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PURPOSE: Interstitial lung disease (ILD) is the most common non-musculoskeletal manifestation of idiopathic inflammatory myopathies (IIM). Identification of body composition change may enable early intervention to improve prognosis. We investigated muscle quantity and quality derived from cross-sectional imaging in IIM, and its relationship to ILD severity. METHODS: A retrospective cohort study assessing IIM of ILD patients (n = 31) was conducted. Two datasets separated in time were collected, containing demographics, biochemical data, pulmonary function testing and thoracic CT data. Morphomic analysis of muscle quantity (cross-sectional area) and quality (density in Hounsfield Units) on thoracic CT were analysed utilising a web-based tool allowing segmentation of muscle and fat. Bilateral erector spinae and pectoralis muscle (ESM&PM) were measured at defined vertebral levels. RESULTS: FVC and DLCO decreased but within acceptable limits of treatment response (FVC: 83.7-78.7%, p < 0.05, DLCO 63.4-60.6%, p < 0.05). The cross-sectional area of the PM and ESM increased (PM: 39.8 to 40.7 cm2, p = 0.491; ESM: 35.2 to 39.5 cm2, p = 0.098). Density significantly fell for both the PM and ESM (PM: 35.3-31 HU, p < 0.05; ESM: 38-33.7, p < 0.05). Subcutaneous fat area increased from 103.9 to 136.1 cm2 (p < 0.05), while the visceral fat area increased but not reaching statistical significance. The change in PM density between time points demonstrated an inverse correlation with DLCO (p < 0.05, R = - 0.49). CONCLUSION: Patients with IIM ILD demonstrated significant body composition changes on CT imaging unlikely to be detected by traditional measurement tools. An increase in muscle area with an inverse decrease in density suggests poor muscle quality.
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Doenças Pulmonares Intersticiais , Miosite , Humanos , Estudos Retrospectivos , Miosite/complicações , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , PrognósticoRESUMO
Objective: To determine if student radiographers and radiation therapists experience harassment (verbal, physical or sexual) while on clinical placement and their awareness of policies in place to report such incidents.Methods: An online questionnaire developed from the World Health Organisation's questionnaire on workplace violence in healthcare and the higher education authority (HEA) national survey of student experiences of sexual violence and harassment in Irish HEIs was used. Undergraduate and postgraduate diagnostic radiography and radiation therapy students in the Republic of Ireland to be included and have completed a minimum of four weeks of clinical placement. Our of 256 students, 98 filled out the survey.Results: Forty-one per cent (n = 40) of students reported experiencing at least one incident of harassment. Thirteen per cent reported experiencing two forms of harassment, and 2 students reported experiencing verbal, physical and sexual harassment. Verbal harassment (n = 33) and sexual (n = 16) were the most common form of harassment while physical harassment was experienced 7 participants. Ninety-one per cent (n = 88) of participants reported they don't believe they have received sufficient training in dealing with incidents of physical, verbal or sexual harassment.Conclusion: Harassment of student radiographers and radiation therapists is occurring while on placement. Male patients are the modal perpetrator, and most incidents go unreported. Students are not empowered to report an incident of harassment and are sometimes unaware of how to report harassment.
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Thoracic computed tomography (CT) is the imaging reference method in the diagnosis, assessment and management of lung disease. In the setting of cystic fibrosis (CF), CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography, and findings correlate with clinical outcomes. Better understanding of the aetiology of CF lung disease indicates that even asymptomatic infants with CF can have irreversible pulmonary pathology. Surveillance and early diagnosis of lung disease in CF are important to preserve lung parenchyma and to optimise long-term outcomes. CF is associated with increased cumulative radiation exposure due to the requirement for repeated imaging from a young age. Radiation dose optimisation, important for the safe use of CT in children with CF, is best achieved in a team environment where paediatric radiologists work closely with paediatric respiratory physicians, physicists and radiography technicians to achieve the best patient outcomes. Despite the radiation doses incurred, CT remains a vital imaging tool in children with CF. Radiologists with special interests in CT dose optimisation and respiratory disease are key to the appropriate use of CT in paediatric imaging. Paediatric radiologists strive to minimise radiation dose to children whilst providing the best possible assessment of lung disease.
