Diagnostic radiographers’ experience of COVID-19, Gauteng South Africa

IntroductionAs of July 2020, South Africa (SA) had the fifth highest number of COVID-19 infections in the world, with the greatest contributor of these infections, being the province of Gauteng. Diagnostic radiographers in Gauteng providing chest CT, chest radiograph and MRI services are frontline workers experiencing these unprecedented times. Therefore, this study undertook to explore diagnostic radiographers’ experiences of COVID-19.MethodsA qualitative approach using an asynchronous opened-ended online questionnaire was used to explore diagnostic radiographers’ experiences of COVID-19. Responses from purposively sampled diagnostic radiographers in Gauteng SA, underwent thematic analysis.ResultsSixty diagnostic radiographers representing both the private and public health sector responded to the questionnaire. Thematic analysis revealed three themes: new work flow and operations, effect on radiographer well-being and radiographer resilience.ConclusionBesides experiencing a shift in their professional work routine and home/family dynamics, diagnostic radiographers’ well-being has also been impacted by COVID-19. Adapting to the “new way of work” has been challenging yet their resilience and dedication to their profession, providing quality patient care and skill expertise is their arsenal to combat these challenges.Implications for practiceUnderstanding the impact of COVID-19 on diagnostic radiographers will allow radiology departments’ management, hospital management, professional bodies and educational institutions to re-evaluate provision of resources, training, employee wellness programs as well as policies and procedures.     

What are we capable of? The motivations of perpetrators in South Africa during the Apartheid era

This article attempts to explain the motivations of perpetrators who committed violent acts in South Africa during the apartheid era. The relevant psychosocial literature is reviewed and the implicit and explicit explanations given during the amnesty hearings of the Truth and Reconciliation Committee by perpetrators working for the state security forces are analysed. The mental health of the South African society during this period is considered, as is the role of the former white South African government and its authorities in shaping the climate for a violent struggle involving all groups. The issues of individual versus social and state culpability, accountability, justice and reconciliation are explored and their implications for the future prevention of reoccurrences are assessed. The aim of the article is to prompt readers to ask the question: what are we capable of?     

Labelled agents for PET studies of the dopaminergic system—some quality assurance methods,experience and issues

Practical methods are described for the quality assurance of three labelled agents (l-6-[¹⁸F]fluoro-DOPA, S-[N-methyl-¹¹C]nomifensine and [O-methyl-¹¹C]raclopride) now produced regularly for PET studies of the dopaminergic system in man. These include indirect methods for the initial determination of label position (e.g. ¹³C-NMR spectroscopy) and also direct methods for the assessment of chiral purity (TLC and HPLC) and the routine determination of radiochemical purity, chemical purity and specific activity (HPLC). Mass spectrometry has been used to identify some impurities. l-6-hydroxy-DOPA (a precursor in vivo of the neurotoxin, l-6-hydroxydopamine) has been detected by HPLC in some preparations of l-6-[¹⁸F]fluoro-DOPA. Formulated S-[N-methyl-¹¹C]nomifensine has been found to decrease in radio-chemical purity with storage, whereas formulated [O-methyl-¹¹C]raclopride has been found to be stable. Some quality assurance issues are discussed in relation to experience in the application of the described methods and the obtained results.     

Imaging strategies in the management of oesophageal cancer: what’s the role of MRI?

Objectives

To outline the current role and future potential of magnetic resonance imaging (MRI) in the management of oesophageal cancer regarding T-staging, N-staging, tumour delineation for radiotherapy (RT) and treatment response assessment.

Methods

PubMed, Embase and the Cochrane library were searched identifying all articles related to the use of MRI in oesophageal cancer. Data regarding the value of MRI in the areas of interest were extracted in order to calculate sensitivity, specificity, predictive values and accuracy for group-related outcome measures.

Results

Although historically poor, recent improvements in MRI protocols and techniques have resulted in better imaging quality and the valuable addition of functional information. In recent studies, similar or even better results have been achieved using optimised MRI compared with other imaging strategies for T- and N-staging. No studies clearly report on the role of MRI in oesophageal tumour delineation and real-time guidance for RT so far. Recent pilot studies showed that functional MRI might be capable of predicting pathological response to treatment and patient prognosis.

Conclusions

In the near future MRI has the potential to bring improvement in staging, tumour delineation and real-time guidance for RT and assessment of treatment response, thereby complementing the limitations of currently used imaging strategies.

