Estimation of radiation dose and establishment of local diagnostic reference levels for computed tomography of head in pediatric population.

BACKGROUND: Pediatric population is more sensitive to the effects of radiation than adults. Establishing diagnostic reference level (DRL) is an efficient dose optimization technique implemented by many countries for reducing radiation dose during Computed Tomography (CT) examinations. OBJECTIVES: To estimate radiation dose and establish a new local diagnostic reference level for CT head examination in the pediatric population. MATERIALS AND METHODS: We prospectively recruited 143 pediatric patients referred for CT head examination with age ranging from 0-5 years old. All patients had undergone CT head examination using the standard pediatric head protocol. Volumetric CT dose index (CTDIvol) and dose length product (DLP) were recorded. The effective dose was first calculated. Then, 75th percentile of dose indices was calculated to establish DRLs. RESULTS: DRLs in terms of CTDIvol and DLP are 23.84 mGy, 555.99 mGy.cm for patients <1 years old and 28.65 mGy, 794.99 mGy.cm for patients from 1-5 years old, respectively. Mean effective doses for <1 years old patients and 1-5 years old patients are 2.91 mSv and 2.78 mSv respectively. CONCLUSION: The study concludes that DRL in terms of CTDIvol is lower but DRL in terms of DLP and the effective dose is higher compared to a few other studies which necessitate the need for dose optimization.

Low Dose Pediatric CT Head Protocol using Iterative Reconstruction Techniques: A Comparison with Standard Dose Protocol.

PURPOSE: Pediatric computed tomography (CT) head examination has also increased in recent years with the advancement in CT technology; however, children exposed to radiation at the youngest age are more vulnerable to the risks of radiation. The aim of the study is to evaluate radiation dose and image quality of low dose pediatric CT head protocol compared to standard dose pediatric CT head protocol. METHODS: This was a prospective study. Group 1 included 73 patients aged < 1 year and 70 patients in the 1-5 years age group and had undergone CT head examination using the standard dose protocol. Group 2 included 31 patients aged < 1 year and 40 patients in the 1-5 years age group and had undergone CT head examination using the low dose protocol. The radiation dose was measured and image quality was assessed quantitatively and qualitatively. RESULTS: There was a significant difference in radiation dose between the standard and low dose protocols (p > 0.05) with lower radiation dose for low dose group. The qualitative analysis did not show a significant difference between the standard and low dose protocols. The gray-white matter differentiation (GWMD), attenuation, contrast to noise ratio (CNR) and figure of merit (FOM) were higher in the low dose protocol compared to the standard dose with a significant difference (p > 0.05). CONCLUSION: The study concludes that a low dose protocol at 80 kV tube voltage/150 mAs tube current exposure time product/iterative reconstruction-iDose4 (level 3) for < 1 year age group and 100 kV/200m As/iDose4 (level 3) for 1-5 years age group provides ultra-low effective dose with diagnostically acceptable image quality for pediatric CT head examination compared with standard dose protocol.

Pacing mode survival in patients with single chamber atrial pacemaker for sinus node dysfunction.

BACKGROUND: Single chamber atrial pacemaker should be sufficient for patients with sinus node dysfunction (SND) with normal atrioventricular (AV) conduction. However, most patients undergo dual chamber pacemaker implantation because of concern of new onset AV block. The annual incidence of new AV block has been reported from 0.6 to 4.4 % in various studies. OBJECTIVES: Our aim is to assess mode survival in sinus node dysfunction with normal AV conduction patients implanted with AAIR. METHODS: Patients who underwent single chamber atrial pacemaker implantation for SND with normal AV conduction between January 2014 and December 2021 were followed up for pacemaker device change, new onset AV block, bundle branch block, atrial fibrillation (AF), lead complications, reoperation and mortality rate. RESULTS: A total of 113 patients underwent single chamber atrial pacemaker implantation for SND during the study period. Mean age was 55.6 ± 12.7 years. During a mean follow up of 48.7 ± 24.9 months, none of the patients required pacemaker device change to VVIR/DDDR. Nine patients underwent reoperation, 5 for lead dislodgment, 1 for high threshold, 1 for pocket site erosion and 3 for pulse generator change. None developed AV block or AF with slow ventricular rate. Only 4 patients developed AF (3 paroxysmal,1 permanent). There were 3 deaths during follow up and none were sudden deaths. CONCLUSION: Single chamber atrial pacing is an acceptable mode of pacing in patients with SND in developing countries. Development of AV conduction abnormalities is rare in this relatively younger population.