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Fibrose Cística/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Exposição à Radiação/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Criança , Fibrose Cística/patologia , Diagnóstico por Imagem/métodos , Humanos , Lactente , Doses de Radiação , Radiografia Torácica/métodosRESUMO
OBJECTIVES: Performance of a modified abdominopelvic CT protocol reconstructed using full iterative reconstruction (IR) was assessed for imaging patients presenting with acute abdominal symptoms. MATERIALS AND METHODS: Fifty-seven patients (17 male, 40 female; mean age of 56.5 ± 8 years) were prospectively studied. Low-dose (LD) and conventional-dose (CD) CTs were contemporaneously acquired between November 2015 and March 2016. The LD and CD protocols imparted radiation exposures approximating 10-20% and 80-90% those of routine abdominopelvic CT, respectively. The LD images were reconstructed with model-based iterative reconstruction (MBIR), and CD images with hybrid IR (40% adaptive statistical iterative reconstruction (ASIR)). Image quality was assessed quantitatively and qualitatively. Independent clinical interpretations were performed with a 6-week delay between reviews. RESULTS: A 74.7% mean radiation dose reduction was achieved: LD effective dose (ED) 2.38 ± 1.78 mSv (size-specific dose estimate (SSDE) 3.77 ± 1.97 mGy); CD ED 7.04 ± 4.89 mSv (SSDE 10.74 ± 5.5 mGy). LD-MBIR images had significantly lower objective and subjective image noise compared with CD-ASIR (p < 0.0001). Noise reduction for LD-MBIR studies was greater for patients with BMI < 25 kg/m2 than those with BMI ≥ 25 kg/m2 (5.36 ± 3.2 Hounsfield units (HU) vs. 4.05 ± 3.1 HU, p < 0.0001). CD-ASIR studies had significantly better contrast resolution, and diagnostic acceptability (p < 0.0001 for all). LD-MBIR studies had significantly lower streak artifact (p < 0.0001). There was no difference in sensitivity for primary findings between the low-dose and conventional protocols with the exception of one case of enteritis. CONCLUSIONS: Low-dose abdominopelvic CT performed with MBIR is a feasible radiation dose reduction strategy for imaging patients presenting with acute abdominal pain.
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Abdome Agudo/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste , Diatrizoato de Meglumina , Feminino , Humanos , Iohexol , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Sensibilidade e EspecificidadeRESUMO
UNLABELLED: We assessed diagnostic accuracy and image quality of modified protocol (MP) computed tomography (CT) of the abdomen and pelvis reconstructed using pure iterative reconstruction (IR) in patients with Crohn disease (CD). METHODS: Thirty-four consecutive patients with CD were referred with suspected extramural complications. Two contemporaneous CT datasets were acquired in all patients: standard protocol (SP) and MP. The MP and SP protocols were designed to impart radiation exposures of 10% to 20% and 80% to 90% of routine abdominopelvic CT, respectively. The MP images were reconstructed with model-based IR (MBIR) and adaptive statistical IR (ASIR). RESULTS: The MP-CT and SP-CT dose length product were 88 (58) mGy.cm (1.27 [0.87] mSv) and 303 [204] mGy.cm (4.8 [2.99] mSv), respectively (P < 0.001). Median diagnostic acceptability, spatial resolution, and contrast resolution were significantly higher and subjective noise scores were significantly lower on SP-ASIR 40 compared with all MP datasets. There was perfect clinical agreement between MP-MBIR and SP-ASIR 40 images for detection of extramural complications. CONCLUSIONS: Modified protocol CT using pure IR is feasible for assessment of active CD.
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Doença de Crohn/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Pelve/diagnóstico por imagem , Doses de Radiação , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Adulto JovemRESUMO
UNLABELLED: The aim of this study was to assess if a low-dose carotid computed tomography angiography (CTA) performed with pure iterative reconstruction (IR) is comparable to a conventional dose CTA protocol. METHODS: Twenty patients were included. Radiation dose was divided into a low-dose acquisition reconstructed with pure IR and a conventional dose acquisition reconstructed with 40% hybrid IR. Dose, image noise, contrast resolution, spatial resolution, and carotid artery stenosis were measured. RESULTS: Mean effective dose was significantly lower for low-dose than conventional dose studies (1.84 versus 3.71 mSv; P < 0.001). Subjective image noise, contrast resolution, and spatial resolution were significantly higher for the low-dose studies. There was excellent agreement for stenosis grading accuracy between low- and conventional dose studies (Cohen κ = 0.806). CONCLUSIONS: A low-dose carotid CTA protocol reconstructed with pure IR is comparable to a conventional dose CTA protocol in terms of image quality and diagnostic accuracy while enabling a dose reduction of 49.6%.
