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1.
J Urol ; 205(1): 78-85, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32614274

RESUMO

PURPOSE: The time between radiographic identification of a renal tumor and surgery can be concerning for patients and clinicians due to fears of tumor progression while awaiting treatment. This study aimed to evaluate the association between surgical wait time and oncologic outcomes for patients with renal cell carcinoma. MATERIALS AND METHODS: The Canadian Kidney Cancer Information System is a multi-institutional prospective cohort initiated in January 2011. Patients with clinical stage T1b or greater renal cell carcinoma diagnosed between January 2011 and December 2019 were included in this analysis. Outcomes of interest were pathological up staging, cancer recurrence, cancer specific survival and overall survival. Time to recurrence and death were estimated using Kaplan-Meier estimates and associations were determined using Cox proportional hazards models. RESULTS: A total of 1,769 patients satisfied the study criteria. Median wait times were 54 days (IQR 29-86) for the overall cohort and 81 days (IQR 49-127) for cT1b tumors (1,166 patients), 45 days (IQR 27-71) for cT2 tumors (672 cases) and 35 days (IQR 18-61) for cT3/4 tumors (563). Adjusting for comorbidity, tumor size, grade, histological subtype, margin status and pathological stage, there was no association between prolonged wait time and cancer recurrence or death. CONCLUSIONS: In the context of current surgeon triaging practices surgical wait times up to 24 weeks were not associated with adverse oncologic outcomes after 2 years of followup.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Nefrectomia/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Canadá/epidemiologia , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Neoplasias Renais/diagnóstico , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Nefrectomia/normas , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Radiografia/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento/normas , Triagem/normas , Triagem/estatística & dados numéricos
2.
Medicine (Baltimore) ; 99(46): e23180, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181695

RESUMO

This study compared implant outcomes following maxillary sinus floor augmentation (MSFA) in edentulous patients with a residual alveolar bone height ≤3 mm. Four techniques were evaluated: 1-stage bone-added osteotome sinus floor elevation procedure (BAOSFE) with simultaneous implant placement; 2-stage BAOSFE with delayed implant placement; 1-stage lateral window sinus floor elevation with simultaneous implant placement; and 2-stage lateral window sinus floor elevation with delayed implant placement. Patients were followed for 18 to 72 months (mean: 52.5 months) after prosthesis placement. Data were analyzed with cone-beam computed tomography. A total of 96 implants from 71 patients were analyzed; pretreatment, there were no significant differences between patients. Total implant survival was 98.9%. The mean residual bone height was significantly higher in the 1-stage BAOSFE group than the other groups (P < .01); 1 implant in this group failed at 3 months. There was no significant difference in total bone height gain between groups. However, the bone height gain of 1st sinus lifting with 2-stage BAOSFE was significantly lower than the 2-stage lateral window procedure (P < .01). There was no prosthesis failure. The favorable implant outcomes suggest these 1-stage and 2-stage MSFA procedures should be considered as alternative treatment options for patients with extremely atrophic posterior maxilla.


Assuntos
Osso e Ossos/cirurgia , Seios Paranasais/cirurgia , Próteses e Implantes/tendências , Levantamento do Assoalho do Seio Maxilar/estatística & dados numéricos , Pesos e Medidas , Osso e Ossos/anormalidades , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Nasais/instrumentação , Procedimentos Cirúrgicos Nasais/métodos , Osteotomia/métodos , Radiografia/métodos , Radiografia/estatística & dados numéricos , Levantamento do Assoalho do Seio Maxilar/instrumentação , Levantamento do Assoalho do Seio Maxilar/métodos , Estatísticas não Paramétricas , Resultado do Tratamento
3.
J Am Coll Radiol ; 17(9): 1096-1100, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32721410

RESUMO

The speed at which coronavirus disease 2019 (COVID-19) spread quickly fractured the radiology practice model in ways that were never considered. In March 2020, most practices saw an unprecedented drop in their volume of greater than 50%. The profound changes that have interrupted the arc of the radiology narrative may substantially dictate how health care and radiology services are delivered in the future. We examine the impact of COVID-19 on the future of radiology practice across the following domains: employment, compensation, and practice structure; location and hours of work; workplace environment and safety; activities beyond the "usual scope" of radiology practice; and CME, national meetings, and professional organizations. Our purpose is to share ideas that can help inform adaptive planning.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/tendências , Radiologistas/estatística & dados numéricos , Radiologia/organização & administração , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Gerenciamento da Prática Profissional/estatística & dados numéricos , Gerenciamento da Prática Profissional/tendências , Padrões de Prática Médica/estatística & dados numéricos , Radiografia/estatística & dados numéricos , Medição de Risco , Estados Unidos , Local de Trabalho/organização & administração
4.
Surgery ; 168(3): 440-447, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32641278

