Conventional Radiological Examinations Research Articles

Bone health in children with primary hyperoxaluria type 1 following liver and kidney transplantation.

Primary hyperoxaluria type 1 is characterized by hepatic oxalate overproduction, leading to nephrocalcinosis, kidney stones, kidney failure and systemic oxalosis, including oxalate osteopathy. Combined liver-kidney transplantation (CLKT) and kidney after liver transplantation (KALT) were established therapeutic options to stop the devastating consequences of oxalate bone disease. We describe a retrospective cohort of 10 children with PH1who were referred to our hospital from different countries for combined transplantation. Demographic and clinical data were collected and symptoms of bone disease, conventional radiological examinations, plasma oxalate levels and other determinants of calcium-phosphate metabolism were compared pre and post transplantation. Ten patients (7 male, median age 5.8 years, median follow-up time 8.1 years) were included in this study. Seven patients were diagnosed with infantile oxalosis and 9 patients received an intensified dialysis regime prior to transplantation. In one patient the transplanted kidney never achieved primary function and the boy remained on HD. All other patients remained without graft failure and retained stable kidney and liver function. Prior to transplantation, seven patients suffered from severe skeletal pain and three children presented with 1-3 series of pathological fractures. Pathological fractures did no longer occur in children who underwent successful CLKT or KALT. Plasma oxalate levels dropped within 6 months following Tx. Determinants of calcium-phosphorus metabolism did not differ significantly in comparison to other HD children. Seven of ten children showed a restricted growth at the time of transplantation and presented a moderate catch-up-growth at the time of last follow-up. Patients with PH1 suffer from severe consequences of a disturbed bone metabolism. However, bone health and growth can partially improve following CLKT/KALT.

Aggressive Osteoblastoma of Temporal Bone Causing Facial Palsy in a 9-year-old Child: A Case Report Based on 2020 WHO Classification of Bone Tumors

AbstractAggressive osteoblastoma (AO) is an uncommon bone tumor that represents a borderline lesion between osteoblastoma and osteosarcoma. The vertebral column, the sacrum, the pelvis, and jaw/craniofacial bones are primarily affected. Aggressive osteoblastoma does not metastasize and is treated by surgical resection. The authors report a case of AO in a 9-year-old female patient presenting with 5th and 7th cranial nerve palsy. Prior pathological history included resection of an expansile nodule in the left temporal bone. Conventional radiological examination and computed tomography (CT) of the skull revealed an osteoblastic lesion arising in the petrous portion of the left temporal bone, measuring 5.2 cm in the largest dimension. The patient was subjected to partial surgical resection of the process. Microscopy revealed a primary neoplastic bone composed of numerous epithelioid round osteoblasts disposed in solid sheets and with mild atypia, large eosinophilic cytoplasm, and an eccentric, ovoid nucleus. The process exhibited loose stroma, low mitotic index, osteoid formation, and a few osteoclast-like multinucleated giant cells. The diagnosis of AO was thus established. After 5 months of clinical follow-up, the patient is asymptomatic, without evidence of tumoral growth on CT scans.

Shoe-Integrated Sensor System for Diagnosis of the Concomitant Syndesmotic Injury in Chronic Lateral Ankle Instability: A Prospective Double-Blind Diagnostic Test.

Chronic lateral ankle instability (CLAI) is commonly secondary to prior lateral ankle ligament injury, and the concomitant latent syndesmosis injury would prolong recovery time and increase the risk of substantial traumatic arthritis. However, differentiating syndesmotic injury from isolated lateral ankle ligament injury in CLAI cases is difficult by conventional physical and radiological examinations. To improve the accuracy of syndesmotic injury diagnosis, a shoe-integrated sensor system (SISS) is proposed. This system measures plantar pressure during walking to detect the presence of syndesmotic injury. The study included 27 participants who had ankle sprains and underwent an examination. Plantar pressure in eight regions of interest was measured for both limbs, and syndesmotic injuries were examined using arthroscopy. The width of the syndesmosis was measured to evaluate its severity. The characteristics of plantar pressure were compared between patients with normal and injured syndesmosis. The results indicated that peak plantar pressure ratios with logistic regression predicted value > 0.51 accurately distinguished concomitant syndesmotic injury during walking, with high sensitivity (80%) and specificity (75%). The post-test probability of having a syndesmotic injury was positively 80% and negatively 25%. These findings demonstrate the effectiveness of cost-effective wearable sensors in objectively diagnosing concomitant syndesmotic injuries in cases of CLAI.

