Radiological Facilities Research Articles

Audit of computed tomography examinations from two selected radio-diagnostic centers in South-South Nigeria

Background: Despite the fact that the number of CT exams is small among all radiography investigations, a high amount of medical radiation exposure comes from CT application. Most developed nations have adopted regular audits to ensure optimization of ionizing radiations in the CT examinations, but on the contrary, it has infrequently been performed in developing countries like Nigeria. Objectives: This study was designed to carry out an audit of CT examinations at two selected diagnostic centers in the South-South region of Nigeria. Materials and methods: This study was a retrospective cross-sectional study conducted in two radiological facilities, which involved 210 tomographs of the chest, head, and abdomen, selected using a convenient method. The CT examinations were done using the departmental protocols and the generated data were analyzed statistically using descriptive statistics. Results: Head examination was the most commonly performed CT examination (56.7%), followed by abdominal 28.6 % and the least 14.8% was chest. The most common indication was a road traffic accident (RTA) 11.4%. The distribution of the type of CT machine that was used for the study showed that the Toshiba machine was used for most of the subjects 132 (62.9%) followed by Optima CT660 78 (37.1%). It was seen that 48.6% of the study used 0.75s, 40.5% used 0.5s, 10.5% used 0.35s and only 0.5% used 1s scan time. The effective doses were adult head (2.31±0.14), chest (4.65±0.21), abdominal (7.70±0.17), pediatric head (2.81±0.21), and pediatric chest (9.96±0.12). Conclusion: The carrying out of clinical audits is imperative to ensure both safeties of patients and diagnostic accuracy.

Occupational health and safety aspects in the handling of cryogenic materials in nuclear and radiological facilities

Cryogenic materials, widely used in industries and facilities associated with nuclear technology and science and radiological applications, pose occupational health and safety hazards owing to their unique properties. The major health hazards include cold burns, asphyxiation, hot burns, and major safety hazards are explosion, fire, and equipment failure. Risk assessment consistent with material safety data sheet and hazard analysis is essential to assess the potential dangers while using cryogenic materials. Safe handling of cryogenic materials in nuclear and radiological facilities requires special considerations to ensure the protection of personnel and the environment. Administrative measures such as access control, training, checklists, and engineering controls such as ventilation, gas detection systems, and purging techniques are applied to deal with cryogenic hazards. Many personal proactive equipments are available to protect users from cryogenic hazards. While some protective measures for cryogenic hazards could suffice for low radioactivity laboratories, additional personal protective equipments are required to protect workers from radiation exposure in workplaces with potentially significant radiation hazards. The formulation of preparedness plans for emergencies resulting from cryogenic hazards should essentially take into account the unique constraints and requirements of radiological facilities. Simultaneous occurrence of radiological and cryogenic emergencies presents complex challenges requiring special mitigative measures.

Estimation of Diagnostic Reference Level for Chest X- Ray Procedures in Some Radiological Facilities in Abuja Metropolis, Nigeria

Estimation of Diagnostic Reference Level for Chest X- Ray Procedures in Some Radiological Facilities in Abuja Metropolis, Nigeria

Assessment of Nuclear Security Risk Perception Considering Knowledge, Believe, and Attitude of Radioactive Source Operators at Nuclear and Radiological Facilities of Bangladesh

Assessment of Nuclear Security Risk Perception Considering Knowledge, Believe, and Attitude of Radioactive Source Operators at Nuclear and Radiological Facilities of Bangladesh

Effective physical protection system design and implementation at a radiological facility: an integrated and risk management approach

Abstract Lives are threatened whenever there is an act of theft or destruction against a nuclear and radiological facility thus, physical protection systems are effectively employed to prevent or mitigate loss of valuable assets. Health facilities that provide radiotherapy services have in their facility a temporary storage unit where disused radioactive sources 60Co, 137Cs and 192Ir are kept and this raises concerns for effective physical protection. An integrated physical protection System was considered to consolidate of all sub systems, sensors and elements related to protection system for an effectively secured environment at a radiological facility. Sequence adversary diagram (ASD) was developed to depict the paths that enemies can take to achieve sabotage or stealing objectives and analyze flews in the paths. The approach to this security system effectiveness focuses on using probabilistic statistical methods for risk evaluation considering detection, delays and response. This paper considers the basic and effective elements required for physical protection system for a radiological center and makes risk evaluation as an approach of security system effectiveness which can serve as fundamental guiding principle for decision makers in the establishment of an effective physical protection for a radiological center.

