Radiology Centers Research Articles

Experience of the department of surgical treatment of bone and soft tissue tumors during COVID-19 pandemic period

Since December 2019 the new coronavirus disease (COVID-19) has hit the world, causing the World Health Organization to declare it a pandemic. With the emergence and spread of the new infection, there has been unprecedented pressure on health care systems around the world. The time constraints associated with receiving routine care also affected the risk group cancer patients, as some hospitals were quarantined. Violation of the terms of both systemic drug, radiation and surgical treatment of cancer patients could lead to the progression of the tumor process and lead to the death of the patient. In connection with the current situation, doctors had to quickly change the tactics of managing cancer patients, due to the lack of accurate data on the basis of which it is possible to determine the optimal approach to the use of therapy, they had to make decisions in conditions of lack of data. The article shows an example of the treatment of 113 patients being treated in the department of surgical treatment of bone and soft tissue tumors in National Medical Research Radiological Center of the Ministry of Health of Russia during the first wave of the pandemic from March 30 to July 1, 2020. Surgical treatment was performed in 103 patients. During the period of stay in the hospital, 11 patients showed signs of coronavirus infection. Of these, 10 patients were diagnosed with coronavirus infection in the postoperative period. According to the study, the nosocomial incidence of COVID-19 is 10%. With timely diagnosis and specialized treatment, the survival rate was 100% in the given example. Consequently, if epidemiological measures are observed at all stages of hospitalization, it is possible to carry out planned surgical treatment for patients with primary and secondary lesions of bones and soft tissues. However, the decision to carry out a planned operation during a pandemic should be individual for each patient.

Evaluating the effectiveness of security systems regime of a hypothetical radiological facility using a risk calculation

This paper presents how security effectiveness can be measured by considering the cost involved in providing security for a radiological center and measures to improve security through risk analysis. The expansion of nuclear technologies and the possible use of nuclear and radioactive materials continues to grow. This increase comes with potential risk of radioactive materials being used for the wrong reasons; thus it is important to provide physical protection of nuclear related facilities to counter these threats and use atomic energy for peaceful purposes. The effectiveness of the security systems put in place at the facility can be assessed by making analysis of the risks associated to the facility.

Three artificial intelligence data challenges based on CT and ultrasound

Purpose: The 2020 edition of these Data Challenges was organized by the French Society of Radiology (SFR), from September 28 to September 30, 2020. The goals were to propose innovative artificial intelligence solutions for the current relevant problems in radiology and to build a large database of multimodal medical images of ultrasound and computed tomography (CT) on these subjects from several French radiology centers. Materials and methods: This year the attempt was to create data challenge objectives in line with the clinical routine of radiologists, with less preprocessing of data and annotation, leaving a large part of the preprocessing task to the participating teams. The objectives were proposed by the different organizations depending on their core areas of expertise. A dedicated platform was used to upload the medical image data, to automatically anonymize the uploaded data. Results: Three challenges were proposed including classification of benign or malignant breast nodules on ultrasound examinations, detection and contouring of pathological neck lymph nodes from cervical CT examinations and classification of calcium score on coronary calcifications from thoracic CT examinations. A total of 2076 medical examinations were included in the database for the three challenges, in three months, by 18 different centers, of which 12% were excluded. The 39 participants were divided into six multidisciplinary teams among which the coronary calcification score challenge was solved with a concordance index > 95%, and the other two with scores of 67% (breast nodule classification) and 63% (neck lymph node calcifications).

THE DIAGNOSTIC VALUE OF ULTRASOUND IN DIAGNOSING CERTAIN COMMON LESIONS OF SHOULDER

The retrospective study was performed on 200 patients with painful shoulders who underwent ultrasound according to the standard protocol of the Radiology Centre of Hanoi Medical UniversityHospital. Out of these patients, 41 cases underwent arthroscopy. The results of ultrasound and arthroscopy were analyzed and compared in the assessment of the diagnostic value of ultrasound in lesions of shoulder.Results: Ultrasound detected 31.5% with partial-thickness rotator cuff tear, 21% with full-thickness rotator cuff tear and 20.5% with tendonitis. Ultrasound showed a sensitivity (Sn) of 80%, specificity(Sp) of 95.2%, positive predictive value (PPV) of 94.1%, negative predictive value (NPV) of 83.3% in diagnosing full-thickness rotator cuff tear. For partial-thickness rotator cuff tear, it showed a Snof 57.1%, Sp of 92.6%, PPV of 80%, NPV of 80.6%. In detection of tendonitis, Sn of ultrasound was 57.1%, Sp was 88.2%, PPV was 50%, NPV was 90%. Ultrasound showed a Sn of 39.3%, Sp of92.3%, PPV of 91.7%, NPV of 43.4% in evaluating subacromial-subdeltoid bursa.