Variants of Acetabular Deformity in Developmental Dysplasia of the Hip in Young Children

Background. The choice of pelvic reconstruction technique in children with developmental dysplasia of the hip (DDH) has been the subject of discussion for many years and is often determined by personal preferences of a surgeon rather than by X-ray anatomical state of the acetabulum. The variants of its anatomy structure have still not been reflected in the available scientific literature.
 Aim of the study to identify the most typical variants of acetabular deformation in children with varying severity of DDH, based on the X-ray anatomical analysis of structure of the acetabulum.
 Methods. The study was based on the results of examination of 200 patients (200 hip joints) aged 2 to 4 years (3.10.45) with Tnnis grade II-IV DDH. All patients underwent conventional clinical and radiological examination. The latter consisted of hip radiography in several views and computed tomography. We took the values of acetabular index, the extent of acetabulum arch and the presence or the absence of bone oriel as criteria for determination of the most typical variants of acetabular deformation.
 Results. X-ray analysis of anatomical structure of the acetabulum in young children with varying severity of DDH revealed 3 most common variants of acetabular deformity: 1 moderate underdevelopment of the acetabulum arch (AI 35), its shortening and the presence of bone oriel; 2 pronounced underdevelopment of the acetabulum arch (AI 35), its shortening and the presence of bone oriel; 3 pronounced underdevelopment of the acetabulum arch (AI 35), its sufficient length and the absence of bone oriel.
 Conclusion. Suggested supplements to existing Tnnis DDH classification might become basic for choosing the surgical correction technique of the acetabulum in children with different severity of DDH.

Overview of findings on radiographic examination of sialography in patients with sialolithiasis: case serial

Background: Sialolithiasis is the most common salivary gland disease. Salivary gland disease usually occurs in middle age, with an incidence of 12 in 1000 in the adult population. The peak incidence is between the ages of 30 and 50. Sialolithiasis generally occurs in the submandibular gland. Sialoliths can be single or multiple. Diagnosis of sialolithiasis can be based on clinical examination or simple supporting examination in the form of sialography. Case Report: There were 3 patients with the main complaint of pain in the lower jaw area with similar symptoms, such as swelling and discomfort every time they chewed food. In all three patients, conventional plain radiographs were examined, namely Skull AP photos, followed by conventional radiological examinations using water-soluble contrast media known as sialography. Conclusion: Correct diagnosis and determine the appropriate treatment for the patient. Plain AP skull radiographs can be used as an early indication of the presence or absence of sialolith images, although they may not be visible if they are relatively small. Furthermore, sialography examination can become the gold standard in determining the location and size of sialoliths. In these three cases, an opacity or filling defect, accompanied by a dilatation of the proximal duct and even narrowing of the distal lumen of the duct, indicates either partial or total obstruction. An ultrasound examination was performed to confirm the diagnosis. In all three cases, it was found that there was indeed a hyperechoic surrounded by clear anechoic (saliva), thus suggesting a sialolithiasis.

Cumulative Radiation Exposure in Covid-19 Patients Admitted to the Intensive Care Unit.

