Safety Survey on Lone Working Magnetic Resonance Imaging Technologists in Saudi Arabia.

PURPOSE: The American College of Radiology (ACR) requires MR personnel not to work alone due to the increased risk of safety issues such as projectiles, aggressive patients, and technologist fatigue. As a result, we intend to assess the current safety of lone-working MRI technologists in MRI departments in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study using a self-report questionnaire was conducted in 88 Saudi hospitals. RESULTS: A response rate of 64% (174/270) was obtained among the 270 MRI technologists which were identified. The study discovered that 86% of MRI technologists had prior experience working alone. In terms of MRI safety training, 63% of MRI technologists received such training. A question about lone MRI workers' awareness of the ACR's recommendations revealed that 38% were unaware of such recommendations. Furthermore, 22% were misinformed, believing that working alone in an MRI unit is optional or depends on the individual's desire to work alone. Working alone has the primary consequence of being statistically significantly associated with projectile/object-related accidents/mistakes (p = 0.03). CONCLUSION: Saudi Arabian MRI technologists have extensive experience working alone without supervision. Most MRI technologists are unaware of lone working regulations, which has raised concerns about accidents/mistakes. There is a need for MRI safety training and adequate practical experience to raise awareness of MRI safety regulations and policies related to lone working among departments and MRI workers.

Assessment of breast dose and cancer risk for young females during CT chest and abdomen examinations.

CT scanning deliver much higher radiation doses than planar radiological procedures, which puts patients to high risks. This study measures and evaluates patient doses during chest and abdomen computed tomography procedures. Particular attention is given to measuring the dose to the equivalent breast (mSv) and to estimate the associated risks of breast cancer to young female patients (15-35 years). Data was obtained from standard examinations from three hospitals. The measured values of CT dose indexes, CTDI (mGy) as well as exposure-related parameters were used for assessment. Breast and effective doses were extrapolated using a software. The results showed remarkable variations of the mean organ equivalent doses for similar CT examinations in the studied hospitals. This could be attributed to the variation in CT scanning imaging technique, and clinical indications. The average effective dose to the chest was 7.9 mSv (2.3-47.0 mSv) and for the abdomen the mean dose was 6.6 mSv, ranging from (3.3-27 mSv). The breast received equivalent doses from chest and abdomen procedures as follows: 10.2 (1.6-33 mSv) and 10.1(2.3-19 mS) Sv respectively. Each procedure yielded high risks of breast cancer for young females. Implementation of accurate referral criteria is recommended to avoid unnecessary breast radiation exposure.

Measurement and comparison of skin dose using OneDose MOSFET and Mobile MOSFET for patients with acute lymphoblastic leukemia.

BACKGROUND: Total body irradiation is a protocol used to treat acute lymphoblastic leukemia in patients prior to bone marrow transplant. It is involved in the treatment of the whole body using a large radiation field with extended source-skin distance. Therefore measuring and monitoring the skin dose during the treatment is important. Two kinds of metal oxide semiconductor field effect transistor (OneDose MOSFET and mobile MOSEFT) dosimeter are used during the treatment delivery to measure the skin dose to specific points and compare it with the target prescribed dose. The objective of this study was to compare the variation of skin dose in patients with acute lymphatic leukemia (ALL) treated with total body irradiation (TBI) using OneDose MOSFET detectors and Mobile MOSFET, and then compare both results with the target prescribed dose. MATERIAL/METHODS: The measurements involved 32 patient's (16 males, 16 females), aged between 14-30 years, with an average age of 22.41 years. One-Dose MOSFET and Mobile MOSFET dosimetry were performed at 10 different anatomical sites on every patient. RESULTS: The results showed there was no variation between skin dose measured with OneDose MOSFET and Mobile MOSFET in all patients. Furthermore, the results showed for every anatomical site selected there was no significant difference in the dose delivered using either OneDose MOSFET detector or Mobile MOSFET as compared to the prescribed dose. CONCLUSIONS: The study concludes that One-Dose MOSFET detectors and Mobile MOSFET both give a direct read-out immediately after the treatment; therefore both detectors are suitable options when measuring skin dose for total body irradiation treatment.

