Complete written/oral information about dose exposure in CT: is it really useful to guarantee the patients' awareness about radiation risks?

AIMS AND OBJECTIVES: According to the European directive 2013/59/Euratom, starting from February 2018, the information relating to patient exposure will be part of computed tomography (CT) reports, but the impact of this information on patients has not been deeply evaluated. Aim of our study was to evaluate patients' perception of radiation exposure related to routine CT and their understanding after communication of their dose exposure. MATERIALS AND METHODS: A survey, investigating patient's knowledge of radiation dose, was given to all adult patients (> 18 years) undergoing a CT examination both before and after CT scan. The first survey was the same for all patients. After CT scan, a second questionnaire was administered (after receiving the CT dose bill report and medical written and/or explanation about ionizing radiation risk). Results of the pre- and post-CT questionnaires responses were compared according to demographics characteristics and among the four post-CT groups. RESULTS: For some questions, statistically significant differences were found between the two centres. Seventy per cent of the patients answered that the presence of CT parameters in the report is considered useful. Even if not always statistically significant there was a slight increase in awareness of ionizing radiation risk comparing the pre- and post-CT surveys. The group that had both written and oral explanations had a better comprehension of CT dose bill (group III vs. I, p = 0.002). CONCLUSION: The way of communication of ionizing radiation risks did not affect the results of the post-CT survey. Indeed, the interest in the topic did not rise in the post-CT survey in any of the group. Adequate information about ionizing radiation risks provided together with dose exposure information may be useful. However, there is not a standardized better way of communicating information on ionizing radiation risks due to CT.

Swallowing impairment in neurologic disorders: the role of videofluorographic swallowing study.

Patients with neurologic diseases almost inevitably develop various degrees of swallowing disorders during their life. Dysphagia is one of the main negative prognostic factors in this class of patients, leading to severe morbidity (i.e. aspiration pneumonia, dehydration, malnutrition, and life quality deterioration) and to a noticeable increase in public health spending. Videofluorographic swallowing study is considered the gold standard technique for swallowing impairment assessment. It is aimed at early identification of the risk of aspiration, definition of the kind and grade of dysphagia, and an indication to suspend oral nutrition and adopt other feeding strategies, and define when the patient is able to return to physiological nutrition. Every radiologist should be familiar with the main videofluorographic swallowing features in neurological patients, not only because early diagnosis of deglutition disorders widely improves their prognosis, but also because customising feeding strategies has a great impact on patients' quality of life.

Comparison of US Strain Elastography and Entero-MRI to Typify the Mesenteric and Bowel Wall Changes during Crohn's Disease: A Pilot Study.

PURPOSE: To evaluate and compare the mesenteric and bowel wall changes during Crohn's disease (CD) on ultrasonography (US) Strain Elastography (SE) and Enterography Magnetic Resonance Imaging (E-MRI). METHODS: From July 2014 to September 2016, 35 patients with ileocolonoscopy diagnosis of CD were prospectively examined with E-MRI and in the same time with US and SE. RESULTS: A total of 41 affected bowel segments and 35 unaffected bowel segments in 35 patients were evaluated. US-SE color-scale coding showed a blue color pattern in the fibrotic mesentery and bowel wall in 15 patients and a green color pattern in the edematous ones in 20 patients. The signal of the bowel wall and mesenteric fat was iso/hypointense on T2-weighted sequence in the fibrotic pattern (23/35 and 12/35 patients) and hyperintense in the edematous pattern (12/35 and 23/35 patients). Mean ADC values were, respectively, 2,58 ± 0,33 × 10-3 for the fibrotic mesentery and 2,14 ± 0,28 × 10-3 for edematous one. There was a statistical correlation between US-SE color-scale and T2 signal intensity and between the US-SE color-scale and ADC maps. CONCLUSIONS: US-SE, ADC, and signal intensity on T2-weighted sequences on MR prove to be useful tools for the evaluation of CD pattern.

Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review.

