Standardized Examination Protocol Research Articles

Advanced echocardiography in adult zebrafish reveals delayed recovery of heart function after myocardial cryoinjury.

Translucent zebrafish larvae represent an established model to analyze genetics of cardiac development and human cardiac disease. More recently adult zebrafish are utilized to evaluate mechanisms of cardiac regeneration and by benefiting from recent genome editing technologies, including TALEN and CRISPR, adult zebrafish are emerging as a valuable in vivo model to evaluate novel disease genes and specifically validate disease causing mutations and their underlying pathomechanisms. However, methods to sensitively and non-invasively assess cardiac morphology and performance in adult zebrafish are still limited. We here present a standardized examination protocol to broadly assess cardiac performance in adult zebrafish by advancing conventional echocardiography with modern speckle-tracking analyses. This allows accurate detection of changes in cardiac performance and further enables highly sensitive assessment of regional myocardial motion and deformation in high spatio-temporal resolution. Combining conventional echocardiography measurements with radial and longitudinal velocity, displacement, strain, strain rate and myocardial wall delay rates after myocardial cryoinjury permitted to non-invasively determine injury dimensions and to longitudinally follow functional recovery during cardiac regeneration. We show that functional recovery of cryoinjured hearts occurs in three distinct phases. Importantly, the regeneration process after cryoinjury extends far beyond the proposed 45 days described for ventricular resection with reconstitution of myocardial performance up to 180 days post-injury (dpi). The imaging modalities evaluated here allow sensitive cardiac phenotyping and contribute to further establish adult zebrafish as valuable cardiac disease model beyond the larval developmental stage.

Injury Trends in Rock Climbers: Evaluation of a Case Series of 911 Injuries Between 2009 and 2012

Rock climbing is a widely performed sport. This prospective single-institution study evaluated the demographics of climbing-related injuries to improve our comprehension of current injury characteristics. During a 4-year period, 836 patients with a total of 911 independent climbing injuries were prospectively evaluated using a standard questionnaire and examination protocol. Of all injuries, 833 were on the upper extremities, 58 on the lower. Seventeen injuries were Union International des Associations d'Alpinisme (UIAA) grade 1 injuries, 881 were grade 2, and 13 were grade 3. No higher UIAA graded injuries occurred. Overall, 380 were acute injuries (359 were seen in clinic, 21 were seen through the emergency department), and 531 were overstrain injuries (all seen in clinic). Finger injuries accounted for 52% of all injuries, the shoulder being the second most frequent location. Pulley injuries were the most frequent finger injuries. Of 20 injured young climbers under the age of 15 years, 14 had an epiphyseal fracture (all epiphyseal fractures: mean age 14 years, range 12 to 15 years). Male climbers were significantly older (P < .05), had more climbing years (P < .05), and were climbing at a higher climbing level (P < .01). Older, more experienced climbers had significantly more overstrain injuries than acute injuries (P < .05). When comparing this study with our previous study from 1998 to 2001, there are some notable differences. Although pulley injuries are still the most common climbing injury, there are now more A4 pulley injuries than A2. Shoulder injuries are becoming more common, as are epiphyseal fractures among young climbers. It is important to understand current patterns of climbing injuries so that health providers can target interventions appropriately.

Connective tissue anomalies in patients with spontaneous cervical artery dissection.