Medical imaging plays a major role in coronavirus disease-2019 (COVID-19) patient diagnosis and management. However, the radiation dose received from medical procedures by these patients has been poorly investigated. We aimed to estimate the cumulative effective dose (CED) related to medical exposure in COVID-19 patients admitted to the intensive care unit (ICU) in comparison to the usual critically ill patients. We designed a descriptive cohort study including 90 successive ICU COVID-19 patients admitted between March and May 2020 and 90 successive non-COVID-19 patients admitted between March and May 2019. In this study, the CED resulting from all radiological examinations was calculated and clinical characteristics predictive of higher exposure risk identified. The number of radiological examinations was 12.0 (5.0-26.0) [median (interquartile range) in COVID-19 vs. 4.0 (2.0-8.0) in non-COVID-19 patient (P < 0.001)]. The CED during a four-month period was 4.2 mSv (1.9-11.2) in the COVID-19 vs. 1.2 mSv (0.13-6.19) in the non-COVID-19 patients (P < 0.001). In the survivors, the CED in COVID-19 vs. non-COVID-19 patients was ≥100 mSv in 3% vs. 0%, 10-100 mSv in 23% vs. 15%, 1-10 mSv in 56% vs. 30% and <1 mSv in 18% vs. 55%. The CED (P < 0.001) and CED per ICU hospitalization day (P = 0.004) were significantly higher in COVID-19 than non-COVID-19 patients. The CED correlated significantly with the hospitalization duration (r = 0.45, P < 0.001) and the number of conventional radiological examinations (r = 0.8, P < 0.001). To conclude, more radiological examinations were performed in critically ill COVID-19 patients than non-COVID-19 patients resulting in higher CED. In COVID-19 patients, contribution of strategies to limit CED should be investigated in the future.

Early Lung Ultrasound Findings in Patients With COVID-19 Pneumonia: A Retrospective Multicenter Study of 479 Patients.

ObjectivesLung ultrasound (LUS) holds the promise of an accurate, radiation‐free, and affordable diagnostic and monitoring tool in coronavirus disease 2019 (COVID‐19) pneumonia. We sought to evaluate the usefulness of LUS in the diagnosis of patients with respiratory distress and suspicion of interstitial severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pneumonia, in comparison to other imaging modalities.MethodsThis was a multicenter, retrospective study. LUS was performed, on Emergency Department (ED) arrival of patients presenting for possible COVID‐19 evaluation, by trained emergency physicians, before undergoing conventional radiologic examination or while waiting for the report. Scans were performed using longitudinal transducer orientation of the lung regions. CXR was interpreted by radiologists staffing ED radiology. Subjects were divided into two group based on molecular test results. LUS findings were compared to COVID test results, nonlaboratory data, and other imaging for each patient. Categorical variables were expressed as percentages and continuous variables as median ± standard error.ResultsA total of 479 patients were enrolled, 87% diagnosed with SARS‐CoV‐2 by molecular testing. COVID positive and COVID negative patients differed with respect to sex, presence of fever, and white blood cells count. Most common findings on lung point of care ultrasound (POCUS) for COVID‐positive patients were B‐lines, irregular pleural lines, and small consolidation. Normal chest X‐ray was found in 17.89% of cases.ConclusionsThis 479 patient cohort, with COVID‐19, found LUS to be noninferior to chest X‐ray (CXR) for diagnostic accuracy. In this study, COVID‐positive patients are most likely to show B lines and sub‐pleural consolidations on LUS examination.

Новые подходы к лечению детей с посттравматическими контрактурами локтевого сустава

Abstract. Introduction Post-traumatic elbow contracture is a severe disabling condition of childhood that interferes with both physical and psychic aspects for the child. A high rate of poor results encourages surgeons seek for better surgical treatments. Current diagnostic modalities were practical to get the clinical picture of the contracture mechanogenesis and determine the treatment strategy. The goal of the study was to review long-term results of new surgical techniques developed for post-traumatic elbow contractures in children. Material and methods The inpatient records of 102 pediatric patients with post-traumatic elbow contractures operated on with the technique offered were reviewed. All patients underwent conventional radiological, ultrasound and MSCT examinations. Results Based on the pathobiomechanics of the injured elbow a mobilization technique was developed to ensure complete bone realignment, relieve pain and allow early exercises for the joint. Postoperative lavage of the joint cavity, intra-articular administration of corticosteroids and polyvalent enzymes in the early postoperative period facilitated improved long-term outcomes of elbow contractures. All patients reported good results. Discussion Tenotomies of the lateral ligaments can be added to arthrotomy and reconstruction of articular surfaces for temporary instability of the joint to restore movement in the elbow joint in severe cases. Post-traumatic elbow contractures are accompanied by impaired biomechanics. MSCT and 3D reconstruction of bone structures is the gold standard in the diagnosis of post-traumatic elbow contractures. Conclusion Bone impingements are to be addressed and an extended mobilization of the capsular ligamentous complex be provided for complete movement recovery through partial elbow instability to be temporarily ensured. Prolonged lavage of the elbow joint can be used to prevent adhesions and allow early elbow exercises and provide improved outcomes.

