Medical Imaging Department Research Articles

Sociodemographic and Scanographic Aspects of Primary Bronchopulmonary Cancer in a Hospital in Mali

Summary: A malignant tumour that develops from the bronchial epithelium and then invades the lungs. It ranks third after colorectal and breast cancer. In Mali, computed tomography (CT) is the main imaging tool used at all stages of treatment. We had initiated this study with the objective of specifying the place of CT in the diagnosis of primary bronchopulmonary cancer at the hospital of Mali. Method: This is a prospective and descriptive study conducted by the Medical Imaging and Thoracic Surgery departments at Mali Hospital from March 2014 to February 2015. All the patients who have benefited from a CT scan and presenting at least one histologically confirmed bronchopulmonary tumor were included. Results: We were recruiting 60 patients with bronchopulmonary cancers out of 500 referred for a thoracic CT scan performed, a frequency of 12%. There was one male patient with a sex ratio of 4H/1F. The average age was 60 years. The history of smoking was 85%. The symptoms were dominated by general condition (63.33%), cough (25%) and haemoptysis (58.33%). CT scans were performed in all patients. The lesions were located more in the lower lobes (71%). The tumours were: heterogeneous tissue density (70%), spiculated contours (80%), and the histology was more non-small cell carcinoma. Conclusion: The incidence of bronchopulmonary cancer is very high and its prognosis is poor at an advanced stage. The evaluative role of CT and biopsy guidance has given it a place of choice in its management. The diagnosis of certainty remains histology.

Acute Intestinal Invagination of the Child at the Teaching Hospital of Bouaké: Ultrasound Diagnosis and Clinical-Echo-Surgical Correlation

Background: Acute intestinal invagination or intussusception is the most common abdominal surgical emergency in infants, but it can occur at any age. Performing an ultrasound scan at the slightest clinical suspicion contributes to early diagnosis and therapeutic management. Objective: To show the relevance of ultrasound in the therapeutic management of the child’s intussusception through a correlation between the ultrasound diagnosis and the clinical and/or per operative diagnosis. Patients and Methods: It was a retrospective study of 24 cases from July 2017 to September 2020 (30 months) in the Medical Imaging and Paediatric Surgery departments of Teaching Hospital of Bouake. We included only patients from 0 to 15 years old who had digestive symptoms, an abdominal ultrasound scan. These patients were eligible for surgery. Data analysis was performed with Epi info 7 software. Results: Median age was 17.2 months [02 - 120]. Male gender predominated (83.3%). Clinico-biological data were dominated by abdominal pain (79.2%), vomiting (75%) and rectorragies (33.3%), with Ombredanne’s triad in 33.3% and hyperleukocytosis (70.8%). Ultrasonography showed invaginated coves (95.8%) sitting in the right angl iliac fossa, peri-umbilical and right flank in 73.9%. Cockade image coupled with the sandwich image accounted for 95.6%. Superficial adenopathies (45.8%) and peri-lesional fluid effusion (20.8%) were associated with it. An occlusive syndrome complicating intussusception was observed in 41.67% associated with intra-peritoneal effusion of fluid (25%). There was a significant diagnostic agreement between the clinic, ultrasound and surgery according to the Fisher’s exact test (p = 0.002). That between ultrasound and surgery was calculated at 95.4%. Conclusion: This study allowed us to show a good clinical-echo-surgical concordance. Ultrasound is therefore an undeniable diagnostic, prognostic and therapeutic tool in the exploration of intussusception, hence the interest of its prescription in the shortest possible time by the clinician.

Uro-Scanner Aspects of Bladder Tumours at the Mali Hospital about 17 Cases

Introduction: Bladder tumours are frequent, have a poor prognosis and are the second most common genitourinary tumour in men. In Mali, recent statistical data on the prevalence of bladder tumours show a progression with 6.71% in 2006. The euro scanner is used in the diagnostic workup. The work was initiated in order to specify the role of the scanner in the diagnosis of these tumors. Patients and Methods: Prospective descriptive study was carried out in the medical imaging department of Mali Hospital from February to November 2018. Were included any patient with a bladder tumour on euro scanner. The patients had benefited from a preliminary preparation and a renal biological assessment in order to eliminate renal insufficiency. Our examinations were performed with a Siemens 16-slice scanner. These were axial slices performed without, with iodine injection from the pulmonary base to the pubic bones. Results: We had collected 17 patients out of 541 scans i.e. a frequency of 3.76%. The age range of 21 to 40 years was 58.8% with an average age of 25 years. The antecedents (ATCD) found were urinary bilharzia (47%) and smoking (17%). The clinic was dominated by haematuria. It was associated with a bladder mass (52%) and dysuria (23.52%). The CT scan showed a budding appearance, a size greater than 3 cm (82%), infiltration of peri-vesical fat (47.05%), and adenopathy (94%). Associated lesions were: utero-hydronephrosis (58.82%) and metastases (bone and liver in 11.76% of cases each). Conclusion: They are frequent and the history of urinary bilharziasis remains the main risk factor in endemic countries. CT scans are essential in the management of this disease. The diagnosis of certainty remains histology.

