A Retrospective Analysis of Prostate Cone Beam Computed Tomography (CBCT) Image Registration: A Tale of Two Techniques

PurposeTo determine the feasibility of the gray-value registration technique as a correction method for prostate image-guided radiotherapy.BackgroundThe current practice at this institution involves a two-step process beginning with an automated bone registration, followed by a manual therapist manipulated registration.ProblemThis process is susceptible to subjective judgement and inter-observer variability, which introduces inconsistencies in image registrations and subsequent treatment delivery. Variation in the time required to complete image registrations may increase the chance for prostate intra-fractional movement, which may increase treatment inaccuracies.MethodsA retrospective image review was completed for 20 patients. Translational shifts and duration data for therapist registrations were retrieved for 15 scans for each patient, totaling 300 scans. Gray-value registrations were completed on the same 300 scans to recalculate shift values and the time to complete this technique was recorded. The analysis of variance test was used to analyze the extent of variance between the two registration techniques.ResultsNo difference between the two registration techniques in the lateral (right-left) direction (P = .364) and superoinferior directions (P = .455) were found. Gray-value registrations took significantly less time to complete and were more consistent than the two-step therapist registrations (P < .001). A statistically significant difference in z shifts exists (P = .003) between the two techniques.ConclusionGray-value registration can minimize and standardize the image registration durations and produce x and y shifts similar to those produced by therapists. Lacking the ability to preferentially match to the prostate-rectum interface, therapists still need to perform a simple inspection in the z (anteroposterior) plane to ensure an adequate registration to the interface.     

Evaluation of Bony Anatomy Versus Endobiliary Stents as Surrogates for Volumetric Image Guidance in Pancreatic Cancer

PurposeOnline treatment setup verification through cone-beam computed tomography (CBCT) in pancreatic cancer patients is limited by low soft tissue contrast. This study aims to quantify the relative positional displacements between bony anatomy and endobiliary stents as surrogates for pancreatic cancers.MethodsUnder ethics approval, 258 localization CBCT images from 15 pancreatic patients with endobiliary stents were evaluated. CBCTs were registered through two methods to assess translations and rotations: target adjacent bony anatomy through automatic registration and automatic stent registration through a shaped region of interest. Displacement vector differences between surrogate registrations were calculated and analysed.ResultsMean (±standard deviation) translational displacements in the right/left, superior/inferior, anterior/posterior directions were 0.9 ± 3.1 mm, 1.8 ± 4.2 mm, and 0.4 ± 2.5 mm for bone registrations, respectively, and 0.9 ± 5.6 mm, −1.5 ± 5.7 mm, and −0.5 ± 4.3 mm for stent registrations, respectively. Mean (±standard deviation) rotational displacements for pitch, roll, and yaw were 0.16 ± 0.97°, −0.32 ± 0.96°, and −0.77 ± 1.8° for bone registrations, respectively, and −0.94 ± 4.6°, −0.4 ± 7.4°, and −0.13 ± 6.64° for stent registrations, respectively. Mean displacement vector between surrogates was 4 mm, with 43% of fractions measuring displacement vectors >5 mm. A maximum displacement vector of 22.6 mm between surrogates was observed.ConclusionsVarying positional differences were observed between bone and stent registration for pancreas CBCT–image-guided radiation therapy. Setup errors for stent matching were larger than bone registrations. Further research is required to determine if endobiliary stent position is equivalent to the pancreas' location to determine its suitability as a surrogate.     

A comparison of voxel- and surface-based cone-beam computed tomography mandibular superimposition in adult orthodontic patients

ObjectiveTo evaluate the accuracy, reliability, and efficiency of voxel- and surface-based registrations for cone-beam computed tomography (CBCT) mandibular superimposition in adult orthodontic patients.MethodsPre- and post-orthodontic treatment CBCT scans of 27 adult patients were obtained. Voxel- and surface-based CBCT mandibular superimpositions were performed using the mandibular basal bone as a reference. The accuracy of the two methods was evaluated using the absolute mean distance measured. The time that was required to perform the measurements using these methods was also compared. Statistical differences were determined using paired t-tests, and inter-observer reliability was assessed by intraclass correlation coefficients (ICCs).ResultsThe absolute mean distance on seven mandible surface areas between voxel- and surface-based registrations was similar but not significantly different. ICC values of the surface-based registration were 0.918 to 0.990, which were slightly lower than those of voxel-based registration that ranged from 0.984 to 0.996. The time required for voxel-based registration and surface-based registration was 44.6 ± 2.5 s and 252.3 ± 7.1 s, respectively.ConclusionsBoth methods are accurate and reliable and not significantly different from each other. However, voxel-based registration is more efficient than surface-based registration for CBCT mandibular superimposition.     

