A pilot study to evaluate the use of virtual lectures for undergraduate radiology teaching

Purpose

To demonstrate that virtual lectures can substitute conventional lectures in radiology education for medical students.

Methods and materials

During the course 2005–2006, 89 out from 191 (46.6%) third year students of a subject entitled “General Radiology”, participated voluntarily in a pilot study including 22 virtual lectures (Flash presentations translated from the same PowerPoint presentations of conventional lectures, adding recorded narration and navigation tools). Participants (P) studied by means of virtual lectures, while non-participants (NP) assisted to conventional lectures.The results of the final oral exam classified from 0 to 3, and a 60-questions evaluation on image interpretation were used to compare both groups after training. Finally, 34 students from the group P (38.2%) fulfilled a 10-points scale quality survey about the project.

Results

Final exam qualifications were significantly higher for P than for NP (2.11 ± 0.85 versus 1.73 ± 1.04) as well as the number of correct answers of the evaluation on image interpretation (24.2 ± 6.2 versus 21.2 ± 5.4), but differences could obey to different attitudes between both groups. The usefulness of virtual lectures to learn General Radiology obtained the highest global scoring (8.82 ± 1.00). Contents were generally better evaluated than the design of the presentations.

Conclusion

Virtual lectures can substitute conventional lectures in radiology education for medical students with no detriment to students’ learning. Their potential advantage is that magisterial lectures can be used to discuss contents with students in a more participative way if virtual lectures are provided before.     

An investigation to ascertain whether or not time pressure influences the accuracy of final year student radiographers in abnormality detection when interpreting conventional appendicular trauma radiographs: A pilot study

IntroductionThere is an increasing demand on diagnostic imaging departments, a shortage of radiologists, and a backlog of images requiring a report across several trusts in the UK. A negative impact on performance can result in significant outcomes for the patient. The aim of this study is to ascertain whether decisions made under time pressure will affect the accuracy of the interpretation of conventional radiographs.MethodsFinal year undergraduate diagnostic radiography students were recruited [n = 21] and separated into three groups of seven at random, assigning time limits per image for a set of normal and abnormal conventional appendicular radiographs; 15 s (high pressure), 30 s (moderate pressure) and unlimited time (low pressure). Each image was assessed, and answers were recorded as normal or abnormal with an approximate location of the pathology.ResultsThe ANOVA test revealed no statistical significance amongst results. The mean accuracy was highest in the 15 s group (82.86%) and lowest in the unlimited time group (74.52%). The results also demonstrated a decrease in accuracy with increased image review times within the unlimited time group; with the quickest participant achieving 88.33% and the slowest, 56.67%.ConclusionThe results demonstrated no statistical significance. However, it is recommended to conduct a similar study using sufficient reporting practitioners to enable direct parallels to be drawn with statistical significance.Implications for practiceThe results signify an importance for imaging departments to manage the number of staff and their workload. Subsequently, this aims to ensure reporting practitioners work at their optimum stress level for efficient work performance.     

A pilot study to evaluate assisted freehand ultrasound elasticity imaging in the sizing of early breast cancer: a comparison of B-mode and AFUSON elasticity ultrasound with histopathology measurements

Objective

This pilot study investigates the role of assisted-freehand ultrasound (AFUSON) elasticity imaging of the breast in assessing the contour, size and area of 23 early breast cancers by making comparison of AFUSON with the equivalent B-mode ultrasound images and gold standard histopathology slides.

Methods

The B-mode, AFUSON and digitised histopathology slides of three early breast cancers were compared for contour, size and area with histopathology scans. AFUSON features that corresponded to areas of known malignant change on the histopathology slides were regarded as diagnostic. These diagnostic criteria were then applied to the B-mode and AFUSON elasticity images of all 23 breast cancers in the pilot study without having the availability of the histopathology scans for reference. Corresponding diameters were measured and the results were compared with the equivalent measurements on the scans of the histology slides. The results were tabulated in histogram form. Diagnostic confidence levels were evaluated.

Results

Size dimension accuracy increased from 66% using B-mode alone to 82% using combined B-mode and AFUSON elasticity images. Tumour area accuracy was also increased. A small number of cases had a striking visual similarity of shape on AFUSON elasticity scans and histopathology slides.

