Clinics in diagnostic imaging (202)

A 14-year-old boy presented with left anterior knee pain, which was aggravated by exercise and relieved by rest. On clinical examination, there was tenderness at the tibial tuberosity with reproducible pain on resisted active extension of the knee. Radiographs showed heterotopic ossification of the patellar tendon with irregularity and fragmentation of the tibial tubercle. Clinical and radiological findings were consistent with Osgood-Schlatter disease, which is a traction apophysitis of the tibial tubercle commonly occurring in adolescents. The clinical presentation and imaging features are discussed.     

降低儿童颞骨CT扫描辐射剂量的临床研究

目的：探讨颞骨CT扫描时降低毫安值对受检者受到的辐射剂量及图像质量的影响,并比较螺旋扫描与非螺旋扫描方式的辐射剂量及图像质量。方法：选择行颞骨CT扫描的患儿60例,分别采用螺旋及非螺旋扫描各30例,每种扫描方式又分为常规剂量（120kV、150mA）组和低毫安（120kV、60mA）组各15例。扫描时记录容积CT剂量指数（CTDIvol/CTDIw）、扫描长度,并计算出平均剂量长度乘积（DLP）;对不同扫描参数的图像质量进行评分及统计学分析。结果：在同一扫描方式下,低毫安组的辐射剂量明显低于常规剂量组（P〈0.01）,而两组的图像质量无明显差异;在同一毫安值时,轴位螺旋扫描方式的辐射剂量明显低于非螺旋扫描方式（P〈0.01）,而两种扫描方式的图像质量无明显差异。结论：低毫安、螺旋扫描方式能够显著降低颞骨CT检查时的辐射剂量,且又能保证图像质量,满足临床诊断的需要,可在儿童检查中推广。     

A simplified approach for anaesthetic management of diagnostic procedures in children with anterior mediastinal mass

INTRODUCTIONChildren with an anterior mediastinal mass (AMM) need general anaesthesia (GA) or deep sedation for diagnostic procedures more often than adult patients. Anaesthetic management to prevent such complications includes maintenance of spontaneous ventilation (SV) and prebiopsy corticosteroids/radiotherapy.METHODSWe reviewed the medical records of children with AMM who were brought to the operating theatre for diagnostic procedures (prior to chemotherapy) between 2001 and 2013. Our aim was to describe the clinical features, radiological findings and anaesthetic management, as well as determine any association with complications.RESULTS25 patients (age range 10 months–14 years) were identified during the study period. Corticosteroid therapy was started before the biopsy for one patient. All 25 patients had GA/sedation. A senior paediatric anaesthesiologist was involved in all procedures. Among 13 high-risk patients, SV was maintained in 11 (84.6%) patients, ketamine was used as the main anaesthetic in 8 (61.5%) patients, 6 (46.2%) patients were in a sitting position and no airway adjunct was used for 7 (53.8%) patients. There were 3 (12.0%) minor complications.CONCLUSIONBased on our results, we propose a simplified workflow, wherein airway compression of any degree is considered high risk. For patients with high-risk features, multidisciplinary input should be sought to decide whether the child would be fit for a procedure under GA/sedation or considered unfit for any procedure. Recommendations include the use of less invasive methods, involving experienced anaesthesiologists to plan the anaesthetic technique and maintaining SV.     

Awareness of head and neck cancers in Saudi Arabia: A questionnaire based study

Objectives:To address the gap in knowledge by providing data and analyses of the status of awareness among Saudi adults.Methods:This cross-sectional questionnaire-based study was carried out in Saudi Arabia from August 2018 to August 2019 through social media platforms using SurveyMonkey. The domains of the questionnaire included demographic information, knowledge of types and symptoms of head and neck cancers (HNCs), and the relation of HNCs to human papillomavirus (HPV) and its vaccine.Results:A total of 3171 respondents completed the questionnaire. The analysis revealed that many of the study respondents (49.3%) were not knowledgeable about HNCs. Almost two-thirds (61.2%) of the study population incorrectly believed that brain cancer was included in HNCs. Over half (57.8%) did not recognize headaches as a symptom. In terms of the risk factors, males showed higher awareness of tobacco and excessive alcohol as risk factors, while females were more knowledgeable about HPV infection (p<0.05).Conclusion:This study revealed that there is a lack of knowledge and awareness of the clinical features of and risk factors for HNCs among the Saudi population.     