Effect of dobutamine and hyperoxia on free radicals production in relation to the ultrastructural alterations in the endothelial of myocardial capillary in rats, Rattus norvigicus.

Hyperoxia has been widely used as model for oxidative stress. Free radicals (FR), suproxide anion (*O(-)(2)) and nitric oxide anion (*NO(-)), are highly toxic and have detrimental effects on nitroso-redox balance in the myocyte. Myocardium is rich with beta-adrenergic receptors and endothelial is the site of NO production. The authors hypothesized that graded doses of dobutamine result in hyperkinetic state, which shifts the nitroso-redox balance toward the buildup of reactive species in dose-dependent excess. The purpose of the present study was to investigate free radicals production and coronary endothelial cell pathological changes following increasing length of breathing oxygen (100% O(2)) and progressive doses of dobutamine. Thirty-five adult male rats, matched with age and body weight, were randomly assigned to 7 groups. The first group served as control (C) and the 2nd, 3rd, and 4th groups were exposed to hyperoxia (100% O(2) breathing) for 24,48, and 72 h, whereas the 5th, 6th, and 7th groups were injected dobutamine 10,20, and 30 microg kg(-1), respectively. Following the treatment condition for each group, animals were sacrificed and heart tissues were divided randomly into two parts. The first part was processed for the ultrastructure, using transmission electron microscope (TEM), and the second was homogenized for FR determination. TEM examination showed that O2 breathing for 24 h resulted in hypertrophy and proliferation of endothelial cells lining the coronary capillary, which was lodged by lymphoid cells. Distended and irregular contour of endothelium, enlarged nucleus, protrusion membrane, as well as pinocytotic vesicles were also observed. Free radicals (FR) production at all levels of hyperoxia exposures and dobutamine injections were significantly (p < .05) higher than control group. In addition, dobutamine induced higher relative FR production, as compared with hyperoxia, implying more severe myocyte injury. Based on the results of the present study, it can be concluded that O2 breathing for 24 h or higher resulted in variety of pathological changes of the endothelium of coronary capillary that were induced by the buildup of oxidants by-products. Because dobutamine caused relative higher in FR production levels, as compared with hyperoxia levels, throughout this implied it aggravated the myocyte capillaries' endothelium more heavily, which could have resulted in more intense ultrastructural deteriorations.

Prevalence, antibiotic susceptibility pattern and production of extended-spectrum beta-lactamases amongst clinical isolates of Klebsiella pneumoniae at Armed Forces Hospital in Saudi Arabia.

The aim of this descriptive study was to determine the prevalence of Klebsiella pneumoniae from different clinical specimens, their antibiotic susceptibility pattern and the extended-spectrum beta-lactamase (ESBL) production among such isolates at Armed Forces Hospital, Al-Kharaj, Saudi Arabia, from November, 2004 to October, 2007. A total of 328 isolates of K. pneumoniae recovered from 8152 different specimens were studied for ESBL production and antimicrobial susceptibility. The prevalence of K. pneumoniae was 4% (328/8152). We observed a high percentage of K. pneumoniae resistant to ampicillin (100%) and tetracycline (92%). The prevalence of ESBL-producing K. pneumoniae was found to be 10.4% (34/328). The ESBL-producing strains were mostly from aspirates (25%) followed by sputum (20%) and blood (18.2%). These ESBLproducing isolates were highly resistant to gentamicin and ciprofloxacin. All isolates were susceptible to imipenem. Our findings demonstrate a high percentage of ESBL-producers among clinical isolates of K. pneumoniae and a high rate of multidrug resistance. Continued infection control measures and prudent use of antimicrobial agents are essential in reducing the spread of multi-resistant ESBL-producing K. pneumoniae.

Prevalence of osteoporosis among postmenopausal females with diabetes mellitus.

