Total Examination Time Research Articles

Virtual bronchoscopic navigation versus non-virtual bronchoscopic navigation assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: a systematic review and meta-analysis.

Background:Image-guided bronchoscopy techniques such as virtual bronchoscopic navigation (VBN) has emerged as a means of assisting in the biopsy of peripheral pulmonary lesions. However, the role of VBN-assisted (VBNA) bronchoscopy in the diagnosing of peripheral pulmonary lesions (PPLs) has not been well established. This meta-analysis investigated the diagnostic yield of VBN-assisted versus non-VBN-assisted (NVBNA) bronchoscopy for PPLs.Methods:PubMed, Embase, Cochrane library, and Web of Sciences databases were searched up to and including August 2020 to identify randomized controlled trials (RCTs) evaluating the performance of VBNA compared with an NVBNA group. Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI).Results:Six RCTs with 1626 patients were included. The overall diagnostic rate was similar in the VBNA (74.17%) and NVBNA (69.51%) groups, with risk ratio of 1.07 (95% CI: 0.98–1.17). However, in the VBNA group, the total examination time was significantly shorter (MD = −3.94 min, 95% CI: −6.57 to −1.36; p = 0.003) than in the NVBNA group. VBNA had superior diagnostic yield than NVBNA for PPLs ⩽ 20 mm (RR = 1.18, 95% CI: 1.05–1.32). In addition, diagnostic yield according to nature of lesion, lesion location in the lung lobe, distance from the hilum, bronchus sign and complications were similar between VBNA and NVBNA groups.Conclusion:VBNA bronchoscopy did not increase overall diagnostic yield in patients with PPLs compared with NVBNA bronchoscopy. The superiority of VBNA over NVBNA was evident among patients with PPLs ⩽ 20 mm. Future multicenter RCTs are needed for further investigation. The reviews of this paper are available via the supplemental material section.

Evaluation of a novel colonoscope offering flexibility adjuster - a retrospective observational study.

Background:Although colonoscopy is the gold standard for colorectal cancer screening, colonic looping may make complete colonoscopy challenging. Commonly available stiffening device colonoscopy has been described as helpful but not effective enough to prevent looping. In this context the effect on cecal intubation time and rate was described differently in various studies and in some studies had no impact on cecal intubation time at all. The aim of this study was to evaluate whether a novel colonoscope with gradual stiffness (Fujifilm EC760R-V/I- flexibility adjuster, Tokyo, Japan) using four significantly different grades of stiffness can be an alternative to established devices in terms of loop prevention, cecal intubation rate and time, adverse events, and patient/examiner satisfaction.Methods:Consecutive patients without previous colorectal surgery were analyzed retrospectively. Colonoscopy was performed with the new colonoscope and performance characteristics, including time to cecum, withdrawal time, total examination time, and patient and endoscopist satisfaction were recorded.Results:Among 180 consecutive procedures, 98.3% of examinations were complete to the cecum. The endoscopic flexibility adjuster was used in 150 of 180 cases (83.3%). Overall, the device was scored by the examiner as helpful to prevent looping in 146 of the 150 cases (97.7%). Mean cecal intubation time was 6.5 min, with 35% of examination performed in under 5 min with a mean withdrawal time of 7 min. Mean total examination time was 18 min. Patient satisfaction was rated as high in all examinations performed.Conclusion:The new flexibility adjuster colonoscope was shown to be helpful in loop prevention, allowed for fast and successful cecal intubation, and led to a high rate of patients satisfaction.

Application of magnetic resonance imaging-compatible incubator in cranial magnetic resonance imaging for neonates: a multicenter prospective randomized clinical trial

Objective To study the safety and efficacy of magnetic resonance imaging (MRI)-compatible incubator in cranial MRI examination for neonates. Methods A total of 120 neonates who were hospitalized in three hospitals and needed to undergo MRI examination were randomly divided into a control group and an experimental group, with 60 neonates in each group. The neonates in the experimental group were transferred with MRI-compatible incubator and underwent cranial MRI examination inside the MRI-compatible incubator, and those in the control group were transferred using a conventional neonatal transfer incubator and then underwent MRI examination outside the incubator. The two groups were compared in terms of the primary efficacy index (total examination time), secondary efficacy indices (times of examination, MRI completion rate on the first day of use), and safety indices (incidence rate of adverse events and vital signs). Results There were no significant differences in total examination time, times of examination, and MRI completion rate on the first day of use between the two groups (P > 0.05). There were also no significant differences between the two groups in the incidence rate of adverse events and vital signs such as respiratory rate, heart rate, blood pressure, and blood oxygen saturation rate at different time points before and after examination (P > 0.05). Conclusions The use of MRI-compatible incubator does not significantly shorten the examination time of cranial MRI, but it does provide a relatively stable environment for examination with acceptable safety. There is a need for further studies with a larger population.