Optimization dose and image quality enhancement of ct scan with back projection filters on the use of automatic exposure control

Dose and image quality are two important parameters in CT Scan examination. The radiation dose produced at the CT scan is far greater than the radiation dose of the conventional radiological examination, so the utilization must be as good as possible. On Siemens CT Scan there is an automatic exposure control software, with expectations that the radiation dose received by the patient can be reduced because the software is an auto mA that is adjusted to the thickness of the object, but the impact of using the software causes a decrease in image quality, so it needs to be done image improvement using a back projection filter (BPF). Experimental research by applying a back projection filter to the Scan Head image on axial sections. Image assessment using 2 radiologists with data analysis using statistical processing and image post processing. CT Scan image information Head axial pieces experience differences in image information between before and after the back projection, with the mean value in each group experiencing an increase in image quality in the group after a back projection filter. Where the image after the back projection filter by applying automatic exposure control with kV 110 is the most optimal kV.

Neoadjuvant therapy for pancreatic cancer: Limitations and advances of response assessment (Review).

Neoadjuvant therapy (NAT) has been widely recommended for managing patients with borderline resectable pancreatic cancer and resectable tumors with high risk factors. Accurate evaluation of the response after NAT is crucial to decide surgery, which then improves the rate of R0 resection and avoids meaningless surgery. The response to NAT is currently evaluated by conventional radiological examination and changes of serum CA19‑9 levels. However, these assessments cannot accurately reflect the response to NAT. This article describes the limitations and advances of NAT response evaluation in pancreatic cancer. The values of some traditional imaging techniques, including positron emission tomography, endoscopic ultrasound, and diffusion weighted magnetic resonance imaging, are discussed, as well as novel imaging modalities or biomarkers, such as radiomics, dual energy computed tomography and liquid biopsy.

Evaluation of Exposure Index Values for Conventional Radiology Examinations: Retrospective Study in Governmental Hospitals at West Bank, Palestine

In the digital radiology system, radiologic technologists (RTs) can choose imaging parameters to include kVp and mAs. The RTs received feedback after acquisition of an image in the form of Exposure Index (EI). The aim of the current study was to check if the EI values are within the range values recommended by the manufacturer (MREI) for radiological examinations that include the chest, abdomen, pelvis, spine, and extremities. Data was collected from 3,000 adult X-ray examinations taken from several government hospitals in Palestine. The information included patient gender, kVp, mAs, EI values, and examination time. All examinations included in the study used the grid. While the study excluded all images that contained an implant or prosthesis. Descriptive statistical analysis was used to analyze the data, while the Mann–Whitney U test was used to detect statistically significant differences, P &lt; 0.05. Some examinations showed the EI values outside the MREI ranges. The EIs in the chest AP examination were higher in the female group than males while other examinations have no difference between males and females. The EIs out of working hours were higher than in working hours, especially in the chest (P &lt;0.0001), abdominal (P &lt;0.0001), pelvic (P =0.02), and spine (P =0.0005) exams. In the summary, it has been proven that some of the examinations are outside the MREIs, with differences between the patient gender and the time of the examination. The retrospective study for the exposure index is very important in reducing the risk of radiation to patients.