Bone quality and quantity of the mandibular symphyseal region in autogenous bone grafting using cone-beam computed tomography: a cross-sectional study

BackgroundBone volume plays a pivotal role in the success of dental implant treatment. Autogenous bone grafts should be harvested from reliable sites in the maxillofacial region. This study sought to assess the quantity and quality of bone in the mandibular symphysis for autogenous bone graft harvesting using cone-beam computed tomography (CBCT).MethodsThis cross-sectional study evaluated the CBCT scans of 78 adults presenting to three oral and maxillofacial radiology centers. The vertical (VD) and horizontal (HD) alveolar bone dimensions, cortical thickness (CT), and cancellous to cortical bone ratio (C/C) were measured in the interforaminal region of the mandible at the sites of central incisor to first premolar teeth. The interforaminal distance (ID) and the anterior loop length were also measured. Nonparametric statistical tests were used to analyze the data with respect to sex, age, and tooth position.ResultsThe median VD, HD, and CT of the symphysis were 20.21 (3.26), 4.13 (0.37), and 2.25 (0.23) mm, respectively. The median C/C was 1.51 (0.11). The median ID was 52.24 (8.24) mm, and the median anterior loop length was 1.82 (1.06) mm. Significant differences were observed in all parameters among different teeth. Most of the measured parameters were greater in males compared with females. There were significant differences in ID, VD, and CT between different age groups.ConclusionsThe quantity and quality of the available bone in the mandibular symphysis for bone graft harvesting vary by gender, age, and harvesting site, necessitating careful preoperative evaluation.

MpMRI PI-RADS score 3 lesions diagnosed by reference vs affiliated radiological centers: Our experience in 950 cases.

The detection rate for clinically significant prostate cancer (csPCa) in men with mpMRI PI-RADS score 3 diagnosed by affiliated radiology centers vs radiological reference center was evaluated. From January 2017 to December 2020, 950 men (median age 64 years) underwent mpMRI for abnormal PSA values (median 6.3 ng/ml). Among the 950 patients who underwent mpMRI 500 were evaluated by a reference center and 450 by outpatient radiological affiliated centers. All the mpMRI index lesions characterized by a PI-RADS 3 underwent targeted cores combined with extended prostate biopsy. Two radiologists of the radiological reference center revised all the mpMRI lesions 3. Overall, 361/950 (38%) patients had a mpMRI lesion PI-RADS score 3: 120/500 cases (24%) vs 241/450 cases (53.5%) were diagnosed by reference vs affiliated radiological centers. The detection rate for cT1c csPCa was equal to 26.7% (35/120 cases) vs 16.6% (40/241 cases) in men with PI-RADS 3 lesions diagnosed in the reference vs the affiliated radiological centers (p < 0.05). Among the 241 PI-RADS score 3 lesions diagnosed by affiliated radiological centers 86/241 (35.7%) and 36/241 (15%) were downgraded (PI-RADS scores < 3) and upgraded (PI-RADS score 4) by the dedicated radiologists of the reference center. In our series, about 35% and 15% of PI-RADS score 3 lesions diagnosed by affiliated radiological centers were downgraded and upgraded when revised by experencied radiologists, therefore a second opinion is mandatory especially in men enrolled in active surveillance protocols in whom mpMRI is recommended to reduce the number of scheduled repeated prostate biopsies.

Evolving Role of MRI in Assessment of Response of Hepatocellular Carcinoma Patients Post Trans-Arterial Chemoembolization: What Does the Physician Want to Know?

