BackgroundSouth Africa has high healthcare expenses. Improving cost-consciousness could decrease government expenditure on healthcare.ObjectivesTo determine cost awareness of radiological studies among doctors at a tertiary hospital. The objective was met by assessing the accuracy of cost estimation according to the level of training and speciality, whether participants had received prior education/training related to cost awareness and if they had a desire to learn more about the cost of radiological imaging.MethodA cross-sectional survey was conducted in six clinical departments at Universitas Academic Hospital using an anonymous questionnaire that determined doctors’ cost awareness of five radiological studies. Each radiological study was answered using six different cost ranges, with one correct option. Costs were based on the Department of Health’s 2019 Uniform Patients Fee Schedule (UPFS).ResultsIn total, 131 (67.2%) of 195 questionnaires distributed to registrars and consultants were returned. Overall, low accuracy of cost estimation was observed, with 45.2% of the participants choosing only incorrect options. No participant estimated all five costs correctly. Only the Internal Medicine clinicians demonstrated a significant difference between registrars and consultants for the number of correct answers (median 0 and 1, respectively) (p = 0.04). No significant differences were found between specialities stratified by registrars/consultants. Most participants (88.6%) would like to learn about imaging costs. Only 2.3% of the participants had received prior education/training related to cost awareness of radiological studies.ConclusionDoctors were consistently inaccurate in estimating the cost of radiological studies. Educating doctors about the cost of radiological imaging could have a positive effect on healthcare expenditure.

Intravesical instillation of Bacillus Calmette-Guérin (BCG) is used as an adjuvant treatment of bladder cancer. Systemic BCG infection occurs in less than 1% of cases, and pulmonary involvement is even rarer (0.3% – 0.7%), with a favourable prognosis. A 78-year-old male developed miliary tuberculosis (TB) secondary to intravesical BCG treatment and subsequent coronavirus disease 2019 (COVID-19) superinfection that led to patient death. High awareness amongst clinicians is needed to proceed with immediate appropriate therapy in these patients, especially during the COVID-19 pandemic

Multiparametric magnetic resonance imaging (MRI) of the prostate has become a vital imaging tool in daily radiological practice for the stratification of the risk of prostate cancer. There has been a recent update to the Prostate Imaging-Reporting and Data System (PI-RADS). The updated changes in PI-RADS, which is version 2.1, have been described with information pertaining to the recommended imaging protocols, the techniques on how to perform prostate MRI and a simplified approach to interpreting and reporting MRI of the prostate. Explanatory tables, schematic diagrams and key representative images have been used to provide the reader with a useful approach to interpreting and then stratifying lesions in the four anatomical zones of the prostate gland. The intention of this article is to address challenges of interpretation and reporting of prostate lesions in daily practice.

BackgroundCongenital anomalies occur in approximately 2% of newborns, resulting in severe medical, physical and social disabilities. Managing clinicians, therefore, require more confidence in their diagnosis and prognostic accuracy before appropriately counselling the parents regarding termination of pregnancy.ObjectiveThe aim of this study was to investigate the role of magnetic resonance imaging (MRI) following the diagnosis of foetal anomalies at a foetomaternal unit of a tertiary South African institution.MethodsEighty-eight pregnant women in their late second/third trimester who underwent both an ultrasound (US) at the foetomaternal unit and foetal MRI at the Radiology Department from 01 July 2013 to 30 September 2019 were included in this clinical study conducted at Steve Biko Academic Hospital.ResultsDespite the high degree of concurrence (73.9%) between both modalities regarding the main diagnoses, MRI provided additional information in 45.5% of patients and changed the diagnosis in 25% of the patients. It further demonstrated superiority in providing diagnostic information in 97% of cases where the US alone was inadequate to counsel parents regarding the termination of pregnancy, and it completely changed the clinical management in 42% of cases.ConclusionIt is clearly evident from this study that foetal MRI is a necessity when termination of pregnancy is being considered following an US conducted by the foetomaternal unit. This allows for a complete foetal assessment and gives the managing clinician sufficient diagnostic confidence to prognosticate the future quality of life of the child.