Ultrasound Diameter of the Portal Vein to Healthy Adult in Parakou (Benin)

Introduction: The portal vein (PVD) diameter is one of the predictive variables of portal hypertension. This diameter can differ according to the population. The objective of this study was to determine the PVD in a healthy adult population in Parakou using ultrasonography. Methods: A cross-sectional descriptive study was conducted in the medical imaging department of the Borgou and Alibori University-affiliated Hospitals in Parakou from July 1st to October 1st, 2019. The study population consisted of 201 healthy adults. The ultrasound diameter of the portal vein was measured at the level of the hepatic hilum on a cross-sectional epigastric view and on an oblique intercostal view. An association was sought between the PVD and sociodemographic and anthropometric factors. Results: The mean age was 28.97 ± 10.56 years and the sex ratio (M/F) was 0.79. The mean PVD in regular breathing (FB) was 9.83 ± 0.95 mm with a 95% confidence interval of [9.70; 9.97], a 95th percentile of 11.49 mm with extremes of 7.50 mm and 12.23 mm. PVD was correlated with age, sex, weight, height and abdominal girth. After multiple linear regressions (r = 0.19), there was correlation between the PVD in normal breathing with age (p = 0.0090), weight (p = 0.0026), body mass index (p = 0.0171) and body surface (p = 0.004). Conclusion: A PVD greater in normal adults is less than 12 mm and seems to be correlated to the subject age, weight, body mass index and body surface. A more than 13 mm PVD should lead to the suspicion of portal vein hypertension in adults in our populations.

Rates and reasons for safety incident reporting in the medical imaging department of a large academic health sciences centre

BackgroundSafety incident reporting is essential in medical imaging (MI) departments due to the fast-paced environment and high patient volume. However, there is an evident knowledge gap in the identification and investigation of contributing factors to incidents reports in MI departments. The objective of this study was to investigate the following rates of incident reporting in a MI department at a large academic health sciences centre: departmental incident rate, incident rates per imaging modality, and incident rates per incident type. Characteristics associated with the most frequently occurring incident types were examined to identify opportunities for quality improvement. MethodsThis observational, retrospective study collected approximately 665 MI incident reports submitted by staff between July 2018 and July 2019. Individual incident reports were categorized according to imaging modality and incident type. Subcategories of the top four incident types were also created to identify possible contributory factors based on the staff member's safety incident report submission. ResultsThe safety incident rate for the entire medical imaging department was 0.263%. The safety incident reporting rate was calculated (# of incidents reported per modality total/ # of completed exams in that modality x 100%) for each modality and varied from 0.113 to 1.26%. The four highest safety incident rates were from adverse drug reaction (ADR) (21.5%), followed by delay in care/treatment (18.9%), identification/documentation/order (18.5%) and extravasation (11.4%). Possible contributory factors involved transfer of accountability (TOA)/communication barriers, and incorrect ordering information. Further analysis was also completed to assess whether patients that experienced an ADR or extravasation incident followed the correct protocols. DiscussionThis study demonstrated the importance of how analysis of incident report data can be used to uncover opportunities for quality improvement in the medical imaging department. However, more information must be collected at the time of safety incident report submission to allow for quality improvement. Investigators hope that by future standardization of safety incident reporting, with the increased use of drop-down menus to capture more open-ended responses, corrective strategies can be implemented to address safety concerns in MI departments. In comparison to incident reporting rates published in similar studies, there may be a significant underrepresentation of safety incident reports filed from underreporting. Reducing barriers to reporting is essential in improving the effectiveness of the current safety incident reporting system.