Evolving radiographic practice: Identifying possible skill requirements for future radiographers practicing in the United Arab Emirates (UAE).

AIM: This study aims to identify the prospective skill requirements for future radiographers practising in the United Arab Emirates (UAE). Such information will inform educational institutions, healthcare organisations, and policymakers in developing effective strategies. METHODS: A cross-sectional study was conducted involving currently practising radiographers, nuclear medicine technologists, sonographers, and radiation therapists in the UAE (n =74). A comprehensive survey questionnaire was developed and validated through piloting and expert consultations. Ethical approval was obtained, and data were collected through purposive sampling. Descriptive statistics, reliability analysis, Chi-square tests, and factor analysis were employed in the data analysis. RESULTS: The results showed that 73%, 47.3%, 43.2%, 40.5%, 39.2%, 33.8% interested in radiology safety, image interpretation, interprofessional and interpersonal skills, research and managerial skills, Picture Archiving and Communication System (PACS) administration and AI (Artificial Intelligence) and, clinical supervision and assessment, respectively. The factor analysis showed four factors factor considered for CPD training are training settings (15.12), training topics (1.88), CPD credits (1.72) and, presenter and expenses (1.49). CONCLUSION: This study sheds light on the CPD requirements and aspirations of radiographers in the UAE, offering insights into their preferences and challenges. These findings can inform strategies for improving CPD opportunities and ensuring that radiographers are equipped to meet the evolving healthcare demands in the UAE, including performing enhanced practice. IMPLICATIONS FOR PRACTICE: Development of flexible and comprehensive CPD programmes tailored to radiographers' career interests is required. Employers should provide financial support and flexibility in training options. Regulatory bodies should continue to mandate CPD, fostering a culture of lifelong learning. Supportive work environments, interdisciplinary collaboration, and technological fluency are crucial. Emphasising patient-centred care, research opportunities, and continuous assessment further enhances radiography practice.

Advanced Computational Methods for Radiation Dose Optimization in CT.

BACKGROUND: In planning radiotherapy treatments, computed tomography (CT) has become a crucial tool. CT scans involve exposure to ionizing radiation, which can increase the risk of cancer and other adverse health effects in patients. Ionizing radiation doses for medical exposure must be kept "As Low As Reasonably Achievable". Very few articles on guidelines for radiotherapy-computed tomography scans are available. This paper reviews the current literature on radiation dose optimization based on the effective dose and diagnostic reference level (DRL) for head, neck, and pelvic CT procedures used in radiation therapy planning. This paper explores the strategies used to optimize radiation doses, and high-quality images for diagnosis and treatment planning. METHODS: A cross-sectional study was conducted on 300 patients with head, neck, and pelvic region cancer in our institution. The DRL, effective dose, volumetric CT dose index (CTDIvol), and dose-length product (DLP) for the present and optimized protocol were calculated. DRLs were proposed for the DLP using the 75th percentile of the distribution. The DLP is a measure of the radiation dose received by a patient during a CT scan and is calculated by multiplying the CT dose index (CTDI) by the scan length. To calculate a DRL from a DLP, a large dataset of DLP values obtained from a specific imaging procedure must be collected and can be used to determine the median or 75th-percentile DLP value for each imaging procedure. RESULTS: Significant variations were found in the DLP, CTDIvol, and effective dose when we compared both the standard protocol and the optimized protocol. Also, the optimized protocol was compared with other diagnostic and radiotherapy CT scan studies conducted by other centers. As a result, we found that our institution's DRL was significantly low. The optimized dose protocol showed a reduction in the CTDIvol (70% and 63%), DLP (60% and 61%), and effective dose (67% and 62%) for both head, neck, and pelvic scans. CONCLUSIONS: Optimized protocol DRLs were proposed for comparison purposes.