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Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Exposição à Radiação/análise , Proteção Radiológica/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Idoso , Feminino , Humanos , Masculino , Doses de Radiação , Exposição à Radiação/prevenção & controle , Intensificação de Imagem Radiográfica/métodos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: The purpose of this study was to analyze the performance of pure model-based iterative reconstruction (MBIR) in low-dose CT enterography. SUBJECTS AND METHODS: Forty-four patients with Crohn disease referred for CT enterography were included. Low-dose modified-protocol and conventional-protocol CT datasets were contemporaneously acquired. Conventional-protocol image formation was performed with 40% adaptive statistical iterative reconstruction (ASIR). Modified-protocol data were reconstructed with 100% MBIR and 40% ASIR. Image quality was assessed subjectively and objectively at six levels. Independent clinical interpretations by two fully blinded radiologists were compared with reference standard consensus reviews by two nonblinded readers who had access to clinical information, previous imaging studies, and medical records. RESULTS: A 74.7% average radiation dose reduction was seen: low-dose modified-protocol effective dose, 1.61 ± 1.18 mSv (size-specific-dose-estimate, 2.47 ± 1.21 mGy); conventional-protocol effective dose, 6.05 ± 2.84 mSv (size-specific-dose-estimate, 9.25 ± 2.9 mGy). Image quality assessment yielded 9372 data points. Objective noise on modified-protocol MBIR images was superior (p < 0.05) to that with the conventional protocol at three of six levels and comparable at the other three levels. Modified-protocol images were superior to conventional-protocol ASIR images (p < 0.05 in all cases) for subjective noise, spatial resolution, contrast resolution, streak artifact, and diagnostic acceptability on coronal reconstructions. Axial diagnostic acceptability was superior for conventional-protocol ASIR (p = 0.76). For both readers, modified-protocol MBIR clinical readings agreed more closely with reference standard readings than did conventional-protocol ASIR readings with regard to bowel wall disease assessment (κ = 0.589 and 0.700 vs 0.583 and 0.564). Overall Crohn disease activity grade (κ = 0.549 and 0.441 vs 0.315 and 0.596) and detection of acute complications (κ = 1.0 and 0.689 vs 0.896 and 0.896) were comparable when evaluated on conventional-protocol ASIR and modified-protocol MBIR images. CONCLUSION: Low-dose CT enterography with MBIR yields images that are comparable to or superior to conventional images.
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Doença de Crohn/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Algoritmos , Feminino , Humanos , Masculino , Modelos Estatísticos , Estudos Prospectivos , Doses de RadiaçãoRESUMO
BACKGROUND: Computed tomography (CT) helps physicians locate and diagnose pathological conditions. In some conditions, having an airway segmentation method which facilitates reconstruction of the airway from chest CT images can help hugely in the assessment of lung diseases. Many efforts have been made to develop airway segmentation algorithms, but methods are usually not optimized to be reliable across different CT scan parameters. METHODS: In this paper, we present a simple and reliable semi-automatic algorithm which can segment tracheal and bronchial anatomy using the open-source 3D Slicer platform. The method is based on a region growing approach where trachea, right and left bronchi are cropped and segmented independently using three different thresholds. The algorithm and its parameters have been optimized to be efficient across different CT scan acquisition parameters. The performance of the proposed method has been evaluated on EXACT'09 cases and local clinical cases as well as on a breathing pig lung phantom using multiple scans and changing parameters. In particular, to investigate multiple scan parameters reconstruction kernel, radiation dose and slice thickness have been considered. Volume, branch count, branch length and leakage presence have been evaluated. A new method for leakage evaluation has been developed and correlation between segmentation metrics and CT acquisition parameters has been considered. RESULTS: All the considered cases have been segmented successfully with good results in terms of leakage presence. Results on clinical data are comparable to other teams' methods, as obtained by evaluation against the EXACT09 challenge, whereas results obtained from the phantom prove the reliability of the method across multiple CT platforms and acquisition parameters. As expected, slice thickness is the parameter affecting the results the most, whereas reconstruction kernel and radiation dose seem not to particularly affect airway segmentation. CONCLUSION: The system represents the first open-source airway segmentation platform. The quantitative evaluation approach presented represents the first repeatable system evaluation tool for like-for-like comparison between different airway segmentation platforms. Results suggest that the algorithm can be considered stable across multiple CT platforms and acquisition parameters and can be considered as a starting point for the development of a complete airway segmentation algorithm.