RESUMO

BACKGROUND: More than 70% of patients with localized pancreatic cancer treated with upfront surgery develop disease recurrence. Herein we describe the radiographic patterns and timing of disease recurrence after neoadjuvant therapy and surgery in patients with pancreatic cancer. METHODS: Radiographic patterns of first disease recurrence were examined in patients with localized pancreatic cancer who completed neoadjuvant therapy and surgery. Disease recurrence was classified as local (pancreas, resection bed, or peripancreatic vasculature); regional (peritoneum or abdominal wall); or distant (liver, lung, bone). Progression-free survival was calculated from the date of diagnosis to the date of recurrence. RESULTS: Of 306 consecutive patients who completed neoadjuvant therapy and surgery, 149 (49%) had resectable pancreatic cancer and 157 (51%) had borderline resectable disease. Neoadjuvant therapy consisted of chemoradiation (32%), chemotherapy (14%), or both therapies (54%). Overall, primary therapy (including preoperative and postoperative therapy) consisted of chemoradiation alone in 29 (9%), chemotherapy alone in 14 (5%), and both therapies in 263 (86%) patients. At a median follow-up of 27 months, 186 (61%) of the 306 patients had recurrent pancreatic cancer. Sites of first recurrence were local-only in 29 (9%), regional-only in 19 (6%), distant-only in 87 (28%), and multisite in 51 (17%). The overall median progression-free survival for all patients was 24 months. Neoadjuvant chemoradiation reduced the odds of local-only recurrence (odds ratio: 0.21; 95% confidence interval: 0.06-0.77; P = .02). CONCLUSION: After neoadjuvant therapy and surgery, 9% of patients were found to have local-only recurrence. Treatment sequencing that incorporates neoadjuvant chemoradiation may improve local disease control.


Assuntos
Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Pâncreas/diagnóstico por imagem , Pancreatectomia , Neoplasias Pancreáticas/terapia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/métodos , Quimiorradioterapia/estatística & dados numéricos , Quimiorradioterapia Adjuvante/métodos , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Feminino , Fluoruracila/uso terapêutico , Seguimentos , Humanos , Irinotecano/uso terapêutico , Estimativa de Kaplan-Meier , Leucovorina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/prevenção & controle , Oxaliplatina/uso terapêutico , Pâncreas/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidade , Intervalo Livre de Progressão , Radiografia/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(26): e20839, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590777

RESUMO

Although the inverse correlation between smoking and degenerative arthritis is controversial, quantitative analysis of the correlation between lifetime cigarette smoking amount and degenerative arthritis has not been performed. We investigated the correlation between knee radiographic osteoarthritis (ROA) and lifetime cigarette smoking amount in the general population.This cross-sectional study used the Fifth and Sixth Korean National Health and Nutrition Examination Survey (2010-2013) data. Subjects included 11,638 community-dwelling adults aged ≥50 years. Knee ROA was defined as a Kellgren/Lawrence grade ≥2 on plain radiography. Lifetime cigarette smoking amount was calculated in terms of pack-year and further divided into quartile groups. Independent correlation between smoking and knee ROA was determined using odds ratios (OR) adjusted for age, sex, obesity, physical activity, and household income on multivariate logistic regression analysis.Knee ROA prevalence was 37.3%; prevalence of lifetime cigarette smokers was 26.0%. Subjects with knee ROA had higher mean age, female sex ratio, and body mass index but lower physical activity level. The adjusted logistic regression model revealed that female sex (OR, 2.110; 95% confidence interval [CI], 1.895-2.349) was significantly associated with knee ROA. Older age, obesity, and lower household income were positively correlated with knee ROA. Second-and fourth-quartile groups of smokers had the lower ROA prevalence than never-smokers (OR, 0.800; 95% CI, 0.643-0.99; OR, 0.812; 95% CI, 0.684-0.965, respectively).An inverse correlation with knee ROA was confirmed in mid-light to heavy smokers. Prospective studies are needed to reveal whether knee ROA involves smoking.