Investigation of RIS/PACS Information Systems’ Incorporation in Greek Public Hospitals

Purpose: The objective of this study is to assess the current level of Radiological Information Systems (RIS) and Picture Archiving and Communication Systems (PACS) incorporation in greek public hospitals through a national web-based survey. Since there are no previous studies on this field of medical imaging management in Greece, we look forward to export useful conclusions about RIS/PACS incorporation and set the foundation for further investigation.
 Material and Methods: A comprehensive measurement instrument that integrates the existing theoretical and empirical literature knowledge on Information Systems (IS) evaluation was properly modified and used for the purpose of this study. A web-based survey was conducted via Google Form questionnaire, which was distributed to the entire population of radiologists and radiologic technologists (potential users) of all greek public hospitals (urban and rural), in order to identify the availability of RIS/PACS Information Systems (IS), the level of incorporation through system’s impact on users satisfaction and their operating capacities (i.e. computerized activities and processes).
 Results: A total of 49 valid responses out of 77 collected questionnaires were received from all 124 greek public hospitals, which represents a response rate of 39.5%. Our very first findings indicate that establishment of RIS/PACS has not been fulfilled so far for the vast majority of greek public hospitals. Almost half of the participants (51%) responded that they use only the capabilities of PACS as a repository for medical images, instead of implementing all capabilities of RIS. Also, although 85.7% of the participants responded that they use disc publisher for medical imaging exams copies, only 6.1% responded that has gone totally filmless or paperless. 59.2% of the respondents has access to 5 or more workstations and 100% of the respondents agrees that ER and clinics should connect on hospital's RIS/PACS for viewing medical images, receiving electronic reports and updating patients' electronic files. Overall findings from statistical techniques demonstrate a statistically significant difference in perceived information (p-value=0.021) and service quality (p-value=0.036) with age of respondents. Finally, open feedback answers indicate that greek public hospitals have still many to set to successfully incorporate and exploit the wide range of RIS/PACS capabilities to improve quality, effectiveness and efficiency of patient care services.
 Discussions: Although, most of the respondents have an adequate level in the operation of information systems, lack of RIS/PACS usage training is noted, as well as users’ support from their own organization IT staff. Also, structural deficiencies worry system’s users, making them intolerant to adopting the system in daily practice. The recommendations of this study include RIS/PACS incorporation in every medical imaging department of greek hospitals, users training and support, as well as updating infrastructures where needed.

Recognizing the Role of the Reticuloendothelial System in the Late Phase of US Contrast Agents.

Recognizing the Role of the Reticuloendothelial System in the Late Phase of US Contrast Agents.

Medical imaging community outreach program: lesson to students and impact to the community.

The community outreach program is one of the main activities of the University of Rwanda, and both staff and students get involved in this tremendous initiative to serve the community free of charge. The main objectives of this community engagement activity were to raise awareness of medical imaging services and abdominal ultrasound screening. The project proposal was planned by the Medical Imaging Department, University of Rwanda College of Medicine and Health Sciences, Remera Campus. It took place at Kigali's main car park. Two ultrasound machines were used, and screening was done by students under supervision of registered sonographers. A cross-sectional design with random sampling was employed, and SPSS version 21 was used for data analysis. Statistical techniques were used to calculate inter-observer reliability by comparing patient complaints and sonographic diagnosis. Herein we report the first medical imaging community outreach, on which 86 patients received ultrasound abdominal scans free of charge. Of these, 33 (38.5%) were male and 53 (61.5%) were female. Their ages varied from 20 to 76years, with a mean age of 48. The screened organs included the liver, gall bladder, pancreas, spleen, kidneys, urinary bladder, prostate, uterus and ovaries, and abnormalities were identified in different organs. The results showed a high degree of reliability between what was presented by the patients and measurements found after diagnosis by the sonographer. The average measure of the intraclass correlation coefficient was 0.973, with 95% confidence intervals ranging from 0.959 to 0.983 (F (85,85) = 37.537, p < 0.001). This experience was beneficial to the Medical Imaging Sciences Department staff and students, as well as to the Society of Medical Imaging and Radiation in Rwanda. The results showed that this outreach was also very positive for the community at large.

A clinical audit of anatomical side marker use in a pediatric medical imaging department: A quantitative and qualitative investigation.