Exposure index in digital radiography: initial results of awareness and knowledge from Nigerian digital radiography practices

IntroductionExposure Index (EI) is incorporated into Digital Radiography (DR) systems to indicate incorrect exposure to enable matching exposure to the desired speed class of operation. However, knowledge of the utilization of EI by radiographers in a low-income country has not been investigated.MethodsA pre-tested questionnaire designed using Google forms, with open and close-ended questions was shared online with radiographers working with DR systems in public and private health facilities in some cities located in southern Nigeria. The 32-item questionnaire had two parts: Part A focused on socio-demographic characteristics and Part B focused on the respondents' awareness and knowledge of EI in DR systems. A 5-point Likert scale with 5 test items was used to assess the respondents' knowledge of EI. Statistical analyses were conducted using the Statistical Package for Social Sciences (SPSS) version 21.0. The probability value of p < 0.05 was considered statistically significant.ResultsAbout 8.3% of the respondents had good knowledge of EI in DR systems in spite of the awareness level of 24.7%. The absence of the EI concept in DR curriculum for undergraduates, the lack of EI software in DR systems, and equipment training by the vendor engineers were reasons for the low level of knowledge of EI in DR systems.ConclusionThere is low awareness and knowledge of EI by radiographers in this study, which suggests the need to maximize the benefits of EI concepts by ensuring its integration into clinical radiography practice and curriculum for undergraduates program, to improve knowledge, awareness, and practice in DR.     

An insight into the current perceptions of UK radiographers on the future impact of AI on the profession: A cross-sectional survey

IntroductionAs a profession, radiographers have always been keen on adapting and integrating new technologies. The increasing integration of artificial intelligence (AI) into clinical practice in the last five years has been met with scepticism by some, who predict the demise of the profession, whilst others suggest a bright future with AI, full of opportunities and synergies. Post COVID-19 pandemic need for economic recovery and a backlog of medical imaging and reporting may accelerate the adoption of AI. It is therefore timely to appreciate practitioners’ perceptions of AI used in clinical practice and their perception of the short-term impact on the profession.AimThis study aims to explore the perceptions of AI in the UK radiography workforce and to investigate its current AI applications and future technological expectations of radiographers.MethodsAn online survey (Qualtrics^?) was created by a team of radiography AI experts. The survey was disseminated via social media and professional networks in the UK. Demographic information and perceptions of the impact of AI on several aspects of the radiography profession were gathered, including the current use of AI in practice, future expectations and the perceived impact of AI on the profession.Results411 responses were collected (80% diagnostic radiographers (DR); 20% therapeutic radiographers (TR)). Awareness of AI used in clinical practice is low, with DR respondents suggesting AI will have the most value/potential in cross sectional imaging and image reporting. TR responses linked AI as having most value in treatment planning, contouring, and image acquisition/matching. Respondents felt that AI will impact radiographers’ daily work (DR, 79.6%; TR, 88.9%) by standardising some aspects of patient care and technical factors of radiography practice. A mixed response about impact on careers was reported.ConclusionsRespondents were unsure about the ways in which AI is currently used in practice and how AI will impact on careers in the future. It was felt that AI integration will lead to increased job opportunities to contribute to decision making as an end user. Job security was not identified as a cause for concern.     