Assuntos
Fumar Cigarros/efeitos adversos , Osteoartrite do Joelho/diagnóstico , Prevalência , Idoso , Índice de Massa Corporal , Fumar Cigarros/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Osteoartrite do Joelho/classificação , Osteoartrite do Joelho/epidemiologia , Radiografia/métodos , Radiografia/estatística & dados numéricos , República da Coreia/epidemiologia , Inquéritos e Questionários
6.
PLoS One ; 15(6): e0234972, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574222

RESUMO

OBJECTIVE: To evaluate prevalence of structural lesions, synovitis and bone marrow lesions (BMLs) on MRI performed with a 0.3T imaging system in patients with erosive hand osteoarthritis (EHOA) and to compare them to the anatomic radiographic Verbruggen-Veys score (VV). DESIGN: For this Cross-sectional study, fifty-five EHOA patients were studied with 0.3T contrast-enhanced MRI and radiography (RX) of their dominant hand. Structural lesions were scored according to the OMERACT Hand Osteoarthritis MRI Scoring System as follows: osteophytes and erosions were graded from 0 to 3. On joint destruction lesion synovitis and BMLs were graded from 0 to 1. And on MRI, we evaluated the presence of several structural features: N: normal, O: osteophytic lesions, E: erosive lesions, E/O: osteophytic and erosive lesions and D: joint destruction. RX was scored according to the VV system. Relations between MRI features and VV stages were analysed. RESULTS: MRI identified more structural lesions than RX (77.3% versus 74.8%) and particularly more erosive lesions (E or E/O) than VV Phase E (33.5% versus 20.2%). E/O and D were mostly found on MRI. Synovitis and BMLs were significantly associated with E/O and D with the following odds ratios (ORs): 8.4 (95% CI 1.8-13.6); OR: 13.7 (95% CI 2.9-21.0); OR: 15.7 (95% CI 3.2-23.5); OR: 38.5 (95% CI 9.5-57.0), respectively. CONCLUSION: MRI 0.3T appears completely relevant for EHOA lesion analysis. First, MRI shows more erosive lesions than RX in EHOA; second, it allows for the analysis of synovitis and BMLs to be associated with more specific structural MRI features (E/O and D).


Assuntos
Medula Óssea/patologia , Articulação da Mão/patologia , Imagem por Ressonância Magnética/estatística & dados numéricos , Osteoartrite/complicações , Radiografia/estatística & dados numéricos , Sinovite/epidemiologia , Idoso , Medula Óssea/diagnóstico por imagem , Estudos Transversais , Feminino , Articulação da Mão/diagnóstico por imagem , Humanos , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/tratamento farmacológico , Osteoartrite/patologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Sinovite/diagnóstico por imagem , Sinovite/etiologia
7.
BMC Public Health ; 20(1): 969, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32560720

RESUMO

BACKGROUND: In Finland, asylum seekers from countries with high tuberculosis (TB) incidence (> 50/100,000 population/year) and those coming from a refugee camp or conflict area are eligible for TB screening. The aim of this study was to characterise the TB cases diagnosed during screening and estimate the yield of TB screening at the reception centres among asylum seekers, who arrived in Finland during 2015-2016. METHODS: Voluntary screening conducted at reception centres included an interview and a chest X-ray. Data on TB screening and health status of asylum seekers was obtained from the reception centres' national health register (HRS). To identify confirmed TB cases, the National Infectious Disease Register (NIDR) data of foreign-born cases during 2015-2016 were linked with HRS data. TB screening yield was defined as the percentage of TB cases identified among screened asylum seekers, stratified by country of origin. RESULTS: During 2015-2016, a total of 38,134 asylum applications were received (57% were from Iraq, 16% from Afghanistan and 6% from Somalia) and 25,048 chest x-rays were performed. A total of 96 TB cases were reported to the NIDR among asylum seekers in 2015-2016; 94 (98%) of them had been screened. Screening identified 48 (50%) cases: 83% were male, 56% aged 18-34 years, 42% from Somalia, 27% from Afghanistan and 13% from Iraq. Furthermore, 92% had pulmonary TB, 61% were culture-confirmed and 44% asymptomatic. TB screening yield was 0.19% (48/25048) (95%CI, 0.14-0.25%) and it varied between 0 and 0.83% stratified by country of origin. Number needed to screen was 522. CONCLUSIONS: TB screening yield was higher as compared with data reported from other European countries conducting active screening among asylum seekers. Half of the TB cases among asylum seekers were first suspected in screening; 44% were asymptomatic. TB yield varied widely between asylum seekers from different geographic areas.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Afeganistão/etnologia , Feminino , Finlândia/epidemiologia , Nível de Saúde , Humanos , Incidência , Iraque/etnologia , Masculino , Pessoa de Meia-Idade , Radiografia/estatística & dados numéricos , Somália/etnologia , Tuberculose Pulmonar/etnologia , Adulto Jovem
8.
PLoS One ; 15(5): e0232403, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32374774