Effects of physical activity breaks during prolonged sitting on vascular and executive function-A randomised cross-over trial.

Objectives: High sedentary behaviour is associated with adverse effects on central vascular function and cognitive function. Although interventions to mitigate the adverse effects of workplace sitting are intriguing, evidence of the efficacy of such interventions remains lacking. This randomised cross-over trial was aimed at exploring the effectiveness of prolonged sitting, with or without physical activity breaks, on central, peripheral vascular and cognitive function in adults. Methods: Twenty one healthy adults completed 4 h of simulated work conditions in three experimental visits: (1) uninterrupted sitting (SIT); (2) sitting interrupted by 3 min of walking every hour (LIT); and (3) sitting interrupted by 3 min of stair climbing every hour (MIT). Carotid (CA) and superficial femoral artery (SFA) diameter, velocity, shear rate and blood flow were measured with Duplex ultrasound at 50 MHz at three time points (hours 0, 2 and 4), and executive function was assessed with the computer based Eriksen Flanker task every hour. Results: The decreases in reaction time (-30.59%) and accuracy (-10.56%) during SIT conditions were statistically significant, and less of a decrease was observed under LIT and MIT conditions. No significant differences in CA and SFA function were observed with LIT and MIT interventions. Conclusion: Physical activity breaks of varying intensity during prolonged sitting improve reaction time. However, the vascular benefits of physical activity breaks should be confirmed in the future through long term studies in natural environment.

Systematic Review on Diagnostic Reference Levels for Computed Tomography Examinations in Radiation Therapy Planning.

Background: In August 2017, the European Commission awarded the "European Study on Clinical Diagnostic Reference Levels (DRL) for X-ray Medical Imaging" project to the European Society of Radiology to provide up-to-date Diagnostic Reference Levels based on clinical indications. This work aimed to conduct an extensive literature review by analyzing the most recent studies published and the data provided by the National Competent Authorities to understand the current situation regarding Diagnostic Reference Levels based on clinical indications for Radiation Therapy Computed Tomography. Objective: To review the literature on established DRLs and methodologies for establishing Diagnostic reference levels in radiation therapy planning computed tomography (RTCT). Methods: Eligibility criteria: A cohort study (observational design) reporting DRLs in adult patients undergoing computed tomography (CT) for radiation therapy for the region head and neck or pelvis were included. The comprehensive literature searches for the relevant studies published between 2000 and 2021 were performed using PubMed, Scopus, CINHAL, Web of Science, and ProQuest. Results: Three hundred fifty-six articles were identified through an extensive literature search. Sixty-eight duplicate reports were removed. The title and abstract of 288 studies were assessed and excluded if they did not meet the inclusion criteria. Sixteen of 288 articles were selected for full-text screening (studies conducted between 2000 and 2021). Five articles were included in the review after the full-text screening. Conclusions: A globally approved standard protocol that includes scanning techniques, dose measurement method, and DRL percentile needs to be established to make a valuable and accurate comparison with international DRLs.

Knowledge of Medical Imaging Professionals on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis.

Healthcare-associated infections (HCAIs) are a significant concern for both healthcare professionals and patients. With recent advances in imaging modalities, there is an increase in patients visiting the radiology department for diagnosis and therapeutic examination. The equipment used for the investigator is contaminated, which may result in HCAIs to the patients and healthcare professionals. Medical imaging professionals (MIPs) should have adequate knowledge to overcome the spread of infection in the radiology department. This systematic review aimed to examine the literature on the knowledge and precaution standard of MIPs on HCIAs. This study was performed with a relative keyword using PRISMA guidelines. The articles were retrieved from 2000 to 2022 using Scopus, PubMed, and ProQuest databases. The NICE public health guidance manual was used to assess the quality of the full-length article. The search yielded 262 articles, of which Scopus published 13 articles, PubMed published 179 articles, and ProQuest published 55 articles. In the present review, out of 262 articles, only 5 fulfilled the criteria that reported MIPs' knowledge of Jordan, Egypt, Sri Lanka, France, and Malawi populations. The present review reported that MIPs have moderate knowledge and precautionary standards regarding HCIAs in the radiology department. However, due to the limited studies published in the literature, the current review limits the application of the outcome in the vast MIPs population. This review recommended further studies to be conducted among the MIPs worldwide to know the actual knowledge and precaution standards regarding HCIAs.