Cone beam-computed tomography angiography by intravenous contrast injection is reliable to evaluate patients with large vessel occlusion

PurposeMechanical thrombectomy (MT) for acute ischemic stroke (AIS) patients due to emergent large vessel occlusion (ELVO) is standard treatment, the benefits, however, are highly time-sensitive. After patient eligibility for reperfusion therapy is determined by conventional radiological examinations, the time to be transferred from the department of radiological examination to angiography-suites is critical. We speculated that the time required for the diagnosis of AIS might be reduced if we could determine MT eligibility in patients with ELVO at angiography-suites. Modern angiography-suites with flat panel detectors can perform cone beam (CB)-CT. We performed CB-CTA using intravenous injection of contrast agent to evaluate occlusion sites, collateral score, and construction of vessels distal to occlusion sites and determined if CB-CTA could be useful to evaluate patients with ELVO. MethodsWe included 15 patients with ELVO diagnosed by conventional MRI or CT/CTA, and investigated whether CB-CTA was reliable to diagnose occlusion sites. We also studied if collateral score on CB-CTA was associated with prognosis after successful reperfusion by MT by comparison between favorable (modified Rankin scale (mRS) 0–2), and unfavorable outcome group (mRS 3–6). ResultsThere was strong agreement of occlusion sites between CB-CTA and conventional radiological examination (κ = 0.80). Collateral score determined by CB-CTA was significantly different between favorable outcome and unfavorable outcome group (median collateral score 2.3 v.s. 1.3, p = 0.040). ConclusionsAlthough prospective study of AIS patients at a radiography department is indispensable, CB-CTA performed in an angiography-suite might be useful to evaluate patients with ELVO.

Paraclinical Investigations in the Pathology of the Urinary System in Dogs

In the pathology of the urinary system, given its structural and functional complexity, the clinician must correlate the data obtained from the clinical and paraclinical examination. The aim of the study was to identify and apply the most relevant paraclinical methods for establishing the diagnosis of renal disease in dogs and to develop a reliable and easy to use working protocol. The biological material consisted of 25 dogs of different ages and sexes. The conventional and contrast-enhanced radiological examination together with the ecography, spectrofluorimetric analysis, urinary sediment examination, renal biopsy, cytological examination completed the disease information in order to establish a certitude diagnosis. In the management of patients with urinary disorders, the working protocol should include not only the animal anamnesis and a complete clinical examination but also a paraclinical examination which should be used depending on the patient’s clinical manifestations.

Diagnostic performance of different imaging modalities in the assessment of distant metastasis and local recurrence of tumor in patients with non-small cell lung cancer.

To compare the diagnostic performance of positron emission tomography with [18F] fluoro-2-deoxy-glucose (FDG-PET) coregistered with magnetic resonance imaging (FDG-PET/MRI), MRI with and without diffusion-weighted imaging (DWI), FDG-PET fused with computed tomography (FDG-PET/CT) with brain contrast-enhanced (CE-) MRI, and routine radiological examination for assessment of postoperative recurrence in nonsmall-cell lung cancer (NSCLC) patients. 96 consecutive postoperative NSCLC patients (52 men, 44 women; mean age 72 years) prospectively underwent whole-body 3T MRI with and without DWI; PET/CTs and routine radiological examinations consisted of CE-brain MRI, whole-body CE-CT, and bone scintigraphy. The patients were divided into a recurrence (n = 17) and a nonrecurrence (n = 79) group based on pathological and follow-up examinations. All coregistered PET/MRIs were generated by proprietary software. The probability of recurrence was visually assessed on a per-patient basis. Receiver operating characteristic analyses were used to compare the diagnostic performance of all methods. Finally, diagnostic capabilities were compared by means of McNemar's test. Areas under the curves (Azs) were significantly larger for PET/MRI and whole-body MRI with DWI (Az = 0.99) than for PET/CT (Az = 0.92, P < 0.05) and conventional radiological examination (Az = 0.91, P < 0.05). Specificity and accuracy of PET/MRI and MRI with and without DWI were significantly higher than those of PET/CT (P < 0.05) and routine radiological examination (P < 0.05). Whole-body FDG-PET/MRI and MRI with DWI were found to be more specific and accurate than FDG-PET/CT and routine radiological examinations for assessment of recurrence in NSCLC patients, although MRI with and without DWI demonstrated slightly lower sensitivity than PET/CT. 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1707-1717.

Improving the quality of radiological examinations: effectiveness of an internal participatory approach.