To investigate the prevalence of connective tissue abnormalities in patients with spontaneous cervical artery dissections (sCeAD). We systematically assessed clinically detectable signs of connective tissue aberration in a series of consecutive patients with sCeAD and of age- and sex-matched patients with ischemic stroke unrelated to CeAD (non-CeAD IS) by a standard examination protocol including 68 items, and performed extensive molecular investigation for hereditary connective tissue disorders in all patients with sCeAD. The study group included 84 patients with sCeAD (mean age, 44.5 ± 7.8 years; 66.7% men) and 84 patients with non-CeAD IS. None of the patients with sCeAD met clinical or molecular diagnostic criteria for established hereditary connective tissue disorder. Connective tissue abnormalities were detected more frequently in the group of patients with sCeAD than in the group of those with non-CeAD IS (mean number of pathologic findings, 4.5 ± 3.5 vs 1.9 ± 2.3; p < 0.001). Eighty-one patients (96.4%) in the sCeAD group had at least one detectable sign compared with 55 patients (66.7%) in the group with non-CeAD IS (p < 0.001). Skeletal, ocular, and skin abnormalities, as well as craniofacial dysmorphisms, were the clinical signs more strongly associated with sCeAD. Signs suggesting connective tissue abnormality were also more frequently represented in patients with sCeAD than in patients with traumatic CeAD (28.6%, p < 0.001; mean number of pathologic findings, 1.7 ± 3.7, p = 0.045). Connective tissue abnormalities are frequent in patients with sCeAD. This reinforces the hypothesis that systemic aberrations of the connective tissue might be implicated in the pathogenesis of the disease.

Research on radiation exposure from CT part of hybrid camera and diagnostic CT

Research on radiation exposure from CT part of hybrid camera in seven different Departments of Nuclear Medicine (DNM) was conducted. Processed data and effective dose (E) estimations led to the idea of phantom verification and comparison of absorbed doses and software estimation. Anonymous data from about 100 examinations from each DNM was gathered. Acquired data was processed and utilized by dose estimation programs (ExPACT, ImPACT, ImpactDose) with respect to the type of examination and examination procedures. Individual effective doses were calculated using enlisted programs. Preserving the same procedure in dose estimation process allows us to compare the resulting E. Some differences and disproportions during dose estimation led to the idea of estimated E verification. Consequently, two different sets of about 100 of TLD 100H detectors were calibrated for measurement inside the Aldersnon RANDO Anthropomorphic Phantom. Standard examination protocols were examined using a 2 Slice CT- part of hybrid SPECT/CT. Moreover, phantom exposure from body examining protocol for 32 Slice and 64 Slice diagnostic CT scanner was also verified. Absorbed dose (DT,R) measured using TLD detectors was compared with software estimation of equivalent dose HT values, computed by E estimation software. Though, only limited number of cavities for detectors enabled measurement within the regions of lung, liver, thyroid and spleen–pancreas region, some basic comparison is possible.

SU‐E‐I‐51: Use of Blade Sequences in Cervical Spine MR Imaging for Eliminating Motion, Truncation and Flow Artifacts

Purpose:To assess the efficacy of the BLADE technique to eliminate motion, truncation, flow and other artifacts in Cervical Spine MRI compared to the conventional technique. To study the ability of the examined sequences to reduce the indetention and wrap artifacts, which have been reported in BLADE sagittal sequences.Methods:Forty consecutive subjects, who had been routinely scanned for cervical spine examination using four different image acquisition techniques, were analyzed. More specifically, the following pairs of sequences were compared: a) T2 TSE SAG vs. T2 TSE SAG BLADE and b) T2 TIRM SAG vs. T2 TIRM SAG BLADE. A quantitative analysis was performed using the signal‐to‐noise ratio (SNR), contrast‐to‐noise ratio (CNR) and relative contrast (ReCon) measures. A qualitative analysis was also performed by two radiologists, who graded seven image characteristics on a 5‐point scale (0:non‐visualization; 1:poor; 2:average; 3:good; 4:excellent). The observers also evaluated the presence of image artifacts (motion, truncation, flow, indentation).Results:Based on the findings of the quantitative analysis, the ReCON values of the CSF (cerebrospinal fluid)/SC (spinal cord) between TIRM SAG and TIRM SAG BLADE were found to present statistical significant differences (p&lt;0.001). Regarding motion and truncation artifacts, the T2 TSE SAG BLADE was superior compared to the T2 TSE SAG and the T2 TIRM SAG BLADE was superior compared to the T2 TIRM SAG. Regarding flow artifacts, T2 TIRM SAG BLADE eliminated more artifacts compared to the T2 TIRM SAG.Conclusion:The use of BLADE sequences in cervical spine MR examinations appears to be capable of potentially eliminating motion, pulsatile flow and trancation artifacts. Furthermore, BLADE sequences are proposed to be used in the standard examination protocols based on the fact that a significantly improved image quality could be achieved.