RESUMO

We present novel multi-energy X-ray imaging methods for direct radiography and computed tomography. The goal is to determine the contribution of thickness, mass density and atomic composition to the measured X-ray absorption in the sample. Algorithms have been developed by our own to calculate new X-ray images using data from an unlimited amount of scans/images of different tube voltages by pixelwise fitting of the detected gray levels. The resulting images then show a contrast that is influenced either by the atomic number of the elements in the sample (photoelectric interactions) or by the mass density (Compton scattering). For better visualization, those images can be combined to a color image where different materials can easily be distinguished. In the case of computed tomography no established true multi-energy methodology that does not require an energy sensitive detector is known to the authors. The existing dual-energy methods often yield noisy results that need spatial averaging for clear interpretation. The goal of the method presented here is to qualitatively calculate atomic number and mass density images without loosing resolution while reducing the noise by the use of more than two X-ray energies. The resulting images are generated without the need of calibration stan-dards in an automatic and fast data processing routine. They provide additional information that might be of special interest in cases like archaeology where the destruction of a sample to determine its composition is no option, but a increase in measurement time is of little concern.


Assuntos
Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Simulação por Computador , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Imageamento Tridimensional/métodos , Imageamento Tridimensional/estatística & dados numéricos , Ciência dos Materiais , Minerais/química , Radiografia/estatística & dados numéricos , Espalhamento de Radiação , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Raios X
9.
Emerg Med J ; 37(6): 345-350, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32245749

RESUMO

OBJECTIVE: To compare the treatment practices (immobilisation vs non-immobilisation) of toddler fractures and other minor tibial fractures (both proven and suspected) in preschoolers, aged 9 months-4 years, and examine rates of ED re-presentations and complications. METHODS: Retrospective chart review of presentations of minor tibial fractures, both proven (radiologically confirmed) or suspected (negative X-ray but clinical evidence of bony injury), in children aged 9 months-4 years presenting to a single tertiary level paediatric ED from May 2016 to April 2018. Data collected included treatment practices, subsequent unscheduled re-presentations (including reasons) and complications (defined as problems relating to the injury that required further active care). RESULTS: A search of medical records yielded 240 cases: 102 had proven fractures (spiral, buckle or Salter-Harris II) and 138 were diagnosed with a suspected fracture. 73.5% of proven fractures were immobilised, predominantly with backslabs. 79% of suspected fractures were treated with expectant observation without immobilisation. Patients treated with immobilisation were more likely to re-present to ED compared with non-immobilised patients (18/104, 17.3% vs 9/136, 6.6% RR 2.62, 95% CI 1.23 to 5.58). 21 complications were seen in 19/104 (18.3%) immobilised patients. There were eight skin complications (complication rate of 7.7%) and 11 cast issues (complication rate of 10.6%). Two (1.5%) of the 136 patients had complications related to pain or limp. Pain was uncommonly found, although follow-up was not universal. CONCLUSION: In our centre, proven minor tibial fractures were more likely to receive a backslab, whereas for suspected fractures, expectant observation without immobilisation was performed. Although there is potential bias in the identification of complications with immobilisation, the study suggests that non-immobilisation approach should be investigated.


Assuntos
Imobilização/normas , Radiografia/estatística & dados numéricos , Fraturas da Tíbia/complicações , Pré-Escolar , Feminino , Humanos , Imobilização/métodos , Imobilização/estatística & dados numéricos , Lactente , Masculino , Radiografia/métodos , Estudos Retrospectivos , Fraturas da Tíbia/terapia
10.
Radiology ; 296(3): E141-E144, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32293225

RESUMO

The coronavirus 2019 (COVID-19) pandemic will have a profound impact on radiology practices across the country. Policy measures adopted to slow the transmission of disease are decreasing the demand for imaging independent of COVID-19. Hospital preparations to expand crisis capacity are further diminishing the amount of appropriate medical imaging that can be safely performed. Although economic recessions generally tend to result in decreased health care expenditures, radiology groups have never experienced an economic shock that is simultaneously exacerbated by the need to restrict the availability of imaging. Outpatient-heavy practices will feel the biggest impact of these changes, but all imaging volumes will decrease. Anecdotal experience suggests that radiology practices should anticipate 50%-70% decreases in imaging volume that will last a minimum of 3-4 months, depending on the location of practice and the severity of the COVID-19 pandemic in each region. The Coronavirus Aid, Relief, and Economic Security, or CARES, Act provides multiple means of direct and indirect aid to health care providers and small businesses. The final allocation of this funding is not yet clear, and it is likely that additional congressional action will be necessary to stabilize health care markets. Administrators and practice leaders must be proactive with practice modifications and financial maneuvers that can position them to emerge from this pandemic in the most viable economic position. It is possible that this crisis will have lasting effects on the structure of the radiology field.