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Algoritmos , Broncografia , Processamento de Imagem Assistida por Computador/métodos , Software , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Animais , Brônquios/fisiologia , Humanos , Respiração , Suínos , Traqueia/fisiologiaRESUMO
BACKGROUND: Despite limitations of routine methods, Clinical Practice Guidelines support the assessment of bone mineral density (BMD) and vascular calcification in renal transplant recipients. Changes in fat mass also occur post-transplantation, although they are traditionally difficult to measure accurately. We report the feasibility, convenience and accuracy of measuring the above 3 parameters using a novel CT protocol. METHODS: We conducted a cross-sectional study of 64 first renal allograft recipients (eGFR > 30 ml/min/1.73 m(2)). Quantitative CT (QCT) BMD analysis was conducted using CT lumbar spine (GE Medical Systems Lightspeed VCT & Mindways QCT Pro Bone Mineral Densitometry System Version 4.2.3) to calculate spinal volumetric BMD and compared with standard DXA calculated areal BMD at the spine, hip and distal forearm. Abdominal aortic calcification was assessed by semi-quantitative Aortic Calcification Index (ACI) method and compared with lateral lumbar x-ray Kappuila score and pulse wave velocity (PWV). Visceral and subcutaneous adipose tissue volume (Osirix 16 Ver 3.7.1) was compared with BMI. RESULTS: Participants were 61 % male, had a mean age of 47 years, median ESKD duration of 5.4 years and a mean eGFR of 54 ml/min. iDXA median T-score at proximal femur was -1.2 and at lumbar spine was -0.2. Median QCT Trabecular T-score at lumbar spine was -1.2. The percent of subjects with a T-score of < 2.5 by site and method was DXA Proximal Femur: 7 %, DXA distal radius: 17 %, DXA spine: 9 %, QCT (American College of Radiology cutoffs): 9 %. CT derived ACI correlated with PWV (r = 0.29, p = 0.02), pulse wave pressure (r = 0.51, p < 0.001), QCT Trabecular (-0.31, p = 0.01) and cortical volumetric BMD and history of cardiovascular events (Mann-Whitney U, p = 0.02). Both visceral and subcutaneous adipose tissue correlated with BMI (r = 0.63 & 0.64, p < 0.001). CONCLUSIONS: Single CT scan triple assessment of BMD, vascular calcification and body composition is an efficient, accurate and convenient method of risk factor monitoring post renal transplantation.
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Adiposidade , Densidade Óssea , Transplante de Rim , Insuficiência Renal/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/fisiopatologia , Adolescente , Adulto , Idoso , Testes Diagnósticos de Rotina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal/diagnóstico , Insuficiência Renal/terapia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Calcificação Vascular/diagnóstico , Adulto JovemRESUMO
BACKGROUND: According to current literature, there is a lack of information regarding the radiation protection (RP) practices of interventional radiology (IR) and cardiology catheter laboratory (CCL) staff. This study aims to determine the RP practices of staff within IR and CCLs internationally and to suggest areas for improvement. METHODS: A cross-sectional study in the form of an online questionnaire was developed. Participation was advertised via online platforms and through email. Participants were included if they were healthcare professionals currently working in IR and CCLs internationally. Questionnaire design included Section 1 demographic data, Section 2 assessed RP training and protocols, Section 3 surveyed the use of different types of RP lead shields, both personal and co-worker use and Section 4 assessed other methods of minimising radiation dose within practice. Questions were a mix of open and closed ended, descriptive statistics were used for closed questions and thematic analysis was employed for open ended responses. RESULTS: A total of 178 responses to the questionnaire were recorded with 130 (73 %) suitable for analysis. Most respondents were female (n = 94, 72 %) and were radiographers (n = 97, 75 %). Only 68 (53 %) had received training, the majority receiving this in-house (n = 54, 79 %). 118 (98 %) of respondents had departmental protocols in place for RP. Radiology managers (n = 106, 82 %) were most likely to contribute to such protocols. Multiple methods of dose minimisation exist, these include low-dose fluoroscopy, staff rotation, radiation dose audits and minimal time in the controlled areas. Respondents reported that lead apron shields were wore personally by 99 % of respondents and by co-workers in 95 % of cases. CONCLUSION: The practices of RP by IR and CCL staff in this survey was variable and can be improved. The unavailability of basic radiation protection tools and RP specific training courses/modules were some of the reasons for sub-optimal self-protection against ionising radiation reported by respondents.