Screening of the spine in adolescents: inter- and intra-rater reliability and measurement error of commonly used clinical tests

BackgroundEvidence on the reliability of clinical tests used for the spinal screening of children and adolescents is currently lacking. The aim of this study was to determine the inter- and intra-rater reliability and measurement error of clinical tests commonly used when screening young spines.MethodsTwo experienced chiropractors independently assessed 111 adolescents aged 12–14 years who were recruited from a primary school in Denmark. A standardised examination protocol was used to test inter-rater reliability including tests for scoliosis, hypermobility, general mobility, inter-segmental mobility and end range pain in the spine. Seventy-five of the 111 subjects were re-examined after one to four hours to test intra-rater reliability. Percentage agreement and Cohen’s Kappa were calculated for binary variables, and interclass correlation (ICC) and Bland-Altman plots with Limits of Agreement (LoA) were calculated for continuous measures.ResultsInter-rater percentage agreement for binary data ranged from 59.5% to 100%. Kappa ranged from 0.06-1.00. Kappa ≥ 0.40 was seen for elbow, thumb, fifth finger and trunk/hip flexion hypermobility, pain response in inter-segmental mobility and end range pain in lumbar flexion and extension. For continuous data, ICCs ranged from 0.40-0.95. Only forward flexion as measured by finger-to-floor distance reached an acceptable ICC(≥ 0.75). Overall, results for intra-rater reliability were better than for inter-rater reliability but for both components, the LoA were quite wide compared with the range of assessments.ConclusionSome clinical tests showed good, and some tests poor, reliability when applied in a spinal screening of adolescents. The results could probably be improved by additional training and further test standardization. This is the first step in evaluating the value of these tests for the spinal screening of adolescents. Future research should determine the association between these tests and current and/or future neck and back pain.

Endovenous Laser Ablation of the Great Saphenous Vein with a 1470 nm Wavelength Laser: Results of a Prospective, Single Centre Cohort Study

Background : Endovenous laser ablation (EVLA) is a widely accepted treatment for venous insufficiency. Our aim was to report the standardised technique used in our centre and to evaluate the anatomic and clinical success rates. Methods : All details of patients treated with EVLA were prospectively collected in a database. A standardized examination and surgical protocol was used, and every detail in the technique was registered. A follow-up visit was organised after 1 week and after 4–6 weeks with a duplex.Results : A total of 441 limbs were treated in 366 patients using a 1470 nm wavelength laser with bare tip fiber (Biolitec®). At 6 weeks postoperative a total obliteration of the vein was established in 98,62% of the cases with 78,67% of the patients free from complaints. No major complications were reported. Minor complaints were low (10,74% induration, 3,9% paresthesia). 93,11% reported no pain, 5,2% mentioned moderate pain. Mean duration of absence was equal or less than 1 week (65,28%). Satisfaction level was high (92,84%, level 10).Conclusion : EVLA of the GSV and the Anterior Accessory Vein (AAV) with a 1470 nm wavelength laser with bare tip fiber is a minimally invasive, safe and effective technique. We are convinced that every detail is important: tumescence technique, Trendelenburg position, no external compression, and the position of the vein in the fascial sheath. Further reduction of linear endovenous energy density (LEED) used for EVLA can improve the therapy. This is possible by using a new fiber tip design (radial optical fiber) and needs further investigation.

Controversies in the pathological assessment of colorectal cancer.

