Image-guided focused ultrasound ablation of breast cancer: current status, challenges, and future directions

Image-guided focussed ultrasound (FUS) ablation is a non-invasive procedure that has been used for treatment of benign or malignant breast tumours. Image-guidance during ablation is achieved either by using real-time ultrasound (US) or magnetic resonance imaging (MRI). The past decade phase I studies have proven MRI-guided and US-guided FUS ablation of breast cancer to be technically feasible and safe. We provide an overview of studies assessing the efficacy of FUS for breast tumour ablation as measured by percentages of complete tumour necrosis. Successful ablation ranged from 20% to 100%, depending on FUS system type, imaging technique, ablation protocol, and patient selection. Specific issues related to FUS ablation of breast cancer, such as increased treatment time for larger tumours, size of ablation margins, methods used for margin assessment and residual tumour detection after FUS ablation, and impact of FUS ablation on sentinel node procedure are presented. Finally, potential future applications of FUS for breast cancer treatment such as FUS-induced anti-tumour immune response, FUS-mediated gene transfer, and enhanced drug delivery are discussed. Currently, breast-conserving surgery remains the gold standard for breast cancer treatment.     

Imaging guidance with C-arm CT: prospective evaluation of its impact on patient radiation exposure during transhepatic arterial chemoembolization

Purpose

To prospectively evaluate the impact of C-arm CT on radiation exposure to hepatocellular carcinoma (HCC) patients treated by chemoembolization.

Materials and Methods

Patients with HCC (N = 87) underwent digital subtraction angiography (DSA; control group) or combined C-arm CT/DSA (test group) for chemoembolization. Dose-area product (DAP) and cumulative dose (CD) were measured for guidance and treatment verification. Contrast agent volume and C-arm CT utility were also measured.

Results

The marginal DAP increase in the test group was offset by a substantial (50%) decrease in CD from DSA. Use of C-arm CT allowed reduction of DAP and CD from DSA imaging (P = .007 and P = .017). Experienced operators were more efficient in substituting C-arm CT for DSA, resulting in a negligible increase (7.5%) in total DAP for guidance, compared with an increase of 34% for all operators (P = .03). For treatment verification, DAP from C-arm CT exceeded that from DSA, approaching that of conventional CT. The test group used less contrast medium (P = .001), and C-arm CT provided critical or supplemental information in 20% and 17% of patients, respectively.

Conclusions

Routine use of C-arm CT can increase stochastic risk (DAP) but decrease deterministic risk (CD) from DSA. However, the increase in DAP is operator-dependent, thus, with experience, it can be reduced to under 10%. C-arm CT provides information not provided by DSA in 33% of patients, while decreasing the use of iodinated contrast medium. As with all radiation-emitting modalities, C-arm CT should be used judiciously.     

The impact of image reconstruction settings on 18F-FDG PET radiomic features: multi-scanner phantom and patient studies

Objectives

The purpose of this study was to investigate the robustness of different PET/CT image radiomic features over a wide range of different reconstruction settings.

Methods

Phantom and patient studies were conducted, including two PET/CT scanners. Different reconstruction algorithms and parameters including number of sub-iterations, number of subsets, full width at half maximum (FWHM) of Gaussian filter, scan time per bed position and matrix size were studied. Lesions were delineated and one hundred radiomic features were extracted. All radiomics features were categorized based on coefficient of variation (COV).

Results

Forty seven percent features showed COV?≤?5% and 10% of which showed COV?>?20%. All geometry based, 44% and 41% of intensity based and texture based features were found as robust respectively. In regard to matrix size, 56% and 6% of all features were found non-robust (COV?>?20%) and robust (COV?≤?5%) respectively.

Conclusions

Variability and robustness of PET/CT image radiomics in advanced reconstruction settings is feature-dependent, and different settings have different effects on different features. Radiomic features with low COV can be considered as good candidates for reproducible tumour quantification in multi-center studies.

