Diagnostic Radiologic Studies Research Articles

Topography of the mandibular canal in male human skulls originating from different time periods.

Dynamic advances in dentistry, especially in implantology has inspired researchers to carry out many studies investigating the topography of the mandibular canal and its ethnic differences. The aim of the study was a comparative analysis of variations in the position and topography of the mandibular canal based on radiographic images of human mandibles originating from modern and medieval skulls. Morphometric examination of 126 radiographs of skulls (92 modern and 34 medieval skulls) was included. The age and sex of individuals were determined based on the morphology of the skull, the obliteration of cranial sutures, and the degree of tooth wear. To define the topography of the mandibular canal on X-ray images, we took 8 anthropometric measurements. We observed significant differences in several parameters. The distance between the base of the mandible and the bottom of the mandibular canal, the distance between the top of the mandibular canal and the crest of the alveolar arch, and the height of the mandibular body. Significant asymmetry was found for two parameters of mandibles from modern skulls: the distance between the top of the mandibular canal and the crest of the alveolar arch at the level of the second molar (p < 0.05), and the distance between the mandibular foramen and the margin of the anterior mandibular ramus (p < 0.007). There were no significant differences between measurements taken on the right and left sides of the medieval skulls. Our study revealed differences in the position of the mandibular canal between modern and medieval skulls, confirming the presence of geographical and chronological differences between populations. Knowledge of variability in the position of the mandibular canal between different local populations is fundamental for the correct interpretation of findings from diagnostic radiological studies used in dental practice and in forensic odontology or analysis of archaeological bone materials.

Well-Differentiated Neuroendocrine Tumors of the Appendix in Children and Adolescents: A Clinicopathologic Study.

Pediatric neuroendocrine tumors (NET) of the GI tract are rare and appendiceal NET are typically incidental. Few studies have been done in the pediatric population and practice guidelines are mainly based on adult data. There are currently no diagnostic studies specific for NET. Our study aimed to identify clinical, radiological, and pathological findings in pediatric appendiceal NET, test criteria for follow up surgical treatment, review potential prognostic pathological findings, and possible pre-operative diagnostic radiological studies. A retrospective data search was conducted for well-differentiated NET of the appendix in patients ≤21 years between 1/1/2003 and 7/1/2022. Available clinical, radiologic, pathological, and follow-up information was recorded. Thirty-seven patients with appendiceal NET were identified. No masses were reported in the patients who underwent presurgical imaging. Appendectomy samples showed NET (0.2->4 cm), most located in the tip. Most cases were WHO G1 (34/37), with negative margins (n = 25). Sixteen cases extended to the subserosa/mesoappendix (pT3). Lymphovascular (6), perineural (2), and both lymphovascular and perineural invasion were also noted (2). The specified tumor stages were pT1 (10/37), pT3 (16/37), and pT4 (4/37). Patients who underwent laboratory testing for chromogranin A (20) and urine 5HIAA (11) had normal limits. Subsequent surgical resection was recommended in 13 cases and performed in 11. To date, all patients have no recurrent or additional metastatic disease. Our study showed that all pediatric well-differentiated appendiceal NET were incidentally found as part of acute appendicitis management. Most NET were localized with low-grade histology. Our small cohort support the previously suggested management guidelines with follow up resection in certain cases. Our radiologic review didn't identify a best modality for NET. Comparing cases with and without metastatic disease, no tumors under 1 cm had metastasis, but serosal and perineural invasion along with G2 status were associated with metastasis in our limited study.

The impact of medical scribes on emergency physician diagnostic testing and diagnosis charting.