Association between Physical Activity Levels and Brain Volumes in Adults Visiting Radio-Imaging Center of Tertiary Care Hospital.

BACKGROUND AND AIM: There is evidence to support the favorable impact of physical activity (PA) on brain volume. However, the empirical evidence exploring the relationship between physical and sedentary behavior remains mixed. We aimed to explore the relationship between PA and sedentary behavior and brain volume. METHODS: The study sample (n = 150, mean age = 39.7 years) included patients interviewed with the International Physical Activity Questionnaire (IPAQ) who underwent an MRI brain scan. From the images obtained, we measured total intracranial, gray matter, and white matter volume along with the hippocampus, amygdala, parahippocampal gyrus, and posterior cingulate cortex (PCC). Multivariable linear regression analysis was done. RESULTS AND DISCUSSION: Left hippocampus and overall PA were positively and significantly associated (ß = 0.71, p = 0.021) whereas time spent on vigorous physical activity showed a negative association (ß = -0.328, p = 0.049) with left hippocampal volume. CONCLUSION: We found a positive association between total PA and the left hippocampus, whereas vigorous PA showed a negative association with the left hippocampus.

Influence of Sedentary Behaviour Interventions on Vascular Functions and Cognitive Functions in Hypertensive Adults-A Scoping Review on Potential Mechanisms and Recommendations.

Since the workplace has become desk-based and leisure time has become dominated by digital relaxation modes, the world is moving at a pace where physical activity has become a time-bound routine. The negative effects of extended sitting are a global concern since the workforce is becoming more desk based. There is a dearth of reviews that may link the knowledge on the effects of sedentary behaviour on hypertension and its accompanying damage to the brain and blood vessels and provide a future scope for the investigations connected to the relationship between sedentary behaviour and hypertension. Methods: Based on the database search and extensive research we did, we found studies that concentrated on the adverse effects of sedentary behaviour in association with blood pressure, cognitive decline and brain damage on adults. Results: We extracted 12 articles out of 20,625. We identified the potential adverse effects of sedentary behaviour, methods to reduce sedentary behaviour and the positive changes on health due to the interventions introduced. Sedentary lifestyle has shown a decline in human health. However, the visible symptoms presented later in life makes it very important to know the areas of decline and look for ways to curb the decline or procrastinate it.

Diagnostic reference levels for computed tomography examinations in pediatric population - A systematic review.

Computed tomography (CT) has vital role in diagnosis of various pathologies using cross sectional images. Besides the advantages of CT in pediatric radiology, radiation dose has a significant adverse effect as children are more vulnerable than adults. Establishing Diagnostic Reference levels (DRLs) will determine unusual increase in radiation doses and therefore helps in optimizing the radiation dose by maintaining optimum diagnostic image quality. The objective of the review is to explore the literature on DRLs in pediatric CT examinations and techniques that have been used to establish them. Detailed search was done in PubMed-Medline, Scopus CINAHL, Web of Science, and the Cochrane Library databases to find studies that have established DRLs for pediatric CT examinations. The Preferred Reporting Items for Systematic Review and Meta-Analyses methodology was used to assess the relevant articles. The articles which assessed DRLs in pediatric CT examinations were included. A total of 501 articles were identified, of which 21 articles were included after a detailed screening process. Our review showed increased in pediatric patient dose surveys across the world and also increased in awareness for establishing DRLS among pediatric CT examinations. The review also demonstrated wide variation in DRLs and also deviation in the scanning techniques, protocols used and categorization methods used for establishing DRLs. As the pediatric population is more sensitive to radiation, the current review emphasizes the need for optimization of protocols and international standardization for establishing DRLs to facilitate a more feasible way of comparison of dose globally across CT sites.