Key Points

? PET/CT image radiomics is a quantitative approach assessing different aspects of tumour uptake. ? Radiomic features robustness is an important issue over different image reconstruction settings. ? Variability and robustness of PET/CT image radiomics in advanced reconstruction settings is feature-dependent. ? Robust radiomic features can be considered as good candidates for tumour quantification

     

糖尿病外周血管病变介入治疗的现状及展望

我国糖尿病发病率逐年增高,糖尿病外周血管病变是严重并发症之一,日益威胁着众多患者的肢体健康.糖尿病外周血管病变的治疗方法主要包括药物治疗,外科手术和介入治疗等.近年来介入技术已经成为其首选的治疗方法.本文综述了目前糖尿病外周血管病变介入治疗的现状,并对其发展做一展望.     

The impact of immediate reporting on interpretive discrepancies and patient referral pathways within the emergency department: a randomised controlled trial

Objective

To determine whether an immediate reporting service for musculoskeletal trauma reduces interpretation errors and positively impacts on patient referral pathways.

Methods

A pragmatic multicentre randomised controlled trial was undertaken. 1502 patients were recruited and randomly assigned to an immediate or delayed reporting arm and treated according to group assignment. Assessment was made of concordance in image interpretation between emergency department (ED) clinicians and radiology; discharge and referral pathways; and patient journey times.

Results

1688 radiographic examinations were performed (1502 patients). 91 discordant interpretations were identified (n=91/1688; 5.4%) with a greater number of discordant interpretations noted in the delayed reporting arm (n=67/849, 7.9%). In the immediate reporting arm, the availability of a report reduced, but did not eliminate, discordance in interpretation (n=24/839, 2.9%). No significant difference in number of patients discharged, referred to hospital clinics or admitted was identified. However, patient ED recalls were significantly reduced (z=2.66; p=0.008) in the immediate reporting arm, as were the number of short-term inpatient bed days (5 days or less) (z=3.636; p<0.001). Patient journey time from ED arrival to discharge or admission was equivalent (z=0.79, p=0.432).

Conclusion

Immediate reporting significantly reduced ED interpretive errors and prevented errors that would require patient recall. However, immediate reporting did not eliminate ED interpretative errors or change the number of patients discharged, referred to hospital clinics or admitted overall.

Advances in knowledge

This is the first study to consider the wider impact of immediate reporting on the ED patient pathway as a whole and hospital resource usage.Emergency department (ED) activity in England continues to increase, with 21.3 million attendances recorded in 2010–11, an increase of 3.9% from the previous year, the large majority (20.7 million) being new rather than follow-up attendances [1]. Musculoskeletal (MSK) injuries account for over 60% of recorded ED primary diagnoses in England [2] and range from simple abrasions to amputations. Radiography plays an important role in the diagnosis of many of these injuries, with 22–50% of ED patients being referred for radiographic examination [3-6] and a smaller, but increasing, number of patients being referred directly for cross-sectional imaging, typically CT [7]. Importantly, these increasing demands for both ED and radiology services are occurring at the same time as healthcare organisations in the UK are being asked to evaluate the quality of care provided and constrain service costs. Specifically, the National Health Service (NHS) quality, improvement, productivity and prevention (QIPP) strategy [8] and new ED quality indicators [9] demand that emphasis is placed on improving patient outcomes and service efficiency. One previously suggested radiology intervention that may support such improvements across trauma care is the provision of immediate ED reporting [10,11].In the UK, the initial interpretation of ED radiographic images is undertaken by either medical staff or emergency nurse practitioners (ENPs). Previous studies have raised concerns regarding the accuracy of interpretation achieved by junior medical staff and ENPs, with reported interpretive discrepancy rates between ED and radiology ranging from 1.2% to 7.8% [12-17]. Undiagnosed injuries, or a delay in diagnosis, can predispose patients to long-term morbidity and have the potential for litigation [15,17,18]. Consequently, UK radiology departments have endeavoured to issue definitive reports within 1 working day of patient attendance at ED [19,20]. Although this has not been universally adopted across all NHS hospitals [21], where undertaken, a delay of at least 72 h before reports are available to ED clinicians and changes to patient treatment or management are implemented may still occur [22].Over the last decade, the reporting of ED radiographs has been increasingly delegated to appropriately qualified radiographers, and previous studies have demonstrated that the quality and accuracy of radiographer reports are similar to those of consultant radiologists [23,24]. Yet, despite the increasing reporting capacity as a consequence of radiographer involvement, the publication of national guidance on report turnaround times [25] and the widespread implementation of digital imaging technology and communication systems, the timeliness of report availability appears to be unchanged. This is perhaps a consequence of traditional workload organisation, which often precludes the implementation of immediate reporting in practice. However, if we consider the wider hospital economy, the lack of progress in developing immediate reporting systems for ED may directly impact on service quality and throughput, with real implications for the achievement of the ED quality indicators [9]. This article presents the findings of a multicentre randomised controlled trial funded by the National Institute of Health Research (Research for Patient Benefit Programme PB-PG-0407-13033) and considers the impact of immediate reporting on interpretive discrepancies and patient referral pathways within the ED.     