Abstract Background: In clinical practice, Transarterial Chemoem-bolization (TACE) has been widely used for the treatment of Hepatocellular Carcinoma (HCC) beyond as well as within guideline recommendations. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) play critical roles for assessing treatment response of Hepatocellular Carcinoma (HCC) after locoregional therapy. Interpretation is challenging because post-treatment imaging findings depend on the type of treatment, magnitude of treatment response, time interval after treatment, and other factors. Aim of Study: To illustrate the prime role of MRI in accurate assessment and early monitoring of hepatocellular carcinoma response to treatment after transarterial chemoem-bolization. Patients and Methods: This study included 80 patients, 52 males and 28 females, patients ages ranged from 45 to 81 years with the mean age of 60 years underwent transarterial chemoembolization over a period of 23 months (Jan. 2019- Dec. 2020). All patients had liver cirrhosis related to chronic viral hepatitis. MRI was conducted at MRI unit in a private radiology centre. Results: Showed superior diagnostic performance of dynamic MRI compared to diffusion studies as dynamic MRI had a sensitivity of 90.9%, a specificity of 95.7%, PPV of 93.7%, NPV of 93.7% and overall agreement of 94% compared to 100%, 65.2%, 68%, 100% and 80% respectively of diffusion weighted imaging. The difference between the malignant residual and well-ablated groups ADC variables was statisti-cally significant p-value 0.006. Conclusion: MRI is a robust tool in detection of tumour viability after TACE of hepatocellular carcinoma and should be performed at regular time intervals. Imaging protocol should include dynamic study combined with diffusion imag-ing. DW MR imaging is a rapid promising technique for the non-invasive evaluation of tumor response after TACE par-ticularly when contrast medium administration is contraindicated. Dynamic study is the corner stone in detection of recurrent lesions.

Final results from ClarIDHy, a global, phase 3, randomized, double-blind study of ivosidenib (IVO) versus placebo (PBO) in patients (pts) with previously treated cholangiocarcinoma (CCA) and an isocitrate dehydrogenase 1 (IDH1) mutation.

4069 Background: CCA is a rare cancer for which there are limited effective therapies. IDH1 mutations occur in ̃20% of intrahepatic CCAs, resulting in production of the oncometabolite D-2-hydroxyglutarate, which promotes oncogenesis. IVO (AG-120) is a first-in-class, oral, small-molecule inhibitor of mutant IDH1 (mIDH1). ClarIDHy aimed to demonstrate the efficacy of IVO vs PBO in pts with unresectable or metastatic m IDH1 CCA. The primary endpoint was met with significant improvement in progression-free survival (PFS) by independent radiology center (IRC) with IVO vs PBO (hazard ratio [HR] = 0.37, p &lt; 0.0001). Objective response rate (ORR) and stable disease for IVO were 2.4% (3 partial responses) and 50.8% (n = 63) vs 0% and 27.9% (n = 17) for PBO. IVO pts experienced significantly less decline in physical and emotional functioning domains of quality of life at cycle 2 day 1 vs PBO pts (nominal p &lt; 0.05). Methods: Pts with m IDH1 CCA were randomized 2:1 to IVO (500 mg PO QD) or matched PBO and stratified by prior systemic therapies (1 or 2). Key eligibility: unresectable or metastatic m IDH1 CCA based on central testing; ECOG PS 0–1; measurable disease (RECIST v1.1). Crossover from PBO to IVO was permitted at radiographic progression. Primary endpoint: PFS by IRC. Secondary endpoints included overall survival (OS; by intent-to-treat), ORR, PFS (by investigator), safety, and quality of life. The planned crossover-adjusted OS was derived using the rank-preserving structural failure time (RPSFT) model. Results: As of 31 May 2020, ̃780 pts were prescreened for an IDH1 mutation and 187 were randomized to IVO (n = 126) or PBO (n = 61); 13 remain on IVO. Median age 62 y; M/F 68/119; 91% intrahepatic CCA; 93% metastatic disease; 47% had 2 prior therapies. 70% of PBO pts crossed over to IVO. OS data were mature, with 79% OS events in IVO arm and 82% in PBO. Median OS (mOS) was 10.3 months for IVO and 7.5 months for PBO (HR = 0.79; 95% CI 0.56–1.12; one-sided p = 0.093). The RPSFT-adjusted mOS was 5.1 months for PBO (HR = 0.49; 95% CI 0.34–0.70; p &lt; 0.0001). Common all-grade treatment emergent adverse events (TEAEs, ≥ 15%) in the IVO arm: nausea 41%, diarrhea 35%, fatigue 31%, cough 25%, abdominal pain 24%, decreased appetite 24%, ascites 23%, vomiting 23%, anemia 18%, and constipation 15%. Grade ≥ 3 TEAEs were reported in 50% of IVO pts vs 37% of PBO pts, with grade ≥ 3 treatment-related AEs in 7% of IVO pts vs 0% in PBO. 7% of IVO pts experienced an AE leading to treatment discontinuation vs 9% of PBO pts. There were no treatment-related deaths. Conclusions: IVO was well tolerated and resulted in a favorable OS trend vs PBO despite a high rate of crossover. These data – coupled with statistical improvement in PFS, supportive quality of life data, and favorable safety profile – demonstrate the clinical benefit of IVO in advanced m IDH1 CCA. Clinical trial information: NCT02989857.

