Asymmetric breast dose in coronary angiography.

The purpose of this study was to demonstrate asymmetric radiation dose distribution to the breasts in coronary angiography. Gafchromic XR-QA2 film was used as an area dosimeter to capture the asymmetric dose distribution to the breasts at various tissue depths in an anthropomorphic phantom. A selection of tube angulations were used under a controlled experiment and during a mock coronary angiography procedure. The Gafchromic XR-QA2 film was able to confirm the asymmetric distribution of radiation dose to the breast and provide a normalized breast dose value. The right breast received the majority of dose for most of the tube angulations in the controlled experiment. However the left breast received the most radiation dose during the mock procedure. Asymmetric dose distribution to the breasts is normally not observed if Monte Carlo based simulations are performed because individual breast dose calculations are not available. The application of a typical coronary angiogram determined in the experiment showed the normalized left breast dose is 0.16 mGy/ Gy.cm2 and the right breast dose is 0.08 mGy/ Gy.cm2.

An assessment of nursing staffs' knowledge of radiation protection and practice.

Although the exposure to nursing staff is generally lower than the allowable radiation worker dose limits, awareness and overcoming fears of radiation exposure is essential in order to perform routine activities in certain departments. Furthermore, the nursing staff, whether they are defined as radiation workers or not, must be able to respond to any radiological emergencies and provide care to any patient affected by radiation. This study aims to gauge the awareness of radiation safety among the nursing staff at a major hospital in different departments and recommend if further radiation safety training is required. A prospective multiple choice questionnaire was distributed to 200 nurses in 9 different departments. The questionnaire tested knowledge that would be taught at a basic radiation safety course. 147 nurses (74%) completed the survey with the average score of 40%. Furthermore, 85% of nurses surveyed felt there was a need for radiation safety training in their respective departments to assist with day to day work in the department. An increase in radiation safety materials that are specific to each department is recommended to assist with daily work involving radiation. Moreover, nursing staff that interact with radiation on a regular basis should undertake radiation safety courses before beginning employment and regular refresher courses should be made available thereafter.

Computed tomography overexposure as a consequence of extended scan length.

INTRODUCTION: This study aimed to raise awareness around the increased effective dose as scan length chosen is increased from standard protocol METHODS: The Monte Carlo-based software CT-Expo (G. Stamm (Medizinische Hochschule Hannover, Hannover, Germany) and H.D. Nagel (SASCRAD, Buchholz, Germany)) was used to simulate the effective dose increase as the scanned region of the standard protocol increased. RESULTS: The results of this study show that for scans with a high computed tomography dose index (CTDI)vol the patient could be exposed to an extra 1 mSv within 6 cm of overscan. Protocols that investigated large scan areas may not see a significant relative dose reduction because of the use of a lower CTDIvol ; however, radiation exposure should be kept as low as reasonably achievable. CONCLUSION: There is significant dose optimisation potential when strictly adhering to appropriate scan lengths within each imaging protocol wherever possible.

Effects of radiographic techniques on the low-contrast detail detectability performance of digital radiography systems.

PURPOSE: To evaluate the effects of the radiation exposure factors kilovolt peak and tube current time (milliampere seconds) on the low-contrast detail detectability performance of 3 types of planar digital radiography systems. Detectability performance of an imaging system refers to its ability to detect and present the low-contrast details of organs in the acquired image. The authors also compare detectability performance between computed radiography, indirect digital radiography, and direct digital radiography by evaluating low-contrast details of the obtained images. METHODS: A low-contrast detail phantom was inserted within 10-cm thicknesses of Perspex plastic sheets. The images were obtained with various kilovolt peak and milliampere second settings for each of the 3 digital radiography systems. Artinis CDRAD Analyser software was used to score the images and calculate the inverse image quality figure (IQFinv). RESULTS: The higher milliampere second levels in each kilovolt peak selection resulted in higher IQFinv in computed radiography and indirect and direct digital radiography. IQFinv values significantly increased in indirect digital radiography with increasing kilovolt peak in only 1 and 2 mAs. There were insignificant differences in IQFinv values when altering kilovolt peak in each milliampere second level in direct digital radiography. The indirect digital radiography system generally demonstrated better detectability performance than computed radiography and direct digital radiography. However, direct digital radiography demonstrated better detectability performance than indirect digital radiography at lower kilovolt peak and milliampere second settings, as did computed radiography at lower kilovolt peak settings. DISCUSSION: Higher milliampere second settings increase photon count, which results in a higher signal-to-noise ratio and thus increased detectability. Lower milliampere second settings increase noise level on images, which increases the risk of diagnostic detail loss. Changing the kilovolt peak at the different milliampere second settings essentially did not affect the IQFinv of the different digital radiography systems. CONCLUSION: Increasing milliampere seconds in all digital imaging systems generally improves detectability performance. However, altering the kilovolt peak setting does not significantly change the IQFinv and detectability of objects in a digital radiograph. Imaging system selection should be based on typical radiographic examinations. Indirect digital radiography systems are better for studies that require higher kilovolt peak, such as large organs, and direct digital radiography is better for studies that require low kilovolt peak, such as small organs and mammography, which is used to examine fine tissue details.