Application of photodynamic therapy,laser therapy,and a cellulose membrane for calcaneal pressure ulcer treatment in a diabetic patient: A case report

Diabetes mellitus is a metabolic disorder in which a person has high blood glucose levels due to inadequate insulin production by the pancreas. Wounds in these individuals cannot heal properly over time due to circulatory changes that hinder and stagnate the healing process. We report the case of an 82-year-old female type 2 diabetes mellitus carrier, presenting to clinical-dermatological examination pressure ulcer (PU) in the right calcaneus region. The patient was treated with photodynamic therapy using curcumin and blue light-emitting diodes (LEDs), laser therapy, and the application of a cellulose membrane in order to promote ulcer decontamination by local action, accelerate wound healing, and maintain favorable conditions of asepsis and moisture, respectively. The ulcer healing occurred after 30 days of treatment and total epithelialization was observed. From the results obtained in this case report, we conclude that the combination of photodynamic therapy, laser therapy, and coating with a cellulose membrane is a promising treatment for the healing of PU in diabetic patients.     

Influence of photodynamic therapy and different lasers Er,Cr:YSGG and Er,YAG on dentin conditioning bonded to conventional and bioactive cement

AimThe aim of the present study was to evaluate the bond integrity of bioactive cement (BA_c) in contrast to conventional cement Calibra (C) after dentin treated with different surface conditioners (PDT, EYL, ECL)Materials and MethodsSixty non-carious permanent mandibular molars were disinfected and embedded in acrylic resin till cement-o-enamel junction. For homogeneity the buccal surface were grounded and polished. Samples were categorized into three main groups based on conditioning technique. Samples in group 1 and 2 dentin conditioned with Er,Cr:YSGG (ECL), group 3 and 4 surface treated with Er:YAG (EYL) and group 5 and 6 treated with photodynamic therapy (PDT).On conditioned surface bonding agent was applied and light cured. Samples from group 1,3,5 were bonded to Calibra (C). Whereas, specimens in group 2,4,6 were conditioned with bioactive cement (BA_c) and subjected to ageing followed by shear bond strength testing (SBS) in universal testing machine. To detect significance difference between means of different groups analysis of variance (ANOVA) was performed followed by Tukey’s post-hoc tests.ResultsThe maximum SBS was displayed in group 1, dentin conditioned with ECL and bonded to C (20.23 ± 0.47 MPa). Whereas, group 6, PDT of dentin to BA_c demonstrated lowest bond integrity among experimental groups (12.97 ± 0.25 MPa). Bond strength of group 1, ECL-C (21.55 ± 3.08 MPa) and group 3 EYL-C (19.11 ± 0.65 MPa) were comparable (p > 0.05). Group 5 samples treated with PDT, MB-C (13.41±0.32 MPa) and group 6, MB-BA_c (12.97 ± 0.25 MPa) were also comparable (p > 0.05)ConclusionBAc bonded to dentin after surface conditioning with ECL, EYL and PDT presented lower SBS in comparison to conventional cement C. Further studies are required to extrapolate the current findings.     