Quantitative-analysis of computed tomography in COVID-19 and non COVID-19 ARDS patients: A case-control study

PurposeThe aim of this study was to assess whether the computed tomography (CT) features of COVID-19 (COVID+) ARDS differ from those of non-COVID-19 (COVID−) ARDS patients.Materials and methodsThe study is a single-center prospective observational study performed on adults with ARDS onset ≤72 h and a PaO₂/FiO₂ ≤ 200 mmHg. CT scans were acquired at PEEP set using a PEEP-FiO₂ table with VT adjusted to 6 ml/kg predicted body weight.Results22 patients were included, of whom 13 presented with COVID-19 ARDS. Lung weight was significantly higher in COVID− patients, but all COVID+ patients presented supranormal lung weight values. Noninflated lung tissue was significantly higher in COVID− patients (36 ± 14% vs. 26 ± 15% of total lung weight at end-expiration, p < 0.01). Tidal recruitment was significantly higher in COVID− patients (20 ± 12 vs. 9 ± 11% of VT, p < 0.05). Lung density histograms of 5 COVID+ patients with high elastance (type H) were similar to those of COVID− patients, while those of the 8 COVID+ patients with normal elastance (type L) displayed higher aerated lung fraction.     

What is in it for me? Norwegian radiographers and radiation therapists’ experiences from obtaining a master's degree

IntroductionRadiographers and radiation therapists are essential in providing patients with high-quality diagnostic imaging or therapeutic services. Therefore, radiographers and radiation therapists must get involved in evidence-based practice and research. Even though many radiographers and radiation therapists obtain their master's degrees, little is known about how this degree affects clinical practice or personal and professional growth. We aimed to fill this knowledge gap by investigating Norwegian radiographers’ and radiation therapists’ experiences when deciding to undertake and complete a master's degree and exploring the impact of the master's degree in clinical practice.MethodsSemi-structured interviews were conducted and transcribed verbatim. The interview guide covered five broad areas: 1) the process of achieving a master's degree, 2) the work situation, 3) the value of competencies, 4) the use of competencies and 5) expectations. Data were analyzed using inductive content analysis.ResultsThe analysis included seven participants (four diagnostic radiographers and three radiation therapists) working at six different departments of varying sizes across Norway. Four main categories emerged from the analysis, of which the categories: Motivation and Management support, were categorized into the theme experiences pre-graduation, whereas the categories Personal gain and Application of skills were categorized into the theme experiences pre-graduation. The fifth category Perception of pioneering embraces both themes.ConclusionParticipants reported great motivation and personal gain, but challenges in management and application of skills post-graduation. The participants perceived themselves as pioneers, as there is a lack of experience with radiographers and radiation therapists undertaking master studies, hence no culture and systems for professional development are established.Implications for practiceThere is a need for professional development and research culture in the Norwegian Departments of Radiology and Radiation therapy. Radiographers and radiation therapists must take the initiative to establish such. Further research should investigate managers’ attitudes and perceptions toward radiographers’ master's competencies in the clinic.     

Diagnostic radiography students' experiences of a practical method demonstrating the effect of milliampere-second in digital X-ray imaging systems

BackgroundThe effect of exposure technique factors varies between analogue and digital X-ray imaging systems (DR). Understanding these variations is paramount to optimising radiation protection, yet radiographers are unclear about these effects. A practical method to demonstrate milliampere second (mAs) effect in DR was developed to assist diagnostic radiography students in understanding exposure technique factors in DR.ObjectivesTo explore second-year diagnostic radiography students' experiences of a practical method to demonstrate the effect of mAs in DR.MethodsA qualitative research approach employing an open-ended questionnaire explored second-year diagnostic radiography students' experiences of the practical method demonstrating the effect of mAs in DR. Twenty students participated in the study, and the data collected underwent thematic analysis.ResultsStudents appreciated working in small groups and provided suggestions to improve the practical method's instruction sheet. Most students' predicted outcome differed from the actual outcome of the demonstration. Seeing and documenting the effect of mAs in DR not only enhanced students' understanding of it but showed the implications of increasing mAs on image quality and radiation exposure.ConclusionStudents found that the practical method enhanced their understanding of mAs and exposure technique factors in DR. Additionally, the practical method highlighted exposure creep in DR and radiographers' role in protecting patients from overexposure to ionising radiation in the digital era.     

