Routine Use of Structured Reporting in Whole-body Trauma CT Facilitates Quality Improvement.

PURPOSE: Structured reporting (SR) is increasingly used. So far, there is minimal experience with SR in whole-body computed tomography (WBCT). The aim of this study was to investigate the value of routine use of SR in WBCT in trauma with a focus on reporting time, reporting errors, and referrer satisfaction. MATERIALS AND METHODS: Reporting time and reporting errors of CT reports were prospectively quantified for residents and board-certified radiologists 3 months before and for 6 months after implementation of a structured report in the clinical routine. Referrer satisfaction was prospectively quantified by means of a survey before and after the implementation period of SR using a 5-point Likert scale. Before and after results were compared to determine the effect of structured reporting on WBCT in trauma at our institution. RESULTS: The mean reporting time was lower when using SR (65 ±â€Š52 min. vs. 87 ±â€Š124 min., p = .25). After 4 months, the median reporting time was significantly lower with SR (p = .02). Consequently, the rate of reports that were finished within one hour rose from 55.1 % to 68.3 %. Likewise, reporting errors decreased (12.6 % vs. 8.4 %, p = .48). Residents and board-certified radiologists reported fewer errors when using SR with 16.4 % vs. 12.6 % and 8.8 % vs. 2.7 %, respectively. General referrer satisfaction improved (1.7 ±â€Š0.8 vs. 1.5 ±â€Š1.1, p = .58). Referrers graded improvements for standardization of reports (2.2 ±â€Š1.1 vs. 1.3 ±â€Š1.1, p = .03), consistency of report structure (2.1 ±â€Š1.1 vs. 1.4 ±â€Š1.1, p = .09), and retrievability of relevant pathologies (2.1 ±â€Š1.2 vs. 1.6 ±â€Š1.1, p = .32). CONCLUSION: SR has the potential to facilitate process improvement for WBCT in trauma in the daily routine with a reduction of reporting time and reporting mistakes while increasing referrer satisfaction. KEY POINTS: · SR for WBCT in trauma is feasable in clinical routine.. · Reporting time in WBCT in trauma decreases by SR.. · SR for WBCT in trauma has the potential to decrease reporting mistakes.. · SR for WBCT in trauma might increase referrer satisfaction.. CITATION FORMAT: · Blum SF, Hertzschuch D, Langer E et al. Routine Use of Structured Reporting in Whole-body Trauma CT Facilitates Quality Improvement. Fortschr Röntgenstr 2023; 195: 521 - 528.

Real-time, ray casting-based scatter dose estimation for c-arm x-ray system.

OBJECTIVES: Dosimetric control of staff exposure during interventional procedures under fluoroscopy is of high relevance. In this paper, a novel ray casting approximation of radiation transport is presented and the potential and limitation vs. a full Monte Carlo transport and dose measurements are discussed. METHOD: The x-ray source of a Siemens Axiom Artix C-arm is modeled by a virtual source model using single Gaussian-shaped source. A Geant4-based Monte Carlo simulation determines the radiation transport from the source to compute scatter from the patient, the table, the ceiling and the floor. A phase space around these scatterers stores all photon information. Only those photons are traced that hit a surface of phantom that represents medical staff in the treatment room, no indirect scattering is considered; and a complete dose deposition on the surface is calculated. To evaluate the accuracy of the approximation, both experimental measurements using Thermoluminescent dosimeters (TLDs) and a Geant4-based Monte Carlo simulation of dose depositing for different tube angulations of the C-arm from cranial-caudal angle 0° and from LAO (Left Anterior Oblique) 0°-90° are realized. Since the measurements were performed on both sides of the table, using the symmetry of the setup, RAO (Right Anterior Oblique) measurements were not necessary. RESULTS: The Geant4-Monte Carlo simulation agreed within 3% with the measured data, which is within the accuracy of measurement and simulation. The ray casting approximation has been compared to TLD measurements and the achieved percentage difference was -7% for data from tube angulations 45°-90° and -29% from tube angulations 0°-45° on the side of the x-ray source, whereas on the opposite side of the x-ray source, the difference was -83.8% and -75%, respectively. Ray casting approximation for only LAO 90° was compared to a Monte Carlo simulation, where the percentage differences were between 0.5-3% on the side of the x-ray source where the highest dose usually detected was mainly from primary scattering (photons), whereas percentage differences between 2.8-20% are found on the side opposite to the x-ray source, where the lowest doses were detected. Dose calculation time of our approach was 0.85 seconds. CONCLUSION: The proposed approach yields a fast scatter dose estimation where we could run the Monte Carlo simulation only once for each x-ray tube angulation to get the Phase Space Files (PSF) for being used later by our ray casting approach to calculate the dose from only photons which will hit an movable elliptical cylinder shaped phantom and getting an output file for the positions of those hits to be used for visualizing the scatter dose propagation on the phantom surface. With dose calculation times of less than one second, we are saving much time compared to using a Monte Carlo simulation instead. With our approach, larger deviations occur only in regions with very low doses, whereas it provides a high precision in high-dose regions.

Trends in capacity utilization for therapeutic monoclonal antibody production.

The administration of high doses of therapeutic antibodies requires large-scale, efficient, cost effective manufacturing processes. An understanding of how the industry is using its available production capacity is important for production planning, and facility expansion analysis. Inaccurate production planning for therapeutic antibodies can have serious financial ramifications. In the recent 5(th) Annual Report and Survey of Biopharmaceutical Manufacturing Capacity and Production, 434 qualified respondents from 39 countries were asked to indicate, among other manufacturing issues, their current trends and future predictions with respect to the production capacity utilization of monoclonal antibodies in mammalian cell culture systems. While overall production of monoclonals has expanded dramatically since 2003, the average capacity utilization for mammalian cell culture systems, has decreased each year since 2003. Biomanufacturers aggressively attempt to avoid unanticipated high production demands that can create a capacity crunch. We summarize trends associated with capacity utilization and capacity constraints which indicate that biopharmaceutical manufacturers are doing a better job planning for capacity. The results have been a smoothing of capacity use shifts and an improved ability to forecast capacity and outsourcing needs. Despite these data, today, the instability and financial constraints caused by the current global economic crisis are likely to create unforeseen shifts in our capacity utilization and capacity expansion trends. These shifts will need to be measured in subsequent studies.