Since the widespread adoption of electronic medical records (EMRs), medical scribes have been increasingly utilized in emergency department (ED) settings to offload the documentation burden of emergency physicians (EPs). Scribes have been shown to increase EP productivity and satisfaction; however, little is known about their effects on the EP's diagnostic process. We aimed to assess what effect, if any, scribes have on EP diagnostic test ordering and their documentation of differential diagnoses. We conducted a retrospective cohort study utilizing a chart review to compare diagnostic practices of EPs working both with and without scribes. We analyzed the number of laboratory and radiologic diagnostic studies ordered per encounter as well as characteristics of differential diagnosis documentation. Scribes did not affect laboratory studies ordered per encounter (mean 6.31 by scribes vs. 7.35 by EPs, difference-1.04; 95% confidence interval [CI]-2.34 to 0.26) or radiologic studies ordered per encounter (mean 1.49 by scribes vs. 1.39 by EPs, difference 0.10; 95% CI-0.15 to 0.35). Scribes did not affect the frequency of documenting a differential diagnosis or the number of diagnoses considered in each differential, but they were associated with higher word counts in EP differentials (mean 72.29 by scribes vs. 50.00 by EPs, mean difference 22.79; 95% CI 6.77 to 38.81). Scribe use does not appear to affect EP diagnostic test ordering but may have a small effect on their documentation of differential diagnoses.

Diagnosis of solitary eosinophilic granuloma by CT, MRI, and 18F-FDG PET/CT: two clinical cases

This paper presents two clinical cases of eosinophilic granuloma of bone diagnosed by CT, MRI, and 18F-FDG PET/CT. In both cases the patients were admitted to the clinic with suspected primary malignant bone tumor and the diagnosis of a solitary eosinophilic granuloma was made based on the results of comprehensive radiological diagnostic examination and histological verification. Solitary eosinophilic granuloma of bone is an infrequent condition, occurring in less than 1% of cases of skeletal tumor masses. The most common eosinophilic granuloma is found in the parietal and frontal bones of the skull and is an osteolytic volumetric mass that gradually increases in size. Although most bone tumors can be detected by radiography, computed tomography is preferred, primarily because of its superior ability to detect cortical bone destruction. The diagnostic accuracy of computed tomography and magnetic resonance imaging may be different. The combined use of radiological and radionuclide methods allows us to narrow the spectrum of differential diagnosis. Unfortunately, relatively low specificity of existing radiological diagnostic studies in most cases does not allow to establish a precise diagnosis, and biopsy with subsequent pathological examination remains the method of choice. These clinical observations demonstrate the need to include eosinophilic granuloma in the differential diagnosis when a solitary osteolytic focus is detected.

Radiation Safety in Children in Children’s Medical Center Hospital

Background: Diagnostic radiology studies in children harbor more radiation hazards than in adults due to their small size and higher cellular proliferation rate. Therefore, reducing the radiation burden to children should be top priority. Measurement of radiation dose is the first step to this goal. Nevertheless, we do not know whether the radiation of portable radiographs at our hospital meets the standards or not. Objectives: This study aims at measuring the primary and scattered radiation at different distances from patients. This eventually would help us to keep the radiation to minimum. Methods: This study was conducted on 84 patients from 4 different wards (U1-U2) in our hospital in 2017. After obtaining ethical approval from ethical committee and also written consent from parents, all patients who needed portable X-ray were included in our study. A thermo-luminescent dosimeter was placed on the patient’s chest to measure the entrance surface dose (ESD), while Geiger-Muller dosimeters located at one and two-meter distances from the X-ray tube used to scale the scattered radiation. Then, data were analyzed in SPSS 16. Results: The average ESD was 0.3873, 0.3867, 0.3700, and 0.4033 millisievert (mSv) in U1 to U4 respectively, whereas the scattered radiation doses measured as 0.00986, 0.00750, 0.01250, 0.1014 at one-meter and 0.00250, 0.00220, 0.00238, 0.00314 mSv at two-meter distances. There was no significant difference in radiation dose between those units (P &gt; 0.05). Conclusions: Radiation received by patients in this study was three to four times higher than the standard dose. Significant scattered radiation was also detected at one and two-meter distances. To reduce radiation, improvement of exposure protocols such as reducing mAs and using proper shielding is emphasized.

Unnecessary use of radiology studies in the diagnosis of inguinal hernias: a retrospective cohort study.