A Comparison of MRI Radiographers' Knowledge in Saudi Arabia and the Republic of Ireland in Relation to Image Quality Management,for Abdomen and Pelvic MRI Examinations

PurposeThe purpose of this article was to qualitatively compare current MRI radiographers’ knowledge from Saudi Arabia and the Republic of Ireland in relation to MR image quality for abdominal and pelvic MRI examinations.Methods and materialsSemistructured interviews were designed to investigate the professional role of radiographers towards image quality management, personal development in MRI, and training in relation to image quality improvement. Public, private, military, and academic hospitals in the Western region of the Kingdom of Saudi Arabia participated, as did a range of public and private Irish centres. Clinical specialist radiographers (CSRs)/supervisors, and MR radiographers working in MR completed the interviews. These were recorded, coded, and transcribed.ResultsSixty-one MR radiographers and CSRs/supervisors within 11 MRI departments in the Kingdom of Saudi Arabia and 11 MRI departments in the Republic of Ireland participated in this study. Three themes resulted by using a qualitative data analysis program called NVivo: (1) health care professional and the cultural attitudes with regards to the scope of professional roles, (2) factors affecting image quality, and (3) departmental policy. Participants' knowledge of image quality varied and challenges to achieving optimal quality levels were noted. Differences in clinical practice between countries were identified, as was the impact of clinical experience and levels of education.ConclusionDifferences in attitude and clinical practice between Saudi and Irish radiographers and CSRs/supervisors working in MRI departments were identified. There is a need for further training and subsequent assessment of professional skills, including developing postgraduate opportunities, particularly for Saudi radiographers, to support radiographers in the routine management of MR image quality.     

Intravenous metoclopramide versus dexketoprofen trometamol versus metoclopramide+ dexketoprofen trometamol in acute migraine attack in the emergency department: A randomized double-blind controlled trial

Study objectiveThe objective of this study was to determine the analgesic efficacy and safety of intravenous, single-dose metoclopramide versus dexketoprofen trometamol versus metoclopramide+ dexketoprofen trometamol in patients presenting with acute migraine attack to the emergency department (ED).MethodsThis single-center, randomized, double-blind study was conducted in a tertiary care ED. Eligible patients met the migraine criteria of the International Headache Society were randomized to receive 10 mg intravenous metoclopramide, 50 mg intravenous dexketoprofen trometamol, or 50 mg dexketoprofen trometamol +10 mg metoclopramide. Visual analogue scale (VAS) was used for pain measurement at baseline, after 15 and 30 min. The primary outcome measure was the changes in the VAS scores at the 15th and 30th minutes of treatment. The secondary outcome measures were the presence of adverse effects and the requirement of rescue medicine.ResultsPatients (n = 150) were randomized into 3 groups with similar VAS scores at baseline. While there was no significant difference between metoclopramide and dexketoprofen trometamol in reducing pain at the 15th and 30th minute (p = 0.618 and p = 0.862, respectively) and between metoclopramide and metoclopramide + dexketoprofen trometamol at the 15th minute (p = 0.074), metoclopramide + dexketoprofen trometamol was superior to both metoclopramide [mean difference: −13.2 mm (95% CI −23.1 to −3.3)] and dexketoprofen trometamol [mean difference: −11.02 mm (95% CI −20.9 to −1.1)] at the 30th min (p = 0.006 and p = 0.025 respectively). The rescue drug was required by 3 patients (6%) were in metoclopramide group, 4 patients (8%) in dexketoprofen trometamol group and one patient (2%) in the metoclopramide + dexketoprofen trometamol group. No side effects were observed in subjects in three treatment groups.ConclusionNo significant difference in VAS was found between three treatment groups at the 15th minute, but metoclopramide + dexketoprofen trometamol was superior to both metoclopramide and dexketoprofen trometamol at the 30th min.     