Assuntos
Infecções por Coronavirus , Necessidades e Demandas de Serviços de Saúde , Pandemias , Pneumonia Viral , Radiografia , Radiologia , Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Radiografia/economia , Radiografia/estatística & dados numéricos , Radiologia/economia , Radiologia/organização & administração
11.
Bone Joint J ; 102-B(4): 495-500, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228072

RESUMO

AIMS: To monitor the performance of services for developmental dysplasia of the hip (DDH) in Northern Ireland and identify potential improvements to enhance quality of service and plan for the future. METHODS: This was a prospective observational study, involving all infants treated for DDH between 2011 and 2017. Children underwent clinical assessment and radiological investigation as per the regional surveillance policy. The regional radiology data was interrogated to quantify the use of ultrasound and ionizing radiation for this population. RESULTS: Evidence-based changes were made to the Northern Ireland screening programme, including an increase in ultrasound scanning capacity and expansion of nurse-led screening clinics. The number of infant hip ultrasound scans increased from 4,788 in 2011, to approximately 7,000 in 2013 and subsequent years. The number of hip radiographs on infants of less than one year of age fell from 7,381 to 2,208 per year. There was a modest increase in the treatment rate from 10.9 to 14.3 per 1,000 live births but there was a significant reduction in the number of closed hip reductions. The incidence of infants diagnosed with DDH after one year of age was 0.30 per 1,000 live births over the entire period. CONCLUSION: Improving compliance with the regional infant hip screening protocols led to reduction in operative procedures and reduced the number of pelvic radiographs of infants. We conclude that performance monitoring of screening programmes for DDH is essential to provide a quality service. Cite this article: Bone Joint J 2020;102-B(4):495-500.


Assuntos
Luxação Congênita de Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Fatores Etários , Medicina Baseada em Evidências/métodos , Feminino , Luxação Congênita de Quadril/epidemiologia , Luxação Congênita de Quadril/cirurgia , Humanos , Lactente , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Irlanda do Norte/epidemiologia , Vigilância da População , Estudos Prospectivos , Melhoria de Qualidade , Radiografia/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos
12.
Eur J Radiol ; 125: 108864, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32062329

RESUMO

PURPOSE: To assess compliance of lumbar spine imaging referrals with national imaging recommendations and to evaluate the impact of inappropriate imaging on the collective radiation dose and health insurance costs. METHOD: In 2011 and 2015, 633 lumbar spine imaging referrals were evaluated across 9 Belgian hospitals. For each patient, a new clinical anamnesis and physical examination were performed. Together with the referral, this data were confronted with the national imaging recommendations. Collective radiation dose was estimated for the radiography and CT procedures. Cost analysis was based on national reimbursement fees. Statistical analysis was performed using multilevel linear and logistic regression models. RESULTS: The fraction of unjustified imaging referrals decreased from 50 % in 2011 to 41 % in 2015 (p = 0.255). The odds of a justified examination are 3.1 times higher when the referral is done by a specialist instead of a general practitioner. The highest percentage of unjustified examinations was found for CT (85 % in 2011, 81 % in 2015; p = 0.044). Seventy-five percent of the collective dose of both the 2011 and the 2015 study population was not justified. Adherence to the recommendations could result in an estimated 16 % and 5 % cost reduction for the 2011 and 2015 study samples, respectively. CONCLUSIONS: Between 2011 and 2015, no significant improvement was found in requesting justified lumbar spine imaging procedures, although a positive trend was observed for CT. A shift from CT to MRI is necessary to improve the appropriateness of lumbar spine imaging referrals and to reduce the collective radiation dose.


Assuntos
Diagnóstico por Imagem/economia , Diagnóstico por Imagem/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Vértebras Lombares/diagnóstico por imagem , Doses de Radiação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica , Análise Custo-Benefício/economia , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Diagnóstico por Imagem/métodos , Feminino , Fidelidade a Diretrizes/economia , Humanos , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Radiografia/economia , Radiografia/estatística & dados numéricos , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/estatística & dados numéricos , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto Jovem
13.
J Surg Res ; 250: 188-192, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32078827