The diagnosis of inguinal hernias is predominantly based on physical exam, although imaging may be used in select cases. The objective of this study was to determine the frequency of unnecessary imaging used in the diagnosis of inguinal hernias. Patients who underwent elective inguinal hernia repair at a large academic health system in the U.S. from 2010 to 2017 were included. Within this cohort, we identified patients who received imaging 6months prior to surgery. Through chart review of physical exam findings and imaging indications, we categorized patients into four imaging categories: unrelated, necessary, unnecessary, and borderline. Multivariable logistic regression analysis was used to identify factors associated with receipt of unnecessary imaging. Of 2162 patients who underwent inguinal hernia surgery, 249 patients had related imaging studies 6months prior to surgery. 47.0% of patients received unnecessary imaging. 66.9% and 33.1% of unnecessary studies were ultrasounds and CT scans, respectively. 24.5% of patients had necessary studies, while 28.5% had studies with borderline indications. On multivariable analysis, having a BMI between 25.0 and 29.9kg/m2 was associated with receipt of unnecessary studies. Primary care providers and ED physicians were more likely to order unnecessary imaging. Nearly 50% of all patients who receive any related imaging prior to surgery had potentially unnecessary diagnostic radiology studies. This not only exposes patients to avoidable risks, but also places a significant economic burden on patients and our already-strained health system.

Trends in Diagnostic Imaging Medicare Reimbursements: 2007 to 2019.

The aim of this study was to evaluate recent trends in Medicare reimbursement rates for various imaging studies. Common diagnostic radiologic studies were selected across multiple imaging modalities: bone densitometry, CT, CT angiography, mammography, MR angiography, MRI, nuclear medicine, radiography, and ultrasound. The Physician Fee Schedule Look-Up Tool from CMS was queried for Current Procedural Terminology codes to extract reimbursement data. All monetary data were adjusted for inflation to 2019 US dollars. The compound annual growth rate, average annual change, and total percentage change in reimbursement were calculated on the basis of these adjusted trends. Inflation-adjusted Medicare reimbursement for all imaging modalities decreased between 2007 and 2019. The greatest mean decrease in reimbursement rates was observed for MRI (-$52.08), and the largest decrease in total percentage change was seen for bone densitometry (-70.5%). Nuclear medicine demonstrated the smallest mean decreases in both annual change (-$0.32) and total percentage change (-4.28%). This study examined Medicare reimbursements for radiologic studies from 2007 to 2019. After accounting for inflation, reimbursement rates were shown to decline for all studies across all imaging modalities except for individual studies in nuclear medicine, radiography, and ultrasound. Further investigation is encouraged to properly model future trends in reimbursement rates.

Cumulative effective dose caused by diagnostic imaging and its associated risk for cancer development in trauma patients referred to the emergency department

Background: The current study aimed to determine the cumulative effective dose caused by diagnostic imaging and its associated risk for cancer development in trauma patients referred to an emergency department. Methods: This study was carried out retrospectively in an emergency department (Kashan, Iran) from April 2015 to October 2015. Then, the types of diagnostic radiologic studies performed on adult trauma patients in their first 24 h upon presentation were recorded. Finally, the cumulative effective dose of trauma patients and its associated risk for cancer development were obtained. Results: In total, the patients received 3323 radiologic examinations including 2169 radiographs and 1154 computed tomography (CT)-scans. The most common type of plain radiographic and CT-scan examinations included anterior posterior and posterior anterior chest as well as head, respectively. The mean cumulative effective dose received by trauma patients referred to the emergency department was 2.47 ± 4.29 mSv. Most of the effective dose was from CT-scan examinations (90.65% of total cumulative effective dose; 2181.91 mSv). The majority of patients (83.40%) received between 0.00 and 5.00 mSv cumulative effective dose. Moreover, the cancer risk per average cumulative effective dose received by trauma patients was 1.01 × 10−4. Conclusions: In current study, the mean cumulative effective dose per each trauma patient (2.47 mSv) was relatively less than that of the other evaluated studies. It was also found that although the number of CT-scans was relatively few compared to plain radiographs, most of the cumulative effective dose of patients resulted from CT-scans; hence, using unnecessary CT-scan examinations should be avoided.