Validation of deep-learning image reconstruction for coronary computed tomography angiography: Impact on noise,image quality and diagnostic accuracy

BackgroundAdvances in image reconstruction are necessary to decrease radiation exposure from coronary CT angiography (CCTA) further, but iterative reconstruction has been shown to degrade image quality at high levels. Deep-learning image reconstruction (DLIR) offers unique opportunities to overcome these limitations. The present study compared the impact of DLIR and adaptive statistical iterative reconstruction-Veo (ASiR-V) on quantitative and qualitative image parameters and the diagnostic accuracy of CCTA using invasive coronary angiography (ICA) as the standard of reference.MethodsThis retrospective study includes 43 patients who underwent clinically indicated CCTA and ICA. Datasets were reconstructed with ASiR-V 70% (using standard [SD] and high-definition [HD] kernels) and with DLIR at different levels (i.e., medium [M] and high [H]). Image noise, image quality, and coronary luminal narrowing were evaluated by three blinded readers. Diagnostic accuracy was compared against ICA.ResultsNoise did not significantly differ between ASiR-V SD and DLIR-M (37 vs. 37 HU, p = 1.000), but was significantly lower in DLIR-H (30 HU, p < 0.001) and higher in ASiR-V HD (53 HU, p < 0.001). Image quality was higher for DLIR-M and DLIR-H (3.4–3.8 and 4.2–4.6) compared to ASiR-V SD and HD (2.1–2.7 and 1.8–2.2; p < 0.001), with DLIR-H yielding the highest image quality. Consistently across readers, no significant differences in sensitivity (88% vs. 92%; p = 0.453), specificity (73% vs. 73%; p = 0.583) and diagnostic accuracy (80% vs. 82%; p = 0.366) were found between ASiR-V HD and DLIR-H.ConclusionDLIR significantly reduces noise in CCTA compared to ASiR-V, while yielding superior image quality at equal diagnostic accuracy.     

Antimicrobial efficacy of photodynamic therapy,Nd:YAG laser and QMiX solution against Enterococcus faecalis biofilm

BackgroundLasers have been recommended in final root canal disinfection protocol, however, there is no clear evidence about their efficacy against bacteria in biofilms. The aim of the study was to evaluate and compare the disinfection effect of antimicrobial photodynamic therapy (aPDT), Nd:YAG laser and QMiX solution against Enterococcus faecalis biofilm.MethodsThe study sample consisted of 65 dentine slices, which were inoculated with E. faecalis and incubated anaerobically for three weeks. The dentine discs were randomly allocated to one of the following experimental groups: aPDT (100 mW, 10 mg/ml phenothiazinium chloride, 1 min), Nd:YAG laser (2 W, 15 Hz, 4 × 5 s), QMiX solution (1 min). Positive controls did not receive any treatment and negative controls were treated with 5.25% NaOCl. To harvest surviving adherent cells, each dentine sample was transffered to a test tube containing of TSB, serial ten-fold dilutions were made and aliquot of 1 ml was plated onto blood agar plates and incubated for 48 h. Colony forming units grown were counted and transformed into actual counts based on the dilution factor. The remaining viable cells after each protocol were analysed by FISH.ResultsThe aPDT and the QMiX solution were equally effective, with the reduction rate of E. faecalis CFUs of 98.8% and 99.3% respectively (p = 1.107). The Nd:YAG laser caused 96% reduction of E. faecalis (P < 0.001).ConclusionThe aPDT and the QMiX solution showed similar antibacterial efficacy against old E. faecalis biofilm, followed by Nd:YAG irradiation.     

The impact of dose reduction on the quantification of coronary artery calcifications and risk categorization: A systematic review

Multiple dose reduction techniques have been introduced for coronary artery calcium (CAC) computed tomography (CT), but few have emerged into clinical practice while an increasing number of patients undergo CAC scanning. We sought to determine to what extend the radiation dose in CAC CT can be safely reduced without a significant impact on cardiovascular disease (CVD) risk stratification. A systematic database-review of articles published from 2002 until February 2018 was performed in Pubmed, WebOfScience, and Embase. Eligible studies reported radiation dose reduction for CAC CT, calcium scores and/or risk stratification for phantom or patient studies. Twenty-eight studies were included, under which 17 patient studies, 10 phantom/ex-vivo studies, and 1 study evaluated both phantom and patients. Dose was reduced with tube voltage reduction and tube current reduction with and without iterative reconstruction (IR), and tin-filter spectral shaping. The different dose reduction techniques resulted in varying final radiation doses and had varying impact on CAC scores and CVD risk stratification. In 78% of the studies the radiation dose was reduced by ≥ 50% ranging from (CTDI_vol) 0.6–5.5 mGy, leading to reclassification rates ranging between 3% and 21%, depending on the acquisition technique. Specific dose reduced protocols, including either tube current reduction and IR or spectral shaping with tin filtration, that showed low reclassification rates may potentially be used in CAC scanning and in future population-based screening for CVD risk stratification.     