Metronidazole is a widely used antibacterial and antiprotozoal agent for a number of conditions. Whilst its more common gastrointestinal side effects are well known, neurotoxicity remains under-recognised. Both central and peripheral neurological side effects have been described. This report describes a case of radiologically confirmed metronidazole-induced cerebellar ataxia in a cirrhotic patient with a review of the literature. Awareness of this side effect is essential for prompt recognition as early drug withdrawal leads to resolution in the majority of cases.

BackgroundThe use of computed tomography (CT) for estimation of split renal function (SRF) has been reported previously. However, most of these studies have small samples, and many do not account for the renal attenuation at CT.ObjectiveThe aim of this study was to compare multidetector computed tomography (MDCT) volumetry-attenuation-based SRF with that obtained via Tc99m-diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy in voluntary renal donors.MethodsBetween January 2017 and January 2020, 526 voluntary renal donors were enrolled prospectively. All donors underwent contrast CT and DTPA scan before surgery. The semiautomatic region of interest (ROI) tool was applied slice by slice on axial CT images acquired in the arterial phase. The renal contour was drawn semiautomatically with mouse clicks around the renal parenchyma, and the renal volume was ascertained. Using renal volume and attenuation, SRF was determined and compared with results obtained at DTPA imaging.ResultsThe mean age was 44.91 ± 10.97 years (mean ± s.d.). There was no significant difference in SRF based on DTPA and MDCT volumetry for the left kidney (49.18% ± 3.40% vs. 49.15% ± 3.38%, p = 0.540) and for the right kidney (50.82% ± 3.40% vs. 50.86% ± 3.39%, p = 0.358). A very good correlation was observed between the two methods for the left kidney (r = 0.953, p = 0.000) and the right kidney (r = 0.955, p = 0.000). On simple linear regression analysis, 90.8% of DTPA SRF values for the left kidney and 91.3% of DTPA SRF values for the right kidney could be predicted correctly using the corresponding MDCT SRF values.ConclusionMDCT volumetry-attenuation-derived estimation of SRF for living renal donors could be an alternative to renal scintigraphy-based SRF estimation.

BackgroundAnatomical variations of the coeliac trunk and renal arteries should be radiologically reported as they affect the surgical approach and subsequent outcome in patients.ObjectivesThe aim of this study was to determine the prevalence of anatomical variations of the coeliac trunk and renal arteries and whether there is a relationship between the occurrence of these variations at Dr George Mukhari Academic Hospital.MethodArterial phase abdominal computed tomography (CT) or CT abdominal angiograms performed during January and December 2017 were analysed. The variations of the coeliac trunk and renal arteries were classified according to accepted classification systems and expressed as a percentage of the study population.ResultsA normal classical coeliac trunk was present in 82.2% and a non-classical pattern was present in 9.7%. The most common variation of the coeliac trunk other than the non-classical pattern was a hepatosplenic trunk, which was present in 3% of the study population. A normal right and left renal artery was present in 88.2% and 83.7%, respectively. The most common variations of the renal arteries were bilateral hilar arteries seen in 3.4% on the right and 9.1% on the left. Renal artery variations were more prevalent on the left than on the right. Concurrent variations of both the right and the left renal arteries were present in 2.4% and variations of both the coeliac trunk and renal arteries were present in 5% of the study population.ConclusionThe most common variation of the coeliac trunk in this study is comparable to other studies in non-African populations. Concurrent vascular variations between the renal arteries and between the coeliac trunk and renal arteries may co-exist.

No abstract available.

No abstract available.

Hutch diverticulum is a congenital diverticulum of the urinary bladder, reported infrequently in children and rare amongst adults. We present a 60-year-old male patient with bilateral Hutch diverticula, detected incidentally during an abdominal ultrasound examination performed for blunt abdominal trauma. This rare case highlights an unusual incidental presentation and opportunity to learn how to differentiate it from acquired bladder diverticula. The available treatment options are also discussed varying from simple follow-up to aggressive surgery.