Conclusion

In spite of the shortfalls in this study, AFUSON elasticity imaging was capable of acquiring some high-quality images that showed strong correlation between AFUSON elasticity and scans of histology slides. Further studies will be carried out to refine the technique and determine if it has a role in the diagnosis and management of breast cancer.Breast cancer is the most common cancer occurring in women in the Western world. Currently, the lifetime risk of developing breast cancer for UK women is 1:9, and on average 126 new cases are diagnosed each day [1]. Current trends in cancer imaging are aimed towards technological development of non-invasive techniques that provide high diagnostic sensitivity and specificity and also prognostic information about the primary tumour upon which to base treatment regimens. Such developments are taking place notably in ultrasound, CT, MRI and positron emission tomography (PET).Ultrasound elasticity imaging of soft tissues has been developed over the last 20 years and is under evaluation as an additional tool in the ultrasound armamentarium to supplement the diagnostic information obtained during conventional B-mode scanning. It is now found on several currently commercially available ultrasound systems [2-4]. These systems rely on freehand ultrasound scanning for its flexibility and simplicity [4-9] but like all freehand systems there is significant inter- and intra-observer error [10,11]. During the last 5 years we have developed an elasticity scanning system called assisted-freehand ultrasound (AFUSON) elasticity imaging as a method of reducing this variability by applying semi-automated, measurable external compression during an ultrasound scan. It shows improvement over freehand elasticity image acquisitions by increasing motion constraint, which translates directly into improved image quality. Improved control increases repeatability [12]. Neither freehand nor fully automated systems can accommodate these improvements while remaining sufficiently flexible for breast assessment.Conventional freehand elasticity studies of breast cancer have largely focused on its ability to detect and classify lesions. An imaging classification and system of semi-quantification has been proposed [4] and progress has been made in the classification of masses demonstrated on ultrasound into those with benign and those with malignant features [4-9,13-15], particularly Breast Imaging Reporting and Data System (BI-RADS) 3 lesions, by assessing the pattern of strain within lesions and their relative sizes on B-mode and elasticity images [14,15]. The little work done so far on the use of this technique as a predictor of breast cancer size when compared with the excised specimen suggests that freehand elasticity may give a more accurate pre-operative assessment than B-mode imaging [16].Given the ability of AFUSON elasticity ultrasound to deliver increased precision and control for imaging, while maintaining the freehand operation familiar to radiologists, this pilot study was devised to test the hypothesis that AFUSON elasticity imaging could deliver a more accurate pre-operative assessment of the size, area and shape of an early breast cancer than B-mode alone. It was hoped that diagnostic criteria could be derived that would define the relationship of the cancer with the surrounding breast parenchyma.     

A pilot study to assess radiographer preliminary clinical evaluation (PCE) introduced for emergency department adult appendicular X-ray examinations: Comparison of trained and untrained radiographers

IntroductionRadiographers are transitioning from using “Red Dot” annotations to flag abnormal emergency X-ray images, to providing written preliminary clinical evaluation (PCE) diagnostic comments. This study explored the impact of local training on radiographers’ PCE participation and accuracy performance during a trial period.MethodsTen radiographers provided PCE comments for adult appendicular trauma X-ray examinations performed in the Emergency Department of an English public hospital over a 19 week trial period. Five senior radiographers who had received local PCE training and five more recently qualified radiographers, without this local training, participated in the trial. PCE participation rates were recorded and the PCE comments were scored for accuracy compared to the formal radiology report.ResultsThere were 796 eligible examinations, of which 528 (66%) had PCE comments. PCE participation was significantly higher (p < 0.001) for the radiographer group who received the training (80%, 253/316) compared to the untrained group (57%, 275/480). Similar levels of PCE accuracy (90% vs. 89%), sensitivity (86% vs. 82%) and specificity (91% vs. 93%) were found for the trained and untrained cohorts respectively, with no statistically significance difference between these scores.ConclusionLocal PCE training was associated with more frequent PCE participation but did not appear to influence PCE accuracy. The accuracy results suggest that radiographers are well equipped to provide PCE comments for adult appendicular X-ray examinations.Implications for practiceLocal PCE training is likely to be important for consistent PCE scheme participation. Both experienced and recently qualified radiographers appear well equipped to provide accurate PCE for adult appendicular trauma X-ray examinations.     