Reducing the renal uptake of radiolabeled antibody fragments and peptides for diagnosis and therapy: present status, future prospects and limitations

Elevated renal uptake and prolonged retention of radiolabeled antibody fragments and peptides is a problem in the therapeutic application of such agents. Over recent years, one of the focuses of research has therefore been to develop suitable methods to reduce this renal uptake, and to evaluate whether the resulting methodology will benefit therapy with antibody fragments and peptides. In these studies it has been shown that the kidney uptake of antibody fragments in animals can be reduced in a dose-dependent manner by almost one order of magnitude by the systemic administration of cationic amino acids and their derivatives, whereas the uptake in all other organs, as well as the tumor, remains unaffected. A similar reduction in renal retention is achieved for all intracellularly retained radionuclides (e.g., radiometals) or radioiodinated immunoconjugates, as well as for smaller peptides. Lysine is usually the preferred agent, and its d- and l-isomers are equally effective whether given intraperitoneally or orally. Amino sugars are effective, but their N-acetyl derivatives, lacking the positive charge, are not. Basic polypeptides are also effective, and their potency increases with increasing molecular weight (i.e., the amount of positive charges per molecule). Urine analysis of treated individuals shows the excretion of unmetabolized, intact fragments or peptides, in contrast to mostly low-molecular-weight metabolites in untreated controls. In therapy studies using radiometal-conjugated Fab fragments, the kidney is the first dose-limiting organ. Administration of cationic amino acids results in a substantial increase in the maximum tolerated dose of such Fab fragments. No biochemical or histological evidence of renal damage has been observed under these conditions. As was the case in animal studies, in pilot clinical trials the renal uptake in patients injected with Fab′ fragments and given amino acids could be decreased significantly, whereas the uptake by all other organs remained unaffected. These recent studies indicate that a variety of basic compounds are capable of inhibiting the tubular reabsorption of peptides and proteins, thus significantly lowering the renal uptake of antibody fragments or peptides in both animals and patients. On a molecular basis, the effect seems to rely essentially on the presence of a positively charged amino group. Thus, radiation nephrotoxicity of antibody fragments and peptides can be overcome successfully; this may provide new prospects for cancer therapy with radiolabeled antibody fragments and peptides.     

Assessing the impact of low level laser therapy (LLLT) on biological systems: a review

Abstract

Purpose: Low level laser therapy (LLLT) in the visible to near infrared spectral band (390–1100?nm) is absorption of laser light at the electronic level, without generation of heat. It may be applied in a wide range of treatments including wound healing, inflammation and pain reduction. Despite its potential beneficial impacts, the use of lasers for therapeutic purposes still remains controversial in mainstream medicine. Whilst taking into account the physical characteristics of different qualities of lasers, this review aims to provide a comprehensive account of the current literature available in the field pertaining to their potential impact at cellular and molecular levels elucidating mechanistic interactions in different mammalian models. The review also aims to focus on the integral approach of the optimal characteristics of LLLT that suit a biological system target to produce the beneficial effect at the cellular and molecular levels.

Methods: Recent research articles were reviewed that explored the interaction of lasers (coherent sources) and LEDs (incoherent sources) at the molecular and cellular levels.

Results: It is envisaged that underlying mechanisms of beneficial impact of lasers to patients involves biological processes at the cellular and molecular levels. The biological impact or effects of LLLT at the cellular and molecular level could include cellular viability, proliferation rate, as well as DNA integrity and the repair of damaged DNA. This review summarizes the available information in the literature pertaining to cellular and molecular effects of lasers.

Conclusions: It is suggested that a change in approach is required to understand how to exploit the potential therapeutic modality of lasers whilst minimizing its possible detrimental effects.     