Military medical organizations capability in delivery of specialized medical care in radiation emergencies

Nuclear and radiation safety remains one of the most important components of the national security of our country. The increasing requirements for the medical care system in the Armed Forces of the Russian Federation in case of peacetime acute radiation injuries are due to the impossibility of completely eliminating the risks of radiation emergencies as a result of natural disasters, industrial radiation accidents and the threat of nuclear terrorism. The peacetime three-level system of medical support in the Armed Forces of the Russian Federation has been developed. It is designed to guarantee the first aid, primary predoctor care, primary doctor care and primary specialized health care for victims of acute radiation injuries by medical units, formations and organizations in the territorial zone of responsibility. In 2017 it was completed a research work "Improving the organization of therapeutic care in acute radiation injuries at the stages of medical evacuation in radiation accidents". An analysis of medical service capabilities to provide specialized, high-tech medical care in radiation injuries showed the relevance of the clinical base development in military medical organizations and the importance of interaction with radiological medical centers of other ministries, agencies and services. The solution of these tasks will be facilitated by the creation of a specialized infrastructure on the basis of military medical organizations of the district (fleet), which is providing necessary conditions for the provision of medical assistance to victims of the radiation emergency.

Comparing the efficacy of laparoscopic and open radical prostatectomy: analysis of treatment outcomes in patients with prostate cancer treated in three federal centers

Background. Prostate cancer is currently one of the most challenging problems in urological oncology due to its constantly increasing incidence and mortality in Russia. Surgery remains one of the most radical treatment options for patients with localized and locally advanced prostate cancer of any risk. Multiple studies have compared long-term and functional outcomes of surgeries performed using different surgical approaches. All studies have demonstrated similar long-term and functional outcomes of open, laparoscopic, and robot-assisted surgeries. Objective: to review the existing literature on this problem and analyze outcomes of surgical treatment in patients who had undergone open or laparoscopic prostatectomy in one of three federal centers of the National Medical Research Radiology Center.Materials and methods. This retrospective study included 2,772 patients with localized and locally advanced prostate cancer who had undergone surgery in one of the three federal centers.Results. We evaluated short-term and long-term outcomes of laparoscopic and open radical retropubic prostatectomy (RRP) performed at three federal centers of the National Medical Research Radiology Center. We found that laparoscopic RRP was associated with a longer surgery, lower blood loss, and fewer lymph nodes removed compared to open RRP. Long-term oncological and functional outcomes (prostate-specific antigen relapse-free survival, time to urination recovery) did not significantly differ between patients who had laparoscopic or open RRP.Conclusion. Both open and laparoscopic RRP are equally effective surgical methods for patients with localized and locally advanced prostate cancer.

Radiologia de tecnologia digital aplicada à pintura: avaliação da qualidade de imagens obtidas em sistemas clínicos de radiologia

Introduction: The area’s studies have a great relevance in artwork. Laboratories committed to this purpose are scarce and employ professionals without specific knowledge in handling of ionizing radiation. It is not known to what extent, in Portugal, clinical radiological centers could provide added value to technology of digital radiography applied to painting, in order to expand their business areas and the performance of radiographers, thus enhancing synergies between these two areas. Goals: It was intended to analyse a possible applicability, to painting, of the Digital Radiology systems (CR and DR), used in the clinic settings, through the evaluation of the variable “radiographic image quality”, since the systems Clinical radiological tests, with indirect or direct conversion detectors of different energies and photodetectors of the electrical signal, show significant improvements in imaging patterns. Material and Methods: 21 radiographs were obtained from exposures made over three paintings in three different radiological systems with an emphasis on exposure parameters (potential difference (kV) and current intensity (mAs)). The sample was directed to works that presented different techniques, materials and compositions and selected by a museologist. The quality of the radiographs, operationalized by the analysis’s dimensions used in the evaluation of artworks: preservation of the support; distinction of details; contrast; contour definition; creative and technical process and components / materials. Four observers (2 specialists in medical image and 2 in art), under conditions of independence, evaluated the radiographs acquired according to a 4-point Likert scale. The analysis dimensions were organized into 11 criteria and the conditions for structured observation of the radiographs were standardized for display on a 15.6 ”GeChic 1503H monitor. Results: The most graded images were obtained with the Computerized Radiography (CR) system (mode: 3) given that this technology, in the opinion of the observers, provided a better view of the analysis criteria previously defined. The results were presented using descriptive statistics and discrete categorical variables, grouped into modal classes. Conclusions: Clinical digital radiography, especially Computed Radiography (CR), applied to painting, showed considerable dimensions of image quality and its use can contribute to the conservation, restoration, validation, analytical study, dating and authentication of artworks.