Tapering body stiffness shortens upper gastrointestinal examination via transoral insertion with ultrathin endoscope.

Background and study aims Ultrathin endoscopes are commonly used for surveillance esophagogastroduodenoscopy (EGD) to reduce discomfort associated with scope insertion. However, the flexibility of an ultrathin endoscope is a trade-off between reducing discomfort and lengthening examination time. Patients and methods The EG17-J10 (EG17) is a novel ultrathin endoscope characterized by its tapering body stiffness; however, the flexibility of its tip is comparable to that of the traditional ultrathin endoscope EG16-K10 (EG16). We compared EGD examination time between EG17 and EG16. A total of 319 examinees who underwent EGD from November 2019 to January 2020 at the Chiba-Nishi General Hospital were enrolled. Six examinees were excluded due to past history of surgical resection of the upper gastrointestinal tract or too much food residues; 313 examinees (EG17, 209; EG16,104) were retrospectively analyzed. The examination time was divided into three periods: esophageal insertion time (ET), gastroduodenal insertion time (GDT), and surveillance time of the stomach (ST). The total amount of ET, GDT, and ST was defined as total examination time (TT). Results TT of EGD using EG17 was significantly shorter compared to EGD using EG16 (222.7 ± 68.9 vs. 245.7 ± 78.5 seconds) ( P = 0.004). Among the three periods of examination time, ET (66.7 ± 24.1 vs. 76.0 ± 24.1 seconds) ( P = 0.001) and GDT (47.9 ± 17.4 vs. 55.2 ± 35.2 seconds) ( P = 0.007) of EGD using EG17 were significantly shorter compared to EGD using EG16, except for ST (108.1 ± 51.5.1 vs. 114.5 ± 50.1 seconds) ( P = 0.148). Conclusion An ultrathin endoscope with tapering body stiffness can shorten EGD examination time, mainly due to the shortening of insertion time.

Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy.

BACKGROUNDRetrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography (DBERC) is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal anatomy. The accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely manner. AIMTo determine the accuracy of carbon dioxide insufflation enterography (CDE) at the branch for selecting the correct route during DBERC.METHODSWe enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017. Route selection via two methods (visual observation and CDE) was performed in each patient. We determined the correct rate of route selection using CDE.RESULTSThirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal anastomosis. The therapeutic target region was reached in 50 patients. The mean procedure times from the teeth to the target (total insertion time), from the teeth to the branch, and from the branch to the target, and the mean total examination time were 15.2, 5.0, 8.2, and 60.3 min, respectively. The rate of correct route selection using visual observation and CDE were 36/52 (69.2%) and 48/52 (92.3%), respectively (P = 0.002). The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33 (87.8%), and the rate in patients with a gastrojejunal anastomosis was 19/19 (100%).CONCLUSIONCDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.

Chromoendoscopy With Indigo Carmine vs Virtual Chromoendoscopy (iSCAN 1) for Neoplasia Screening in Patients With Inflammatory Bowel Disease: A Prospective Randomized Study.

The risk of colon cancer is greater in patients with inflammatory bowel disease (IBD) than in the general population. Chromoendoscopy with dye (CE) is the currently recommended method for detecting dysplasia in screening colonoscopies in IBD patients; however, the role of virtual chromoendoscopy (VC) is not yet well defined. The object of this study was to compare CE and VC with the iSCAN 1 system in the detection of neoplastic lesions in IBD patients. We conducted a prospective, single-center, randomized study in IBD patients who underwent a colonoscopy for colon cancer screening. A total of 129 patients were included and were randomized to undergo a CE (n = 67) or a VC (n = 62). The rates of detection of neoplastic lesions by the 2 endoscopic techniques were compared. A total of 19 neoplastic lesions (9 adenomas and 10 low-grade dysplasias [LGD]) was detected in 16 patients, 12 lesions in the CE group (17.9%), and 7 lesions in the VC group (11.3%; P = 0.2); no differences were found in the overall rate of detection of lesions (neoplastic or nonneoplastic; P = 1). The median of the total examination time and endoscope withdrawal time (minutes) was significantly lower in the VC group than in the CE group (15 vs 20 and 10 vs 14, respectively; P < 0.001). No differences occurred in the rate of detection of neoplastic lesions between CE and VC with iSCAN 1. The time spent on the technique with VC is significantly less than that with CE.