Transmural pressure and membrane potential in human saphenous vein.

OBJECTIVE: An increase in transmural pressure reportedly depolarizes myocytes in various arterial blood vessels. We have examined the relationship between transmural pressure and membrane potential (E(m)) in human saphenous veins with a view to determine whether contractile force generation, hence spasmogenesis in vein grafts, involves a similar process of mechanoelectrical excitation. METHODS: Intracellular recordings were made by sharp glass microelectrodes in human isolated saphenous veins and parallel measurements were performed in ring preparations. RESULTS: E(m) values obtained in pressurized vessels at four different pressure levels were (mean+/-SD): -74.4+/-5.5 mV (0-6 cm H(2)O; n=10), -72.6+/-6.5 mV (11-14 cm H(2)O; n=27), -72.1+/-6.5 mV (26-27 cm H(2)O; n=30), and -72.9+/-4.0 mV (50-54 cm H(2)O; n=38), demonstrating the lack of an overt pressure-dependence. Except at the lowest transmural pressure tested, these values were significantly different from E(m) obtained in ring preparations (-77.8+/-4.0 mV; n=30). Raising extracellular K(+) to 80 mM produced a comparable depolarization in tissues either pressurized to 50-54 cm H(2)O (-64.9+/-4.3 mV; n=27) or set up as ring preparations (-64.06+/-6.9 mV; n=35). CONCLUSIONS: Human saphenous veins respond to transmural pressure with a limited depolarization that lacks correlation with pressure. The absence of a pressure-induced graded depolarization suggests that pressure-dependent vasoconstriction does not play a primary role in blood flow regulation in lower limb large veins. Moreover, this raises doubts that mechanical stimuli per se would lead to development of vasospasm in the early stages of saphenous vein grafting into arterial vascular beds.

Successful management of left ventricular free wall rupture.

Cardiac rupture is a complication of myocardial infarction with an exceedingly high mortality rate. Imaging modalities, such as echocardiography, have facilitated premortem diagnosis, thus increasing chances of survival. A review of pertinent literature is accompanied by a case report that details an episode of left ventricular free wall rupture and its successful outcome.

Influence of tangential stress on mechanical responses to vasoactive agents in human saphenous vein with and without perivascular adipose tissue.

AIM: Improvement in short-term patency of vein grafts harvested with the surrounding tissue and no distention has been noted. The influence of transient tangential stress on mechanical function to vasoactive agents in isolated human saphenous veins stripped or with attached perivascular adipose tissue was assessed. METHODS: Concentration-response curves to noradrenaline, 5-hydroxytryptamine, methylcholine, sodium nitroprusside and nicardipine were constructed for veins exposed to no, low (approximately 120 mmHg) or high (approximately 240 mmHg) tangential stress. RESULTS: Tangential stress did not affect contractile effects of noradrenaline or relaxant effects of methylcholine and sodium nitroprusside. Regression analysis of the concentration-response curve to 5-hydroxytryptamine revealed a significant (P=0.042) increase in sensitivity in saphenous veins without perivascular adipose tissue exposed to no tangential stress, compared with veins with attached adipose tissue. Exposure to high stress significantly (P=0.024) increased the potency of 5-hydroxytryptamine in blood vessels without perivascular adipose tissue, as opposed to veins with adipose tissue. Relaxant responses to nicardipine in veins with perivascular adipose tissue were significantly (P=0.001) affected by exposure to low tangential stress compared with no or high tangential stress. A parallel comparison revealed that intact veins compared with those without perivascular adipose tissue exposed to low stress were significantly (P=0.020) more resistant to the relaxant effects of nicardipine. CONCLUSION: The findings of the present report support the view that tangential stress has an impact on the actions of vasoactive agents, but this influence is variable and factor(s) released from perivascular adipose tissue may have a bearing on the observed effect.