To assess the quality of radiological examinations (REs) and to evaluate the effectiveness of a participatory continuous improvement approach to ensure best practices in a Portuguese hospital imaging department. At baseline, we found 232 (10.2%) non-compliances, mostly related to the criteria image centering and framing in chest radiography (CXR), proper use of radiological protection equipment in other conventional RE (CR) and X-ray beam collimation (CXR/CR). A baseline and three consecutive evaluations of the RE quality were conducted. Each assessment was followed by participatory focused interventions for improvement. For each evaluation, we selected a random sample (n = 60) of cases for four types of examination (total n = 240 for each assessment, and 960 for the whole project). Both the building of quality criteria and the design of interventions for improvement were participatory, involving the radiology technicians. Estimates of criteria compliance were calculated with 95% confidence intervals. The statistical significance of absolute and relative improvements was tested using one-tail z-tests. After the intervention, non-compliances decreased to 48 (2.1%). Compliance estimates improved in 25 of 38 criteria assessed, with statistical significance for 5 criteria in CXR and 3 in CR and digestive examination. The internal participatory approach enabled the identification of existing quality problems and, by focusing on the more frequent quality defects, was effective in improving the quality of RE.

Novel capsules for potential theranostics of obscure gastrointestinal bleedings

Obscure gastrointestinal (GI) bleeding is identified as persistent or repeated bleeding from the gastrointestinal tract which could not be defined by conventional gastrointestinal endoscopy and radiological examinations. These GI bleedings are assessed through invasive diagnostic and treatment methods including enteroscopy, angiography and endoscopy. In addition, video capsule endoscopy (VCE) is a non-invasive method used to determine the location of the bleeding, however, this does not provide any treatment. Despite of these successful but invasive methods, an effective non-invasive treatment is desperately needed. Herein, we prepare non-invasive theranostic capsules to cure obscure GI bleeding. An effective theranostic capsule containing endothelin as the targeting agent, thrombin-fibrinogen or fibrin as the treating agent, and fluorescein dye as the diagnostic tool is suggested. These theranostic capsules can be administered orally in a simple and non-invasive manner without a risk of complication. By using these novel capsules, one can diagnose obscure GI bleeding with having a possibility of curing.

Gonad Shielding for Patients Undergoing Conventional Radiological Examinations: Is There Cause for Concern?

Background: Gonad shielding is one of the fundamental methods by which to protect reproductive organs in patients undergoing conventional radiological examinations. A lack of or inadequate shielding of the gonads may increase the exposure of these organs and result in malignancies future generations. Objectives: The aim of this study is to investigate the prevalence of gonad shielding in patients undergoing conventional radiological examinations and the availability of gonad shields and gonad shielding protocols in radiology departments. Materials and Methods: A retrospective, observational cross-sectional study on the application of gonad shielding, the availability of gonad shields and the existence of gonad shielding protocols in radiology departments was performed in five different hospitals in Ahvaz, Iran. Results: The highest application of gonad shielding was 6.6% for the pediatric hospital. The prevalence of gonad shielding was less than 0.2%. In 64.3% of the radiography rooms, at least one flat-contact gonad shield of a large size was available. Only large-sized gonad shields were available. Curved-contact and shadow gonad shields did not exist. Gonad shielding protocols were not existence in any of the fourteen radiography rooms investigated. Conclusions: Comprehensive protection programs with on-the-job training courses for staff members are strongly recommended, as well as, the provision of radiological shields and gonad shielding protocols in radiology departments to reduce the patient’s radiation dose during radiological examinations.