Non-contrast-enhanced MR-angiography (MRA) of lower extremity peripheral arterial disease at 3 tesla: Examination time and diagnostic performance of 2D quiescent-interval single-shot MRA vs. 3D fast spin-Echo MRA

PurposeNon-contrast enhanced MRA is a promising diagnostic alternative to contrast-enhanced (CE-) MRA or CT in patients with lower extremity peripheral arterial disease (PAD) but potentially associated with prolonged examination times and inferior diagnostic performance. We aimed to compare examination times and diagnostic performance of non-contrast enhanced quiescent-interval slice-selective (QISS)-MRA and fast-spin-echo (FSE)-MRA at 3.0 T. Materials and methodsForty-five patients with PAD were recruited for this IRB approved prospective study. Subjects underwent lower extremity MRA with 1) QISS-MRA, 2) FSE-MRA, and 3) CE-MRA (continuous table movement MRA and time-resolved MRA of the calf), which served as the standard of reference. Scan times for each examination step and total examination times for each of the three techniques was determined. Image quality and degree of stenosis were rated by two readers on a 5-point Likert scale. Sensitivity, specificity and diagnostic accuracy for relevant (>50%) stenosis were calculated. ResultsMedian total examination time was 27:02 min for QISS-MRA (IQR, 25:13–31:01 min), 28:37 min for FSE-MRA (IQR, 25:51–33:12 min), and 31:22 min for CE-MRA (IQR, 26:41–33:23 min). Acquisition time for QISS-MRA was significantly longer compared to FSE-MRA and CE-MRA (p ≤ 0.0001), while time for localizers, scouts and planning of the MRA sequence was significantly shorter for QISS-MRA compared to FSE-MRA and CE-MRA (p ≤ 0.0001). QISS-MRA had significantly better image quality compared to FSE-MRA with less segments classified as non-diagnostic (Reader 1: 3% vs. 35%; Reader 2: 3% vs. 50%, p ≤ 0.0001). Overall, QISS-MRA showed significantly better diagnostic performance than FSE-MRA (sensitivity, 85% vs. 54%; specificity, 90% vs. 47%, diagnostic accuracy, 89% vs. 48%; p ≤ 0.0001). ConclusionTotal examination time of QISS-MRA and FSE-MRA was comparable with a conventional CE-MRA protocol. QISS-MRA showed significantly higher diagnostic performance than FSE-MRA.

A hybrid genetic algorithm for appointment scheduling in a health examination system

A health examination system is a large system comprised of many units that include sectors or rooms, such as healthcare clinics, each of which requires unique tasks and experts to offer complete and timely healthcare. In general, every HES must accommodate a diverse population of individuals with unique medical histories and special behaviours. Access to and consideration of individuals' medical histories can reduce total exam times within a HES. Therefore, this study proposed a hybrid genetic algorithm that can be used to address the appointment scheduling in a HES to reduce the total preparation time of each room or sector, with a general aim to reduce total examination time. The proposed method is performed for 18 cases with different patient and room sizes in a health system. Results obtained all these cases showed higher accuracy and performance of the proposed method to the CPLEX solver in terms of the objective function and computational time.

Analysis of intervention effect of improved nursing measures in deep brain stimulation for patients with dystonia in MRI localization