Non‐invasive ventilation abolishes the IL‐6 response to exercise in muscle‐wasted COPD patients: A pilot study

Systemic inflammation in patients with chronic obstructive pulmonary disease (COPD) has been related to the development of comorbidities. The level of systemic inflammatory mediators is aggravated as a response to exercise in these patients. The aim of this study was to investigate whether unloading of the respiratory muscles attenuates the inflammatory response to exercise in COPD patients. In a cross‐over design, eight muscle‐wasted stable COPD patients performed 40 W constant work‐rate cycle exercise with and without non‐invasive ventilation support (NIV vs control). Patients exercised until symptom limitation for maximally 20 min. Blood samples were taken at rest and at isotime or immediately after exercise. Duration of control and NIV‐supported exercise was similar, both 12.9 ± 2.8 min. Interleukin‐ 6 (IL‐6) plasma levels increased significantly by 25 ± 9% in response to control exercise, but not in response to NIV‐supported exercise. Leukocyte concentrations increased similarly after control and NIV‐supported exercise by ～15%. Plasma concentrations of C‐reactive protein, carbonylated proteins, and production of reactive oxygen species by blood cells were not affected by both exercise modes. This study demonstrates that NIV abolishes the IL‐6 response to exercise in muscle‐wasted patients with COPD. These data suggest that the respiratory muscles contribute to exercise‐induced IL‐6 release in these patients.     

Neuromechanical response to passive cyclic loading of the ACL in non-professional soccer players: A pilot study

ObjectiveTo investigate the effects of passive cyclic loading (CYC) on anterior tibial translation (ATT), knee extensor and flexor muscle strength and activation in soccer players.DesignCross-sectional study.Setting: Functional Assessment Laboratory; Participants: Eight healthy competitive soccer players.Interventions: The knee of the dominant limb was subjected to 10 min of CYC at 200 N force.Main outcomes measuresATT was measured before and after CYC. Percentage of variation was used to estimate ACL creep. Knee extension and flexion maximal voluntary contractions (MVCs) were assessed both before and after CYC. EMG amplitudes of both Biceps Femoris (BF) and Vastus Lateralis (VL) were recorded during both MVCs and CYC.ResultsThere was a 20.7% increase in ATT after CYC application (p<0.001). Post-CYC agonist and antagonist BF activations were 37.7% and 18.4% lower than pre-CYC ones during MVCs (p<0.05). BF EMG activity in the last 30s of CYC was 19.9% higher than in the first 30s (p<0.05).ConclusionThe increased ATT and the variations in neuromuscular activation of the BF in response to loading may expose the knee at higher injury risk by increasing joint instability. Further studies are required to thoroughly investigate these aspects in both laboratory and real-field settings.     

Correction to: A phase 2, open-label,multi-center study to evaluate the efficacy and safety of 99m Tc-TRODAT-1 SPECT to detect Parkinson’s disease

The corresponding author of the article would like to remove “Jian Wang” in the author group.     

Implementation of In vivo exposure therapy to decrease injury-related fear in females with a history of ACL-Reconstruction: A pilot study

ObjectiveThe objective of this pilot study was to examine the preliminary feasibility and efficacy of in vivo exposure therapy (IVET) to decrease injury-related fear in females with history of ACLR.DesignPilot Study.SettingSports Medicine Research Laboratory.Participants12 female participants with history of ACLR (≥ 1 year post-operative) were randomized into a 5-week IVET group (n = 6) or 5-week sham physical activity (PA) monitoring group (n = 6).Main outcome measuresThe independent variables were Group and Time. The dependent variables were the Photographic Series of Sports Activities for ACLR (PHOSA-ACLR) and the Tampa Scale of Kinesiophobia-11 (TSK-11) scores. A Group x Time repeated measures two-way analysis of variance was completed for the PHOSA-ACLR and the TSK-11. Partial η² effect sizes were used to examine clinically meaningful differences.ResultsHigh retention and adherence rates were observed in the intervention group. The PHOSA-ACLR exhibited a significant main effect for Time (F_1,10 = 9.92, p = 0.01, partial η² = 0.50), but not for Group. No statistically significant or clinically meaningful differences were observed for the TSK-11.ConclusionBoth groups exhibited decreased injury-related fear for specific functional tasks. Future research should further examine the efficacy of IVET and PA monitoring to decrease injury-related fear in patients after ACLR.     