双源CT冠脉成像不同扫描方法的辐射剂量比较

目的 比较双源CT前瞻性心电门控扫描与应用不同管电压回顾性心电门控扫描的冠脉成像质量和患者的辐射剂量.方法 对23例心率＜70次/min且心率波动＜5次/min的患者采用前瞻性心电门控,55例心率不齐或＞70次/min的患者采用按体重指数 （BMI）不同而改变管电压的回顾性心电门控.并随机抽取30例采用常规回顾性心电门控CT冠脉成像（不变动管电压）的患者作为对照组.由两位放射科医师对图像独立进行质量评价,同时对患者的辐射剂量进行统计.结果 前瞻性心电门控冠脉成像与按患者的BMI指数应用不同管电压的回顾性心电门控冠脉成像的质量均能满足临床诊断要求.前瞻性心电门控冠脉成像的辐射剂量较回顾性心电门控下降了约60%～70%,降低管电压也可使辐射剂量明显下降,差异有统计学意义 （P＜0.05）.结论 在保证冠脉成像质量的前提下,根据患者的自身情况制定最合适的检查方案,能够切实降低患者的辐射剂量.     

数字X线摄影辐射剂量与图像质量相关性的实验研究

目的:前瞻性研究不同X线辐射剂量与图像质量的相关性,以探索数字X线摄影(Digital radiography,DR)最适宜曝光量.方法:在仿真胸部体模中放置模拟网状、线状和结节病变结构.用125 kVp不同mAs,对体模及分辨率测试卡进行DR成像.4位放射陕师分别对所有图像进行阅片评分,同时测量入射体表剂量(Entrance surface dose,ESD)、均方根(Root mean squar,RMS)和空间分辨率.结果:ESD随着mAs的增加会增加,而RMS随着mAs的增加会降低;ESD增加至一定量时,空间分辨率达到极限值.曝光指数(Exposure index,EI)值1800以下的图像模拟微小结节显示不清,EI值2000以上的图像对模拟病变的检出高.结论:在保证DR图像质量的前提下,最优化的曝光剂量可以有效地减少辐射损伤.     

128层MSCT低剂量“一站式成像”在急性胸痛中的应用价值

目的探讨128层MSCT低剂量＂一站式成像＂在急性胸痛病因诊断中的临床应用价值。方法 120例急性胸痛患者行128层MSCT＂一站式成像＂检查,所选患者采用简单随机法分为A、B两组,分别行前瞻性心电门控轴扫描（A组,62例）及回顾性心电门控螺旋扫描（B组,58例）。采用t检验和χ2检验分别比较两组的辐射剂量及图像质量。结果A组平均有效剂量为（7.92±2.19）mSv,B组平均有效剂量为（24.01±7.62）mSv,两组间差异具有统计学意义（t=4.089,P〈0.001）;两组冠脉图像质量无明显差异（χ2=3.521,P=0.318）;两组肺动脉及主动脉增强后CT值均大于200HU,两组肺动脉及主动脉增强后CT值无明显差异（t=0.733,P=0.467;t=1.636,P=0.107）。结论 128层MSCT低剂量＂一站式成像＂对于低心率的患者,采用前瞻性心电门控扫描能够在保证图像质量的同时,又明显降低了辐射剂量。     

加强口腔医学教育过程中服务意识的培养

现代医学模式的转变与和谐社会的构建,要求医学教育在提升学生专业技能的同时,也要重视服务意识的培养。本文结合口腔医学诊疗对象的特殊性、治疗手段的多样性、以及口腔医学生的个人发展模式,探讨了口腔医学教育过程中加强服务意识培养的重要性,并提出了尊重患者的人格与权利、倾听患者的诉说与需求、体察患者的内心与感受、引导患者的认知与选择四个方面的培养要求。     

RTEX: A novel framework for ranking,tagging, and explanatory diagnostic captioning of radiography exams