RESUMO

BACKGROUND: Routine chest x-rays (CXRs) ordered on thoracic surgery inpatients are common, costly, and of unclear clinical utility. We sought to investigate CXR ordering practices and their impact on clinical care. MATERIALS AND METHODS: A single-center, retrospective cohort study of adult patients admitted after undergoing thoracic surgery with an intraoperative chest tube (CT) placed was performed over a 1-y period. Our primary outcome was a CXR-driven change in care. We evaluated routine CXR orders immediately after surgery in the postanesthesia care unit (PACU) and after final CT removal. "Routine" was defined as not ordered during a workup for a clinical concern. Patients were excluded if they underwent pleurodesis, were discharged with a CT, or had an immediate post-CT removal clinical change prompting intervention. RESULTS: A total of 241 patients met inclusion. All patients received a routine PACU CXR, and 48% (117) had abnormal radiographic findings (e.g., pneumothorax, consolidation, effusion, etc). Secondary to this CXR, one patient (0.4%) experienced a change in care: a repeat CXR only. All patients received a routine final CT removal CXR, and 58% (140) had abnormal radiographic findings. After this CXR, 33 patients (14%) experienced a change in care: 32 underwent repeat CXR and one was clinically observed. Overall, no patients experienced a procedural intervention. CONCLUSIONS: Routine post-thoracic surgery CXRs in the PACU and after CT removal have limited clinical impact. Quality initiatives should be pursued to decrease empiric CXR use and reserve ordering for specific clinical concerns.


Assuntos
Pneumopatias/diagnóstico , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Radiografia/estatística & dados numéricos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Idoso , Tubos Torácicos/efeitos adversos , Feminino , Humanos , Pneumopatias/epidemiologia , Pneumopatias/etiologia , Masculino , Sobremedicalização/prevenção & controle , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Radiografia/normas , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/instrumentação , Tórax/diagnóstico por imagem
14.
Arthritis Rheumatol ; 72(6): 966-971, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31904188

RESUMO

OBJECTIVE: Pain sensitization contributes to the complex osteoarthritis (OA) pain experience. The relationship between imaging features of hand OA and clinically assessed pain sensitization is largely unexplored. This study was undertaken to examine the association of structural and inflammatory features of hand OA with local pressure pain thresholds (PPTs) in the Nor-Hand study. METHODS: The cross-sectional relationship of severity of structural radiographic features of hand OA (measured according to the Kellgren/Lawrence scale [grade 0-4] and the absence or presence of erosive joint disease) as well as ultrasound-detected hand joint inflammation (assessed by gray-scale synovitis [grade 0-3] and the absence or presence of power Doppler activity) to the PPTs of 2 finger joints was examined by multilevel regression analyses adjusted for age, sex, and body mass index, using beta values with 95% confidence intervals (95% CIs). RESULTS: A total of 570 joints in 285 participants included in the Nor-Hand study were assessed. Greater structural and inflammatory severity was associated with lower PPTs, with adjusted beta values of -0.5 (95% CI -0.6, -0.4) per Kellgren/Lawrence grade increase, -1.4 (95% CI -1.8, -0.9) for erosive versus non-erosive joints, -0.7 (95% CI -0.9, -0.6) per gray-scale synovitis grade increase, and -1.5 (95% CI -1.8, -1.1) for joints with power Doppler activity on ultrasound versus those without. CONCLUSION: Greater severity of structural pathologic features and hand joint inflammation was associated with lower PPTs in the finger joints of patients with hand OA, indicating pain sensitization. Our results indicate that pain sensitization might be driven by structural and inflammatory pathology in hand OA.


Assuntos
Artralgia/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Limiar da Dor/fisiologia , Radiografia/estatística & dados numéricos , Ultrassonografia Doppler/estatística & dados numéricos , Idoso , Artralgia/etiologia , Artralgia/fisiopatologia , Sensibilização do Sistema Nervoso Central/fisiologia , Estudos Transversais , Feminino , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/fisiopatologia , Articulação da Mão/diagnóstico por imagem , Articulação da Mão/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/fisiopatologia , Pressão
15.
Pediatr Surg Int ; 36(1): 93-101, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31435734