Role of multislice computed tomography in assessment of epicardial adipose tissue in coronary artery diseases

Background This study aims to evaluate the relationship between epicardial fat volume and the severity of coronary artery disease (CAD) using multislice computed tomography (CT) coronary angiography. Patients and methods This was prospective study conducted in Misr Radiology Center, International Medical Center, and National Heart Institute and included 70 patients with clinical suspicious of CAD. They were aged from 35 to 73 years, with a mean age of 53.6±9.6 years. Results The study was performed on 70 patients with clinical suspicion of CAD. They were referred to undergo CT coronary angiography in the period from January 2018 to December 2019. They aged from 35 to 73 years, with a mean age of 53.6±9.6 years. Conclusion In our study, we found that epicardial fat volume is associated with presence and degree of CAD, although most multidetector CT fat depot measurements showed good association and correlation with grade of CAD.

Evaluation of Stylohyoid Complex Patterns on Digital Panoramic Radiographs in the Local Population in Ilam, Iran

Background: Stylohyoid ligament ossification is a complication that is repeatedly and accidentally observed on panoramic radiographs and may be the cause of some symptoms. Accordingly, awareness of this incidence enables the clinicians in the accurate diagnosis of head and neck pains while avoiding unneeded therapy. Methods: This was a descriptive cross-sectional study. The number of samples was 196 people who referred to an oral and maxillofacial radiology center in Ilam in 2020. Information was completed by a checklist which consisted of two parts, including a questionnaire (age, gender, history of maxillofacial trauma, history of maxillofacial surgery, and pregnancy) and a second part (including the ossification of the stylohyoid complex, its length, involved side, and the process category according to Langlais classification). Differences between the groups were compared by Student’s t test, Welch’s t test, or chi-square test (P&lt;0.05). Results: The results revealed the influence of age on the calcification and elongation patterns of the styloid process while no significant association was found between gender and elongation and calcification patterns. The ossification of the stylohyoid complex was unilateral and bilateral in 24 (40.6%) and 35)59.3%) patients. Finally, the ossification of the stylohyoid complex was bilateral in 17 patients (48.6%) aged 40-59 years. Conclusions: The evaluation of stylohyoid complex patterns using panoramic radiography is essential, especially in patients with related symptoms. Further studies are needed to completely understand the underlying mechanism of the ossification of the styloid process and to assess different types of the styloid process and the relation between them in patients.