The influence of calcium channel antagonists on isolated human distal radial arteries.

A comparison was made between the efficacies and potencies of calcium channel antagonists on contractions induced by 5-hydroxytryptamine, norepinephrine, or high-potassium buffer in isolated human distal radial arteries. Also, the impact of removal of extracellular calcium ions on contractions induced by 5-hydroxytryptamine or norepinephrine was assessed. Isometric contractions were induced by agonists, and relaxant responses to calcium channel antagonists, nifedipine, diltiazem, verapamil, or mibefradil were examined. 5-hydroxytryptamine-induced contractions when compared with norepinephrine or high-potassium induced contractions were significantly more sensitive to inhibition by nifedipine (pIC50 = 7.53 +/- 0.15; 6.78 +/- 0.12; 6.6 +/- 0.22, respectively, mean +/- SEM). Diltiazem was more effective in producing relaxations when contractions were elicited with 5-hydroxytryptamine (pIC50 = 6.48 +/- 0.84) or norepinephrine (pIC50 = 6.20 +/- 0.21) than with high potassium (pIC50 = 5.43 +/- 0.10). Verapamil was more effective at relaxing arteries contracted with 5-hydroxytryptamine (pIC50 = 6.09 +/- 0.19) or norepinephrine (pIC50 = 6.00 +/- 0.17) than with high potassium (pIC50 = 5.60 +/- 0.16). Mibefradil was not very effective in producing relaxations. The studies revealed that removal of extracellular calcium significantly attenuated contractions produced by 5-hydroxytryptamine (-67.7 +/- 6.3%) and norepinephrine (-89 +/- 1.5%). In conclusion, our data indicates that nifedipine was the most effective drug in producing relaxations; also, contractions produced by 5-hydroxytryptamine and norepinephrine were found to be critically dependent on the presence of extracellular calcium.

Comparative study of functional responses and morphometric state of distal radial arteries in male and female.

BACKGROUND: Differences can exist in terms of physiology and morphology of blood vessels on the basis of gender. Radial artery is now considered to be the second choice for coronary artery bypass grafting. However, there is a lack of comparative studies on the function and morphometery of radial arteries in female and male patients. METHODS: Radial arteries from 9 female and 9 male patients undergoing coronary artery bypass grafting were used to compare the effects of vasoconstrictors, noradrenaline and 5-hydroxytryptamine, as well as the influence of endothelium-dependent (with methacholine) and endothelium-independent (with sodium nitroprusside) relaxations. Furthermore, morphomteric measurements of smooth muscle thickness, lumen perimeter, lumen area, and intima area (including plaque) of distal radial arteries from female and male patients were also made. RESULTS: Radial arteries from female patients when compared to male patients were significantly more sensitive to the actions of noradrenaline, and somewhat more sensitive towards the actions of 5-hydroxytryptamine. However, no significant differences were found between the relaxant effects of methacholine in radial arteries of female and male patients. In contrast, radial arteries from female patients when compared to male patients were significantly less sensitive to the relaxant effects of sodium nitroprusside. Morphometric measurements of blood vessels from female and male patients revealed that vessels obtained from female patients had a smaller lumen area and perimeter than vessels from male patients. In contrast, there were no significant differences between tunica intima area (including plaque area) or smooth muscle thickness in radial arteries of female patients when compared to male patients. However, the radial arteries from female patients had a significantly greater ratio of tunica intima area (including plaque) to lumen area when compared with radial arteries from male patients. CONCLUSIONS: Differences exist between the functional behavior and morphometery of radial arteries of female and male patients. It is possible that postbypass, radial artery graft may show different characteristics in female versus male patients.