OBJECTIVE: To assess the prevalence of osteopenia and osteoporosis among Saudi postmenopausal women with non-insulin dependent type 2 diabetes mellitus (T2DM). METHODS: The study was carried out at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from February 2000 to September 2002. Bone mineral density (BMD) of the lumbar spine and femoral neck using dual x-ray absorptiometry (DXA; Lunar Wisconsin), were performed in 104 postmenopausal Saudi women with T2DM, and 101 postmenopausal non-diabetic women (control). Bone mineral density was measured in gm/cm2 and both T-score and Z-score were measured but only T-score was used for analysis based on World Health Organization criteria. Bone profile, 25(OH) Vitamin D, 1,25(OH)2 Vitamin D, parathyroid hormone and urine deoxypyridinoline (DPD) were measured in most patients and controls. Body fat measurement around the biceps muscles using Futrex (body composition analyzer) were performed in patients and controls. Years postmenopausal, duration of diabetes mellitus, parity, exercise, sun exposure and milk consumption were also recorded. RESULTS: In the diabetic group, the mean spine BMD was 0.928 gm/cm2 (T-score = -2.28 SD) and for femoral neck the mean BMD was 0.817 gm/cm2 (T-score = -1.21 SD). In control group, the mean spine BMD was 1.036 gm/cm2 (T-score = -1.2) and mean femoral neck BMD was 0.914 gm/cm2 (T-score = -0.608). In the diabetic group, there was 16 (16.64%) patients with normal BMD of the spine, 42 patients (43.68%) with osteopenia (mean T-score = -1.8 SD) and 45 (46.8%) with osteoporosis (mean T-score = -3.3 SD). CONCLUSION: Osteoporosis is more common among Type 2 postmenopausal females in this ethnic group. Since both groups are postmenopausal, having equal percentage of Vitamin D deficiency, multi-parity, non exposure to sun, lack of exercise and negligible milk intake, one can conclude that the low BMD can be attributed to DM in the absence of other causes of osteoporosis.

Effect of age on the biomechanical and microcirculatory properties of the skin in healthy individuals and during venous ulceration.

BACKGROUND: With aging there is alteration of elastic properties of the skin and skin-blood flow. AIM: The purpose of this study was to compare age-related changes in selected biomechanical parameters of the skin (skin hardness, skin extensibility, relaxation time constant, τ) and subcutaneous microcirculatory quality (SMQ) in individuals with and without venous diseases. MATERIALS AND METHODS: TWO GROUPS WERE STUDIED: the first group was of asymptomatic healthy individuals and the second group included patients with chronic venous insufficiency (CVI) and venous ulceration, without edema. Both groups were subdivided to three age categories (21-40, 41-60 and 61-90 years old). Skin hardness was measured by durometer, extensibility and τ were measured using extensometer and SQM was assessed via postural vasoconstrictive response (LDF). RESULTS: Results showed that skin hardness, extensibility, and τ-values were increased, whereas LDF was decreased in the older groups as compared with younger groups. These changes are attributed to alterations in the skin structure and reduced capillaries density networks. Similar behavior was found in the biomechanical and microcirculatory changes in patients with venous ulceration and CVI, but these changes were more increased further in older patients with venous ulceration as compared with older patients with CVI and that can be attribute to more intense response against tissue injury. CONCLUSIONS: Since aging elevated skin hardness and extensibility, but lowered vasoconstrictive response in individuals, with and without, venous diseases, we conclude that aging process is likely to cause an accumulation of damaged skin tissues and that could induce an apparent antigen-driven response that altered skin structure and the subsequent biomechanical properties obtained in this study.

Integrated PET/CT in imaging of non-small cell lung cancer.

Lung cancer is one of the most frequently occurring cancers in the world. Accurate staging of patients with non-small cell lung cancer ( NSCLC ) is of paramount importance. It will guide choices of treatment and determine prognosis and outcome. PET-CT, the integration of the functional data of PET with the anatomic data of CT, has emerged as a modality to potentially change the way patients are evaluated. Integrated PET/CT has several advantages. One of the advantages is the use of CT data for attenuation correction that is significantly faster compared to that in conventional PET systems. Due to the use of CT data for attenuation correction, artifacts can be generated on PET images related to the use of CT contrast agents, CT beam-hardening artifacts due to metallic implants and motion artifacts. PET/CT appears to offer superior staging of NSCLC compared with CT and PET individually. However, there are undoubtedly falsepositives and false-negatives that need to be taken into account. The purpose of this review is to discuss some technical considerations concerning the use of PET/CT in lung cancer imaging and to give a short overview of the results of staging of NSCLC. Key Words : PET/CT , Technical aspects , NSCLC.