INTRODUCTION: Dysphagia and hoarseness are possible complications that can be observed in patients undergoing thyroidectomy or other neck surgery procedures. These complaints are usually related to superior and inferior laryngeal nerves dysfunction, but these can appear even after uncomplicated surgical procedure. METHODS: We reviewed the current literature available on MEDLINE database, concerning the swallowing disorders appearing after the thyroidectomy. The articles included in the review reported pathophysiology and diagnostic concerns. RESULTS: Twenty articles were selected for inclusion in the review. Depends on the possible causes of the difficulty swallowing (related to nerve damage or appearing after uncomplicated thyroidectomy), different types of diagnostic procedures could be used to study patient discomfort, as well as intraoperative nerve monitoring, fiber optic laryngoscopy, endoscopy, pH monitoring, esophageal manometry and videofluorography. Among all these procedures, videofluorography is considered the gold standard to evaluate the entire swallowing process, since that allows a real-time study of all the three phases of swallowing: oral phase, pharyngeal phase and esophageal phase. CONCLUSION: The diagnostic procedures described can help to identify the mechanisms involved in swallowing disorders, with the aim to choose the best therapeutic option. More studies are needed for understanding the causes of the dysphagia appearing after thyroidectomy.

A comparison of Bayesian and non-linear regression methods for robust estimation of pharmacokinetics in DCE-MRI and how it affects cancer diagnosis.

The aim of this work is to compare Bayesian Inference for nonlinear models with commonly used traditional non-linear regression (NR) algorithms for estimating tracer kinetics in Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI). The algorithms are compared in terms of accuracy, and reproducibility under different initialization settings. Further it is investigated how a more robust estimation of tracer kinetics affects cancer diagnosis. The derived tracer kinetics from the Bayesian algorithm were validated against traditional NR algorithms (i.e. Levenberg-Marquardt, simplex) in terms of accuracy on a digital DCE phantom and in terms of goodness-of-fit (Kolmogorov-Smirnov test) on ROI-based concentration time courses from two different patient cohorts. The first cohort consisted of 76 men, 20 of whom had significant peripheral zone prostate cancer (any cancer-core-length (CCL) with Gleason>3+3 or any-grade with CCL>=4mm) following transperineal template prostate mapping biopsy. The second cohort consisted of 9 healthy volunteers and 24 patients with head and neck squamous cell carcinoma. The diagnostic ability of the derived tracer kinetics was assessed with receiver operating characteristic area under curve (ROC AUC) analysis. The Bayesian algorithm accurately recovered the ground-truth tracer kinetics for the digital DCE phantom consistently improving the Structural Similarity Index (SSIM) across the 50 different initializations compared to NR. For optimized initialization, Bayesian did not improve significantly the fitting accuracy on both patient cohorts, and it only significantly improved the ve ROC AUC on the HN population from ROC AUC=0.56 for the simplex to ROC AUC=0.76. For both cohorts, the values and the diagnostic ability of tracer kinetic parameters estimated with the Bayesian algorithm weren't affected by their initialization. To conclude, the Bayesian algorithm led to a more accurate and reproducible quantification of tracer kinetic parameters in DCE-MRI, improving their ROC-AUC and decreasing their dependence on initialization settings.

Umbilical venous catheters placement evaluation on frontal radiogram: application of a simplified flow-chart for radiology residents.

BACKGROUND: Umbilical Venous Catheter (UVC) are commonly used in neonatal period; they can be not correctly positioned and could be associated with complications. The purpose of this article is to suggest a flow-chart to evaluate the placement of UVC, testing it in young radiologists-in-training. METHOD: We developed a simple flow-chart to asses, steps by step, UVC placement considering its course and tip location (ideally placed in the atriocaval junction). We tested the flow-chart impact asking to 20 residents to evaluate the placement of 10 UVC before and after they familiarized with the flow-chart and the anatomical findings of a newborn. The agreement among the 20 students was evaluated too. RESULTS: The number of correct characterizations was different due to the administration of the flow-chart. One hundred and six correct UVC assessments at the beginning switched to 196 after the administration of the flow-chart (p = 0.0001). The observed agreement among the twenty radiology residents was statistically significant, both before (kappa = 0.41, p < 0.001) and after (kappa = 0.37, p < 0.001) the flow-chart administration. CONCLUSION: The developed flow-chart demonstrated to be useful in increasing residents performance in UVC placement assessment.

The burnout phenomenon among student radiographers: a single centre experience.