ObjectiveThe study sought to assist practitioners in identifying and prioritizing radiography exams that are more likely to contain abnormalities, and provide them with a diagnosis in order to manage heavy workload more efficiently (eg, during a pandemic) or avoid mistakes due to tiredness.Materials and MethodsThis article introduces RTEx, a novel framework for (1) ranking radiography exams based on their probability to be abnormal, (2) generating abnormality tags for abnormal exams, and (3) providing a diagnostic explanation in natural language for each abnormal exam. Our framework consists of deep learning and retrieval methods and is assessed on 2 publicly available datasets.ResultsFor ranking, RTEx outperforms its competitors in terms of nDCG@k. The tagging component outperforms 2 strong competitor methods in terms of F1. Moreover, the diagnostic captioning component, which exploits the predicted tags to constrain the captioning process, outperforms 4 captioning competitors with respect to clinical precision and recall.DiscussionRTEx prioritizes abnormal exams toward the improvement of the healthcare workflow by introducing a ranking method. Also, for each abnormal radiography exam RTEx generates a set of abnormality tags alongside a diagnostic text to explain the tags and guide the medical expert. Human evaluation of the produced text shows that employing the generated tags offers consistency to the clinical correctness and that the sentences of each text have high clinical accuracy.ConclusionsThis is the first framework that successfully combines 3 tasks: ranking, tagging, and diagnostic captioning with focus on radiography exams that contain abnormalities.     

儿童胸部CT辐射剂量指标比较及扫描前剂量预算回归模型的建立

目的 比较容积CT剂量指数（CTDIVOL）与基于水当量直径（DW）的体型特异性剂量估算值（SSDEDW）在辐射剂量衡量上的差异,分析CTDIVOL、SSDEDW、剂量长度乘积（DLP）与儿童年龄（Age）、胸围（CC）的相关性,建立快速计算CTDIVOL、SSDEDW、DLP的回归模型。方法 回顾性分析2021年1月—12月我院748例儿童胸部影像学资料,根据年龄分为<5岁、5~≤10岁及10~≤15岁3个年龄组。手动测量最中间横断面图像的兴趣区面积（AROI）及CT值（CTROI）,计算基于DW的SSDEDW,使用t检验比较不同年龄段CTDIVOL与SSDEDW间差异。Pearson分析CTDIVOL、SSDEDW、DLP与Age、CC间相关性,建立基于Age、CC计算CTDIVOL、SSDEDW、DLP的回归模型并对其准确性进行分析。结果 所有患儿CTDIVOL为（3.05±0.72）mGy;SSDEDW为（5.69±0.87）mGy;CTDIVOL较SSDEDW低46.40%,二者间比较差异有统计学意义（t=-241.95,P＜0.001）。基于Age的回归模型：CTDIVOL：y=1.78exp(0.06x)(x=Age,R2=0.64);SSDEDW：y=4.16exp(0.03x)(x=Age,R2=0.51);DLP：y=40.10exp(0.09x)(x=Age,R2=0.81);基于CC的回归模型：CTDIVOL：y=-0.76+0.06x(x=CC,R2=0.84);SSDEDW：y=0.06x+1.99(x=CC,R2=0.55);DLP：y=-84.26+2.96x(x=CC,R2=0.81)。基于变量Age、CC计算CTDIVOL其误差分别为（0.13±0.10）、（0.09±0.06）;基于变量Age、CC计算SSDEDW其误差分别为（0.10±0.06）、（0.09±0.07）;基于变量Age、CC计算DLP其误差分别为（0.13±0.09）、（0.13±0.10）;基于CC计算的辐射剂量指标其误差值较Age小。结论 在儿童胸部CT辐射剂量衡量上,CTDIVOL较SSDEDW低估其辐射剂量,使用SSDEDW更为精确;使用年龄、胸围作为水当量直径的替代指征来预计算患儿的辐射剂量指标,可以在检查前快速预算其辐射,对于辐射剂量更好的控制具有重要作用     

医院PET-CT中心18F正电子放射性药物生产及使用中工作人员的辐射剂量监测

目的 研究以18F-脱氧葡萄糖（18F-FDG）为代表的正电子放射性药物在生产和使用过程中医务人员的辐射剂量,为临床辐射防护提供参考数据。方法 测量18例工作人员在制药、质控、分装、传送、注射及摆位的工作流程中手、胸部的当量剂量率（d）及操作时间（t）,并结合不同年检查工作量（w）估算各工作场所工作人员的年受照剂量。结果 估算得到年检查工作量为1000、4000、7000和10000例时,不同工作环节工作人员的累计年剂量为质控0.27mSv,分装0.02～0.20mSv,传送0.06～0.58mSv,注射2.49～24.9 mSv,摆位1.19～11.91mSv。结论 在现有防护设施和操作条件下, 分装和注射是接受剂量较高的工作环节。当年检查工作量在4000例以上时,从事分装工作的人员手部受照剂量超过国家标准关于职业个人年剂量限值的规定;当年检查工作量在10000例时,从事注射的人员年有效剂量亦超过相关国家标准的规定。     

Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments

ObjectiveDiagnostic errors are major contributors to preventable patient harm. We validated the use of an electronic health record (EHR)-based trigger (e-trigger) to measure missed opportunities in stroke diagnosis in emergency departments (EDs).MethodsUsing two frameworks, the Safer Dx Trigger Tools Framework and the Symptom-disease Pair Analysis of Diagnostic Error Framework, we applied a symptom–disease pair-based e-trigger to identify patients hospitalized for stroke who, in the preceding 30 days, were discharged from the ED with benign headache or dizziness diagnoses. The algorithm was applied to Veteran Affairs National Corporate Data Warehouse on patients seen between 1/1/2016 and 12/31/2017. Trained reviewers evaluated medical records for presence/absence of missed opportunities in stroke diagnosis and stroke-related red-flags, risk factors, neurological examination, and clinical interventions. Reviewers also estimated quality of clinical documentation at the index ED visit.ResultsWe applied the e-trigger to 7,752,326 unique patients and identified 46,931 stroke-related admissions, of which 398 records were flagged as trigger-positive and reviewed. Of these, 124 had missed opportunities (positive predictive value for “missed” = 31.2%), 93 (23.4%) had no missed opportunity (non-missed), 162 (40.7%) were miscoded, and 19 (4.7%) were inconclusive. Reviewer agreement was high (87.3%, Cohen’s kappa = 0.81). Compared to the non-missed group, the missed group had more stroke risk factors (mean 3.2 vs 2.6), red flags (mean 0.5 vs 0.2), and a higher rate of inadequate documentation (66.9% vs 28.0%).ConclusionIn a large national EHR repository, a symptom–disease pair-based e-trigger identified missed diagnoses of stroke with a modest positive predictive value, underscoring the need for chart review validation procedures to identify diagnostic errors in large data sets.     

Infrared thermography in the diagnosis of palmar hyperhidrosis: A diagnostic study

BackgroundPrimary hyperhidrosis is a common condition affecting 1–3% of the general population. Excessive sweating leads to reduced surface temperature due to evaporation that can be captured using a thermal camera. We performed this study to find the utility of thermography in the diagnosis of palmar hyperhidrosis.MethodsThis was a cross-sectional diagnostic study conducted in a tertiary care dermatology center during the study period Apr 20–Mar 21. Adult patients with palmar hyperhidrosis diagnosed by expert dermatologists were recruited. The severity was assessed using the hyperhidrosis disease severity scale (HDSS). The measurements were done using a FLIR™ thermal camera. A pilot study, including 30 patients and 30 controls were performed. The results of the pilot study were used for the calculation of sample size.ResultThe study included 55 patients and 110 controls. The mean age of the patients and controls was 22.4 (±3) years and 21.7 (±2.5) years, respectively. The mean temperature difference in the patient and control group was found to be 19.6 (±3.3)⁰ F and 5.8 (±2.9)⁰ F, respectively (p < 0.001). A receiver operating characteristics curve (ROC) to assess the discriminatory ability of mean temperature difference in diagnosis of hyperhidrosis found the area under the curve (AUC) to be 0.995 and a temperature difference of 11.5 °F provides sensitivity and specificity of 98.2% and 97.3% for the diagnosis of hyperhidrosis.ConclusionsThermal imaging is a simple, noninvasive, and objective tool for the diagnosis of hyperhidrosis. It has potential utility in monitoring the effect of the treatment.     