Risk Of Cancer And Radiation Dose Received By Patients From Common Diagnostic Radiological Examinations

Background: Although radiological diagnostic studies (RDS) are an important and acceptable part of medical practice, it is not without hazards. It is associated with increased risk of cancer. Unfortunately the typical and safe dose of each radiological examination is not known. Most of our knowledge of cancer risk comes from studies of survivors of those exposed to whole body radiation from atomic bomb in Hiroshima &amp; Nagasaki, jobs associated with radiation exposure, Chernobyl survivors &amp; patients treated with radiation therapy for cancer and other diseases.&#x0D; Objectives To estimate radiation dose received by patients from diagnostic radiological examinations and lifetime attributable risk of cancer (LTARC).&#x0D; Type of the study: A prospective study.&#x0D; Methods A prospective study was conducted in Al-Kindi Teaching Hospital (KTH) during the period from 1st June to 31st august 2016. The study was performed on 910 adult patients. There were 595 males (65.38%) and 315 females (34.62%); mean age was 41.5 years (range 20-63).Different RDS were considered including chest-x ray (CXR), skull x-ray(SXR), x-ray of limbs and pelvis (LPXR) for orthopedic causes , computed tomography scan (CTS) and mammography (MG) .&#x0D; Results CXR was performed for 260 (28.57%) patients which delivers 0.12 mSv. SXR was done for 160 (17.58%) patients which delivers 0.3 mSv. LPXR was performed for 220 (24.175%) which delivers 0.3-0.6 mSv. MG exposes 150 (16.48%) to 3 mSv. While CTS ,which delivers 6.2-16 mSv according to anatomic area being scanned, was done for 120(13.19%) patients.&#x0D; Conclusion There is great abuse for using RDS from both patients and doctors, without realizing their danger and association with cancer development. It was proved that RDS expos patients to different kinds of tissues injury including cancer.

A Study of Aetiological Profile of Unilateral Sensorineural Hearing Loss

Introduction: It is necessary to identify the aetiology of sudden sensorineural hearing loss for proper management. Despite advancement in the field of diagnostic radiology, immunochemistry and genetic studies, there are still many cases of USNHL where a definite cause cannot be identified. In this study, an attempt has been made to identify the aetiological factors responsible for unilateral sensorineural hearing loss (USNHL).. &#x0D; Materials and Methods: Seventyfive patients with acquired unilateral sensorineural hearing loss without chronic otitis media were included in the study. Hearing was assessed by tuning fork test and pure tone audiometry. Special tests were done to differentiate between cochlear and retrocochlear pathology, to objectively assess hearing loss and to diagnose nonorganic hearing loss. Radio-imaging was done to diagnose skull bone fractures, space occupying lesions in internal auditory meatus and cerebellopontine angle or intracranial pathologies. Biochemical analysis of blood, immunoglobulin and serological assay were done to rule out specific causes.&#x0D; Results: Majority of patients were within 21-30 years of age. 37 patients presented with sudden and remaining with progressive hearing loss. Majority (57.3%) were found to have idiopathic cochlear pathology. Amongst the remaining, there were 8 cases of acoustic trauma, 4 each of Meniere’s disease and cerebellopontine angle tumour and 3 each of Noise-induced hearing loss, labyrinthitis and Non-organic hearing loss. There were 2 cases of meningitis and 1 each of barotrauma, connective tissue disorder, iatrogenic trauma, fracture of petrous bone and cerebrovascular accident. &#x0D; Conclusion: Most of the studies have been done on sudden sensorineural hearing loss. Current study, including sudden and progressive cases, is hence an attempt to ascertain aetiological profile of unilateral SNHL.

Assessment of the Possibilities of B-Mode Ultrasonography in the Diagnosis of Partial Damage to the Rotator Cuff of the Shoulder

Diagnosis of lesions of pararticular tissue is an actual problem of traumatology and orthopedics. The shoulder joint belongs to the most vulnerable parts of the motor apparatus. Damage to the rotator cuff of the shoulder (RMP) is a complex diagnostic task, including clinical, radiological and morphological studies. Diagnosis of complete tendon ruptures does not cause difficulties in clinical examination, while partial ruptures complicate clinical evaluation. Due to the complexity of the anatomy of the rotator cuff, its ultrasound examination is a difficult task [1-3]. The method is considered an operator dependent. However, the trained specialist can achieve high accuracy of the method [4,5].

