National UK Survey of Radiation Doses During Endovascular Aortic Interventions.

PURPOSE: Endovascular aortic repair (EAR) interventions, endovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), are associated with significant radiation exposures. We aimed to investigate the radiation doses from real-world practice and propose diagnostic reference level (DRL) for the UK. MATERIALS AND METHODS: Radiation data and essential demographics were retrospectively collected from 24 vascular and interventional radiology centres in the UK for all patients undergoing EAR-standard EVAR or complex, branched/fenestrated (BEVAR/FEVAR), and TEVAR-between 2018 and 2021. The data set was further categorised according to X-ray unit type, either fixed or mobile. The proposed national DRL is the 75th percentile of the collective medians for procedure KAP (kerma area product), cumulative air kerma (CAK), fluoroscopy KAP and CAK. RESULTS: Data from 3712 endovascular aortic procedures were collected, including 2062 cases were standard EVAR, 906 cases of BEVAR/FEVAR and 509 cases of TEVAR. The majority of endovascular procedures (3477/3712) were performed on fixed X-ray units. The proposed DRL for KAP was 162 Gy cm2, 175 Gy cm2 and 266 Gy cm2 for standard EVAR, TEVAR and BEVAR/FEVAR, respectively. CONCLUSION: The development of DRLs is pertinent to EAR procedures as the first step to optimise the radiation risks to patients and staff while maintaining the highest patient care and paving the way for steps to reduce radiation exposures.

Life course reproductive dynamics associated with menopause in Ugandan women aged 40-49.

BACKGROUND: Early menopausal onset can increase adverse health outcomes in later life; meanwhile, reproductive experiences before menopause may affect its timing. Framed by life course methodology, the study tested for independent and interdependent associations between reproductive history (contraception, age at first birth, parity, terminated pregnancy) and socioeconomic factors (education, wealth, rural-urban residence, cigarette use, marital status, age at first cohabitation) with the occurrence of early menopause. METHODS: The study population was ever-married women aged 40-49 from the 2016 Demographic & Health Survey (N = 2748). Analytical methods involved probability- and age-adjusted multivariate logistic regression models and predictive margins. RESULTS: Connections between reproductive and socioeconomic characteristics were key dynamics associated with menopause in ages 40-49. Contraception, parity, and ages at first birth and marriage were found to be independently associated with menopause in this age group. Evidence of interactions was found where no contraceptive use was associated with higher probabilities of menopause for first-time mothers aged 12-15 and for women with no education. CONCLUSIONS: Studying Ugandan women's reproductive histories highlighted the importance of regional knowledge about menopause. Though we hypothesized that risks would correlate in a chain, the results pointed to risks clustering around contraception, suggesting that improving contraceptive use and education for women could increase menopausal age. Furthermore, the positive association between low parity and early menopause supports the biological mechanism of faster oocyte depletion; however, high-parity populations like Uganda tend to have a younger menopausal age than low-parity populations. Declining mortality in the demographic transition could explain these inverse associations.

Quality assurance of paediatric lateral chest radiographs.

INTRODUCTION: Lateral chest radiographs aid in paediatric clinical practice in countries where the diagnosis of primary pulmonary tuberculosis (PTB) still relies heavily on the chest radiograph. This study aimed to create a validated quality assurance (QA) tool investigating the diagnostic performance of this projection by applying this to a database of lateral chest radiographs in children with suspected PTB. METHOD: The QA tool was built to include a compilation of criteria from the different sources, accompanied by graphic representations and objective measurements where appropriate. Each defined criterion (radiographic error) was evaluated by implementing the QA tool on 300 radiographs, scored by three readers. The sample was subjected to two separate sets of data analysis, based on averages, and on majority decision methodology. RESULTS: The QA tool was based on existing published criteria, as well as under-collimation and under-inspiration, two de novo criteria. For the total 900 reads, errors were categorized as patient-related in 681 (75.7%) and radiographer-related in 421 (46.8%) and 122 (13.6%) had no errors. The average number of errors per radiograph ranged from 0.9 to 4.7 errors out of the 11 quality factors reviewed. When considering the majority decision, the median errors per radiograph was 1 (IQR 1-2) (range 0-5). Inter-rater agreement varied for different criteria. CONCLUSION: A novel QA tool for evaluating lateral chest radiographs was developed which requires further efforts of refinement regarding criteria such as exposure, field of view: under-collimation, and motion artifact, which remain subjective. The designed QA tool will allow comparison of radiograph quality before and after interventions. Furthermore, the tool can be used in tackling childhood PTB in low- and middle-income countries (LMICs) since the hallmark of the disease is lymphadenopathy, which is often depicted best on lateral chest radiographs.

Use and effectiveness of Pioneer re-entry device for subintimal true lumen re-entry: single-centre data and a review of the literature.

INTRODUCTION: During subintimal angioplasty (SIA), it is not always possible to re-enter the vessel lumen due to a variety of factors. Recanalization using hydrophilic wires and catheters alone, apart from its potential technical failure, is also limited by minimal control over the re-entry point. This is frequently well beyond the point of occlusion, thus often compromising important collaterals. In order to bypass the obstruction and attain controlled re-entry into the lumen of the diseased vessel, a re-entry device (RED) may be required. This paper assesses our centre's experience with the safety and efficacy of the Pioneer re-entry system and systematically reviews the pertinent literature. METHOD: A single centre retrospective study of subintimal angioplasty involving the use of the Pioneer Plus intravascular guided reentry catheter was performed. Patient demographics including age, gender, risk factors, comorbidities clinical indication and complications were recorded. Lesion characteristics, including location and severity of calcification were also assessed. A systematic literature review of all reported studies where the Pioneer RED was used for iliac and lower limb revascularization was conducted by 2 of the authors using the PubMed (MEDLINE) and EMBASE databases. RESULTS: The study comprised 30 cases. Technical success was 97%. A small, quickly resolved extravasation was the only device related complication. These results are in line with the systematic review which identified 16 studies using the Pioneer RED, reporting a technical success rate of 87.4-100% (median = 100%) and complication rate of 0-25.8% (median = 0%). However, due to heterogeneity in definitions of technical success, data was not pooled.

Laryngeal granular cell tumour: a very rare diagnosis for a child presenting with hoarse voice in the UK.

We present a rare case of a paediatric laryngeal granular cell tumour (GCT) of the vocal cord. GCTs are rare clinical entities, thought to arise from Schwann cells. There are only a handful of paediatric laryngeal GCTs in the literature, and therefore, little is known regarding their natural history or preferred management strategies. In this case report, we discuss the incidence, aetiopathogenesis, presentation and management of a laryngeal GCT in an 11-year-old girl, who presented with dysphonia. We believe that this case will aid otolaryngologists in the management of paediatric patients with the common dysphonia.