RESUMO

PURPOSE: Pediatric cervical spine injuries are rare events. Missed injuries must be weighed against radiation exposure and excess resource utilization in a young population. A universal pediatric cervical spine clearance algorithm does not exist. The study objective is to determine if care improved after the implementation of a standardized cervical spine clearance pathway by evaluating imaging rates, length of stay, speciality consultation, and injury detection. METHODS: A multidisciplinary group reviewed relevant literature to develop an algorithm for cervical spine clearance in pediatric trauma patients. We reviewed patient charts 15 months before and after implementation. Categorical comparisons were tested with Chi-square. A p value less than 0.05 was considered statistically significant. RESULTS: The pre- and post-implementation groups were homogenous when comparing demographics, mechanism and severity of injury. Using the cervical spine clearance pathway, patients received fewer plain cervical spine radiographs (34% vs 16%), fewer spine speciality consults (28% vs 13%), and more patients were cleared clinically (44% vs 62%) (p < 0.05). There were 2 (1.7%) documented injuries in the pre-implementation group and 3 (3%) documented injuries in the post-implementation group. There were no missed injuries. CONCLUSIONS: Use of a standardized pathway allows more patients' cervical spines to be cleared clinically and better utilizes resources without compromising patient care. LEVEL OF EVIDENCE: Level III. TYPE OF STUDY: Care Management Study.


Assuntos
Vértebras Cervicais/lesões , Procedimentos Clínicos , Traumatismos da Coluna Vertebral/diagnóstico , Algoritmos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Michigan , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Radiografia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco , Centros de Traumatologia
16.
J Am Acad Orthop Surg ; 28(8): e356-e362, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-31415302

RESUMO

BACKGROUND: Radiographs are the most commonly available diagnostic imaging modalities used to evaluate orthopaedic conditions. In addition to suspected findings based on the initial indication to obtain radiographic images, incidental findings may be observed as well, some of which may have notable medical and legal ramifications. This study evaluates the number of incidental findings reported from orthopaedic radiographs ordered in an academic orthopaedic multispecialty group over 1 year. METHODS: A retrospective review was conducted of 13,948 eligible radiographs recorded at our institution over a 12-month period. Reports were categorized based on examination type. Incidental findings were categorized as having concern for possible malignancy versus likely benign conditions. The possibly malignant findings were then further subdivided into either bone or lung malignancies. The benign findings were subcategorized by etiology and anatomic location. RESULTS: Thirteen thousand nine hundred forty-eight radiographs were evaluated, and 289 (2.07%) incidental findings were identified. The three study categories with the highest prevalence of incidental findings were spine (3.96%), leg length alignment (3.94%), and pelvic and hip (2.81%) radiographs. The three most common types of incidental findings identified were for possible malignancy or metastases in bone (30.1%), benign bone disease (24.9%), and gastrointestinal conditions (6.57%). Follow-up was recommended for 122 (42.2%) incidental findings. DISCUSSION: This study describes the prevalence of incidental findings on orthopaedic radiographs in adults. Axial radiographs such as of the spine and pelvis are more likely to report an incidental finding as opposed to appendicular radiographs of distal extremities. The exception is leg alignment radiographs that include the entire lower extremity and pelvis and image a larger area of the body. Nearly one-third of incidental findings were suspicious for possible malignancy or metastases. Additional diagnostic workup with focused imaging is often recommended. This information is useful to orthopaedic surgeons who read their own radiographs (without formal radiologist interpretation) to increase awareness of common, concerning incidental findings that may be missed and warrant additional follow-up. LEVEL OF EVIDENCE: Level III.


Assuntos
Achados Incidentais , Neoplasias/diagnóstico por imagem , Cirurgiões Ortopédicos , Radiografia/estatística & dados numéricos , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Tempo
17.
Ear Nose Throat J ; 99(1): 47-51, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30974996

RESUMO

BACKGROUND: Foreign body aspiration (FBA) is a major cause of morbidity and mortality in children. It is a preventable event that predominates in preschool age. The signs and symptoms mimic respiratory diseases common in the same age-group. We compared FBA in infants to FBA in older children. METHODS: Retrospective analysis of all the cases of suspected FBA of children under the age of 18 years hospitalized at one medical center during 2002 to 2016. We analyzed the data according to age: up to 1 year (infants) and 1 to 18 years. RESULTS: One hundred seventy-five children with suspected FBA were admitted; of whom, 27 (15%) were infants and 148 (85%) were older children (age 1-18 years). For the 2 age groups, adults witnessed 85% and 73%, respectively, of the incidents (P = .4). In the neonate group, 48% presented with normal X-ray findings compared to only 20% in the older group; 15% of the older group had a positive chest X-ray for a foreign body, while none had such in the infants' group (P = .01). For the 2 age groups, the majority of the FBs found were from organic origin. About half of the patients were diagnosed and managed within 24 hours of the aspiration event. In 10%, repeated bronchoscopy was performed due to a retained FB remnant. In a multivariate analysis, signs and symptoms (P < .05), location of the FB (P < .001), and witnessed aspiration (P < .001) were independent prognostic factors for the length of hospitalization. CONCLUSION: Foreign body aspiration is not uncommon in young infants; the management is challenging due to small airways, the need to use smaller bronchoscopes, and the lack of working channel forces in pediatric bronchoscopes.