Diagnostic accuracy of a rapid telemedicine encounter in the Emergency Department

ObjectivesEmergency Department crowding is an increasing problem, leading to treatment delays and higher risk of mortality. Our institution recently implemented a telemedicine physician intake (“tele-intake”) process as a mitigating front-end strategy. Previous studies have focused on ED throughput metrics such as door to disposition; our work aimed to specifically assess the tele-intake model for clinical accuracy. MethodsWe retrospectively reviewed ED visits at a high acuity, tertiary care academic hospital before and after tele-intake implementation. We defined the primary outcome as the degree of additional laboratory, imaging, and medication orders placed by the subsequent ED provider. Our secondary outcomes were the cancellation rate of intake orders and the percentage of encounters where no additional second provider orders were necessary. ResultsFor in-person and tele-intake physician encounters between September 2015 and February 2017, most labs and diagnostic radiology studies, and approximately half of CT, ultrasound, and pharmacy orders were initiated by the intake physician. We found no significant difference for our primary outcome (p = 0.2449). For both tele-intake and in-person encounters, <1% of orders were cancelled by the second provider. Additionally, 30.8% of in-person and 31.5% of telemedicine patient encounters required no additional orders to make a disposition decision. DiscussionThis novel analysis of an innovative patient care model suggests that the benefits of tele-intake as a replacement for in-person physician directed intake are not at the cost of over or under utilization of diagnostic testing or interventions.

Incidence and Causes of Adverse Events in Diagnostic Radiological Studies Requiring Anesthesia in the Wake-Up Safe Registry.

General anesthesia or sedation can facilitate the completion of diagnostic radiological studies in children. We evaluated the incidence, predictors, and causes of adverse events (AEs) when general anesthesia is provided for diagnostic radiological imaging. Deidentified data from 24 pediatric tertiary care hospitals participating in the Wake-Up Safe registry during 2010-2015 were obtained for analysis. Children 18 years or younger receiving general anesthesia for radiological procedures were identified using Current Procedural Terminology codes, and reported AEs were analyzed if they were associated with anesthetic care at magnetic resonance imaging or computed tomography locations. Logistic regression was used to determine predictors of AE occurrence in cases with complete covariate data. We identified 175,486 anesthetics for diagnostic radiological exams, compared with 83 AEs in magnetic resonance imaging or computed tomography locations (AE incidence of 0.05%). In multivariable analysis, AEs were more likely among patients with American Society of Anesthesiologists physical status IV compared with American Society of Anesthesiologists physical status I patients (adjusted odds ratio, 8.9; 95% confidence interval, 2.8-28.0; P < 0.001). Twenty-three AEs resulted in harm to the patient, whereas 32 AEs required unplanned hospital or intensive care unit admission. Anesthetic complications or issues were the most common cause of AEs (n = 52). Anesthesia provided for pediatric radiological studies is very safe and with an overall low AE incidence. The contribution of anesthetic complications to reported AEs suggests opportunities for further process improvement in this setting.

Considerations in radiation therapy for pregnant women with malignancy

Treatment of pregnant women with cancer with radiation presents medical, technical, and ethical challenges. Cancer during pregnancy occurs in 1 out of 1000 cases. The most common cancers are those that are common in females of childbearing age, including breast cancer, cervical cancer, melanoma, Hodgkin lymphoma, and leukemia. The in utero radiation exposure of a developing fetus through diagnostic radiology/nuclear medicine and radiation therapy is always a concern for healthcare providers and parents. Radiation exposure to the fetus seems to be associated with increased incidences of childhood cancer at any fetal dose. However, there also seem to be threshold doses for non-cancer adverse outcomes such as intellectual disability, organ malformation, and fetal death. The fetal radiation exposure from diagnostic radiology and nuclear medicine studies is far smaller than these threshold levels. On the other hand, fetal doses from radiation therapy for treatment of maternal cancers depend largely on gestational age and distance of fetus from the treatment field. Treatment of cancers in head and neck or extremities is relatively safe, while that of pelvic organs, such as cervical cancer, is not compatible with pregnancy. It is important to note that the “threshold” doses were calculated based on observational data and therefore should be used with careful considerations in individual clinical scenarios. Ultimately, it is the frank discussion between the pregnant mother and her family with the entire medical team, including her oncologist, the obstetrician, the neonatologist, the psychologist, and the social worker, that will lead to the best individualized management plan.