Objective To explore the intervention effect of improved nursing measures in the treatment of patients with dystonia with deep brain stimulation in MRI localization. Methods Twenty patients with dystonia treated with deep brain stimulation from January 2013 to December 2015 were selected as the control group. Twenty patients with dystonia treated by deep brain stimulation surgery with improved nursing from January 2016 to December 2018 were in the experimental group. The primary success rate of MRI localization, examination time related indexes and incidence of adverse reactions after intravenous anesthesia were observed in the 2 groups. Results The primary success rate of MRI localization in the experimental group (95.00%,19/20) was higher than that in the control group (55.00%,11/20), and the difference was statistically significant (χ2=8.533, P<0.01).The total examination time of the experimental group (33.60±8.27) min was significantly shorter than that of the control group (44.30±13.43) min, and the difference was statistically significant (t=-3.663, P<0.05).The incidence of total adverse reactions to MRI localization after intravenous anesthesia was lower in the experimental group (5%, 1/20) than in the control group (30%, 6/20), and the difference was statistically significant (χ2 =4.329, P < 0.05). Conclusions Improved nursing measures can effectively improve the success rate of MRI stereotactic brain target location in patients with dystonia, providing a guarantee for accurate calculation of surgical targets, enabling the operation to achieve the best results, early detection of changes in vital signs during examination, and the close cooperation of the medical team is the guarantee for the smooth completion of MRI examination. Key words: Deep brain stimulation; Dystonia; Magnetic resonance imaging; Improved care; Intervention effect

Transitioning to whole-body SPECT/CT in prostate cancer staging: anew concept for a better imaging workflow.

Whole-body bone scan (BS) is the clinical standard in detecting bone metastases in prostate cancer patients. Additional SPECT/CT has allowed to significantly increase its diagnostic accuracy. However, performing both planar and additional SPECT/CT prolongs the total examination time and lowers patient throughput. In this study we aim to assess the diagnostic performance of a SPECT/CT-only protocol compared to the traditional procedure that is BS with a facultative SPECT/CT in case of unclear findings. 50 patients with high-risk prostate cancer and suspected bone metastases were enrolled in this retrospective study. All patients received a whole-body Tc-99m-DPD BS followed by a 3 field-of-view (FOV) SPECT/CT (GE Discovery 670 Pro®) covering an area from the vertex to the mid-femur. Metastatic lesions were evaluated visually on BS and SPECT/CT and correlated to PSA-levels. Detection rate was up to 50 % higher in SPECT/CT than in BS (n = 2829 vs. n = 1942; p < 0.001), but 31/1942 (1.5 %) lesions detected on BS were located out of the SPECT/CT field-of-view. In our analysis a PSA-level of > 80 µg/l could be defined as a cut-off-value for metastatic spread beyond mid-thigh, as no patient with PSA< 80 µg/l had localizations outside the SPECT/CT field-of-view (AUCPSA = 0.95, p < 0.001 sensitivity: 100 %, specificity: 77 %, NPV: 100 %, PPV: 67 %). The SPECT/CT-only protocol did not prolong acquisition time significantly as compared to BS. In patients with high-risk prostate cancer presenting with PSA < 80 µg/l and absent clinical symptoms, vertex to mid-thighs 3-FOV-SPECT/CT was representative for the entire skeletal system and was able to detect more lesions than planar acquisition. This procedure did not prolong patient handling time significantly.

Operator learning curve for transradial liver cancer embolization: implications for the initiation of a transradial access program.

We aimed to analyze transradial access (TRA) learning curve on patients undergoing hepatic chemoembolization, investigating the relationship between procedural volumes and various benchmarks of procedural success. We enrolled 60 consecutive patients who received two unilobar hepatic chemoembolizations within a 4-week interval performed by a single interventional radiologist, highly-trained in conventional transfemoral access (TFA) procedures, but without any previous practical experience in TRA procedures and with a preliminary 2-day theoretical training only. Consecutive patients were prospectively enrolled and analyzed in 3 groups: A (cases 1 to 20), B (cases 21 to 40), and C (cases 41 to 60). All patients underwent one hepatic chemoembolization using TRA and the other one using TFA in random order. All TFA procedures performed by the same operator in the same series of patients were considered as the control group. Primary endpoint was to analyze the relationship between TRA procedure operator experience and benchmarks of procedural success, to define the optimal procedural learning curve. Technical success was obtained in all patients, with a crossover rate (radial to femoral access) of 0%. An association between incremental TRA operator experience (in terms of performed procedures) and decrease of preparation, puncture, fluoroscopy, and total examination times was observed. Similarly, inverse associations between incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 0.001) were also observed. Compared with TFA, CM volumes and RD values were significantly higher only in group A (cases 1-20). Procedure success remained high in all TRA groups and no significant association between TRA incremental experience and postprocedural outcomes was found. Higher postprocedural complaints at the access route and more limitations in performing basic activities were recorded after TFA vs. TRA (P < 0.001). TRA catheterizations can be safely performed in patients treated for liver cancer embolization after a relatively short training in controlled conditions and with a better performance in comparison with TFA. Operator proficiency improves with greater TRA experience, with a threshold needed to overcome the learning curve represented by about 20 procedures.