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BACKGROUND: Patients with dementia frequently present to the Radiology Department. However, stigmas have been recorded amongst radiographers surrounding imaging persons with dementia (PwD). This study aimed to investigate the impact of PwD attending the Radiology Department for imaging and the resultant effects to all patients, radiographers, and the Department from the perspectives of the examining radiographer. METHODS: A paper-based questionnaire of radiographers' perceptions and experiences of individual examinations 'termed an interaction form' was created and made available in a public hospital in Ireland for a period of eight weeks. Radiographers completed the interaction form collecting data regarding individual imaging examinations of PwD. The form comprised sixteen closed and one open-ended question on the radiographers' individual perspectives of PwDs' abilities and distress levels, carers and comforters and their role in the examination, what the radiographer found helpful in the interaction, and any adverse events. Data were analysed using a combination of descriptive analysis and thematic content analysis. RESULTS: Thirty-three interaction forms were completed by the participating radiographers. The modality most commonly represented in the survey was general X-ray (58%). Radiographers reported 84% of examinations for PwD required extra time, with 27% of examinations required repeat imaging and 69% of patients appeared distressed. A carer helped facilitate the completion of 77% of examinations. Qualitative data indicated that distractive and communicative techniques were used by radiographers to make the patient feel more comfortable and help with examination success. CONCLUSION: PwD often require more time for radiological examinations, they often need repeat imaging and re-scheduling of an examination at a more appropriate time. These factors need to be considered when scheduling and performing radiological examinations. Patient distress was frequently encountered, this area may benefit from further research and dedicated practitioner training which could help drive improvements in patient experience.
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Atitude do Pessoal de Saúde , Demência , Serviço Hospitalar de Radiologia , Humanos , Demência/psicologia , Inquéritos e Questionários , Masculino , Feminino , IrlandaRESUMO
INTRODUCTION: To reduce the risks involved with ionising radiation exposure, typical values (TVs) and diagnostic reference levels (DRLs) have been established to help keep radiation doses 'as low as reasonably practicable. TVs/DRLs provide standardised radiation dose metrics that can be used for comparative purposes. However, for paediatrics, such values should consider the size of the child instead of their age. This study aimed to establish and compare paediatric TVs for chest, abdomen and pelvis radiography. METHODS: Study methods followed processes for establishing paediatric DRLs as outlined by the Health Information and Quality Authority (HIQA). Kerma-area product (KAP) values, excluding rejected images, were retrospectively acquired from the study institution's Picture Archiving and Communications System (PACS). Paediatric patients were categorised into the following weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg) and stratified based on the examination that was performed (chest, abdomen, and pelvis), and where it was performed (the different X-ray rooms). Anonymised data were inputted into Microsoft Excel for analysis. Median and 3rd quartile KAP values were reported together with graphical illustrations. RESULTS: Data from 407 X-ray examinations were analysed. For the previously identified weight categories (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg), TVs for the chest were 0.10, 0.19, 0.37 and 0.53 dGy.cm2, respectively. For the abdomen 0.39, 1.04, 3.51 and 4.05 dGy.cm2 and for the pelvis 0.43, 0.87, 3.50 and 7.58 dGy.cm2. Between X-ray rooms TVs varied against the institutional TVs by -60 to 119 % (chest), -50 to 103 % (abdomen) and -14 and 24 %% (pelvis). CONCLUSION: TVs in this study follow established trends with patient weight and examination type and are comparable with published literature. Variations do exist between individual examination rooms and reasons are multifactorial. Given that age and size do not perfectly correlate further work should be undertaken around weight-based TVs/DRLs in the paediatric setting.