Key Points

? MRI’s role in oesophageal cancer has been somewhat limited to date. ? However MRI’s ability to depict oesophageal cancer is continuously improving. ? Optimising TN-staging, radiotherapy planning and response assessment ultimately improves individualised cancer care. ? MRI potentially complements the limitations of other imaging strategies regarding these points.     

Interventional radiology in the management of hepatic injuries

Ｔｈｅｌｉｖｅｒｉｓｔｈｅｍｏｓｔｃｏｍｍｏｎｌｙｉｎｊｕｒｅｄａｂｄｏｍｉｎａｌｏｒｇａｎｉｎｂｌｕｎｔｔｒａｕｍａａｎｄａｃｏｍｍｏｎｉｎｊｕｒｙａｆｔｅｒｐｅｎｅｔｒａｔｉｏｎ．Ｉａｔｒｏｇｅｎｉｃｈｅｐａｔｉｃｄａｍａｇｅｃａｎａｌｓｏｒｅｓ...     

FDG-PET/CT imaging in the management of HIV-associated multicentric Castleman’s disease

Purpose  To evaluate the role of FDG-PET/CT scanning in the management of HIV-associated multicentric Castleman’s disease (MCD) a rare lymphoproliferative disorder associated with infection by human herpesvirus 8 (HHV8). Materials and methods  Nine patients with histologically confirmed MCD underwent fused FDG-PET/CT scans at initial MCD diagnosis (n = 3), at MCD relapse (n = 4), or during remission (n = 2). All seven patients with active MCD had markedly elevated plasma HHV8 viral loads, but the patients in remission had no HHV8 viraemia. The three patients with newly diagnosed MCD were not on antiretroviral therapy at the time of imaging, but the other six were all on fully suppressive antiretroviral regimens. Results  In the seven patients with active MCD (newly diagnosed or relapse) 33/91 lymph node groups (36%) included radiologically enlarged nodes on the CT scan, whilst 57/91 lymph node groups (63%) showed enhanced FDG uptake on the PET scan. In scans from patients in remission, there were no enlarged lymph nodes on the CT scan but 3 lymph nodes (11%) demonstrated enhanced FDG uptake. The median SUV recorded for the seven patients with active MCD was 4.8 (range 2.6–9.3) which was significantly higher than the median value of 2.5 recorded for the patients in remission (Mann-Whitney U test, p = 0.011). Conclusion  Despite the small number of patients, in HIV-positive individuals with active MCD, FDG-PET scans more frequently detected abnormal uptake than CT scans detected enlarged lymph nodes. FDG-PET scanning has a useful role in the management of HIV-associated MCD in selecting appropriate sites for biopsy, and in staging and monitoring these lymphoproliferations.     

⁶⁸Ga-labelled peptides in the management of neuroectodermal tumours

Neuroectodermal tumours arise from chromaffin cells and possess the ability to secrete catecholamines. They are generally rare and may occur in association with a variety of hereditary syndromes such as MEN-2A and 2B, neurofibromatosis type 1 and von Hippel-Lindau disease. The most common types are phaeochromocytoma arising from the adrenal medulla and paraganglioma of extra-adrenal origin. Phaeochromocytomas tend to be benign and are often associated with a gene mutation if the disease is bilateral, while paragangliomas are often malignant, have a more aggressive nature and tend to metastasize. There are no specific histological or immunohistochemical features that indicate the malignant potential and the diagnosis of malignancy can only be established by the presence of distant metastases. Therefore, imaging can play a vital role in the diagnosis, localization, staging and assessment of spread. Traditionally, this is achieved with a combination of cross-sectional (CT and MRI) and functional ((123)I-MIBG or (111)In-octreotide) imaging. However, these modalities are not adequate and achieve moderate sensitivity. The introduction of (68)Ga-DOTA peptide in PET/CT imaging has led to improved receptor targeting and superb PET resolution, as well as accurate localization of lesions. The use of this technique in neuroectodermal tumours has been shown to be superior to all available modalities, but the available data are limited and larger studies are awaited to establish its role in the management of these tumours.     