P047 Relevant factors and significant endoscopic findings for detecting UC-associated neoplasms using pan-colonic NBI surveillance colonoscopy: A sub-analysis of navigator study

BACKGROUND: We recently reported the results of a prospective multicenter randomised controlled trial comparing pancolonic observation using a newly developed NBI (CF-HQ290I) and panchromoendoscopy (PCE) for surveillance colonoscopy in UC patients. The results revealed that the NBI observation was not inferior to PCE for the detection of both neoplastic lesions (13.4% vs 9.0%; P = 0.33) and colitis-associated dysplasia or cancer (CC/D) (6.3% vs 4.9%; P = 0.86). Moreover, the total examination time of NBI (15.0 min) was significantly shorter than that of PCE (19.8 min) (P &lt; 0.01). This sub-analysis aimed to evaluate the relevant factors or NBI findings of the background mucosa of CC/D in the preceding Navigator Study (UMIN000013527). METHODS: In total, 263 patients were randomised to the PCE group (n = 130) and the NBI group (n = 133). Surveillance colonoscopy in both groups was performed mainly with targeted biopsy. The pathological diagnoses were made by 2 expert pathologists who performed including immunohistochemical staining (p53, Ki-67) while being blinded to clinical information. RESULTS: A total of 21 sporadic adenoma, 3 traditional serrated adenoma, 2 sessile serrated adenoma/polyp, 10 indefinite for dysplasia, 9 low grade dysplsisadysplasia, and 7 high grade dysplasia or cancer cases were detected. There was no statistical difference for in the contents of these detected lesions between the 2 groups (P = 0.91). The median number of biopsy samples was not different between the 2 groups (1.80/case in NBI, 1.85/case in PCE; P = 0.88). Multivariate analysis demonstrated that age (OR 1.05, 95% CI 1.02–1.08, P &lt; 0.01) and past history of CC/D (OR 4.26, 95% CI 1.29–14.05, P = 0.02) were the relevant factors for the detection of neoplastic lesions, and past history of CC/D (OR 5.70, 95% CI 1.33–24.50, P = 0.02) was the relevant factor for the detection of CC/D. CC/D was significantly more frequently detected than sporadic adenoma in cases in which the background mucosa had an obscure vascular pattern or scar rather than a fair view of the vascular pattern or out of range for inflammation (OR 25.0, 95% CI 3.80–164.4, P &lt; 0.01). CONCLUSION(S): In the Navigator Study, a past history of endoscopic resection or detection of dysplasia on random biopsy was the relevant factor for the detection of CC/D. The NBI findings of the background mucosa were useful in differentiating CC/D and sporadic adenoma.

A Preliminary Study of Neonatal Cranial Venous System by Color Doppler.

Aim To present anatomic data in the ultrasound planes for the identification of the major veins and the venous sinuses in cerebrum and to establish the sonographic normal reference values for the visualization of vein vessels and vein sinuses and blood flow velocities. Methods This study involved 55 healthy full-term neonates for transfontanellar color Doppler sonography. The imaging included both sagittal and coronal planes with LA332E probe, supplemented with PA240 probe as necessary. As low as reasonably achievable (ALARA) principle was obeyed, limiting Doppler exposure time and maximizing signal intensity by increasing gain rather than outputting transducer power settings. The output power was kept at a minimum level consistent with recording an adequate signal. Keeping the newborns in calm state, the total examination time which every neonate required was less than 5 min. All images were stored also in a workstation for further analysis. The description statistics and t-test for statistical analysis were used. Result In all studied cases (100% cases), subependymal veins (SV), internal cerebral veins (ICV), Galen vein (GV), straight sinus (SS), superior sagittal sinus (SSS), and transverse sinuses (TS) were visualized. The visualization percentages of inferior sagittal sinus (ISS) or basal veins/Rosenthal veins (BV/RV) were lower than 100%. Based on vessel visualization percentage from high to low, the vessels were ordered as follows: SV, ICV, BV, SS, TS, ISS, and SSS. In SSS and TS, the pulsation percentage was 100%. The descending percentages of vessel pulsation were noted in SS, BV, ICV, and SV. On the basis of the mean of maximum velocities of the vessels from low to high, the vessels were ordered as follows: ISS, BV-L, BV-R, ICV-R, ICV-L, SV-L, SV-R, SSS, TS-L, TS-R, and SS. Conclusion The measurements percent of visualization of cerebral deep veins was higher than the percent of cerebral venous sinuses. The pulsation percent of measurement and the velocities of cerebral venous sinuses were absolutely higher than the cerebral deep venous system. The pairs of vascular blood flow velocities were nonsignificantly different from one another.