BackgroundThe presence of a radiopaque or digital anatomical side marker (ASM) is an important diagnostic feature on radiographs and should be a routine feature on every radiographic image. Despite its importance, research has indicated numerous instances where ASMs were absent which have the potential to lead to adverse events. To date, few studies have systematically examined the use of ASMs in clinical practice and explored medical imaging professionals’ perspectives on ASM use. This research aimed to address this knowledge gap.MethodsThis investigation was conducted in two stages. Stage 1 involved a retrospective clinical audit of 421 randomly selected radiographs within 12-months at a pediatric medical imaging department. The data were analyzed for overall presence and type of marker use. Stage 2 comprised of semi-structured interviews with 11 radiographers to garner their perspectives on ASM use, and barriers and enablers to their use in clinical practice. The interviews were transcribed verbatim and thematically analyzed.ResultsThe overall presence of ASMs (radiopaque and digital) was observed on 99 per cent of radiographs. There was a noticeable shift towards the use of digital (78.8 per cent) compared to radiopaque ASMs (20.2 per cent), highlighting the growing trend towards using ASM in post-processing. A handful of images (N = 4) did not include any ASMs. Semi-structured interviews revealed multifaceted barriers (time, infection precautions, and patient factors) and few enablers (professionalism, legal requirement) for ASM use.ConclusionThis investigation, informed by quantitative and qualitative research paradigms, has shed new light on an important area of radiography practice. While missing ASMs were a small feature, there continue to remain opportunities where best practice standards can be improved. The increasing use of digital ASMs potentially highlights a shift in clinical practice standards.

Exploration of infection Control in Medical Imaging Department during Novel Coronavirus's Period

Exploration of infection Control in Medical Imaging Department during Novel Coronavirus's Period

Invited Commentary: FIGO Staging Classification for Cervical Cancer-Behold the Big Picture.

Invited Commentary: FIGO Staging Classification for Cervical Cancer-Behold the Big Picture.

Surgeon-performed ultrasound in a head and neck surgical oncology clinic: saving time and improving patient care.

Surgeon-performed ultrasound (SUS) for head and neck masses is increasingly being performed by head and neck surgeons. This is the first study assessing its impact in a head and neck surgical oncology clinic, examining the effect on various parameters. Retrospective analysis was conducted on a database, analysing and comparing all new patients reviewed 6months prior to (pre-SUS group) and 6months following (post-SUS group) the introduction of SUS to the outpatient head and neck surgical oncology clinic. The numbers of radiology imaging investigations (ordered through a medical imaging department), fine-needle aspirations (FNAs) performed, clinical appointments and time to definitive treatment decision were analysed and compared. A total of 365 patients were included: 169 in the pre-SUS group and 196 in the post-SUS group. There was a statistically significant difference in the number of total radiological imaging investigations performed (1.60 vs. 0.70, p < 0.00001), radiologist-performed FNAs (0.24 vs. 0.10, p = 0.0234), time for definitive treatment decision being made (16.4days vs. 11.6days, p = 0.04338), and number of clinical encounters (3.03 vs. 2.29, p < 0.00001). No statistically significant difference was observed in the number of head and neck surgical oncology clinic appointments (1.70 vs. 1.66, p = 0.6672). Surgeon-performed ultrasound reduces the number of radiological imaging investigations and FNAs performed, reduces time for definitive treatment decision being made, and reduces the number of clinical encounters for patients. This supports its use in head and neck cancer setting and has important implications for both patients and the health-care system.

The Diagnostic Efficacy of MRI Dedicated-Epilepsy Protocol in Evaluation of Seizures

Aims: The aims of this study were to identify the diagnostic efficacy of dedicated epilepsy protocol in detecting possible structural abnormalities that underlie seizure disorders, and compare the diagnostic yields of MRI and electroencephalogram individually and in combination.&#x0D; Study Design: This was a cross-sectional analytic study.&#x0D; Place and Duration of Study: Medical Imaging and Diagnostic Radiology Department at Tishreen University Hospital, Lattakia, Syria; between July 2019 and July 2020.&#x0D; Methodology: Our study included 100 cases (58 females, 41 males, age range 13-77 years) who presented with seizure over 18 months. Patients underwent complete neurological examination, EEG, and MRI with a standard and dedicated epilepsy protocol.&#x0D; Results: We found epileptogenic lesions in MRI in 55.5%. MRI detected epileptogenic lesions in 74.5% patients who had focal onset seizures. Mesial temporal lobe sclerosis was the most common epileptogenic lesion (45.5%). The diagnostic efficacy of MRI had increased with dedicated epilepsy protocol compared to standard protocol. Abnormal MRI and EEG were compatible in 21%.&#x0D; Conclusion: Dedicated epilepsy protocol increased the diagnostic efficacy of brain MRI in detecting a structural epileptogenic lesion, with 100% of mesial temporal sclerosis, the most common lesion in our study, was detected only in dedicated epilepsy protocol and missed in standard protocol.