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INTRODUCTION: Lead contact shielding has been a crucial component of patient radiation protection since it was first introduced in the early 1900s. Concerns surrounding the hereditary effects of ionising radiation were a driver for using lead shielding. Recently the American Association of Physics in Medicine (AAPM) and the British Institute of Radiology (BIR) have published position papers that suggest that lead contact shielding is no longer needed due to reduced radiation doses for x-ray examinations. This work examines radiographers' opinions on these position papers. METHODS: An online survey with quantitative and qualitative elements was designed to explore knowledge and attitudes toward the BIR and AAPM position papers. The population for this survey was all qualified radiographers. RESULTS: The majority (59%) of participants are aware of the AAPM guidance, and 76% are aware of the BIR guidance. Given the changes in the gonad tissue weighting factor, 66% believed additional emphasis should be placed on protecting organs and tissues with higher tissue weighting factors. The vast majority (87%) believed lead shielding is not the primary dose reduction strategy, with 82% agreeing that lead shielding may interfere with the AEC. CONCLUSION: This study identifies a perception that lead protection may still play a role in patient protection, particularly for children and pregnant patients. However, it is not considered the primary mechanism of protection. More specific guidance and information are needed to incorporate the guidance for radiographers into working practice, improving patient care. IMPLICATIONS FOR PRACTICE: Lead shielding remains a tool for radiation protection in particular examinations, however, its role has diminished in clinical practice. RECOMMENDATIONS: Additional research is required into the number of repeat x-rays associated with the use of lead shielding and the actual dose saving for shielding outside the field of view. Additional education and specific clarification on when to use and not use lead contact shielding is required.
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Radiologia , Feminino , Gravidez , Criança , Humanos , Radiografia , Raios X , Radiação Ionizante , AtitudeRESUMO
This study aimed to systematically review the literature to synthesise and summarise the evidence surrounding the efficacy of artificial intelligence (AI) in classifying paediatric pneumonia on chest radiographs (CXRs). Following the initial search of studies that matched the pre-set criteria, their data were extracted using a data extraction tool, and the included studies were assessed via critical appraisal tools and risk of bias. Results were accumulated, and outcome measures analysed included sensitivity, specificity, accuracy, and area under the curve (AUC). Five studies met the inclusion criteria. The highest sensitivity was by an ensemble AI algorithm (96.3%). DenseNet201 obtained the highest level of specificity and accuracy (94%, 95%). The most outstanding AUC value was achieved by the VGG16 algorithm (96.2%). Some of the AI models achieved close to 100% diagnostic accuracy. To assess the efficacy of AI in a clinical setting, these AI models should be compared to that of radiologists. The included and evaluated AI algorithms showed promising results. These algorithms can potentially ease and speed up diagnosis once the studies are replicated and their performances are assessed in clinical settings, potentially saving millions of lives.
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BACKGROUND: According to the literature, low back pain (LBP) is one of the top ten diseases and injuries contributing to disability-adjusted life years worldwide. To the best of the authors' knowledge there are no studies investigating the prevalence of LBP among radiographers working in Ireland or have compared prevalence rates with the national population or other cohorts of radiographers or healthcare professionals. This study aimed to determine the prevalence of LBP among radiographers working or who have previously worked in Ireland and to identify any causative factors. METHODS: A cross-sectional study in the form of an online questionnaire was developed. Participation was advertised online via social media platforms. Inclusion criteria included qualified radiographers working in Ireland or who had recently worked in Ireland. Section A of the questionnaire focussed on acquiring demographic data. Section B comprised eight questions relating to LBP, including current and previous experiences, causative factors and consequences. Further details on any episodes of LBP in the previous year, whether work and leisure activities had been affected, whether any extracurricular activities caused LBP, and whether a participant sought professional advice. Section C (six questions) used a 5-point ordinal scale to collect information on the frequency of specific tasks performed by radiographers in their daily roles. Section D involved exploratory questions, including whether LBP has forced a career change if they knew anyone who has changed their career as a result of LBP, reaction to the amount of manual handling required for radiographers, whether they thought manual handling training was sufficient, thoughts on the availability of assistive transfer devices, reasons for not following correct patient transfer guidelines, and finally whether they were concerned about LBP affecting their future. RESULTS: 151 radiographers participated in this study, and the point prevalence rate of LBP was 50%, with 12 months prevalence rate of 75%. Regarding activity levels, 25% (n=37) reported reduced work activity, and a further 43%(n=65) reduced leisure activities due to LBP. 37% (n=56) have sought medical advice from a doctor, physiotherapist, or other HCP concerning their LBP in the last year. 68% (n=104) of respondents who have LBP confirmed it was not a result of any extracurricular activities. CONCLUSION: The prevalence of LBP among radiographers in Ireland was high and 4.7 times higher than the period prevalence rate recorded in the general population. LBP rates were similar to radiographers working in other jurisdictions. Data from this study may help manage LBP and monitor any interventions' effectiveness.