Gaps in Pre-rituximab Hepatitis B Screening

The aim of the study was to evaluate the pretreatment workup of patients referred to our tertiary care center with low-grade lymphoma for compliance with National Comprehensive Cancer Network guidelines. This was a retrospective chart review. The study included all new patients with low-grade lymphoma who were diagnosed and treated at our center from January 1, 2005, to December 30, 2011. All the major facets of pretreatment workup were examined, including bone marrow biopsy, lactate dehydrogenase, hepatitis B screening, performance status of the patient, and diagnostic radiological studies. A total of 53 new patients were identified, of whom 36 (68%) had pretreatment workup and treatment at our center. The median age at diagnosis was 67. Fifty-four percent of the patients had bone marrow biopsy done. Radiological diagnostic studies were conducted in 97% of the patients. Hepatitis B screening was done in 19% of the total patients and 25% of the patients who received rituximab. Lactate dehydrogenase levels were checked in 72% of the patients. A significant deviation from the National Comprehensive Cancer Network guidelines for low-grade lymphoma pretreatment workup was observed for hepatitis B screening. Measures to ensure that patients have hepatitis B screening before rituximab were implemented. Studies such as these help to improve patient care.

Pain management following major intracranial surgery in pediatric patients: a prospective cohort study in three academic children's hospitals.

Pain management following major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect postoperative outcome and interfere with the neurologic examination. Nevertheless, evidence in adults is accumulating that these patients suffer moderate to severe pain, and this pain is often under-treated. The purpose of this prospective, clinical observational cohort study was to assess the incidence of pain, prescribed analgesics, methods of analgesic delivery, and patient/parent satisfaction in pediatric patients undergoing cranial surgery at three major university children's hospitals. After obtaining IRB and parental consent (and when applicable, patient assent), children who underwent cranial surgery for cancer, epilepsy, vascular malformations, and craniofacial reconstruction were studied. Neither intraoperative anesthetic management nor postoperative pain management was standardized, but were based on institutional routine. Patients were evaluated daily by a study investigator and by chart review for pain scores using age appropriate, validated tools (FLACC, Faces Pain Scale-Revised, Wong-Baker Faces Scale or Self-Report on a 0-10 scale), for patient/parent satisfaction using a subset of the NRC Picker satisfaction tool and in adolescents a modified QoR-40, and for the frequency, mode of administration, and type of analgesic provided. Finally, the incidence of opioid-induced side effects, specifically nausea, vomiting, pruritus, altered level of consciousness, and need for emergency diagnostic radiologic studies for altered neurologic examination were recorded. Data are provided as mean ± SD. Two hundred children (98:102 M:F), averaging 7.8 ± 5.8 years old (range 2 months-18.5 years) and 32.2 ± 23.0 kg (range 4.5-111.6 kg) undergoing craniectomy (51), craniotomy (96), and craniofacial reconstruction (53) were studied. Despite considerable variation in mode and route of analgesic administration, there were no differences in average pain score, length of hospital stay, or parental satisfaction with care. Interestingly, opioid-induced side effects were not related to total daily opioid consumption, site of surgery, or method of opioid delivery. The most common side effect was vomiting. No patient developed respiratory depression or altered mental status secondary to analgesic therapy. Regardless of age or procedure, once eating, most patients were treated with oral oxycodone and/or acetaminophen. Despite considerable variation in modality and route of analgesic administration, there were no differences in average pain score, length of stay, or parental satisfaction with care. Pain scores were low, side effects were minimal, and parental satisfaction was high, providing equipoise for future blinded prospective randomized trials in this patient population.

Radiation exposure from diagnostic procedures following allogeneic stem cell transplantation – How much is acceptable?