诊断剂量的~(131)碘全身显像后甲状腺组织顿抑效应的评价

目的 :探讨甲状腺癌切除术后诊断剂量 (185MBq)的13 1I全身显像是否会产生甲状腺组织顿抑效应而影响去除剂量的吸收。方法 :分化型甲状腺癌 87例 ,手术切除后给予13 1I(185MBq) 72h后进行诊断剂量的全身显像 ,显像结束后当天或隔天给予去除剂量的13 1I(370 0 - 740 0MBq)去除甲状腺组织。去除处理后第 5天再进行全身显像 ,并与诊断剂量的全身显像图比较 ,评价是否存在明显顿抑现象。结果 :甲状腺癌切除术后诊断剂量的13 1I全身显像并未产生明显顿抑现象 ,也未影响去除剂量的吸收 ,包括转移灶的数量和13 1I摄取的相对密度。结论 :13 1I去除治疗前 72h进行 185MBq的13 1I全身诊断性显像与甲状腺组织顿抑无关 ,可以有效地应用     

CT对肾结核病理表现的诊断评价

目的 探讨肾结核的CT表现及其诊断价值.方法 回顾性分析经病理证实且行CT检查的124例肾结核患者临床资料.分析CT在肾脏形态改变、肾盏虫蚀样变、肾盏变形消失、肾实质空洞、肾实质瘢痕化、肾自截、肾区钙化灶、肾盂输尿管壁增厚、肾外表现、肾功能减退、狭窄导致肾盂肾盏及输尿管积水等方面的检出率.以病理结果为金标准,从肾脏钙化、肾实质空洞和肾盂输尿管壁增厚方面评价CT对肾结核表现的诊断价值.结果 124例中明确诊断肾结核105例(84.7%).主要表现:肾实质空洞115例(92.7%),肾实质瘢痕化83例(67.7%),肾区钙化灶98例(79.0%),肾盂输尿管壁增厚107例(85.8%)等.在显示结核肾的钙化、肾实质空洞和肾盂输尿管壁增厚方面,CT的灵敏度、特异度、符合率、阳性预测值及阴性预测值均较高.结论 CT能清晰显示肾结核病变的部位、程度、范围、解剖关系及对侧肾情况,CT对中晚期肾结核有较好的诊断价值.     

对天津市3所高校糖尿病患者保健意识的调查分析

目的研究糖尿病患者对糖尿病保健知识的了解程度.方法用访谈法调查了486例2型糖尿病患者的保健意识.结果糖尿病患者的保健知识的来源主要是印刷宣传品,占51.1%;其次是医护人员,占38.2%.不同年龄的糖尿病患者对运动疗法和并发症方面的保健知识的了解程度有所不同,不同文化程度的糖尿病患者对戒烟酒、自测血糖和尿糖及并发症方面的保健知识的了解程度有所不同.结论应该有针对性地对高校职工加强有关糖尿病保健知识的健康教育.     

摆位误差对乳腺癌患者放疗中心脏受量的影响

目的 探讨摆位误差对乳腺癌患者放疗中心脏受量的影响.方法 选取18例乳腺癌放疗患者制定放疗计划,保持原计划射野角度、射野剂量、射野权重等参数不变,移动射野中心,模拟3个方向(X、Y、Z轴)的线性摆位误差,重新计算移动射野中心后的心脏受量,并与原计划比较.其中X-、Y-分别代表患者身体相对于射野向患侧、头侧移动.结果 新计划X-3、X-5、X-7、X-9、Y-5、Y-7、Y-9的30 Gy剂量线所包绕心脏的体积百分比(V30)较原计划增加(P＜0.05),其中X-7、X-9、Y-9超过限量;X-9、Y-7、Y-9、Z7、Z9的V40较原计划增加(P＜0.05);X-5、X-7、X-9、Y-5、Y-7、Y-9的心脏平均剂量较原计划增加(P＜0.05),增加幅度分别为54 cGy、80 cGy、110 Gy、100 cGy、142 cGy、182 cGy.结论 对于接受放疗的乳腺癌患者,患侧方向和头方向均≥5mm的摆位误差会使心脏平均剂量明显增加;患侧方向≥3mm、头方向≥5 mm的摆位误差会使心脏V30明显增加.建议当患侧方向、头方向的摆位误差≥5 mm时,应校正误差.     

高等医学放射技术专业教育的比较与思考

通过对中国、日本和中国台湾地区高等医学放射技术教育体系和内涵的比较,试图分析和研究我国高等医学放射技术专业人才培养中存在的问题;进一步明确高等医学放射技术教育的内涵,明确人才培养目标;合理调整教学计划,在课程设置、教学内容和教学手段等方面与国际医学放射技术教育接轨,办出特色,办出水平;培养出基础扎实、素质高雅、技术和技能全面的高级实用型人才。