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Dor Lombar , Humanos , Dor Lombar/epidemiologia , Prevalência , Estudos Transversais , Pessoal Técnico de Saúde , Inquéritos e QuestionáriosRESUMO
This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen-pelvis examinations using automatic tube current modulation to protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 µSv without ODM (1.92-1.91 µSv, p = 0.49) and increased by 0.03 µSv with ODM (1.53-1.56 µSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 µSv with shielding (1.91-1.56 µSv, p = 0.24) and by 0.39 µSv without shielding (1.92-1.53 µSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen-pelvis.
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Children with congenital heart disease are exposed to repeated medical imaging throughout their lifetime. Although the imaging contributes to their care and treatment, exposure to ionising radiation is known to increase one's lifetime attributable risk of malignancy. A systematic search of multiple databases was performed. Inclusion and exclusion criteria were applied to all relevant papers and seven were deemed acceptable for quality assessment and risk of bias assessment. The cumulative effective dose (CED) varied widely across the patient cohorts, ranging from 0.96 mSv to 53.5 mSv. However, it was evident across many of the included studies that a significant number of patients were exposed to a CED >20 mSv, the current annual occupational exposure limit. Many factors affected the dose which patients received, including age and clinical demographics. The imaging modality which contributed the most radiation dose to patients was cardiology interventional procedures. Paediatric patients with congenital heart disease are at an increased risk of receiving an elevated cumulative radiation dose across their lifetime. Further research should focus on identifying risk factors for receiving higher radiation doses, keeping track of doses, and dose optimisation where possible.
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INTRODUCTION: The SARS-CoV-19 (COVID-19) pandemic has become a global problem but has affected the paediatric population less so than in adults. The clinical picture in paediatrics can be different to adults but nonetheless both groups have been subject to frequent imaging. The overall aim of this study was to comprehensively summarise the findings of the available literature describing the chest radiograph (CXR) findings of paediatric patients with confirmed COVID-19. The COVID-19 landscape is rapidly changing, new information is being constantly brought to light, it is therefore important to appraise clinicians and the wider scientific community on the radiographic features of COVID-19 in children. METHODS: Four databases, which included, PubMed; Medline; CINAHL; ScienceDirect were searched from the 30 November 2020 to the 5 March 2021. The review was conducted using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA" guidelines. Studies were included for (1) publications with full text available, (2) patients with confirmed COVID-19 diagnoses, (3) CXR imaging features of COVID-19 were reported, (4) the age of patients was 0-18 years, (5) studies were limited to human subjects and (6) a language restriction of English was placed on the search. Quality assessment of included articles used the National of Health Quality Assessment Tool for Case Series Studies. RESULTS: Eight studies met our criteria for inclusion in the review. All eight studies documented the number of CXRs obtained, along with the number of abnormal CXRs. Seven out of the eight studies noted greater than 50% of the CXRs taken were abnormal. Opacification was the number one feature that was recorded in all eight studies, followed by pleural effusion which was seen in six studies. Consolidation and peri-bronchial thickening features were both evident in four studies. Opacification was sub-divided into common types of opacities i.e., consolidation, ground glass opacities, interstitial, alveolar and hazy. Consolidation was reported in half of the studies followed by ground glass opacities and interstitial opacities which was seen in three out of the eight studies. CONCLUSION: This systematic review provides insight into the common COVID-19 features that are seen on CXRs in paediatric patients. Opacification was the most common feature reported, with consolidation, ground glass and interstitial opacities the top three opacifications seen. Peri-bronchial thickening is reported. in the paediatric population but this differs from the adult population and was not reported as a common radiographic finding typically seen in adults. ADVANCES IN KNOWLEDGE: This systematic review highlights the CXR appearances of paediatric patients with confirmed SARS-CoV-19, to gain insight into the disease pathophysiology and provide a comprehensive summary of the features for clinicians aiding optimal management.