Перкутанная нефролитотрипсия у детей младшей возрастной группы

Introduction. Urolithiasis remains one of the most common diseases in the pediatric urology practice. A special category is made up of children weighing up to 15 kg with large and coral-like kidney stones, which require a smaller instrument to remove. Aim. The aim of the study was to evaluate the effectiveness of percutaneous nephrolithotripsy, used for urolithiasis treatment in children aged 1 to 3 years. Materials and methods. Between 2008 and 2019 in the pediatric uroandrology department of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation 93 children aged 1 to 3 years (69 (74.2%) boys and 24 (25.8%) girls) had nephrolithotripsy. The average patients age was 1 year and 9 months. Fifty-one (54.8%) patients had coral-like kidney stones, while the remaining 42 (45.2%) had kidney pelvic stones. The average stone size was 25.8mm. (15 – 56 mm). Nephrolithotripsy was performed according to the standard technique, all patients underwent cystoscopy and ureteral catheterization. In the prone position, under ultrasound and X-ray guidance, a puncture of the renal collecting system was performed. In 59 cases (63.5.1%) the puncture was performed through the lower calyx, in 31 cases (33.3%) – through the middle one, and in nine children two approaches were performed. In 93 children the intervention was performed using a mini-nephroscope with tubes of 12, 15 and 16.5 Ch. To disintegrate the stone, a pneumatic lithotripter and a holmium laser "Auriga" with a fiber of 365 and 600 μm in diameter were used. Only in 31 cases, when the kidney size allowed, a standard 24 Ch nephroscope and combined lithotripsy (ultrasound and pneumatic) were used. The duration of the procedure varied from 32 to 145 minutes, with an average of 43.5 minutes. In the postoperative period, all patients underwent infusion and antibiotic therapy based on the results of urine bacteriological examination. After the patients’ activation on days 1 – 3, a survey urography and antegrade pyeloureterography were performed. In the absence of residual stones and urinary passage disorders, nephrostomy drainage was removed. Results. The effectiveness of nephrolithotripsy in our cohort of patients was 87.1% (81 patients). Four children (4.3%) required second percutaneous intervention. The remaining 8 (8.6%) patients with residual stones underwent distance lithotripsy in the short postoperative period. Significant bleeding occurred in 2 patients who then required transfusion of blood products. Fever was noted in 5 (5.4%) patients. We have not observed a single case of septic and bacteriotoxic shock. Discussion. As a first-line surgical treatment in pediatric practice, it is recommended to use extracorporeal shock wave lithotripsy (ESWL). This treatment is ideal for stones ≤ 15 mm in size, with SFR of 68-95%. However, the need for repeated ESWL sessions occurs in 14-54% cases. Complications rate, frequency of retreatment, as well as a decrease in SFR, increase when a stone size is greater than 1.5 cm. Since all types of surgical treatment in children require anesthesia, and the treatment approach may not provide a complete problem solution, it is preferable to choose a procedure with the greatest possible success in one session. Primary SFR was significantly lower in children with stones ≥ 30 mm in size and multiple kidney stones. Mini– percutaneous nephrolithotripsy is an effective (87.1%) method for nephrolithiasis treatment in children aged 1 to 3 years. Conclusion. Mini-percutaneous nephrolithotripsy in children aged 1 to 3 years is an effective treatment for nephrolithiasis. However, in a small percentage of cases, it becomes necessary to combine the procedure with extracorporeal lithotripsy. Paying attention to the small size of the organ, to reduce the number of hemorrhagic complications, it is preferable to perform this intervention with one approach. The occurrence of even a small amount of bleeding during the operation is a formidable complication, given the small volume of circulating blood in children.

Placing a Hemodialysis Catheter in Patients With Multiple Access Failure and Exhausted Usual Approachable Veins: Egyptian Single Center Experience

Highlights Abstract Background: End-stage renal disease (ESRD) is a growing global health hazard. Most patients are maintained on dialysis rather than transplantation. Adequate vascular access for hemodialysis is crucial to achieve an optimal dialysis dose and to reduce morbidity and mortality. Patients with multiple access failure are in desperate need for lifesaving access, especially in the absence of alternatives (transplantation or peritoneal dialysis). Objective: Patients with multiple vascular access failure and exhausted approachable veins are being referred to an interventional nephrology or radiology centers. The aim of this work is to evaluate a single center’s experience of sophisticated venous approaches to provide access for hemodialysis. Methods: This study was performed at the Interventional Nephrology Center at Kasr Al-Ainy University Hospitals. Epidemiological data of patients, e.g., age, gender, as well as the number of previously cannulated central veins, were documented. Results: Data of 188 patients with multiple dialysis venous access failure (117 females and 71 males, aged 17–56 years) were collected. Successful innominate (brachiocephalic) venous cannulation was achieved in 149 patients (79%). Eighteen patients had successful external iliac venous approach (9%). Successful transhepatic venous approach was placed as permanent access in 7 patients (4%). The rest of the patients (n = 14, 7%) were referred to other centers due to failure. Conclusions: Sophisticated central venous approaches, mainly brachiocephalic, as described in this study, may play as alternatives for placing either temporary or tunneled hemodialysis catheters in patients with multiple vascular access failure and stenosed or thrombosed central veins.

Epidemiology of Supernumerary Teeth in 5000 Radiography Films: Investigation of Patients Referring to the Clinics of Ardabil in 2015-2020.