BackgroundFrequent diagnostic radiology procedures in allogeneic stem cell transplantation (SCT) recipients raise concern about the potential harm from incidental radiation.ObjectivesTo determine the cumulative radiation dose from diagnostic studies in allogeneic SCT and its impact on clinical outcome.Patients and methodsThis retrospective cohort study was conducted to determine the cumulative radiation dose from diagnostic studies following SCT. Sixty-four consecutive patients with hematological malignancies in a single tertiary care institution underwent total body irradiation (TBI)-based myeloablative conditioning followed by six of six human leukocyte antigen (HLA)-identical sibling allogeneic SCT. The median follow-up was 3 years. The cumulative effective dose in mSv from diagnostic radiological studies in the peri-transplant period from day −30 to day +200 was calculated for each patient and its impact on overall survival and non-relapse mortality was determined.ResultsThe median cumulative radiation exposure from diagnostic radiological procedures was 92 mSv (range 1.2–300), representing about 30× the normal annual background radiation for the population and 10% of the 1200 cGy TBI dose used in conditioning. Sixty-five percent of the cumulative radiation exposure was delivered between day +1 and day 100 and computed tomography scans contributed 88%. In multivariate analysis, diagnostic procedures did not significantly impact clinical outcomes.ConclusionsWhile radiation exposure from diagnostic procedures did not impact clinical outcomes the risk of secondary cancers in long-term survivors is likely to be increased. Our results indicate that patients who are acutely ill for prolonged periods can receive clinically significant radiation doses during their hospital care. Our findings should prompt attempts to limit radiation exposure from diagnostic procedures in post-SCT recipients

Automated determination of metastases in unstructured radiology reports for eligibility screening in oncology clinical trials.

Enrolling adequate numbers of patients that meet protocol eligibility criteria in a timely manner is critical, yet clinical trial accrual continues to be problematic. One approach to meet these accrual challenges is to utilize technology to automatically screen patients for clinical trial eligibility. This manuscript reports on the evaluation of different automated approaches to determine the metastatic status from unstructured radiology reports using the Clinical Trials Eligibility Database Integrated System (CTED). The study sample included all patients (N = 5,523) with radiologic diagnostic studies (N = 10,492) completed in a two-week period. Eight search algorithms (queries) within CTED were developed and applied to radiology reports. The performance of each algorithm was compared to a reference standard which consisted of a physician's review of the radiology reports. Sensitivity, specificity, positive, and negative predicted values were calculated for each algorithm. The number of patients identified by each algorithm varied from 187 to 330 and the number of true positive cases confirmed by physician review ranged from 171 to 199 across the algorithms. The best performing algorithm had sensitivity 94%, specificity 100%, positive predictive value 90%, negative predictive value 100%, and accuracy of 99%. Our evaluation process identified the optimal method for rapid identification of patients with metastatic disease through automated screening of unstructured radiology reports. The methods developed using the CTED system could be readily implemented at other institutions to enhance the efficiency of research staff in the clinical trials eligibility screening process.

The impact of early diagnostic laparoscopy on the prognosis of patients with suspected acute mesenteric ischemia.

To assess the impact of early diagnostic laparoscopy in patients with suspected acute mesenteric ischemia in whom other diagnostic studies are inconclusive or unavailable. The medical records of patients who underwent diagnostic laparoscopy with a preoperative diagnosis of acute mesenteric ischemia between January 2008 and January 2012 were reviewed. The patients who had a preoperative diagnosis of acute mesenteric ischemia based on computed tomography or angiography were excluded. Outcome variables were the time between admission and diagnostic laparoscopy, overall revascularization rate, successful revascularization rate, and in-hospital mortality rate. Fifty-three patients were included in the study. Twelve patients (22.6%) had negative diagnostic laparoscopy. In 43 patients (77.4%) who were found to have acute mesenteric ischemia at diagnostic laparoscopy, the mean time between admission and diagnostic laparoscopy, overall revascularization rate, successful revascularization rate, and in-hospital mortality rate were 10.2h, 32.5%, 13.9%, and 74.4%, respectively. The mean time between admission and diagnostic laparoscopy was significantly shorter in patients who underwent successful revascularization, and in those who survived with or without developing short bowel syndrome. Diagnostic laparoscopy is a safe and reliable diagnostic tool that can have a positive impact on the prognosis of patients with suspected acute mesenteric ischemia if carried out in a timely manner when radiological diagnostic studies are inconclusive or unavailable.

Streamlining the Receipt and Upload of Diagnostic Images in a Clinic Setting

Neurosurgeons, like most surgeons, require clinical information to perform patient assessments in an ambulatory care clinic setting. Information such as referral notes, radiologic diagnostic studies (digital or film), and clinical reports is critical in determining the type of treatment a patient may require. Technology has advanced from hard films that can be read on any light box to multiple images saved on compact discs (CDs). The advantage of storing images on CDs is their portability and ability to store detailed scans that hard x-ray films cannot provide.