerotic RAS (69.2%) followed by RAS secondary to fibromuscular dysplasia (15.3%) and RAA (15.3%). There was a 100% technical success in our cohort of patients. The majority of patients (84.6%) had cross-sectional imaging in the form of computed tomography or magnetic resonance angiography prior to intervention. CONCLUSION: When performed in appropriate settings following close liaison with referring physicians, percutaneous renal angioplasty and stenting remains an important treatment modality for renovascular disease.

Ocular health among radiologists in the age of PACS: is it time for our profession to open its eyes to this issue in light of existing European legislation?

The regular use of visual display units (VDUs) at work has been shown to cause the development of a constellation of symptoms ranging from dry eyes to temporary myopia. European workers who use VDUs are now protected under detailed legislation enacted by the European Union (Directive 90/270/EEC). The use of picture archiving and communications systems, which are almost ubiquitous in European countries, means that, as a profession, radiologists fall under the remit of this legislation. This paper aims to assess the impact that full implementation of this law would have on a radiologist's practice and to more broadly examine the issue of eye care as an occupational health issue in radiology. The authors conclude that eye care in the setting of regular VDU use among radiologists is an important quality control and occupational health issue. There is a clear legal basis requiring employers to provide regular eye examinations and reporting breaks. In the absence of leadership from employers on this issue individual radiologists have a responsibility to ensure that their work practices reflect the legal situation and minimise the effect of eye strain on their performance.

Radiation-induced aortic occlusion.

Arterial occlusion is a late complication of radiotherapy usually seen in extracranial vessels following treatment for head and neck malignancy. Determining the etiology behind vessel occlusion can be difficult and involves consideration of several factors. We present a case of radiotherapy induced aortic occlusion and discuss the relevant clinical and imaging factors that allow the diagnosis to be made.

The MRI findings of a de Garengeot hernia.

The presence of the appendix within a femoral hernia is rare. It was first described by the French surgeon Jacques Croissant de Garengeot in 1731. This phenomenon accounts for 0.8-1% of all femoral hernias. Acute appendicitis occurring within a femoral hernia is even rarer and is difficult to diagnose pre-operatively. This type of hernia is termed a de Garengeot hernia. The ultrasonographic and CT imaging features of de Garengeot hernias have been described previously. We report a case of a 57-year-old female who presented with a painful right-sided groin mass. She underwent MRI of the inguinal region, which successfully diagnosed this rare hernia pre-operatively. To our knowledge, this is the first description of a de Garengeot hernia diagnosed using MRI.