Dosimetric Impact of Image-Guided Radiotherapy in Liver Stereotactic Radiotherapy

IntroductionIn the absence of volumetric image-guided radiotherapy (IGRT) with or without intravenous contrast, IGRT with two-dimensional (2D) imaging can improve the accuracy and precision of radiation delivery by correcting the largest sources of geometric uncertainty, facilitating the delivery of higher doses to the tumor and/or reduced doses to normal tissues. The purpose of this work was to estimate dosimetric impact of 2D IGRT for patients undergoing breath hold liver stereotactic body radiotherapy (SBRT).Materials/MethodsOffline residual offsets were determined using orthogonal image pairs acquired with patients positioned with external setup marks (non-IGRT) and following IGRT and repositioning (IGRT) for 30 patients treated with 6-fraction liver SBRT. The diaphragm was used as a surrogate for the liver for craniocaudal positioning, and the vertebral bodies for anterioposterior and right-left positioning, with a 3-mm threshold. The planned dose distributions were shifted by the measured IGRT and non-IGRT offsets. Total doses to target volumes and organs at risk (OAR) were calculated and compared to the prescribed plans.ResultsA total of 643 images (416-MV electronic portal images; 227 kV cone beam computed tomography projection images) were evaluated. Residual non-IGRT offsets frequently exceeded 3 mm (72%), resulting in clinically significant variations from the prescribed minimum planning target volume dose (mean change –6.5 Gy; P =.0150). The population mean reductions in minimum gross tumor volume doses (standard deviation (σ) to 0.5 mL with were 7.2 Gy (6.3) and 4.7 Gy (6.1) for non-IGRT and IGRT, respectively. The mean population increase in maximum OAR dose (to 0.5 mL) was largest for bowel (2.7 Gy, σ = 5.5 Gy) for non-IGRT.ConclusionsIGRT significantly improves concordance of delivered doses with planned doses for liver target volumes and OARs.     

Validation of the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness With the Coma Recovery Scale-Revised

ObjectiveTo examine (1) the concurrent validity of the Music Therapy Assessment Tool for Awareness in Disorders of Consciousness (MATADOC) with the criterion standard Coma Recovery Scale-Revised (CRS-R) for outcomes of awareness in patients with prolonged disorders of consciousness (PDoC), (2) the relationship between MATADOC items and CRS-R function subscales in similar domains, and (3) determine if items/function subscales measure different constructs.DesignA prospective multicentric blinded study with repeated concurrent measures.SettingThree inpatient rehabilitation units.ParticipantsConvenience sample of 74 adults with PDoC (N=74).Main Outcome MeasuresThe MATADOC protocol elicits behavioral responsiveness using live music in 5 tasks. A total score ranges 0-10 scoring behaviors across 14-items. The CRS-R uses a language-based protocol and scores observed responses ranging from 0-23 in 6 function subscales. Both measures were delivered at 4 concurrent time points over 2 weeks.ResultsFair (κ=0.238, P=.006) ranging to moderate (κ=0.419, P<.001) significant agreement was found between CRS-R and MATADOC diagnostic outcomes. Fair-borderline moderate significant agreement was found for overall diagnostic outcomes across all diagnostic categories (κ=0.397, P=.001). There was moderate significant agreement between measures for motor scores (0.551≤κ≤0.571, P<.001) and visual outcomes (0.192≤κ≤0.415, .001≤P<.005) but no agreement for item/function subscale outcomes assessing auditory responsiveness. Exploratory factor analysis of all items showed 2 factors, suggesting that MATADOC and CRS-R measure the same underlying latent variable (awareness) in different ways and could complement each other for diagnosis and intervention purposes. This was supported by scale analysis, which showed increased reliability when the 2 scales are used together rather than separately.ConclusionsUnlike the CRS-R, the music-based MATADOC scores auditory localization for complexity of response and categorizes these behaviors as conscious rather than reflexive. The MATADOC may supplement the CRS-R, having a particular role in interdisciplinary programming for providing a more robust assessment of auditory responsiveness because of using nonverbal musical stimuli.     