Ultra-high dose rate FLASH irradiator at the radiological research accelerator facility

The Radiological Research Accelerator Facility has modified a decommissioned Varian Clinac to deliver ultra-high dose rates: operating in 9 MeV electron mode (FLASH mode), samples can be irradiated at a Source-Surface Distance (SSD) of 20 cm at average dose rates of up to 600 Gy/s (3.3 Gy per 0.13 µs pulse, 180 pulses per second). In this mode multiple pulses are required for most irradiations. By modulating pulse repetition rate and irradiating at SSD = 171 cm, dose rates below 1 Gy/min can be achieved, allowing comparison of FLASH and conventional irradiations with the same beam. Operating in 6 MV photon mode, with the conversion target removed (SuperFLASH mode), samples are irradiated at higher dose rates (0.2–150 Gy per 5 µs pulse, 360 pulses per second) and most irradiations can be performed with a single very high dose rate pulse. In both modes we have seen the expected inverse relation between dose rate and irradiated area, with the highest dose rates obtained for beams with a FWHM of about 2 cm and ± 10% uniformity over 1 cm diameter. As an example of operation of the ultra-high dose rate FLASH irradiator, we present dose rate dependence of dicentric chromosome yields.

Hospital Characteristics Associated with the Availability of Interventional Radiology Facilities and Services.

HomeRadiologyVol. 307, No. 1 PreviousNext Original ResearchHealth Policy and PracticeHospital Characteristics Associated with the Availability of Interventional Radiology Facilities and ServicesTuna C. Hayirli , Chloe B. WarinnerTuna C. Hayirli , Chloe B. WarinnerAuthor AffiliationsFrom the Harvard Medical School, Avenue Louis Pasteur, Boston, MA 02115 (T.C.H.); Harvard Business School, Boston, Mass (T.C.H.); Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Mass (C.B.W.); and Massachusetts Eye and Ear, Boston, Mass (C.B.W.).Address correspondence to T.C.H. (email: [email protected]).Tuna C. Hayirli Chloe B. WarinnerPublished Online:Dec 6 2022https://doi.org/10.1148/radiol.221189MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractDownload as PowerPoint

ASSESSMENT THE SAFETY AND SECURITY REQUIREMENTS OF THE X-RAY CLINICS IN ALAZIZIA-WASTE

The two main parts of radiation are waves like sunlight, X-rays, and gamma rays, or small particles like beta and alpha particles. Medical X-rays are frequently utilized for diagnosing diseases and disorders including fractures and the state of vertebrae, joints, and other structures in the body. Excessive exposure to radiation (higher than 200 rems) causes radiation impacts burns are examples. Additionally, when administered at larger rates and doses acute radiation syndrome can be brought on by rapidly increasing the radiation dose, such as loss of hair, blistering redness, and ulceration of the skin. With a focus on healthcare workers who deal with ionizing radiation on the job, we evaluated the perception, knowledge, and mitigation of the hazards that are related to the radiological examinations in this work. For assessing their level of understanding of ionizing radiation, a questionnaire has been given to the technicians and other staff members who work in several X-ray clinics in Wasit's Aziziyah district. The results of a survey showing that the majority of radiography clinics are committed to safety and security measures. The majority of radiology clinics adhere to Iraqi Ministry of Health regulations. It was noted that there are just four clinics, which isn’t enough given the size of population. Furthermore, there were none of the specialist radiological facilities like fluoroscopy, CT, or mammography. Al-Azizia is unique in that it has a huge population, which raises the possibility that more people will need radiological testing. Thus, Iraqi Ministry of Health and Environment must concentrate on the radiological element by expanding the number of specialized radiological centers, as it is a crucial requirement for medical diagnosis and treatment. Keywords: X-Ray Protection; Diagnostic X-Ray Safety; X-Ray Clinic Shielding

Assessment of Whole-Body Occupational Radiation Exposure in a Gamma Irradiation Facility (2009-2018) in Abuja, Nigeria

Individuals working in both radiological and nuclear facilities are often exposed to sources of ionizing radiation resulting in some level of occupational hazards. Appropriate levels of radiation protection of workers are essential for the safe and justified use of radiation, radioactive material and nuclear energy. Occupational exposure to radiation workers in a Gamma Irradiation Facility has been analysed for a 10 year period between 2009 and 2018. The data from 2009-2018 were used to compute the average annual effective dose and the annual collective dose. The results show that the total deep dose, Hp (10), received by the radiation workers for the ten year period ranged between 10.21 mSv to 16.05 mSv with a mean of 13.97 mSv. It also showed that the average annual effective dose ranged between 0.65±0.04 mSv to 1.98±0.30 mSv with a mean of 1.51±0.42 mSv. The Collective dose ranged between 10.92 man.Sv to 33.66 man.Sv with a mean of 23.76±8.32 man.Sv. This shows that the risk due to radiation exposure of the workers is within the recommended and regulatory limits.