Comparing the effects of adapting to a weight on one leg during treadmill and overground walking: A pilot study

BackgroundLocomotor adaptation has been suggested as a way to improve gait symmetry in individuals post-stroke. Most perturbation methods utilize costly, specialized equipment. The use of a unilateral leg weight may provide a low cost, clinically translatable alternative. Furthermore, previous studies have suggested that adaptation context may affect movement outcomes. The purpose of this study was to assess the ability of a unilaterally applied ankle weight to drive locomotor adaptation and determine the effect of context (treadmill versus overground) in young, non-disabled participants.MethodsEighteen young non-disabled adults were randomly assigned to receive 10 min of walking on a treadmill with a weight (TG), overground with a weight (OG) or as a control on a treadmill/overground without a weight (CG). Outcomes measured before, during and after adaptation were: step length symmetry, single limb support symmetry and gait speed.ResultsAfter adding the weight, single limb support immediately became asymmetrical for all participants without changes in step length symmetry. After walking for 10 min, TG step length became asymmetrical. After weight removal, both TG and OG had increased step length asymmetry. TG decreased single limb support asymmetry while OG did not. After walking overground without the weight, walking parameters eventually returned to baseline in both weighted groups. The control group showed no changes.ConclusionA unilaterally applied ankle weight appears able to cause gait adaptation in young, non-disabled participants. However different adaptive changes in the gait pattern are made by the nervous system when the perturbation is applied in different contexts.     

Direct MR arthrography of the shoulder under axial traction: Feasibility study to evaluate the superior labrum‐biceps tendon complex and articular cartilage

Purpose:

To assess the value of adding axial traction to direct MR arthrography of the shoulder, in terms of subacromial and glenohumeral joint space widths, and coverage of the superior labrum‐biceps tendon complex and articular cartilage by contrast material.

Materials and Methods:

Twenty‐one patients investigated by direct MR arthrography of the shoulder were prospectively included. Studies were performed with a 3 Tesla (T) unit and included a three‐dimensional isotropic fat‐suppressed T1‐weighted gradient‐recalled echo sequence, without and with axial traction (4 kg). Two radiologists independently measured the width of the subacromial, superior, and inferior glenohumeral joint spaces. They subsequently rated the amount of contrast material around the superior labrum‐biceps tendon complex and between glenohumeral cartilage surfaces, using a three‐point scale: 0 = no, 1 = partial, 2 = full.

Results:

Under traction, the subacromial (Δ = 2.0 mm, P = 0.0003), superior (Δ = 0.7 mm, P = 0.0001) and inferior (Δ = 1.4 mm, P = 0.0006) glenohumeral joint space widths were all significantly increased, and both readers noted significantly more contrast material around the superior labrum‐biceps tendon complex (P = 0.014), and between the superior (P = 0.001) and inferior (P = 0.025) glenohumeral cartilage surfaces.

Conclusion:

Direct MR arthrography of the shoulder under axial traction increases subacromial and glenohumeral joint space widths, and prompts better coverage of the superior labrum‐biceps tendon complex and articular cartilage by contrast material. J. Magn. Reson. Imaging 2013;37:1228–1233. © 2012 Wiley Periodicals, Inc.     

Reduced oxygen cost of running is related to alignment of the resultant GRF and leg axis vector: A pilot study

This pilot study investigated whether a 10‐week running program (10wkRP), which reduced the oxygen cost of running, affected resultant ground reaction force (GRF), leg axis alignment, joint moment characteristics, and gear ratios. Ten novice, female runners completed a 10wkRP. Running kinematics and kinetics, in addition to oxygen consumption () during steady‐state running, were recorded pre‐ and post‐10wkRP. decreased (8%) from pre‐10wkRP to post‐10wkRP. There was a better alignment of the resultant GRF and leg axis at peak propulsion post‐10wkRP compared with pre‐10wkRP (10.8 ± 4.9 vs 1.6 ± 1.2°), as the resultant GRF vector was applied 7 ± 0.6° (P = 0.008) more horizontally. There were shorter external ankle moment arms (24%) and smaller knee extensor moments (23%) at peak braking post‐10wkRP. The change in was associated with the change in alignment of the resultant GRF and leg axis (r_s = 0.88, P = 0.003). As runners became more economical, they exhibited a more aligned resultant GRF vector and leg axis at peak propulsion. This appears to be a self‐optimization strategy that may improve performance. Additionally, changes to external ankle moment arms indicated beneficial low gear ratios were achieved at the time of peak braking force.     