Radiological characteristics of the knee joint in nail patella syndrome

Nail patella syndrome (NPS) is a skeletal dysplasia with patellofemoral dysfunction as a key symptom. We present the first in-depth radiological evaluation of the knee in a large series of NPS patients and describe the typical malformations. Conventional radiological examination of 95 skeletally mature patients with NPS was performed. Patellar morphology was classified according to the Wiberg classification as modified by Baumgartl and Ficat criteria, and trochlear shape was classified according to the Dejour classification. Patellar aplasia was present in 4/90 (4%), and patellar hypoplasia in 77/90 (86%) of patients. The prevailing patellar shapes were type III, type IV and Hunter's cap. No patellar shape genotype-phenotype association could be found. The malformations of the distal femur comprised shortening of the lateral femoral condyle in 46 out of 84 patients (55%), with a prominent anterior surface of the lateral femoral condyle in 47 out of 84 patients (56%) and a flat anterior surface of the medial femoral condyle in 78 out of 85 patients (92%). The trochlea was type A1 according to the Dejour classification in 79 out of 85 patients (93%). An easily recognisable characteristic quartet of malformations consisting of patellar aplasiaor hypoplasia and the malformations of the distal femur was found in 22 out of 81 patients (27%), with the majority displaying at least three malformations. The distinct malformations of the knee in nail patella syndrome are easily recognisable on conventional radiographs and lead to the correct interpretation of the aberrant morphology which is essential in the treatment of these patellofemoral disorders.

Non-invasive imaging to monitor lupus nephritis and neuropsychiatric systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple different organs, including the kidneys and central nervous system (CNS). Conventional radiological examinations in SLE patients include volumetric/ anatomical computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US). The utility of these modalities is limited, however, due to the complexity of the disease. Furthermore, standard CT and MRI contrast agents are contraindicated in patients with renal impairment. Various radiologic methods are currently being developed to improve disease characterization in patients with SLE beyond simple anatomical endpoints. Physiological non-contrast MRI protocols have been developed to assess tissue oxygenation, glomerular filtration, renal perfusion, interstitial diffusion, and inflammation-driven fibrosis in lupus nephritis (LN) patients. For neurological symptoms, vessel size imaging (VSI, an MRI approach utilizing T2-relaxing iron oxide nanoparticles) has shown promise as a diagnostic tool. Molecular imaging probes (mostly for MRI and nuclear medicine imaging) have also been developed for diagnosing SLE with high sensitivity, and for monitoring disease activity. This paper reviews the challenges in evaluating disease activity in patients with LN and neuropsychiatric systemic lupus erythematosus (NPSLE). We describe novel MRI and positron-emission tomography (PET) molecular imaging protocols using targeted iron oxide nanoparticles and radioactive ligands, respectively, for detection of SLE-associated inflammation.

Estimated radiation exposure from medical imaging for patients of radiology service of Al Faraby Hospital, Oujda Morocco

Purpose: To evaluate the effective dose received per radiological examination per patient and the additional cancer risk factor in the Radiological Service of Al Faraby Hospital in 2012. Methods : From the number of radiological procedures (N X ) made in 2012 in the radiology service of Al Faraby Hospital and the average effective dose D E X associated with each type of act exam X, it is possible to calculate the effective dose collective [S =∑ D E X * N X ]. The additional cancer risk factor is calculated by the X-ray risk software promoting responsible imaging through patient and provider education. It is function of the effective dose received, the age at the time of exam, and gender of patient. Results : The radiological average effective dose received per act exam is 1 millisievert (mSv), whereas it is 4.45 mSv and 0.21 mSv for the computed tomography (CT) scan and conventional radiological examinations, respectively. As for the average number of acts per patient 2.66, the effective dose is 1.16 mSv and 3.8 mSv for CT scan and conventional radiological examinations, respectively. As for the average effective dose per patient 2.69 mSv, it is 5.16 mSv and 0.81 mSv for CT scan and conventional radiological examinations, respectively. As for the additional cancer risk in 40 years at the time of exam, the average additional cancer risk is equal to 2.17 × 10 -4 , wheras the risk is 4.17 × 10 -4 and 6.54 × 10 -5 for CT scan and conventional radiological examinations, respectively. Conclusion : Medical exposure related to the diagnosis of patients in the radiology service in 2012 can be characterized by: (a) 2.66 Act exams on average per patient diagnosis corresponding to a mean effective dose equal to 2.69 mSv per patient, (b)frequency of conventional radiology and CT scan was 81% and 19%, respectively. These act exams contribute to the collective effective dose by 17% and 83%, respectively, and (c) radiological acts can be divided into three levels of exposures: 0 to 5 mSv, 5 to 10 mSv, and > 5 mSv, and the proportion of each level is 90.12%, 9.84%, and 0.05%, respectively.