Usefulness of virtual bronchoscopic navigation combined with endobronchial ultrasound guided transbronchial lung biopsy for solitary pulmonary nodules

Background:The aim of this study was to evaluate the diagnostic utility of virtual bronchoscopic navigation (VBN) combined with endobronchial ultrasound (EBUS) guided transbronchial lung biopsy for solitary pulmonary nodules (SPN).Methods:A total of 115 patients with suspected SPN who underwent transbronchial lung biopsy were evaluated. The patients were randomly divided into an EBUS (EBUS) group and a virtual bronchoscopic navigation combined with endobronchial ultrasound (VBN+EBUS) group. The diagnostic yield and examination time were compared.Results:There was no significant difference in the diagnostic yield between the VBN+EBUS group and the EBUS group (83.6% vs 66.7%, P = .419). When the lesions less than 20 mm in diameter of the lesions were analyzed, the diagnostic yield was higher in the VBN+EBUS group than in the EBUS group (80.0% vs 53.6%, P = .041). The time for positioning lesions in VBN+EBUS group was less than that in EBUS group (5.67 ± 2.48 min vs 8.65 ± 2.23 min, P = .015). But the total examination time was not significantly different between the 2 groups (20.59 ± 2.12 min vs 21.53 ± 1.62 min, P = .236). The incidence of complications did not differ between the 2 groups.Conclusions:In conclusion, VBN can shorten the positioning time and it is a safe and effective technique for pulmonary nodules.

Screening colonoscopy: High quality regardless of endoscopist specialty

BackgroundData suggests that screening colonoscopy performed by non-gastroenterologists are lower quality with lower adenoma detection rates (ADR). The aim of this study was to investigate the effect of the endoscopist's specialty on quality parameters in screening colonoscopy. MethodsScreening colonoscopies performed between January 2016 and June 2017 were queried from a prospectively maintained institutional database. Quality parameters including overall ADR, gender-specific ADR, total examination time, cecal intubation rate and withdrawal time were compared between gastroenterology (GI) and colorectal surgery (CRS). ResultsA total of 15,276 patients were included in the study (mean age 60.3 ± 8; 52.4% female). 11,339 (74.2%) of the colonoscopies were performed by GI, and 3937 (25.7%) were by CRS. Withdrawal time and total scope time were shorter in the GI group. Cecal intubation rate was comparable. Overall ADR, female ADR and male ADR were significantly higher in the GI group, although both groups met national quality benchmarks. ConclusionBoth specialties achieve appropriate quality metrics for screening colonoscopy. Prospectively evaluating each endoscopist's outcomes, regardless of specialty, is an important tool for ongoing quality improvement towards better patient outcomes.

The added value of qualitative and quantitative diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating benign from malignant breast lesions

ObjectiveTo evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) with calculation of the apparent diffusion coefficient (ADC) value in characterizing benign and malignant breast lesions. Patients and methodsThe imaging data of thirty-nine female patients (mean age 48 years) who underwent breast MRI using conventional pulse sequences. DW-MRI and dynamic contrast enhanced (DCE) study were all analyzed and correlated with the results of histopathological evaluation. ResultsForty-six breast lesions were detected in the thirty-nine patients of the study. According to the histopathological analysis, there were 27 malignant lesions (58.69%) and 19 benign lesions (41.31%). The malignant lesions showed a mean ADC value of 0.93 ± 0.42 × 10−3 mm2/s. and the benign lesions showed a mean ADC value of 1.54 ± 0.43 × 10−3 mm2/s. The receiver operating characteristic (ROC) curve could identify an ADC 1.26 × 10−3 mm2/s as a cut-off value to differentiate between benign and malignant lesions with sensitivity and specificity of 89% and 94.7% respectively. ConclusionDW-MRI is useful for differentiating malignant and benign breast lesions, increasing the specificity of breast MRI. DW-MRI doesn't cause significant increase in the total examination time and is recommended to be incorporated in the standard breast MRI protocol.