Pathologic assessment of colorectal cancer specimens plays an essential role in patient management, informing prognosis and contributing to therapeutic decision making. The tumor-node-metastasis (TNM) staging system is a key component of the colorectal cancer pathology report and provides important prognostic information. However there is significant variation in outcome of patients within the same tumor stage. Many other histological features such as tumor budding, vascular invasion, perineural invasion, tumor grade and rectal tumor regression grade that may be of prognostic value are not part of TNM staging. Assessment of extramural tumor deposits and peritoneal involvement contributes to TNM staging but there are some difficulties with the definition of both of these features. Controversies in colorectal cancer pathology reporting include the subjective nature of some of the elements assessed, poor reporting rates and reproducibility and the need for standardized examination protocols and reporting. Molecular pathology is becoming increasingly important in prognostication and prediction of response to targeted therapies but accurate morphology still has a key role to play in colorectal cancer pathology reporting.

Evaluation of radiographer-acquired contrast-enhanced ultrasonography of the liver reviewed by radiologists

Purpose: Contrast enhanced ultrasonography (CEUS) has become a reliable method for assessment of focal liver lesions. Higher quality requirements motivate searching for routines combining the diagnostic accuracy of radiologist-performed examinations. One possible approach is for a radiographer to exam the patient with the use of strictly standardized examination protocols and documentation made by cine-loops. This will give the radiologist access to all relevant information after the examination. The aim of this study was to compare the intraobserver agreement between two radiologists when reviewing ultrasound examinations of the liver performed by radiographer, using a standardized examination protocol, with and without CEUS.

Inheritance of equine sarcoid disease in Franches-Montagnes horses

The mode of inheritance for susceptibility to equine sarcoid disease (ES) remains unknown. The objectives of this study were to analyse a large sample of the Franches-Montagnes (FM) horse population and investigate the heritability and mode of inheritance for susceptibility to ES. Horses were clinically examined for the presence of sarcoid tumours. A standardized examination protocol and client questionnaire were used and a pedigree- and subsequent segregation-analysis for the ES trait performed. To investigate the mode of inheritance, five models were evaluated and compared in a hierarchical way.The analyses reveal that variation in susceptibility to ES is best explained by a model incorporating polygenic variation. The possible effect of a major gene, such as specific equine leukocyte antigen alleles, is unlikely, but cannot be ruled-out entirely. The heritability of the phenotype on the observation scale for the trait ‘affected with ES’ was estimated to be 8%. A corrected value for the heritability on a liability scale was estimated at 21% and it is therefore possible to estimate breeding values for ES. The arguments against the practical implementation of an estimated breeding value in a multifactorial condition like ES are discussed.

Dual Intervention to Improve Pathologic Staging of Resectable Lung Cancer

Detection of lymph node metastasis is of immense prognostic value in patients with resectable non-small cell lung cancer (NSCLC), but routine pathologic nodal staging is suboptimal. To determine the impact on the rate of detection of nodal metastasis, we tested dual intervention with a prelabeled lymph node specimen collection kit to improve intraoperative node dissection and a fastidious gross dissection of the lung resection specimen for intrapulmonary lymph nodes. We matched dual-intervention cases with controls staged using standard surgical specimen collection and pathologic examination protocols. Controls were hierarchically matched for extent of resection, laterality, surgeon, pathologist, and T stage. All statistical comparisons were made with exact conditional logistic regression, to account for the matched case-control design. One hundred dual-intervention cases were matched with 100 controls. The dual interventions resulted in approximately a 3-fold increase in the number of lymph nodes examined and the number of lymph nodes with metastasis detected; they also increased the proportion of patients with lymph node metastasis from 21% to 35% (p= 0.02). There were strong trends toward higher aggregate stage distribution, and eligibility for postoperative adjuvant chemotherapy in the dual-intervention cases. The combination of interventions improved the thoroughness and accuracy of pathologic nodal staging. A prospective randomized trial to test the survival impact of the dual interventions is warranted.