A practical guide to post-mortem selective cervical angiography in a regional institution.

When a cervicocerebral dissection syndrome (CDS) is amongst the potential causes of death, investigation of the arteries is required. Whilst the proximal common carotid arteries (CCA) are relatively easy to interrogate at post-mortem (PM), assessment of the vertebral arteries (VA) is more challenging. Post-mortem selective cervical angiography (PM-SCA) provides a method to visualise these arteries to replace or guide further dissection. Our institution does not have dedicated radiological facilities; we are reliant on availability in the general hospital of both equipment and staffing. In addition, there is an expectation of the release of the body within 24h. Therefore, our methods have to be time-efficient, flexible and suitable for available staff. The current paper aims to describe the indications for the procedure, the method as completed in our institution, imaging findings and problem solving.

Community-acquired pneumonia – use of chest x-rays for diagnosis in family practice

BackgroundAccording to guidelines, the diagnosis of pneumonia should be confirmed by chest x-ray, ensuring appropriate management and wise use of antibiotics. Our study aimed to describe use of x-rays by family doctors and patients following diagnosis of pneumonia in primary care practices in the north of Israel.MethodsThis was a retrospective database study including adults diagnosed with pneumonia, assessing rates of referral and actual use of chest x-rays. We examined rates of referral for chest x-rays and rates of adherence to the referral, according to age, gender, smoking status, comorbidities and distance of residence from the radiology facility.ResultsDuring one year there were 4,230 diagnosed cases of pneumonia in the practice, of which 2,503 were referred for chest x-rays, and 1,920 adhered to the referral (45% of those diagnosed with pneumonia). The rate of referral was higher when the radiology facility was located in the same city as the family doctor compared to outside the city (69.7% and 53.2%, p < 0.001). Patients aged 40–64 were referred more than patients aged 18–39 or 65+ (61.5% vs. 56.5% and 58.3%, p = 0.03). Actual use of chest x-rays (considering both referral and adherence) was more likely when the radiology facility was in the same health centre or city than when it was outside the city [OR = 2.4; 95% CI: 2.1–2.8]; patients aged 65 + or 40–64 were more likely to adhere to the referral for x-ray than those aged 18–39 [OR = 1.3; 95% CI: 1.1–1.6, OR = 1.2; 95% CI: 1.0–1.4, respectively].ConclusionAccessibility of radiology facilities seems to be an important factor associated with both doctors’ decisions and patients’ adherence to the referral for chest x-rays.

A survey on radiation protection awareness at various hospitals in Karachi, Pakistan

PurposeTo assess the awareness level of radiation protection among the radiation workers (i.e. medical radiation technologists, medical physicists, and medical radiological professionals) at the selected radiology, nuclear medicine, and radiotherapy facilities in Karachi, Pakistan. Material and methodsThis survey was carried out in Karachi which has the largest number of hospitals, including radiology, nuclear medicine, and radiotherapy facilities in all Pakistan. In this double-blind survey, a questionnaire was designed and distributed to one hundred and sixty five (165) medical radiation workers at their respective workplaces. These radiation workers included the medical radiation technologists, medical physicists, and medical radiological practitioners. These radiation workers had varying experiences, training records, education, and fields of specialization. Out of these total 165 respondents, 84 belonged to the radiology facilities, 20 to nuclear medicine facilities, and 61 to radiotherapy facilities. The educational level was classified as less than 16 years, and equal to or greater than 16 years. Similarly, the training was classified as “attended” or “never attended” and the experience as less than five years, between 5 and 10 years, and greater than ten years. The data was processed through SPSS (v.20) against a significance level (P ≤ 0.05). ResultsThe statistical analysis of the survey indicates that the radiation workers in radiology, nuclear medicine, and radiotherapy facilities in Karachi have limited awareness of radiation protection issues. The overall outcome of the survey also concluded that the awareness regarding radiation effects, radiation warning signs, and annual dose limit is optimum. However, the response to the questions related to patient protection remained unsatisfactory. ConclusionThis study showed that most of the radiation workers who participated in the survey lacked appropriate awareness of radiation protection measures. The radiation workers did show a better understanding of basic radiation protection parameters, such as the annual dose limit and radiation effects. However, the radiation workers needed an overall improvement in radiation protection awareness, particularly, related to patient protection. This awareness and knowledge should be improved through systematic and periodic trainings.