Can Diaphragm Dysfunction Be Reliably Evaluated with Pocket-Sized Ultrasound Devices in Intensive Care Unit?

Background Diaphragm dysfunction (DD) is frequently seen in critically ill patients, and ultrasound could be a useful tool to detect it and to predict extubation success or failure in mechanically ventilated patients. Besides, it would also be useful in differential diagnosis of dyspnea and respiratory failure. The aim of this study is to evaluate usefulness and accuracy of pocket-sized ultrasound devices (PSDs) in assessment of DD in intensive care unit (ICU) patients in comparison with standard ultrasound devices (SD). Methods In this prospective observational study, we compared the performance of PSD and SD in visualization of diaphragm, detection of paradoxical movement, measurement of tidal and maximal thickness, tidal and maximal excursion, and calculation of thickening fraction (TF) of the diaphragm. We used Bland and Altman test for agreement and bias analysis and intraclass correlation analysis to evaluate interobserver variability. Results Thirty-nine patients were included in the study. In 93% of the patients, diaphragm was visualized with PSD. There was very good agreement between the measurements of the devices, and there was no proportional bias in the measurements of tidal inspiratory and expiratory thickness, tidal TF, tidal excursion, and maximal inspiratory thickness. In interobserver reliability analysis of all measurements for both devices, ICC coefficients were higher than 0.8. Total diaphragm examination times of the devices were similar (p > 0.05). Conclusion These results suggest that PSD can be useful in ICU patients for evaluating DD. But further studies are required to determine the exact place of these devices in evaluation of DD in ICU patients.

Low-field magnetic resonance imaging of changes after femoral osteosynthesis failure: a case report

We describe here a case study of a 16-month-old female European shorthair cat examined about 6 months after the osteosynthesis of a femoral fracture. Clinical examination revealed a non-weightbearing left limb, pain upon manipulation of the hip joint, complete immobilisation of the stifle joint and muscle atrophy in the left thigh. Low-field magnetic resonance images were acquired in sagittal, transverse and dorsal planes with T1-weighted spin echo, T2-weighted fast spin echo, T1-weighted gradient echo, gradient echo short tau inversion recovery and T1-weighted XBone sequences. Total examination time was 59 min 20 s. The obtained images revealed the presence of osteophytes on the surface of the femoral head, subluxation of the hip joint, atrophy and fatty infiltration of the quadriceps femoris muscle. The symmetry and size of callus in the fracture site were also evaluated. Based on the results of the magnetic resonance imaging exam, the patient was diagnosed with hip osteoarthritis, atrophy and fatty degeneration of the quadriceps femoris muscle with homogeneous and symmetrical distribution of callus in the fracture site. The results of this study confirm the high diagnostic value of low-field magnetic resonance imaging in diagnostics of musculoskeletal injuries in cats.

Quality assessment of the detailed anomaly ultrasound scan

Objectives: The objective of this study is to assess the quality of the views in the detailed anomaly ultrasound scan and examine the parameters that influence it. Methods: Prospective study on singleton pregnancies examined at 20–24 weeks. Detailed views of all fetal organs were classified by the examiner as optimal/suboptimal. The duration of the examination was observed. Maternal characteristics, Fat Index (FI) (distance between the skin and the surface of the uterus), and fetal position were recorded. Results: The study population consisted of 940 singleton pregnancies. Optimal visualization of all fetal structures was achieved in 66% of cases. Significant predictors were BMI, FI, and fetal position. None of the women with BMI ≥ 44 and none of the women with FI ≥ 60 mm had optimal visualization of all fetal structures. Median duration of the examination was 23 min. In 75% of cases, it was completed in the first attempt. Maternal weight, FI, and fetal position were the significant independent predictors of total examination time. Conclusions: Optimal visualization of the fetal anatomy is restricted by maternal parameters and fetal position. The main limitation is accumulation of abdominal fat, usually but not always related to maternal obesity. The FI may be recorded as a measure of technical difficulty. The anomaly scan should be allocated at least 30 min scanning time.

Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project

BackgroundGlaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through...