Symptoms of anxiety and depression assessed with the Hospital Anxiety and Depression Scale in patients with oropharyngeal dysphagia

ObjectiveThe aim of the present study is to determine the presence and severity of symptoms of anxiety and depression in patients with oropharyngeal dysphagia who visit the outpatient clinic for dysphagia. MethodsSymptoms of anxiety and depression (affective symptoms) were prospectively assessed in 96 patients using the validated Hospital Anxiety and Depression Scale. In addition, all patients underwent a standardized examination protocol used for regular healthcare in the outpatient setting for dysphagia. The protocol included the following: otorhinolaryngological examination, logopedic observation of oral intake, fiber optic endoscopic evaluation of swallowing, videofluoroscopy of swallowing, the Functional Oral Intake Scale, a dysphagia severity scale, and the M.D. Anderson Dysphagia Inventory. Depending on the presence/absence of symptoms of anxiety and depression, several groups were distinguished. Descriptive statistics and the Mann–Whitney U test were used to test for group differences. Logistic regression models were used to identify factors associated with symptoms of anxiety and/or depression (cut-off score >8). ResultsClinically relevant symptoms of anxiety were observed in 37% (N=34) and clinically relevant symptoms of depression in 32.6% (N=31) of the present patient population, with 21.3% having symptoms of both anxiety and depression. In total, 47.3% (N=43) of this population showed affective symptoms. ConclusionGiven that psychological burden can enhance somatic complaints, the high number of patients suffering from affective symptoms is a relevant clinical outcome in dysphagic patients. The contribution of anxiety or depression to the development or worsening of oropharyngeal dysphagia and their role in interdisciplinary treatment strategy is warranting further research.

AB0763 Olfactory and respiratory nasal function in churg-strauss syndrome

BackgroundNasal involvement seems to be common in Churg-Strauss Syndrome (CSS, (1,2)). Detailed investigations of nasal function are not available.ObjectivesTo analyze nasal function in CSS regarding especially olfactory and respiratory capacities...

Dual intervention with a lymph node (LN) specimen collection kit and enhanced specimen dissection to improve staging of resectable non-small cell lung cancer (NSCLC).

7569 Background: LN metastasis impairs survival of resectable NSCLC, but routine pathologic nodal staging is suboptimal. We tested the impact of a dual intervention (a surgical specimen collection kit with specific, pre-labeled LN collection cups, to improve intraoperative hilar/mediastinal LN dissection; and a fastidious gross dissection of the resected lung specimen for perihilar/intrapulmonary LNs) on the rate of detection of LN metastasis. Methods: We matched dual intervention cases with controls performed with standard surgical specimen collection and pathology examination protocols. Controls were hierarchically matched for extent of resection, laterality, surgeon, pathologist and T-stage. All statistical comparisons were made with Exact Conditional Logistic Regression, to account for the matched case-control design. Results: Patient demographic, tumor histology, and size characteristics were similar between the groups. The impact of the dual interventions is shown in the Table. Conclusions: The dual interventions significantly increased retrieval of N1 and N2 LNs, the rate of detection of LN metastasis, and nodal up-staging. There were strong trends towards higher aggregate stage and increased adjuvant therapy eligibility. The interventions may improve stage-adjusted survival by improving stage accuracy, and improve aggregate survival by increasing the appropriate use of post-operative adjuvant therapy. A prospective randomized trial to test survival impact of the dual interventions is at an advanced planning phase. [Table: see text]

A comparative study between enteric parasites of Coyotes in a protected and suburban habitat