质子重离子放射治疗的临床研究概况

对clinicaltrials.gov及PTCOG网站上注册的目前正在进行中的质子重离子放射治疗相关的前瞻性临床研究予以分类、归纳和分析,并介绍上海市质子重离子医院IONTRIS设备的临床注册研究结果以及临床实践的现状。大多数研究主要基于前期欧美和日本的临床实践经验。目前开展的近150项前瞻性临床研究中,大多为质子相关研究,涉及全身各个解剖部位的肿瘤;20项重（碳）离子相关研究中,大多涉及头颈部和中枢神经系统肿瘤。以新适应证和分割方式的Ⅱ期或Ⅰ/Ⅱ期临床研究为主,仅15项Ⅱ/Ⅲ期或Ⅲ期随机临床研究,另21项为0/Ⅰ期研究。上述临床研究的开展,将为质子重离子放射治疗剂量与分割的优化,以及适应证的进一步开拓提供依据。     

The impact of rectal/bladder filling and applicator positioning on in vivo rectal dosimetry in vaginal cuff brachytherapy using an enhanced therapy setting

PurposeThe impact of rectal filling and bladder volume on in vivo rectal dosimetry (IVD) in vaginal cuff brachytherapy (VCBT) is unknown. The purpose of this study was to compare rectal doses from IVD with those calculated from treatment planning and to identify influencing factors.Materials and MethodsWe collected data of 80 VCBT sessions, four for each of 20 patients. Each was retrospectively compared with doses determined by the treatment planning system. Factors potentially predicting the IVD rectum dose were analyzed.ResultsFor a series of 80 brachytherapy applications, the calculated mean dose to the rectum was 2.52 Gy. The mean difference between all calculated and measured doses for the 80 applications with five probe positions each was 0.09 Gy (p = 0.952) proving high overall accordance between IVD and calculated doses at the rectum. The mean volume of the rectum was 119 ± 57 cm³. The rectal volume was not statistically significantly associated with the IVD or the calculated rectum doses. At the third and fourth rectal probe position in craniocaudal ordering, increased filling of the urinary bladder resulted in decreased measured and calculated doses (p < 0.05 for both). A rectum pointing position of the applicator significantly increased the maximum rectum dose compared with a bladder-oriented position (p < 0.05).ConclusionsIVD provided valuable data for rectal exposure in VCBT. Increased bladder filling and vaginal applicator positioning off the rectum elicited related with less rectal radiation exposure, whereas rectal filling did not. Further confirmation including assessment of IVD in bladder is pending to define optimal dosimetric conditions in VCBT.     

A comparison of treatments of squamous cell carcinoma of the base of tongue: surgical resection combined with external radiation therapy, external radiation therapy alone, and external radiation therapy combined with interstitial radiation

PURPOSE: The outcomes of patients treated at a single institution over a specific time frame using three different therapeutic approaches for cancer of the base of tongue were reviewed. METHODS AND MATERIALS: Between 1992 and 1998, 53 patients were treated with curative intent for base of tongue cancer. Seventeen patients underwent surgical resection with postoperative radiation therapy, 16 patients received definitive external radiation therapy only, and 20 patients were treated with external and interstitial radiation, with neck dissection in 16 of those patients. Local control, survival, and functional status were assessed with each approach. RESULTS: The 5-year actuarial local control and survival for the surgically treated patients were 74% and 44%, respectively. The patients treated with external radiation therapy alone had local control of 28% and 5-year survival of 24%. The patients treated with external and interstitial radiation with neck dissection as indicated had 5-year actuarial local control of 87% and survival of 33%. Survival was not statistically different between the three treatment approaches (p=0.0995) but local control was worse in the definitive external radiation group (p < 0.0001). Speech and swallowing function among the long-term survivors was superior in the definitively irradiated patients compared with the operated patients. CONCLUSION: In this retrospective analysis, survival and local control was lowest in the patients treated with external radiation alone, however, patient selection likely played an important role. Local control was far better with surgical treatment and with external combined with interstitial radiation but survival remains less than 50% with each approach. Surgical treatment was superior for patients with T4 disease. Functional status was higher in the long-term survivors treated nonsurgically.     