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INTRODUCTION: Intrasaccular flow disruption is a new and effective endovascular treatment for intracranial aneurysms. While endovascular treatment is a minimally invasive procedure, it does carry a radiation risk. As radiation dose should be kept as low as reasonably achievable (ALARA), the main objective of this study was to analyse KAP (kerma area product), fluoroscopy and procedure time during the treatment of aneurysms treated with coiling and the Woven-EndoBridge (WEB) device. A secondary objective was to look at the reference air kerma (RAK) to determine if the patient receives a dose that could cause tissue effects. METHODS: KAP, fluoroscopy and procedure time were retrospectively analysed in patients who had an aneurysm treatment. Aneurysms with diameters of 4-11mm, over a four-year period, in the anterior and posterior circulation of the brain were analysed in this study. Patients were treated by coiling or WEB. RAK were summed together in the working projection to give an estimated entrance surface dose (ESD) in cases with the highest KAP. RESULTS: A total of 47 aneurysms treated with WEB and 104 aneurysms treated with coiling techniques met the inclusion criteria. The average KAP was 6884.1 ± 2774.4µGym2 with coiling techniques and 5658.7 ± 1602.5µGym2 with WEB (p=0.006; CI =363-2086µGym2). This demonstrates an 18% reduction with WEB. Mean fluoroscopy time for coiling was 63.5 ± 42.6minutes and 33.8 ± 28.8minutes for WEB (p=<0.001; CI=16-43minutes). Fluoroscopy time was reduced by nearly 50% with WEB. On average, there was a 27-minute reduction of procedure time when using WEB compared to coiling. The RAK determined for the working projections did not exceed the 2Gy threshold for tissue effects. CONCLUSION: Treatment of aneurysms using the WEB shows a reduction in KAP, fluoroscopy, and procedure time. This study further demonstrates the benefits of intrasaccular flow disruption for treatment of intracranial aneurysms.
Assuntos
Procedimentos Endovasculares , Aneurisma Intracraniano , Benchmarking , Auditoria Clínica , Procedimentos Endovasculares/métodos , Humanos , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/terapia , Doses de Radiação , Estudos RetrospectivosRESUMO
BACKGROUND: Interventional radiographers have substantially contributed to patient care during the pandemic by providing imaging guidance during minimally invasive procedures. The aim of this research is to quantify the impact of the pandemic on an interventional radiographers' wellbeing during the COVID-19 pandemic. METHODS: Ethical approval was obtained at the outset of this study. An explanatory sequential mixed methods approach, using questionnaires and interviews, was used to explore and evaluate interventional radiographers' wellbeing; physical, mental and social. An electronic self-administered questionnaire was administered to interventional radiographers and a semi-structured interview was conducted on two respondents. RESULTS: Responses were received from 40 interventional radiographers. Physical, mental and social wellbeing of interventional radiographers deteriorated since the onset of COVID-19. All forms of wellbeing were negatively impacted during the pandemic with mental wellbeing (82.5%) the most impacted, closely followed by physical (75%) and social wellbeing (50%). Half of responding interventional radiographers reported being "highly stressed" while working during COVID-19. Physical activity levels decreased, caffeine consumption increased and consumption of a healthy diet decreased. Almost all interventional radiographers (95%) had anxiety about passing the virus onto family or friends and 60% of noted a deterioration in relationship with friends. Three key themes identified included the importance of teamwork, the physical demand and mental impacts of working in interventional radiology during the pandemic. CONCLUSIONS: The COVID-19 pandemic has had a negative effect on interventional radiographers' wellbeing. The implications of staff having a diminished sense of wellbeing is that productivity is likely to have been reduced and potentially related burnout can lead to illness. This research highlights the need to focus on identifying methods of addressing the shortcomings in support services and identifying the specific needs of interventional radiographers to improve their wellbeing.