Chest X-Ray ESD and ESAK Assessment in A Few Diagnostic Radiological Facilities in Delta State

Background: The utilization of X-rays in medical procedures has sparked apprehension regarding their potential adverse consequences, despite their undeniable advantages in the realms of diagnosis and therapy. The present study aimed to evaluate the levels of Entrance Skin Dose (ESD) and Entrance Skin Air Kerma (ESAK) associated with chest X-ray examinations conducted in diagnostic radiological facilities located within Delta State. The present study employed a standardized approach to describe the materials and methods used in the research. The dose assessment was performed on a sample of 700 patients who were 18 years of age or older. These patients were selected from 10 operational facilities located throughout the State. The findings of the study are as follows: The effective dose (ESD), ascertained through the utilization of patient anatomical data and exposure parameters, fell within the recommended reference dose limits of 1 mGy (National Nuclear Regulatory Agency) and 0.4 mGy (International Atomic Energy Agency) for the majority of healthcare facilities. Nevertheless, certain centers demonstrated elevated dose levels, which can be attributed to factors such as increased exposure rates, aging x-ray tubes, and inadequate technician competency. The effective dose values (ESD) exhibited a range of 0.018 to 1.671 mGy for males and 0.084 to 1.542 mGy for females. The range of Entrance Skin Air Kerma (ESAK) values for males was found to be between 0.019 and 0.085 mGy, while for females it ranged from 0.016 to 0.098 mGy. These values were observed to be within the recommended dose limits. In conclusion, this study emphasizes the significance of surveillance of radiation exposure and the implementation of quality assurance protocols in order to safeguard patient well-being and mitigate potential hazards linked to chest X-ray procedures conducted in diagnostic radiological establishments.

Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation on the Basis of Risk for Recall

PurposeThe aim of this study was to develop a prioritization strategy for scheduling immediate screening mammographic interpretation and possible diagnostic evaluation. MethodsA population-based cohort with screening mammograms performed from 2012 to 2020 at 126 radiology facilities from 7 Breast Cancer Surveillance Consortium registries was identified. Classification trees identified combinations of clinical history (age, BI-RADS® density, time since prior mammogram, history of false-positive recall or biopsy result), screening modality (digital mammography, digital breast tomosynthesis), and facility characteristics (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 considered high and ≥16/100 very high. An efficiency ratio was estimated as the percentage of recalls divided by the percentage of mammograms. ResultsThe study cohort included 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The most important predictor of recall was time since prior mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening modality. Recall rates were very high for baseline mammograms (21.3/100; 95% confidence interval, 19.7-23.0) and high for women with ≥5 years since prior mammogram (15.1/100; 95% confidence interval, 14.3-16.1). The 9.2% of mammograms in subgroups with very high and high recall rates accounted for 19.2% of recalls, an efficiency ratio of 2.1 compared with a random approach. Adding women <50 years of age with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Results including facility-level characteristics were similar. ConclusionsPrioritizing women with baseline mammograms or ≥5 years since prior mammogram for immediate interpretation and possible diagnostic evaluation could considerably reduce the number of women needing to return for diagnostic imaging at another visit.

Investigation of the effectiveness of ECOLAB ’Drape ArmourTM’ Radiation Protection in limiting eye-lens doses of healthcare personnel exposed to ionizing radiation during gastroenterology - interventional radiology procedures

Objectives: To investigate the efficiency of the ECOLAB “Drape ArmourTM” device in limiting the eye-lens doses absorbed by healthcare personnel exposed to ionizing radiation, in a four-month trial during gastroenterology interventional radiology procedures. Methods: Eyelens doses measured with eye-lens dosimeters calibrated in terms of equivalent dose at 3 mm depth ( Hp(3) ) were collected and analyzed since 2016 along with the irradiation parameters (Dose Area Product - DAP). The eye-lens doses received during the four-month trial, have been compared with doses normally received, in the same conditions of irradiation, in the absence of the protection drape. Results: During the period of use of Drape ArmourTM, the average dose to the eye lens was estimated to be 0.73 mSv (St.dev = 0.40 mSv). The average dose to the eye lens, measured in the same four-month period, across different years from 2017 to 2021, was equal to 1.30 mSv (st. dev = 0.35 mSv). Conclusions: Results suggest the effectiveness of Drape ArmourTM in containing the doses to the eye lens. Keypoint: Limiting eye-lens doses to a maximum value of 20 mSv/year is a real challenge, especially in interventional radiologic facilities. The use of suitable radio-opaque drapes may help healthcare workers involved in such facilities. The aim of the work is to evaluate the efficiency of the ECOLAB “Drape ArmourTM” sterile mono-use drape.

