Radiation Exposure to the Sacroiliac Joint From Low-Dose CT Compared With Radiography.

OBJECTIVE: The primary objective of this study was to estimate the effective dose delivered to the sacroiliac joint (SIJ) from low-dose (LD) CT compared with that from radiography. Secondary objectives included evaluation of diagnostic quality of LD CT of the SIJ and development of a clinical protocol for LD CT of the SIJ. MATERIALS AND METHODS: Data from 36 patients (19 women, 17 men) undergoing LD CT for suspected renal colic were analyzed. Two effective dose estimates were calculated: one for the SIJ and another for an extended region from the iliac crest to 1 cm below the SIJ. Thirty-six anteroposterior pelvic and 36 SIJ view radiographs were age-, sex-, and body width-matched to CT scans. Effective dose from radiography was estimated using the method described in International Commission on Radiologic Protection Publication 60. RESULTS: Maximum effective dose to the SIJ from LD CT was less than 1 mSv in all cases, with a mean ± SD of 0.42 ± 0.18 mSv (range, 0.14-0.83 mSv), whereas mean dose to the extended region was 0.57 ± 0.24 mSv (range, 0.19-1.11 mSv). Mean dose from SIJ radiographs was 0.15 ± 0.10 mSv (range, 0.07-1.38 mSv), and mean dose from a single pelvic radiograph was 0.09 ± 0.06 mSv (range, 0.04-0.37 mSv). All CT studies were of diagnostic quality for assessment of the SIJ. CONCLUSION: LD CT of the SIJ can be consistently performed with an effective radiation dose of less than 1 mSv. Because reliability and sensitivity of radiography for sacroiliitis is poor, we recommend that LD CT replace radiography for dedicated evaluation of the SIJ.

Comprehensive musculoskeletal sonographic evaluation of the hand and wrist.

Sonography is widely used for evaluation of hand and wrist lesions. The easy accessibility, cost-effectiveness, and good diagnostic accuracy of sonography coupled with the numerous benefits of real-time imaging make it desirable. The aim of this article is to describe the typical sonographic appearances of lesions in the hand and wrist that are encountered frequently in routine clinical practice, such as inflammatory arthropathies, tumors, traumatic injuries, foreign bodies, and nerve entrapment syndromes. Relevant anatomy, scanning methods, and recent developments in musculoskeletal sonography are also discussed.

Role of simulation-based education in ultrasound practice training.

The aim of this systematic review was to determine whether ultrasound (US)/US procedural simulation leads to improvement in US competence, particularly in the clinical setting. The electronic databases MEDLINE, EMBASE, CINAHL, ERIC, and OVID were searched for relevant published articles between 1950 and April 2011. Fourteen articles of an initial 371 articles met the inclusion criteria. The eligible studies differed in terms of the study population, sample size, study design, US simulator used, and measured outcomes. Most of the studies demonstrated acquisition of knowledge and skills with suggestions of correlation with simulation training and improved performance in the same simulated environment. There is little compelling evidence based on published studies at present to support the widespread adoption of simulation-based medical education to improve clinical US competence.

Colo-pleural fistula following pneumonectomy.

Following pneumonectomy and diaphragmatic reconstruction for carcinoid tumour, a fistula developed between the pneumonectomy space and the splenic flexure of the colon. The problem was successfully treated by colon resection and thoracoplasty.