Interventional radiology in the management of pelvic retroperitoneal hemorrhage

ＩｎｔｒｏｄｕｃｔｉｏｎＰｅｌｖｉｃｆｒａｃｔｕｒｅｓａｒｅｃｏｍｍｏｎ，ｐｏｔｅｎｔｉａｌｙｌｉｆｅｔｈｒｅａｔｅｎｉｎｇｉｎｊｕｒｉｅｓｗｈｉｃｈａｒｅｃａｕｓｅｄｂｙｈｉｇｈｅｎｅｒｇｙｉｍｐａｃｔｔｒａｕｍａ．Ｐｅｌｖｉｃｆｒａｃｔｕｒｅｓ...     

Elite athletes’ experiences of musculoskeletal pain management using neuroanatomical dry needling: A qualitative study in Swedish track and field

ObjectivesTo investigate how elite track and field athletes with a history of musculoskeletal pain (MSKP) describe their perceptions of clinical treatments based on dry needling guided by a neurological map (neuroanatomical dry needling (naDN)).DesignQualitative study.MethodsIn-depth interviews were conducted with eight elite Swedish track and field athletes (6 males, 2 females, median age 28.5) treated at a clinic specialised in MSKP management. All interviews were audio recorded and transcribed verbatim. The data were structured and analysed using a thematic method.ResultsThe athletes approached clinical MSKP treatment from a performance-orientated perspective. They explained that they inevitably suffered MSKP episodes due to the intense physical demands of their sport. The use of naDN was considered an integral part of their sports practice and the study clinic's services were readily utilised when MSKP caused minor reductions in physical capacity. The athletes appreciated an unambiguous anatomical diagnosis, preferably supported by imaging scans, as this increased their confidence in clinical services. They valued the naDN treatment as it was perceived to provide fast-acting analgesia that enabled rapid return-to-play. These factors combined to reduce performance-related stress.ConclusionsElite track and field athletes with a history of MSKP sought and appreciated clinical treatment with naDN largely because it provided fast-acting analgesia that enabled rapid return-to-play at a high-performance level. These athletes’ expectations of MSKP diagnosis and management appear incongruent with current research indicating that MSKP sensitivity within the nervous system does not accurately reflect musculoskeletal tissue state or recovery following tissue damage.     

The understanding of the concept of ‘rest’ in the management of a sports concussion by physical therapy students: A descriptive study

ObjectivesTo investigate physical therapy students’ understanding of the concept of rest following a sport concussion and to ascertain if this understanding changes following a lecture based on current best practice concussion knowledge.DesignPre-post observational survey.SettingUniversity classroom setting.ParticipantsA cohort of 118 (40 male, 78 female) physical therapy students participating in volunteer sports medic training.ResultsParticipants provided 320 (pre) and 350 (post) responses depicting activities which should be restricted following a concussion. The responses were classified into three rest-related categories: ‘Physical rest’, ‘Cognitive rest’ and ‘Mixed’ (a combination of physical and cognitive rest). Pre-lecture, approximately 74% of the student’s responses were categorized as Physical rest, and 25% under Mixed. There was a shift in the response pattern post-lecture, with 96% of the responses falling in the Mixed category.ConclusionsThe results of the study highlight a lack of understanding of the concept of cognitive rest in concussion management among trainee sport medics. The need for wider dissemination of this concept as recommended by the recent consensus statement on sports concussion is indicated.     

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures

Purpose  

To determine the value of a breast ultrasound (US) examination in addition to mammography in cases of American College of Radiology (ACR) tissue pattern III and IV in symptomatic women and women at risk.     

Professionals' experiences of imaging in the radiography process – A phenomenological approach

IntroductionPrevious studies on radiographers' professional work have shown that this practice covers both technology and patient care. How these two competence areas blend together in practice needs to be investigated. The professionals' experiences of their work have not been studied in depth, and there is a need to focus on their experiences of the main features of their practice.The aimTo explore, from the perspective of the radiographer, the general tasks and responsibilities of their work.MethodData were generated through a combination of open interviews with radiographers and observations of their work with Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The interviews and observations were analysed using an interpretative phenomenological method.ResultRadiographers' professional work with diagnostic imaging, in a Swedish context, can be viewed as a problem-solving process involving judgments and responsibility for obtaining images that can be used for diagnosis. The examination process comprises three phases; planning, producing the images, and evaluation. In the first phase the radiographer makes judgments on adapting the method to the individual patient, and the second phase involves responsibilities and practical skills for image production. In the third phase, the quality of the images is judged in relation to the actual patient and the imaging process itself.ConclusionsRadiographers consider that the main features of their professional work are patient safety aspects and their knowledge and skills regarding how to produce images of optimal quality, in the actual circumstances of each examination.