Coyotes (Canis latrans) have inhabited Florida (USA) since the 1960s and are currently found throughout the state. Our objective was to obtain information on enteric parasites of coyotes from two different habitats. Fresh coyote fecal samples were collected from protected and suburban habitats in Pinellas County, Florida, USA (27o54′ N, 82o41′W) from May 2005 to March 2007. A standard fecal flotation examination and formalin-ethyl acetate sedimentation protocol were utilized on fecal samples from both habitats. Five newly documented coyote parasites were documented: one cestode (Hymenolepis spp.), one nematode (Ascaris spp.), and three protozoa (Balantidium coli, Blastocystis spp., and Entamoeba histolytica). Nine hitherto unreported parasites for FL coyotes were also discovered: two cestodes (Diphyllobothrium latum and Dipylidium caninum), two nematodes (Toxocara canis and Uncinaria stenocephala), one trematode (Paragonimus spp.), and four protozoa (Cryptosporidium spp., Giardia canis, Cystoisospora spp., and Sarcocystis cruzi). The protected area supported significantly more undocumented (i.e., newly identified) parasites for FL coyotes, and Protozoa as compared to the suburban area. Florida coyotes are likely more susceptible to infection by novel parasites because of their rapid range expansion and lack of acquired immunity. In addition, rapid habitat loss and urbanization in Florida may increase the probability of disease transmission between wild and domestic canids. We suggest preventative measures that may lower the risk of parasitic infection and promote co-existence with coyotes in urban landscapes.

Workflow Efficiency of Two 1.5 T MR Scanners with and without an Automated User Interface for Head Examinations

Workflow efficiency and workload of radiological technologists (RTs) were compared in head examinations performed with two 1.5 T magnetic resonance (MR) scanners equipped with or without an automated user interface called "day optimizing throughput" (Dot) workflow engine. Thirty-four patients with known intracranial pathology were examined with a 1.5 T MR scanner with Dot workflow engine (Siemens MAGNETOM Aera) and with a 1.5 T MR scanner with conventional user interface (Siemens MAGNETOM Avanto) using four standardized examination protocols. The elapsed time for all necessary work steps, which were performed by 11 RTs within the total examination time, was compared for each examination at both MR scanners. The RTs evaluated the user-friendliness of both scanners by aquestionnaire. Normality of distribution was checked for all continuous variables by use of the Shapiro-Wilk test. Normally distributed variables were analyzed by Student's paired t-test, otherwise Wilcoxon signed-rank test was used to compare means. Total examination time of MR examinations performed with Dot engine was reduced from 24:53 to 20:01 minutes (P < .001) and the necessary RT intervention decreased by 61% (P < .001). The Dot engine's automated choice of MR protocols was significantly better assessed by the RTs than the conventional user interface (P = .001). According to this preliminary study, the Dot workflow engine is a time-saving user assistance software, which decreases the RTs' effort significantly and may help to automate neuroradiological examinations for a higher workflow efficiency.

Do Radiologists Agree on Findings in Radiographer-Acquired Sonographic Examinations?

Sonographic examinations are usually regarded as observer dependent, but a recently introduced method using documentation with cine loops acquired in a standardized way attempts to address this problem. The aim of this study was to evaluate the intraobserver and interobserver agreement of sonographic liver examinations using strictly standardized examination protocols with cine loop documentation. Ninety-eight outpatients were examined by a radiographer using the standardized method. Three radiologists, each with 10 to 20 years of experience in sonography, reviewed the cine loops retrospectively. After 4 weeks, the review was repeated; the 3 radiologists were blinded to the initial reading. The κ coefficient was used to analyze intraobserver and interobserver agreement, and agreement in percent was also calculated. The intraobserver agreement was highest for concrements in the gallbladder (κ= 0.91-0.96) and lowest when assessing the need for further examination (κ = 0.38-0.64). For increased liver echogenicity, κ varied between 0.73 and 0.92 and for skip areas between 0.73 and 0.90. The interobserver agreement was also highest for concrements in the gallbladder (κ = 0.84-1.00) and lowest for the need for further examination (κ = -0.12-0.46). For most other findings, substantial intraobserver agreement was found. For sonographic examinations performed according to a standardized examination protocol by a radiographer and viewed by an experienced radiologist, good interobserver agreement was found, except for judgments of the need for further examinations.