Estimation of blood and urine levels of eight metals and essential trace elements collected from living Subjects compared to urine,cardiac and femoral postmortem blood,and other postmortem samples: A forensic toxicology study

Along with the regular toxicology testing, different samples collected during the autopsy might be subjected to metal level estimation to investigate the cause of death in some cases. Utilizing a scientific procedure on postmortem specimens is crucial for interpreting forensic toxicological analytical results. Even modest procedural errors made by incompetent forensic toxicologists and chemists who lack proper specialized training and knowledge can alter the scientific conclusions and hence the legal verdict.The current work studies an overview of eight metals and element levels in living and deceased human bodies. It could be a substantial contribution to establishing normal or so-called "reference" metal levels under antemortem and postmortem situations, hence aiding in identifying reliable future interpretations of results produced by numerous researchers in the same field.Aim of the workThe current work aimed to study the concentration of eight metals in the blood samples (cardiac and femoral), urine, and other samples (Spleen, liver, and renal tissues) collected from human cadavers at different postmortem intervals in addition to blood and urine samples collected from the living population as a contribution to establishing normal or so-called "reference" metal levels under antemortem and postmortem situations.Subjects and methodsPostmortem autopsy blood samples (cardiac and femoral), urine, and other samples (Spleen, liver, and renal tissues) were collected from 400 deceased subjects. These samples were analyzed for the estimation of the eight metals under research, namely, Arsenic (As), Selenium (Se), Silver (Ag), Cadmium (Cd), Antimony (Sb), Mercury (Hg), Zinc (Zn) and Lead (Pb). In addition, blood and urine samples from 400 living volunteer subjects were analyzed for the same eight elements under study.ResultsIn the postmortem group, the mean metal levels in cases with absent, early, and advanced putrefaction simultaneously in μg/L were 2.45 ± 3.30, 3.25 ± 5.18, and 3.81 ± 1.95 for As. For Se, the results were 10.74 ± 4.21, 10.54 ± 5.28, and 9.96 ± 4.14. 4.04 ± 1.74, 3.48 ± 1.32, and 3.74 ± 0.91 were the results for Ag. For Cd, they were 8.35 ± 3.91, 12.15 ± 3.05, and 24.51 ± 31.25 with P < 0.0001**. 1.48 ± 1.85, 1.61 ± 1.85, and 1.62 ± 1.74 were the same results for Sb; 6.07 ± 2.44, 5.22 ± 2.17, and 5.39 ± 1.82 for Hg. 395 ± 79.8, 553 ± 51.7, and 704 ± 97.2 for Zn with a P-value <0.005*. As for lead, the results were 15.61 ± 24.19, 14.76 ± 23.05, and 24.61 ± 52.72. As the postmortem interval increased, Cd and Zn levels increased (p < 0.0001, <0.005* simultaneously).     

Stress perfusion/metabolism imaging: A pilot study for a potential new approach to the diagnosis of coronary disease in women

BACKGROUND: The diagnosis of coronary artery disease (CAD) in women continues to be a challenge. F-18 deoxyglucose (FDG) positron emission tomography (PET) has been used for detection of myocardial ischemia at rest. Little has been reported about FDG stress imaging. The aim of this pilot study was to assess stress FDG PET imaging for defining CAD in a group of women referred for chest pain. METHODS: Stress FDG imaging was performed in 19 women (mean age 59 +/- 10 years). All had abnormal stress testing before entering the study. FDG and 2-methoxy-2-methylpropyl isonitrile were injected at peak stress (treadmill n = 8, dipyridamole n = 11) followed by PET and single photon emission computed tomography image acquisitions. Myocardial ischemia was defined by regions that demonstrated both a defect on perfusion imaging and increased FDG uptake relative to uptake in normal perfusion zones. Defect/normal zone FDG ratios were also determined. Coronary angiography was performed on all patients. RESULTS: Average, or mean, body mass index was high at 29.2 +/- 5 kg/m2. Nine of 19 patients had significant CAD. Eight of 9 with CAD had FDG-defined ischemia. Nine of the 10 without CAD had negative FDG images (sensitivity 89%, specificity 90%). The average defect/normal zone FDG ratio was greater in patients with CAD than in those without (2.4 +/- 1.9 vs 0.9 +/- 0.4, P < .05). CONCLUSIONS: Regional FDG uptake in areas of perfusion defects with stress increased in this group with CAD. These pilot data suggest that stress FDG PET may be diagnostically helpful in obese female patients. This novel approach may complement current methods of CAD detection in women and warrants further study.