OBJECTIVES: Burnout syndrome is a condition that may occur not only for staff in human service sectors/jobs, involving intensive interactions with others, but also people that are engaged in activities psychologically similar to work, such as students. Radiographers in training suffer double stress, first linked to the status of being a university student and secondly as early career workers who have relations with the public of the health system. Aim of our study was to investigate the prevalence and levels of burnout syndrome among radiographers in training in an University Hospital. METHODS: In order to gain a better understanding of nature of the burnout syndrome a modified version of Maslach's questionnaire (investigating three areas: emotional exhaustion, depersonalization and reduced personal accomplishment), was administered to two groups selected from a cohort of radiographers University students (from the 1st and 3rd year of course). RESULTS: 62/62 questionnaires were completed, returned and analysed. The research outcomes highlighted a clear difference between group I and group II in relation to one of the three areas of the Maslach's model: "depersonalization" (p<0.001). Moreover, the third year students group presented a significantly higher risk to develop burnout. On the other hand, the third area examined, the reduced personal accomplishment domain, was surprisingly high even among first-year students. CONCLUSIONS: The research outcomes seem to suggest that the presence of emotional burnout, or risk of burnout, among third year students is statistically significant, compared to the first year students, being a significant aspect to investigate further in this class of students. It is also assumed that the high degree of "past failures, feeling of self failure" observed among all student, is related to a feeling of poor efficacy and poor self worth that appear to grow from the beginning of the course. This topic needs further investigation in the light of the result of this study.

MR imaging of perianal fistulas in Crohn's disease: sensitivity and specificity of STIR sequences.

INTRODUCTION: Although some studies proved the role of STIR sequences in the evaluation of perianal fistulas in Crohn's Disease (CD), contrast medium is still injected in many institutions since there is not a validated reference MR protocol. Our purpose was to evaluate the role of the STIR sequence in the detection and characterization of perianal fistulae comparing it to the post-contrast T1 sequence and correlating it with rectal examination under anesthesia. MATERIALS AND METHODS: We retrospectively reviewed all clinical records of 31 CD patients, suspected of having perianal fistulas, who had been submitted to an MR study before and after contrast medium injection and surgical exploration under anesthesia within the same month. Perianal fistulas were classified according to the Parks' criteria. Finally, comparison between STIR and post-contrast T1-weighted fat saturated sequences was done. RESULTS: 29 fistulas were detected in 25 patients who underwent an MR study. There was no significant difference between MR imaging and exploration under anesthesia. For the detection of perianal fistulas of any type, there was a perfect statistical agreement between gadolinium-enhanced and STIR sequences (kappa value = 1). CONCLUSION: STIR sequences represent a valid alternative to the T1-weighted sequences acquired after the injection of contrast medium, allowing the identification of the primary fistula, any secondary ramification, and complications of the disease.

PET-MRI: clinical application of the new hybrid technology.

There is huge emphasis on noninvasive study of disease processes in the field of biomedical research. Combined PET-MRI allows simultaneous acquisition of physiologic information provided by PET images and morphologic and functional information obtained from MRI. The potential clinical and research applications of this technique in different organ systems and pathologies are promising (i.e. brain, cardiovascular, oncological, and inflammatory conditions). The purpose of this review is to illustrate the potential clinical advantages of this new technology, based on the authors' experience.

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn's disease: relationship of CT findings with CDAI and acute-phase reactants.

PURPOSE: Few studies have correlated computed tomography enterography (CTE) findings with Crohn's disease (CD) clinical and biochemical activity. The aim of this study was to evaluate correlations between CTE findings with CD activity. MATERIALS AND METHODS: The CTE datasets from 62 patients were retrospectively reviewed for different parameters: bowel wall thickening and hyperenhancement, mesenteric alterations, abdominal free fluid and complications related to the disease (fistulas, strictures, abscesses). Activity was assessed using the Crohn's Disease Activity Index (CDAI) and some biochemical markers (C-reactive protein, erythrocyte sedimentation rate, alpha 2-globulins, fibrinogen, platelets, haemoglobin). Correlations between CTE parameters, clinical activity score and laboratory parameters were assessed by logistic regression. RESULTS: CDAI was significantly correlated with increased fat density (p = 0.03) and intestinal strictures (p = 0.04). Platelet counts were elevated in patients with enlarged mesenteric lymph nodes (p = 0.009) and the comb sign (p = 0.05). Serum alpha 2-globulins were higher in the presence of the comb sign (p = 0.03). CONCLUSION: The CTE finding of perienteric inflammation (increased fat density) and vascular engorgement of the vasa recta in CD patients suggest that the disease is clinically active and that these patients may require more aggressive treatment than patients without these findings.