What do people with dementia and their carers want to know about neuroimaging for dementia?

Neuroimaging forms an important part of dementia diagnosis. Provision of information on neuroimaging to people with dementia and their carers may aid understanding of the pathological, physiological and psychosocial changes of the disease, and increase understanding of symptoms. This qualitative study aimed to investigate participants' knowledge of the dementia diagnosis pathway, their understanding of neuroimaging and its use in diagnosis, and to determine content requirements for a website providing neuroimaging information. Structured interviews and a focus group were conducted with carers and people with dementia. The findings demonstrate an unmet need for information on neuroimaging both before and after the examination. Carers were keen to know about neuroimaging at a practical and technical level to help avoid diagnosis denial. People with dementia requested greater information, but with a caveat to avoid overwhelming detail, and were less likely to favour an Internet resource.

Current Practice in the Referral of Individuals with Suspected Dementia for Neuroimaging by General Practitioners in Ireland and Wales.

OBJECTIVES: While early diagnosis of dementia is important, the question arises whether general practitioners (GPs) should engage in direct referrals. The current study investigated current referral practices for neuroimaging in dementia, access to imaging modalities and investigated related GP training in Ireland and North Wales. METHODS: A questionnaire was distributed to GPs in the programme regions which included approximately two thirds of all GPs in the Republic of Ireland and all general practitioners in North Wales. A total of 2,093 questionnaires were issued. RESULTS: 48.6% of Irish respondents and 24.3% of Welsh respondents directly referred patients with suspected dementia for neuroimaging. Irish GPs reported greater direct access to neuroimaging than their Welsh counterparts. A very small percentage of Irish and Welsh GPs (4.7% and 10% respectively) had received training in neuroimaging and the majority who referred patients for neuroimaging were not aware of any dementia-specific protocols for referrals (93.1% and 95% respectively). CONCLUSIONS: The benefits of direct GP access to neuroimaging investigations for dementia have yet to be established. Our findings suggest that current GP speciality training in Ireland and Wales is deficient in dementia-specific and neuroimaging training with the concern being that inadequate training will lead to inadequate referrals. Further training would complement guidelines and provide a greater understanding of the role and appropriateness of neuroimaging techniques in the diagnosis of dementia.

Neuroimaging referral for dementia diagnosis: The specialist's perspective in Ireland.

BACKGROUND: Neuroimaging is an increasingly important tool in the diagnostic workup of dementia. Neurologists, geriatricians, and old-age psychiatrists are involved in key tasks in the diagnostic process, frequently referring patients with suspected dementia for neuroimaging. METHODS: The research design was a postal survey of all geriatricians, old-age psychiatrists, and neurologists in the Republic of Ireland (N = 176) as identified by the Irish Medical Directory 2011-2012 and supplementary listings. RESULTS: Almost 65% of specialists did not have access to 2-[18F]fluoro-2-deoxy-D-glucose positron emission (FDG-PET) or FDG-PET/computed tomography (CT), and 80.3% did not have access to perfusion hexamethylpropyleneamine oxime single-photon emission computed tomography (SPECT) or dopaminergic iodine-123-radiolabeled 2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane SPECT. Most specialists (88.7%) referred patients with mild cognitive impairment or suspected dementia for magnetic resonance imaging (MRI), 81.7% referred for CT, and 26.8% for FDG-PET or FDG-PET/CT. Only 44.6% of respondents were aware of dementia-specific protocols for referrals for neuroimaging. CONCLUSION: Specialist access to imaging modalities other than CT and MRI is restricted. Improved access may affect patient treatment and care.

Is the iPad suitable for image display at American Board of Radiology examinations?

OBJECTIVE: The study aimed to determine the acceptability of the iPad 3 as a display option for American Board of Radiology (ABR) examinations. SUBJECTS AND METHODS: A set of 20 cases for each of nine specialties examined by the ABR was prepared. Each comprised between one and seven images and case information and had been used in previous ABR Initial Certification examinations. Examining radiologists (n = 119) at the ABR oral Initial Certification examinations reviewed sets from one or more specialties on both a 2 MP LED monitor and on the iPad 3 and rated the visibility of the salient image features for each case. The Wilcoxon signed rank test was performed to compare ratings. In addition, a thematic analysis of participants' opinions was undertaken. RESULTS: When all specialties were pooled, the iPad 3 ratings were significantly higher than the monitor ratings (p = 0.0217). The breast, gastrointestinal, genitourinary, and nuclear medicine specialties also returned significantly higher ratings for the visibility of relevant image features for the iPad 3. Monitor ratings were significantly higher for the vascular and interventional specialty, although no images were rated unacceptably poor on the iPad in this specialty. CONCLUSION: The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.

Nonselective Filters Offer Important Dose-Reducing Potential in Radiological Examination of the Paediatric Pelvis.

RATIONALE AND OBJECTIVES: Children are more vulnerable to the harmful effects of radiation than adults; therefore, every effort should be made to keep radiation doses as low as reasonably achievable. One effective dose-reducing tool for pediatrics is additional filtration. This anthropomorphic phantom-based study explores use of additional filters for the radiographic anteroposterior pelvis examination. MATERIALS AND METHODS: Image quality, entrance surface, and effective doses were monitored with the existing inherent level of filtration for 0-, 5-, and 15-year-old pediatric phantoms. A range of filter types and thicknesses were added, including aluminium, copper, and compound (aluminium and copper), and changes were noted. RESULTS: Compared with the current level of filtration, results showed a decrease in entrance surface dose by up to 62.9%, 56.4%, and 55.0%, and effective dose by up to 46.4%, 36.1%, and 28.7% for the 0-, 5-, and 15-year-olds, respectively. No significant degradation in image quality was noted. CONCLUSION: Despite compound filters offering marginal benefits over copper, 0.3 mm copper filtration is recommended for clinical trials because of reduced physical thickness. Results demonstrated that additional filtration in excess of current recommendations may offer important benefits for children undergoing this radiographic examination.