Background Supernumerary tooth is defined as any extra tooth or odontogenic structure that is formed on normal dentition. Supernumerary teeth cause such problems as deficiency in tooth growth, ectopic growth, displacement, crowding, diastema, odontogenic cyst formation, decay of the adjacent tooth, malocclusion, and esthetic problems. This study was conducted aiming at determining epidemiology of supernumerary teeth in Ardabil city in 2020. Materials & Methods. In this retrospective descriptive analytical study, 5000 panoramic radiographs of patients referring to Rad and Baser Oral and Maxillofacial Radiology Centers were selected through multistage sampling method during 2015–2020. The data were collected by checklist and analyzed with using SPSS-21 and chi-squared, Fisher, and one-way ANOVA tests with a significance level less than 5%. Results The prevalence of supernumerary teeth was estimated as 1.06% (n = 53), and no significant difference between the males and females was seen. Most supernumerary teeth were found in the distomolar (44.1%) and parapremolar (29.4%) locations. The majority of supernumerary teeth were present in the maxilla (73.5%) and were impacted (77.9%) and unilateral (71.7%). The number of supernumerary teeth was 68 cases and majority of patients (86.8%) had one supernumerary tooth. Conclusion Supernumerary tooth in this study had a high prevalence compared to similar studies, and unlike most previous studies, the most common type of supernumerary tooth was distomolar. Early diagnosis and proper medical planning are essential for managing supernumerary teeth.

The impact of common variables on non-attendance at a radiology centre in Singapore

IntroductionWith the increasing demand for medical imaging, non-attendance inhibits private and public radiology practices in Singapore from providing timely care and achieving maximal efficiency. Missed radiological appointments adversely affect clinical and economic outcomes and strain the finite healthcare resources. We examined the prevalence and predictors of patient non-attendance for radiological services at a regional public hospital in Singapore and compared them against other medical imaging centres globally. MethodsOutpatient records of patients who were scheduled for specialised medical imaging obtained from Radiological Information System (RIS) were retrospectively reviewed. Analysed variables include patient demographics, radiology modalities, visit statuses and appointment lead times where Pearson's chi-square test and Fisher's exact test were used for categorical variables, and independent sample t-test was used for continuous variables. The association between each patient characteristic and non-attendance status was assessed using Binary Logistics Regression. Variables that showed statistical significance in univariate analysis were included in the multivariate logistic regression model to identify the independent risk factors associated with non-attendance. ResultsAmong the 59,748 outpatient appointments with medical imaging requests, 15.5% did not turn up for their appointments. Logistic regression indicated that patient's age, ethnicity, subsidy status, house ownership, living vicinity to regional hospital cluster, appointment wait times, appointment hours and appointment months were significant factors associated with the failure to attend scheduled radiological examinations. ConclusionEven though predictors of non-attendance remained consistent across medical imaging centres worldwide, Singapore reported a higher prevalence of missed appointments calling for future exploratory studies to understand the population's health-seeking behaviours and ordering patterns of clinicians. Implications for practiceComparison and identification of these predictors will assist in the design of targeted interventions that may improve patient's adherence and utilisation of imaging services.

Magnet dislocation following magnetic resonance imaging in cochlear implant users: Diagnostic pathways and managment

Objectives Although modern cochlear implants (CIs) are approved for magnetic resonance imaging (MRIs) adverse events still occur with unacceptable frequency. Methods: In this retrospective study, magnet displacement due to MRIs was analysed. Relevant factors e.g. symptoms during MRI, diagnostics, surgical intervention following the diagnosis and possible subsequent damage were assessed. Results 16 patients were enclosed. All patients complained about pain while the scan was conducted. Computed tomography (CT) scans of the temporal bone or X-rays of the skull were performed to confirm diagnosis. Artefacts on CT scans delayed immediate diagnosis in some cases. Discussion Despite various studies demonstrating the range of adverse events related to CIs following MRI, little information is available on diagnosis and radiologic recognition of magnet dislocation. In patients complaining about pain following an MRI scan an X-ray of the head should be performed immediately. Most adverse events occur in radiological centres without expertise in cochlear implants. Conclusion Comprehensive training of patients, surgeons and radiologists is the most efficient tool to prevent damage to the CI and the patient. X-ray of the skull is suggested to be used as the method of choice in imaging.

