The Great Contrast Shortage of 2022-Lessons learnt in Australia.

INTRODUCTION: Computed tomography (CT) imaging is one of the most commonly used diagnostic tools. Iodine-based contrast media (IBCM) are frequently administered intravenously to improve soft tissue contrast in a wide range of CT scans. Supply chain disruptions triggered by the SARS-CoV-19 pandemic led to a global shortage of IBCM in mid-2022. The purpose of this study was to explore the impact of this shortage on the delivery of healthcare in Western Australia. METHODS: We performed a single-centre retrospective analysis of the provision of CT studies, comparing historical patterns to the shortage period. We focussed our attention on the total number of CT scans (noncontrast CT [NCCT] and contrast-enhanced CT [CECT]) and also specifically CT pulmonary angiogram (CTPA) and CT neck angiogram with or without inclusion of circle of Willis (CTNA) examinations. We also examined whether a decrease was compensated by increasing frequency of alternate examinations such as ventilation/perfusion (V/Q) scans, carotid Doppler ultrasound studies and Magnetic Resonance Angiograms (MRAs). RESULTS: Since 2012, there has been an approximate linear increase in the frequency of CT examinations. During the period of contrast shortage, there was an abrupt drop-off by approximately 50% in the CECT, CTPA and CTNA groups compared with the preceding 6 weeks (49%, 55% and 44%, respectively, with P < 0.001 in all cases). During the contrast shortage, the frequency of V/Q scans increased fivefold (from 13 to 65; P < 0.001). However, the provision of carotid Doppler ultrasound studies and MRAs remained approximately stable in frequency across recent time intervals. CONCLUSION: Our findings demonstrate that the IBCM shortage crisis had a very significant impact on the delivery of healthcare. While V/Q scans could (partially) substitute for CTPA studies in suspected pulmonary emboli, there appeared to be no valid alternative for CTNA studies in stroke calls. The unexpected and critical shortage of IBCM forced healthcare professionals to conserve resources, prioritise indications, triage patients based on risk, explore alternate imaging strategies and prepare for similar events recurring in the future.

Supporting engagement and retention of online and blended-learning students: A qualitative study from an Australian University.

Enrolment numbers in online higher education courses have continued to increase over the last decade. The challenges brought about by the COVID-19 pandemic have further accelerated the growth in online and blended course offerings. The development of institutional support services, however, does not reflect this growth. Many students are not equipped with the skills or given adequate support to engage and succeed in their courses, leading to student disengagement and attrition. This study investigated the perceptions of students in online and blended subjects, regarding both the academic and institutional support they were provided. The research team collected interview data from 41 online and blended-learning students and then analysed these data using an iterative thematic analysis approach. This article introduces the key findings with two models: one presenting support strategies at multiple levels within this university; the other presenting three key elements of subject-level teacher support, which were identified by the interviewees as the most significant, effective, and relevant support mechanism in this context. The findings will inform higher education institutions who aim to engage and support online and blended students better, through an improved understanding of how support is perceived by this student cohort. This study was conducted at one Australian university; however, the findings are relevant to higher education institutions in other countries that strive to bring about positive experiences and enhance retention rates for online and blended students.

Review and audit of the post-surgical MRI breast: Pictorial essay.

Audit of contrast-enhanced breast MRI performed over a 3-year period in a single institution to describe and summarise the changes seen after surgery and radiation therapy for primary breast cancer, breast augmentation and oncoplastic surgery. Seventy women were identified and reviewed (100 breast MRIs in total). The most common change seen was haemosiderin deposition. The early changes of skin thickening, oedema, seroma and background parenchymal enhancement decreased with time leaving residual breast shrinkage, haemosiderin/calcification and architectural distortion due to fibrosis and scarring.

68Ga DOTATATE PET/CT of Non-FDG-Avid Pulmonary Metastatic Hemangiopericytoma.

We present the FDG and Ga DOTATATE PET/CT findings of a 68-year-old woman with pulmonary metastases 28 years after her initial diagnosis of central nervous system hemangiopericytoma. The largest of the pulmonary lesions showed prominent Ga DOTATATE uptake with comparatively minimal FDG avidity. Hemangiopericytoma is a rare mesenchymal tumor that arises from malignant pericytes, cells that form the walls of capillaries and postcapillary venules. This case demonstrates the potential of radiolabeled somatostatin analogs as a therapeutic option in the setting of widespread metastatic disease.