Whole body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure

The objective of this study was to compare two different scanning protocols in patients suspected to have multiple trauma using multidetector 16-row computed tomography (CT) to better define scanning time, imaging quality and radiation exposure. Forty-six patients, between March 2004 and March 2005, with suspected multiple trauma (cerebral, spine, chest, abdominal and pelvis) were evaluated with two different protocols: Protocol “A” 26 patients; Protocol “B” 20 patients. Protocol A consists of a single-pass continuous whole-body acquisition (from vertex to pubic symphysis), whereas Protocol B of conventional segmented acquisition with scanning of body segments individually. Both protocols were performed using a multidetector 16-rows CT (Light-Speed 16, General Electric Medical System, Milwaukee, WI, USA) with the same technical factors. Radiation dose was evaluated in two ways: computer tomography dose index (CTDI) = dose measured in central and peripheral region of the subjects as a direct result of a CT section acquisition of T millimeters thick (independent from the two protocols) and dose length product (DLP) = total dose deposited over the length of the acquisition (dependent from the two protocols). Image quality was rated according to the following scores: 1, excellent; 2, good; 3, satisfactory; 4, moderate and 5, poor. The results were compared using Wilcoxon’s test to identify significant difference in terms of image quality, scanning time, radiation exposure and presence of artifacts, assuming significance at a p value of <0.05. In the single-pass scanning, DLP was 2.671 mGy × cm and a total scan time of 35 s. In whole-body protocols, we have seen artifacts due to arm adduction in thorax and less image quality in brain. In the conventional segmented study, DLP was 3.217 mGy × cm and a total scan time of 65 s; this protocol offered less extraction capabilities of off-axial on focused images of the entire spine, aorta, facial bones or hip without rescanning. Protocol A revealed a significant decrease in scan time (35 vs 65 min, p < 0.05), time in the CT examination room (21.7 vs 31.6 min.; p < 0.05), and final image analysis (83.7 vs 102.9 min; p < 0.05) and radiation dose compared to protocol B (p < 0.05). No significant difference was found for patient transport time, image reconstruction time and imaging quality. Reconstruction and isotropic reformation of axial image acquired by whole-body, single-pass protocols due to entire spine evaluation, aortic and splanchnic CT angiography eliminate additional studies. The whole-body, single-pass protocols, compared with segmented acquisitions protocols, resulted in a reduced total radiation dose without relevant loss of diagnostic image information.     

The global impact of the COVID-19 pandemic on clinical radiography practice: A systematic literature review and recommendations for future services planning

IntroductionWorldwide, reports and experiences indicate that there has been extensive re-organisation within diagnostic imaging and radiotherapy departments in response to the COVID-19 pandemic. This was necessary due to changes in workload and working practice guidelines that have evolved during the pandemic. This review provides a comprehensive summary of the global impact of the COVID-19 pandemic on radiography practice, service delivery and workforce wellbeing.MethodsA systematic review methodology was adopted to obtain data from primary studies of qualitative, quantitative, and mixed methods designs from databases (PubMed, Science Direct, Cumulative Index of Nursing and Allied Health Literature [CINAHL], and SCOPUS: all 2020 to present). The included articles were subjected to information extraction and results-based convergent synthesis.ResultsThe electronic database search yielded 10,420 articles after removal of duplicates. Of these, 31 articles met the final inclusion criteria with some (n = 8) fully focussed on radiotherapy workforce and service delivery. The pandemic impact on radiography practice is broadly themed around: training, communication, and information dissemination; infrastructure, technology, and clinical workflow; and workforce mental health and well-being.ConclusionGlobally, most radiographers received inadequate training for managing COVID-19 patients during the initial acute phase of the pandemic. Additionally, there were significant changes to clinical practice, working patterns and perceived increase in workload due to surges in COVID-19 patients and the consequent strict adherence to new infection protocols. These changes, coupled with fear emanating from the increased risk of the workforce to contracting the infection, contributed to anxiety and workplace-related stress during the pandemic.Implications for practiceLocal pandemic response strategies must be appropriately developed from standard protocols in readiness for safe clinical practice and well-being management training of practitioners.