Estimation of Diagnostic Reference Level for Lumbar Spine X- Ray Procedures in Some Radiological Facilities in Abuja Metropolis, Nigeria

The worldwide increase in the use of radiation in diagnostic radiology practice has increased the need for organizations that deal with radiation protection to focus on improving patient protection. The essential aim of this study is to determine the diagnostic reference level for lumbar spine anterior posterior in some radiological facilities in Abuja metropolis, Nigeria. This study was performed to assess the values of entrance surface air kerma via indirect method for 87 adult patients whom their ages ranged between 19 to 75 years that underwent lumbar spine X-ray examination in six diagnostic radiology centres. The age of patients ranged from 20 to 60yrs; their weight ranged from 46 to 90 Kg, while the height of patients ranged from 1.4 to 1.8 m. The mean entrance surface air kerma for centres A, B, C, E and F were 2.41mGy, 2.39mGy, 2.75mGy, 2.91mGy and 2.67mGy respectively while the determined diagnostic reference level was 2.83mGy. This indicates improvement in optimization of patients’ doses when compared to established international reference levels. Keywords: Entrance surface air kerma, diagnostic reference level, lumbar spine X- ray examination and radiological facilities DOI: 10.7176/APTA/86-04 Publication date: October 31 st 2022

Technology-Enabled Advances in Pain Management.

Technology-Enabled Advances in Pain Management.

Work Place Assessment of Ambient Background Gamma Exposure Level of Some Radiological Facilities in FCT Abuja, Nigeria

Work Place Assessment of Ambient Background Gamma Exposure Level of Some Radiological Facilities in FCT Abuja, Nigeria

Development of an automatic multiplanar reconstruction processing method for head computed tomography.

Head computed tomography (CT) is a commonly used imaging modality in radiology facilities. Since multiplanar reconstruction (MPR) processing can produce different results depending on the medical staff in charge, there is a possibility that the antemortem and postmortem images of the same person could be assessed and identified differently. To propose and test a new automatic MPR method in order to address and overcome this limitation. Head CT images of 108 cases are used. We employ the standardized transformation of statistical parametric mapping 8. The affine transformation parameters are obtained by standardizing the captured CT images. Automatic MPR processing is performed by using this parameter. The sphenoidal sinus of the orbitomeatal cross section of the automatic MPR processing of this study and the conventional manual MPR processing are cropped with a matrix size of 128×128, and the value of zero mean normalized correlation coefficient is calculated. The computed zero mean normalized cross-correlation coefficient (Rzncc) of≥0.9, 0.8≤Rzncc < 0.9 and 0.7≤Rzncc < 0.8 are achieved in 105 cases (97.2%), 2 cases (1.9%), and 1 case (0.9%), respectively. The average Rzncc was 0.96±0.03. Using the proposed new method in this study, MPR processing with guaranteed accuracy is efficiently achieved.

Splenic artery embolization changes the management of blunt splenic injury: an observational analysis of 680 patients graded by the revised 2018 AAST-OIS

BackgroundThis study aimed to evaluate the management of blunt splenic injury (BSI) and highlight the role of splenic artery embolization (SAE).MethodsWe conducted a retrospective review of all patients with BSI over 15 years. Splenic injuries were graded by the 2018 revision of the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS). Our hospital provide 24/7 in-house surgeries and 24/7 in-house interventional radiology facility. Patients with BSI who arrived hypotensive and were refractory to resuscitation required surgery and patients with vascular injury on abdominal computed tomography were considered for SAE.ResultsIn total, 680 patients with BSI, the number of patients who underwent nonoperative management with observation (NOM-obs), SAE, and surgery was 294, 234, and 152, respectively. The number of SAEs increased from 4 (8.3%) in 2001 to 23 (60.5%) in 2015 (p < 0.0001); conversely, the number of surgeries decreased from 21 (43.8%) in 2001 to 4 (10.5%) in 2015 (p = 0.001). The spleen-related mortality rate of NOM-obs, SAEs, and surgery was 0%, 0.4%, and 7.2%, respectively. In the SAE subgroup, according to the 2018 AAST-OIS, 234 patients were classified as grade II, n = 3; III, n = 21; IV, n = 111; and V, n = 99, respectively.; and compared with 1994 AST-OIS, 150 patients received a higher grade and the total number of grade IV and V injuries ranged from 96 (41.0%) to 210 (89.7%) (p < 0.0001). On angiography, 202 patients who demonstrated vascular injury and 187 achieved hemostasis after SAE with a 92.6% success rate. Six of the 15 patients failed to SAE preserved the spleen after second embolization with a 95.5% salvage rate.ConclusionsOur data confirm the superiority of the 2018 AAST-OIS and support the role of SAE in changing the trend of management of BSI.Graphical abstract