Image-guided Transcranial Doppler Sonography for Monitoring of Defined Segments of Intracranial Arteries

Transcranial Doppler sonography (TCD) is widely used in neurointensive care. Image guidance (IG) could simplify secure vessel identification and reduce interinvestigator and intrainvestigator variability. The present study was purposed to investigate the precision and reproducibility of image-guided TCD. The Kolibri IG system (Brainlab AG, Feldkirchen, Germany) was used to track a hand-held Doppler probe of a DWL Multi-Dop® T digital device (Compumedics Germany GmbH, Singen, Germany). The patient's head was registered noninvasively to the IG system. Distance between predefined vascular target and optimal Doppler signal was evaluated to assess spatial accuracy of image-guided TCD. To investigate reproducibility, spatial accuracy of trajectories acquired during an initial examination using the IG system was analyzed in serial examinations. Furthermore, stability of noninvasive registration of the patient's head to the IG system was analyzed. Data are presented as mean±SD for descriptive statistics. Twelve patients were included. Using IG, a Doppler signal was recorded immediately in all cases for middle cerebral artery (MCA) (29 examinations), in 81% for carotid-T (27 examinations), and in 90% for basilar tip (29 examinations). The optimal Doppler signal was found within 2.64±1.15 mm (94 preplanned targets). At serial examinations, a spatial deviation of 2.75±1.20 mm was found (56 trajectories acquired in 19 serial examinations). Examination time did not influence accuracy of noninvasive patient registration. Data suggest that image-guided TCD allows for accurate examinations with high intraprocedural and high interprocedural reproducibility. It facilitates identification of specific vessel segments and generation of standardized examination protocols for serial examinations.

Assessment of Dementia by a Primary Health Care Dementia Team Cooperating with the Family Doctor – The Norwegian Model

Background: To describe how dementia assessment could be organized in primary health care and how it works. Methods: The project had two phases. In phase one 104 elderly patients were assessed by a local authority dementia team that used a standardized examination protocol, which enabled the family doctors to establish a dementia diagnosis. After evaluation and adjustments the model was extended to 31 local authorities and 474 patients were assessed. Results: The mean age of the patients was 84.4 (SD 5.6) and 81.8 (SD 7.8) years, respectively; 81 and 67% were women, respectively. The mean Mini Mental State Examination scores were 21.1 (SD 5.0) and 19.2 (SD 5.1), respectively. All patients in phase one and 70% in phase two were diagnosed with dementia. In 15 local authorities a specially assigned family doctor assisted in establishing diagnoses. In these local authorities 80% of the patients were diagnosed. Conclusion: A local authority dementia team can collect the information required to enable a family doctor to establish a dementia diagnosis. Ideally, such teams should be assisted by a family doctor interested in dementia diagnostics.

Assessment of impact factors on shear wave based liver stiffness measurement

Shear wave based ultrasound elastographies have been implemented as non-invasive methods for quantitative assessment of liver stiffness. Nonetheless, there are only a few studies that have investigated impact factors on liver stiffness measurement (LSM). Moreover, standard examination protocols for LSM are still lacking in clinical practice. Our study aimed to assess the impact factors on LSM to establish its standard examination protocols in clinical practice. We applied shear wave based elastography point quantification (ElastPQ) in 21 healthy individuals to determine the impact of liver location (segments I–VIII), breathing phase (end-inspiration and end-expiration), probe position (sub-costal and inter-costal position) and examiner on LSM. Additional studies in 175 healthy individuals were also performed to determine the influence of gender and age on liver stiffness. We found significant impact of liver location on LSM, while the liver segment V displayed the lowest coefficient of variation (CV 21%). The liver stiffness at the end-expiration was significantly higher than that at the end-inspiration (P=2.1E−05). The liver stiffness was 8% higher in men than in women (3.8±0.7kPa vs. 3.5±0.4kPa, P=0.0168). In contrast, the liver stiffness was comparable in the different probe positions, examiners and age groups (P>0.05). In conclusion, this study reveals significant impact from liver location, breathing phase and gender on LSM, while furthermore strengthening the necessity for the development of standard examination protocols on LSM.