Endovascular image-guided navigation - validation of two volume-volume registration algorithms

Abstract

The limited volume covered by intraoperatively acquired CT scans makes the use of navigation systems difficult. Preoperative images cover a larger volume of interest. Hence, reliable registration of high quality preoperative to intraoperative CT will provide the necessary image information required for navigation. This study evaluates two algorithms (Siemens, CAMP) for volume-volume registration for usage during endovascular navigation. Twenty patients treated for abdominal aortic aneurysm were scanned with pre-, intra- and postoperative CT. Six data sets were excluded due to variations in image acquisition parameters and severe artifacts. Fourteen intra- and postoperative datasets were registered ten times with both algorithms, altogether 140 registrations for each program. In all data sets five specified landmarks placed by two radiologists were used to evaluate registration accuracy. The distance between the paired landmarks in the registered intra- and postoperative volumes was measured and the root mean square value calculated. Reference registrations were based on rigid body registration of the five landmarks in the intra- and postoperative volumes. Registration accuracy (mean ± SD) was for Siemens 5.05 ± 4.74 mm, for CAMP 4.02 ± 1.52 mm and for the reference registrations 2.72 ± 1.18 mm. The registration algorithms differed significantly, p < 0.001.     

三维超声图像融合技术对肝脏的影响因素

目的 探讨三维超声图像融合技术的影响因素,以获取最佳图像融合效果。方法 纳入10名健康志愿者进行肝脏三维超声容积图像,采用基于肝脏血管树三维超声图像融合技术,对肝脏右前叶进行图像自动融合。于平静呼气末、平卧位、容积角度90°采集图像,设为对照图像,观察呼吸时相、体位、扫查切面和容积角度对该技术成功率和配准误差的影响。结果 对照图像融合成功率达100%(10/10),中位配准误差为1.22 mm(0.57~1.88 mm);变换呼吸相、容积角度、体位及切面均不同程度降低了图像融合成功率,以体位[40.00%(4/10)]和容积角度[30.00%(3/10)]为著(P均<0.05),变换体位和切面明显提高了中位配准误差[3.01(2.59~4.49)、2.74(1.66~4.30),P均<0.05]。结论 于同一呼吸相、同一体位、相同切面及采集最大容积角度下,三维超声图像融合技术能够获得最佳的融合效果。     

Estimation of unregistered patients who left without being seen: At an urban mid-sized Canadian community emergency department

ObjectiveTo determine whether changes to the appearance of an emergency department (ED) waiting room influenced the number of patients who left without being seen (LWBS).DesignRetrospective analysis using National Ambulatory Care Reporting System data collected at the time of patient registration.SettingThe ED of Belleville General Hospital, a mid-sized secondary care community hospital in Ontario with a catchment population of 125 000.ParticipantsAll unscheduled patients registering at the hospital to be seen in the ED from July 1 to December 31, 2016 (control period), and from July 1 to December 31, 2017 (study period).Main outcome measuresThe volume of patients registering by Canadian Triage and Acuity Scale (CTAS) level to be seen in the ED during the study period compared with the volume of patients registering during the control period, and the number of LWBS during the 2 time periods.ResultsThe average number of patients registered per month was significantly greater in the study period than in the control period (t₁₀ = -5.53, P < .01). A total increase of 1881 registrations was recorded in the study period, or 10.47% (increase per month ranged from 9.59% to 11.66%). The proportion of patients with less acute triage scores decreased in the study period; however, the differences in CTAS levels between the 2 years was not statistically significant (χ² = 1.05, P = .90). The number of LWBS according to CTAS level was lower in all categories in the study period, including those in the less acute levels, decreasing from 60 in CTAS 5 in 2016 to 45 in 2017, and 585 in CTAS 4 in 2016 to 330 in 2017. Overall, the distribution of LWBS by CTAS level was significantly different between the control and study periods (P < .01).ConclusionThe number of patients registering is influenced by the apparent high or low occupancy of the waiting area at the time of registration.     

Kinematic and spatiotemporal gait characteristics in pregnant women with pelvic girdle pain,asymptomatic pregnant and non-pregnant women