COVID‐19 Pandemic – considerations and challenges for the management of medical imaging departments in Queensland

The purpose of this commentary was to outline several key considerations and challenges for medical imaging departments during a global pandemic. Five public hospital medical imaging departments were identified in South‐East Queensland, Australia, to provide insight into their response to the COVID‐19 pandemic. Common themes were identified, with the four considered most pertinent documented in this commentary. Similar operational considerations and challenges were identified amongst all sites. This commentary intends to serve as a starting point for medical imaging departments in considering the planning and implementation of services in a pandemic scenario.

Examination of the Practicability of Brain Atlas Technique in Patients with Intracranial Space-Occupying Lesions

Marianna Nagy*1, Csaba Aranyi2, Gábor Opposits2, Levente Lánczi1, Tamás Papp1, Mária Kern1, Tamás Spisák3, Ervin Berényi1 and Miklós Emri2 Author Affiliations 1Department of Medical Imaging, Division of Radiology and Imaging Science, Hungary 2Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Hungary 3Department of Neurology, Essen, Germany Received: August 13, 2020 | Published: August 21, 2020 Corresponding author: Marianna Nagy, Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of Medicine, 4032 Debrecen, Nagyerdei krt 98, Hungary DOI: 10.26717/BJSTR.2020.29.004842

Peripherally Inserted Central Catheters (PICCs) at the Bedside by X-ray Technologists: A Review of Our Experience

IntroductionPeripherally inserted central catheters, also known as PICC lines, are very common procedures for patients in the hospital who need to have long-term intravenous access, for various reasons such as antibiotics or total parenteral nutrition. At our institution, there is currently only one interventional radiology (IR) suite in our department to accommodate all IR procedures. Therefore, the bedside PICC program was introduced to help alleviate the workload in the IR suite and to improve overall patient care. Under the supervision of the hospital's interventional radiologists, trained x-ray technologists (medical radiation technologists [MRTs]) are inserting PICCs at the bedside. The purpose of this article is to describe the creation of a bedside PICC program by x-ray technologists in a hospital setting and to analyze the PICC insertions performed by MRTs over a six-year period. MethodsIn 2012, a bedside PICC insertion program was developed at our hospital, whereby two technologists would perform the procedure, using the Site-Rite® 8 Ultrasound System alongside the integrated Sherlock 3CG™ Diamond Tip Confirmation System. Training on these systems and procedural techniques, including venipuncture, sterile technique, and equipment knowledge and troubleshooting was provided for technologists. The point-of-care program was revamped in 2017 in that only one technologist would go to the bedside alone for PICC insertions. All data for the analyses were obtained from the Radiology Information System program used by our medical imaging department, called Coral RIS/PACS. ResultsOwing to staffing issues and inconsistent scheduling, an overview of yearly volumes of bedside PICCs performed increased from 45 in 2012 to 486 in 2018. After program changes made in 2017, these changes yielded a total volume of 382 of bedside PICCs performed, and an even more remarkable amount of 486 in 2018. For these two latter years, an evaluation of the program was carried out by analyzing how many bedside PICCs were performed successfully by the solo technologist. Overall success was achieved for both years: in 2017, 82% of the cases were performed by the technologist alone without any assistance, and likewise 89% in 2018. ConclusionSince the onset of this process improvement initiative, the bedside PICC program by MRTs under the supervision of the interventional radiologists at our institution has benefited many patients and the hospital as a whole. It was apparent during the development of the program that consistent scheduling of trained and dedicated MRTs to do these bedside procedures on a regular basis improved the efficiency of the program.