Assuntos
Broncoscopia/estatística & dados numéricos , Corpos Estranhos/epidemiologia , Radiografia/estatística & dados numéricos , Aspiração Respiratória/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/terapia , Humanos , Lactente , Masculino , Análise Multivariada , Aspiração Respiratória/etiologia , Aspiração Respiratória/terapia , Estudos Retrospectivos
18.
Pediatr Emerg Care ; 36(1): 34-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29210887

RESUMO

The care of major trauma patients continues to be a challenge for emergency physicians and trauma surgeons. We found that the total number of radiological examinations for major trauma patients in this study was high and mainly comprised radiography and computed tomography (CT), with CT being more commonly adopted. The number of CT scans was positively correlated with severity of injury and intensive care unit length of stay. Further study is warranted to optimize radiological examinations involving major trauma patients.


Assuntos
Radiografia/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ferimentos e Lesões/diagnóstico por imagem , Adulto , China , Hospitais Gerais , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Estudos Prospectivos , Centros de Atenção Terciária , Centros de Traumatologia
19.
J Perinatol ; 40(2): 330-336, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31844185

RESUMO

OBJECTIVE: Our aim was to decrease radiograph use for monitoring placement of peripherally inserted central catheters (PICC) and endotracheal tubes (ETT) in neonates admitted to the neonatal intensive care unit (NICU) by 20% from November 2017 to November 2018. STUDY DESIGN: We carried out three Plan-Do-Study-Act (PDSA) cycles: (1) implementation of a radiograph protocol emphasizing ideal patient positioning, standard radiograph views and frequency, (2) standardizing ETT depth using the NRP guidelines, and (3) implementation of an institution specific ETT depth guideline. RESULTS: The pre-intervention radiographs per PICC day was 0.86 versus a post-intervention value of 0.46 (P = 0.004). The pre-intervention radiographs per ETT day was 1.45 versus a post-intervention value of 1.07 (P = 0.002). CONCLUSIONS: Our multidisciplinary NICU team performed a QI project, which resulted in more than a 20% decrease in the number of radiographs used for monitoring placement of PICCs and ETTs.


Assuntos
Cateterismo Periférico , Intubação Intratraqueal , Melhoria de Qualidade , Radiografia/estatística & dados numéricos , Cateterismo Venoso Central , Cateterismo Periférico/métodos , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Intubação Intratraqueal/métodos , Sobremedicalização/prevenção & controle , Guias de Prática Clínica como Assunto , Radiografia/normas
20.
Radiol Med ; 125(3): 296-305, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845091

RESUMO

The advances in technology have led to a growing trend in population exposure to radiation emerging from the invention of high-dose procedures. It is, for example, estimated that annually 1.2% of cancers are induced by radiological scans in Norway. This study aims to investigate and discuss the frequency and dose trends of radiological examinations in Europe. European Commission (EC) launched projects to gain information for medical exposures in 2004 and 2011. In this study, the European Commission Radiation Protection (RP) reports No. 154 and 180 have been reviewed. The RP 154 countries' data were extracted from both reports, and the average variation trend of the number of examinations and effective doses were studied. According to the results, plain radiography and fluoroscopy witnessed a reduction in the frequency and effective dose per examination. Nevertheless, European collective dose encountered an average increase of 23%, which resulted from a growing tendency for implementation of high-dose procedures such as CT scans and interventional examinations. It is worth noting that most of the CT procedures have undergone an increase in effective dose per examination. Although demand and dose per examination in some radiological procedures (such as intravenous urography (IVU) have been reduced, population collective dose is still rising due to the increasing demand for CT scan procedures. Even though the individual risks are not considerable, it can, in a large scale, threaten the health of the people at the present time. Due to this fact, better justification should be addressed so as to reduce population exposure.


Assuntos
Exposição à Radiação/estatística & dados numéricos , Radiografia Intervencionista/tendências , Radiografia/tendências , Tomografia Computadorizada por Raios X/tendências , Europa (Continente)/epidemiologia , Fluoroscopia/estatística & dados numéricos , Fluoroscopia/tendências , Humanos , Neoplasias Induzidas por Radiação/epidemiologia , Noruega/epidemiologia , Doses de Radiação , Proteção Radiológica , Radiografia/estatística & dados numéricos , Radiografia Intervencionista/estatística & dados numéricos , Radiologia/tendências , Tomografia Computadorizada por Raios X/estatística & dados numéricos
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