BackgroundWalking difficulties are common among pregnant women with pelvic girdle pain. This cross-sectional study investigated the influence of pelvic girdle pain, pregnancy and speed on spatiotemporal and trunk, pelvic and hip kinematics during gait in the 2nd trimester of pregnancy.MethodsThree-dimensional gait analysis at self-selected speed was performed in 25 pregnant women with pelvic girdle pain, 24 asymptomatic pregnant and 24 non-pregnant women. Linear mixed models were used to investigate between-group differences in gait variables. Adjustment for gait speed was included in the analysis. Correlations between speed and fear of movement, disability and pain were examined using Spearman correlation coefficient (r_s).FindingsPregnant women with pelvic girdle pain walked 18% slower (estimated marginal means (95% confidence intervals) 1.18 (1.22, 1.24) meter/s) compared to asymptomatic pregnant women (1.44 (1.38, 1.50) meter/s) (P < 0.001). Moreover, with longer double limb support (5%, P = 0.04), shorter contralateral step length (3%, P = 0.03) and more restricted pelvic and hip kinematics (0.001 ≤ P ≤ 0.01) adjusted for speed. Only stance, double limb support and thoracic rotation (0.001 ≤ P ≤ 0.04) differed between asymptomatic pregnant and non-pregnant women. Speed was negatively correlated with fear of movement (r_s = −0.63, P = 0.01) and disability (r_s = −0.46, P = 0.03) in the pelvic girdle pain group.InterpretationGait is primarily influenced by pelvic girdle pain and less by pregnancy. Pregnant women with pelvic girdle pain walked slower and with a more rigid gait pattern compared to asymptomatic pregnant women, presumably related to altered load transfer. Our results may assist clinical evaluation of pelvic girdle pain, as well as direct future research.     

Reliability and validity of the Four Square Step Test in patients with hip osteoarthritis before and after total hip replacement

ObjectiveTo determine the validity and inter- and intra-rater reliability of the Four Square Step Test (FSST) in assessing gait performance, balance and physical function for patients with hip osteoarthritis before and after total hip replacement (THR).DesignObservational, repeated measures.SettingA specialist orthopaedic hospital.ParticipantsFifty-eight participants with moderate to severe hip osteoarthritis scheduled to receive primary hip replacement within 4 months from recruitment.Main outcome measureTime to complete the FSST, time and steps to complete the Figure of 8 Walk Test (F8W) and Berg Balance Scale score (BBS).ResultsThe Bland and Altman limits of agreement for intra-rater measurements of the FSST were −3.2 s to 3.5 seconds before THR and −1.5 to 2.0 seconds after THR. Limits of agreement for two different raters were −2.2 to 3.4 seconds, all with small mean differences indicating little bias between raters or replications. Concurrent validity was assessed, and the FSST correlated highly with the F8W (r = 0.7, P < 0.001) and moderately with the BBS (r = 0.6, P < 0.001). Only one participant was rated as being at moderate risk of falls on the BBS, with the other participants scoring low; only one participant failed to complete the F8W. This is in contrast to the FSST, which 21 people failed to complete pre-operatively.ConclusionsThe FSST is a valid and reliable measure of multi-directional stepping speed and balance, giving a more informative measure of gait performance than the F8W and BBS, and is feasible for use in a clinical population of patients both before and after THR.     

Improving STEMI management in the emergency department: Examining the role of minority groups and sociodemographic characteristics

ObjectiveTo evaluate whether a fast-track intervention program will reduce time-lags of patients with STEMI considering minority groups, various socioeconomic status (SES) and clinical risk factors.MethodsA retrospective-archive study was conducted according to clinical guidelines, comparing all STEMI patients (n = 140) admitted to the emergency department (ED) before (n = 60) and during (n = 80) implementation of the fast track intervention program. The program comprised four steps: (1) immediate bed rest, (2) marking patient chart, (3) assessing time-lags according to defined clinical guidelines, and (4) physician signing a dedicated sticker on the ECG.ResultsThe major ethnic group compared to other minority patients with STEMI were less delayed for physician examination (r = −0.398, p < 0.01), spent less time at ED (r = −0.541, p < 0.01) and reached percutaneous coronary intervention earlier (r = −0.672, p < 0.01). Patients with higher SES spent less time for physician (r = −338, p < 0.05) and in the ED (r = −0.415, p < 0.01). Before intervention patients with diabetes mellitus (DM) spent more time at ED compared to non DM patients, however during intervention this difference was blurred (β = −0.803, p < 0.001). Gaps regarding sociodemographic bias remained present throughout the intervention despite monthly staff evaluations considering patient cases.ConclusionsThe fast track intervention was associated with less time at ED and to cardiac reperfusion. Yet, sociodemographic bias was present. Our findings highlight the need for the healthcare profession to address the role of biases in disparities in healthcare.