Salvage high-dose-rate brachytherapy for recurrent prostate cancer

Background . Prostate cancer (PCa) is one of the most common malignant diseases in men worldwide, with over 1.1 million cases of PCa reported annually. In the Russian Federation, the proportion of patients with stage I—II PCa from 2008 to 2018 increased from 37.6 % to 56 %, which in turn allows more and more patients to perform radical treatment methods. However, it should be noted that the number of patients with both recurrent PCa after radiation therapy (external beam radiation therapy (EBRT) or brachytherapy) and with local recurrence after radical prostatectomy (RPE) is steadily increasing. Objective . Improve treatment outcomes for patients with recurrent PCa. Materials and methods. A. F. Tsyb Medical Radiological Research Center — branch of the National Medical Research Radiological Center, since 2016, has been treating patients with recurrent PCa using salvage high-dose brachytherapy (SHDR) (192Ir) after radical radiation treatment (EBRT, brachytherapy) or with local recurrence after RPE. Patients with recurrent PCa were divided into three groups, depending on the type of initial radical treatment: patients with recurrent disease after RPE, after EBRT and after brachytherapy. Results . The most favorable results of SHDR were registered in the group of patients with local recurrence after RPE: in 7 patients out of 8 (87 %), one year after the PSA, the prostate-specific antigen (PSA) level was less than 0.1 ng/mL. In 1 patient, the PSA level dropped to 0.71 ng/mL (baseline 2.47 ng/mL) two years after salvage treatment. Currently, there is a further decrease in PSA levels. Results after SHDR ( 192 Ir) in patients with relapse after EBRT: of 8 patients, 2 (25 %) had PSA levels less than 0.2 ng/mL after a year. In 4 patients, the PSA level two years after treatment was more than 2.0 ng/mL. In these patients, a relapse was registered. Another 2 patients also had a repeated relapse after SHDR. The following results were obtained after carrying out SHDR in patients with relapse after braahythempy (both low- and high-dose). Of the 12patients, 7patients (58 %) had PSA levels less than 0.5 ng/mL two years after SHDR. SHDR was performed in the mode of two fractions of 12.5 Gyerahwith an interval of two weeks between them. In 3 patients, the PSA level exceeded 0.5 ng/ mL two years after the salvage treatment, and therefore, a second relapse is determined in them. Another 2 patients also had a repeated relapse. Conclusion . This article provides preliminary results of our research. We would like to reiterate that as possible options for the treatment of local recurrence of PCa, it is possible to choose salvage prostatectomy, salvage radiation therapy, hormonal therapy or SHDR brachytherapy. In some cases EBRT is used in this category of patients, however, this can lead to the development of severe radiation damage. The choice of a treatment method in case of recurrent PCa is a complex problem, the decision of which is based on many factors. The clinical course of PCa, the prevalence of the disease, the level of markers, and molecular genetic data are taken into account.

Investigating the level of Safety Considerations in Radiology Centers (North of Iran): Cross –Sectional Study

Background and Purpose Providing health care is the basic right of people(1). Diagnostic radiology is one of the main procedures in health care services and proper benefiting from this technology is brought only under well planning and management(1). Supervision of the available condition and its comparison with the recommended standards is a key role in assessing assurance from the benefit of these instruments (2). Data show that more than 80% of patients referring to these hospitals need radiology image (3).Improper service causes repetition of radiography and even wrong diagnosis, as a results threatening health of the patients (3) lack of protective barrier leads to the exposure of the staff to X-ray which is obviously carcinogen us (4). It happens that the instruments are not working properly, like of symmetry in X-ray field, defects in collimators, lack of adjusting ray field and X-ray, low quality or defective developing machine, lack of proper protective barrier, using low quality film and drugs, lack of protective barrier for children, all of which cause severe hazards for the patients and staff (4). Materials and Methods The crucial aim of medical services is to provide the public with their needs which are very important. The sensitivity of such services is to such an extent that in case of lack of care, the hazards are too high. In evaluation of health services, the first thing is to evaluate the device used. Methods, efficiency, profits and their combination for prevention and eradication of diseases are also important. Therefore to gain this goal, it is necessary the obtain results comparable with recommended standards. The purpose of this study was to access the conditions of radiology units at Mazandaran University hospitals and compare them with the standards of ICRU NCRP and ICRP. Radiology unit is the most expensive section of any hospital for its instruments, manpower and space provided. In a study conducted in 51centers on radiology staff, radiography room and protective barrier, ray leakage, the outcome were 89%, 82%, 77% and 37% respectively. It was found that the condition of these centers regarding the protective barriers is very unsuitable due to unawareness of the leakage (5, 6).Considering the mentioned necessities, in this study, the condition of radiography centers affiliated to the Mazandaran University of Medical Sciences was studied for the type and the rate of problem, in order to provide a proper solving method. Results Data were collected through, observation, interviewing and filling questionnaire. Results show that, the situations of the radiology units are for from international standard, to such an extent that it is matched clout 50%. Conclusion The results showed that, none of the dark rooms are standard, and do not have proper alarm signal. In 63% of these units there no tiling system about staff protection from radiation. Defects in radiography room, protective barrier and lack looking rays were 60%, 51% and 47% respectively. Referring to the obtained data, periodic supervision, and obeying of the standards are necessary.