Assessment of Radiation Protection Practices in Abbas Institute of Medical Sciences Muzaffrabad

Background/objective: There is a substantial need for radiographers to improve their awareness of radiation protection issues and their knowledge of radiological procedures. Specific actions such as regular training courses for both undergraduate and postgraduate students as well as for working radiographers must be considered in order to assure patient safety during radiological examinations. The study aimed to assess the knowledge, attitude and practices of radiology department workers towards radiation protection. Methodology: This descriptive study was carried out in the Department of Radiology and Medical Imaging, Abbas Institute of Medical Sciences (AIMS) Muzaffarabad, Azad Jammu and Kashmir (AJK) from a period of August 2016 to January 2017. The calculated sample size was 29 and all the staff members and students who worked in the Radiology Department were included in the study following the inclusion and exclusion criteria. A radiation protection practice was assessed by observing the availability of all radiation protection kits. Results: There were only 5 (17%) study subjects, trained and having diploma in radiology in radiology while 83% of study subjects were non-technical and untrained although educated in various science and arts qualification. Among all the study participants, 53% showed positive responses about their knowledge, attitude and practices regarding radiology procedures. Conclusion: There is a substantial need for radiology department workers to improve their awareness of radiation protection issues and their knowledge of radiological procedures.

Editorial Comment.

No AccessJournal of UrologyAdult Urology1 May 2020Editorial CommentThis article comments on the following:Comparison of Initial Experience with Transrectal Magnetic Resonance Imaging Cognitive Guided Micro-Ultrasound Biopsies versus Established Transperineal Robotic Ultrasound Magnetic Resonance Imaging Fusion Biopsies for Prostate Cancer Sangeet Ghai Sangeet GhaiSangeet Ghai Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital – Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000692.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 203(5), pp. 923–924

Application of Standardized Measures in Clinical Teaching of Medical Imaging Department

Objective: To explore the application of standardized measures in clinical teaching of medical imaging department. Methods: Forty-eight medical interns in Department of Medical Imaging of our hospital from February 2018 to May 2019 were selected as research objects. They were divided into 2 groups according to random number table method, with 24 cases in each group. Routine education management was performed in clinical teaching for control group, standardized measure management was performed in clinical teaching for observational group. Performance assessment before and after intervention was compared between two groups of medical students. Results: Before intervention, there was no significant difference in assessment result between two groups of medical students (P&gt;0.05). Assessment result after intervention was higher than before intervention in two groups of medical students. Observational group was higher than control group, the difference was statistically significant (P&lt;0.05). Conclusions: Implementation of standardized measures in clinical teaching of medical imaging department could significantly improve assessment result of medical students, and its application can be considered in clinical teaching.

Clinical predictors of significant intracranial computed tomography scan findings in adults experiencing headache disorder.

IntroductionRadiological assessments for adult headache disorder show significant intracranial findings in 2.5% to 10% of performed computed tomography scans (CT-scans), leading to an overuse consideration for CT-scan requests by physicians in headache-experiencing patients. Therefore, we undertook this study in order to determine predictors of significant intracranial CT-scan findings in adults experiencing headache disorder; in order to help physicians better select patients who need imaging, which would subsequently decrease the costs of headache disorder management and the useless irradiation rates.MethodsWe carried out a cross-sectional study in the medical imaging departments of Yaounde Central Hospital and Douala Laquintinie Hospital, which are two teaching hospitals in Cameroon, over a period of five months. We consecutively and non-exhaustively included all consenting patients aged eighteen years and above, referred to the radiology department to perform a head CT-scan as aetiological workup of headache disorder, from either a traumatic or non-traumatic mechanism. Patients having a known brain lesion and those with a Glasgow coma scale less than thirteen were excluded. The clinical history of patients was taken and a complete physical examination was performed. Demographic data, clinical characteristics of the headache, results of neurological and physical examinations were collected and correlated to the results of head CT-scan.ResultsWe enrolled 169 patients in the study, 56.2% were males, with a sex ratio of 1.3; sudden onset of headache increased by two the risk of discovering significant intracranial pathology (p = 0.032). Occipital and cervical location of headache, headache evolving by crisis, and recurrent paroxysmal headache were rather significantly correlated to no structural brain finding. An abnormal neurological examination with specifically abnormal stretch reflexes, aphasia, loss of consciousness, raised intracranial signs, weakness, and meningeal signs were predictive of structural intracranial pathology. Otorrhagia, epistaxis, and periorbital ecchymosis in addition were predictive in post-traumatic headaches.ConclusionAbnormal results from neurological examination are the best clinical parameters to predict structural intracranial pathology on CT-scan in adult patients experiencing headache disorder. In case of post-traumatic headaches, in addition, otorrhagia, epistaxis, and periorbital ecchymosis are too highly predictive.