Minimal dose CT for left ventricular ejection fraction and combination with chest-abdomen-pelvis CT.

Objectives: This prospective study tested the diagnostic accuracy, and absolute agreement with MRI of a low-dose CT protocol for left ventricular ejection fraction (LVEF) measurement. Furthermore we assessed its potential for combining it with Chest-Abdomen-Pelvis CT (CAP-CT) for a one-stop examination. Materials & methods: Eighty-two patients underwent helical low-dose CT. Cardiac magnetic resonance imaging (MRI) was the reference standard. In fifty patients, CAP-CT was performed concurrently, using a modified injection protocol. In these, LVEF was measured with radioisotope cardiography (MUGA). Patients >18 years, without contrast media or MRI contraindications, were included. Bias was measured with Bland-Altman analysis, classification accuracy with Receiver Operating Characteristics, and inter-reader agreement with Intra-Class Correlation Coefficient (ICC). Correlation was examined using Pearson's correlation coefficients. CAP image quality was compared to previous scans with visual grading characteristics. Results: The mean CT dose-length-product (DLP) was 51.8 mGycm, for an estimated effective dose of 1.4 mSv, compared to 5.7 mSv for MUGA. CT LVEF bias was between 2 % and 10 %, overestimating end-diastolic volume. When corrected for bias, sensitivity and specificity of 100 and 98.5 % for classifying reduced LVEF (50 % MRI value) was achieved. ICC for MUGA was significantly lower than MRI and CT. Distinction of renal medulla and cortex was reduced in the CAP scan, but proportion of diagnostic scans was not significantly different from standard protocol. Conclusion: When corrected for inter-modality bias, CT classifies patients with reduced LVEF with high accuracy at a quarter of MUGA dose and can be combined with CAP-CT without loss of diagnostic quality.

[Truncus coeliacus compression syndrome is a rare cause of mesenteric ischaemia].

Truncus coeliacus compression syndrome (TCK) is a rare condition which causes mesenteric ischaemia. The pathogenesis is compression of truncus coeliacus, where it branches off the aorta, commonly because of an anatomical variant of the median arcuate ligament. The syndrome is characterized by the clinical triad: postprandial abdominal pain, weight loss and vomiting. An atypical clinical case of TCK is described here. A 67-year-old woman had postprandial pain and pain while supine. However, she did not suffer a worsening of the pain while she was physically active.

Poor interpretation of chest X-rays by junior doctors.

INTRODUCTION: Studies targeting medical students and junior doctors have shown that their radiological skills are insufficient. Despite the widespread use of chest X-ray; however, a study of Danish junior doctors' skills has not previously been performed. MATERIAL AND METHODS: A total of 22 participants per-used a standardised series of ten chest X-rays. The test used a multiple-choice form for each image, and the clinical data and the tentative diagnosis of each image were also made available to the participants. For each image, the participant chose a single primary diagnosis; and for each diagnosis, the participant's confidence in the diagnosis was assessed on a five-point Likert scale. The diagnoses were divided into four groups: normal findings, chronic diseases, acute diseases and hyperacute diseases or conditions. RESULTS: A total of 22 doctors receiving basic clinical education (BCE) completed the study. Overall, participants correctly established 51% of the diagnoses. The participants' overall confidence in the primary diagnoses was 57.5% on the Likert scale, corresponding to 57.5% confidence in the proposed diagnoses. The sensitivity was calculated to 0.49 (95% confidence interval (CI): 0.41-0.57) and the specificity to 0.55 (95% CI: 0.41-0.68). CONCLUSION: Based on the results from this study, we conclude that BCE doctors do not meet the minimum requirements for radiological diagnostic skills for the use of chest X-ray that were established for this study.