-
British Journal of Hospital Medicine... May 2022Abdominal X-rays are frequently requested by clinicians in the Aberdeen Royal Infirmary acute medical initial assessment unit.
BACKGROUND/AIMS
Abdominal X-rays are frequently requested by clinicians in the Aberdeen Royal Infirmary acute medical initial assessment unit.
METHOD
The proportion of indicated abdominal X-rays requested within 24 hours of admission was retrospectively examined. This process was repeated after displaying an educational poster with the Royal College of Radiologists guidelines (cycle 2) and a graded assertive communication poster (cycles 3 and 4); a tool to enable junior doctors to challenge inappropriate requests for abdominal X-rays from seniors.
RESULTS
Only 47.2% of abdominal X-ray requests were deemed appropriate in cycle 1. A 1.54% reduction in abdominal X-ray requests and an 11.5% increase in indicated abdominal X-rays were noted after cycle 2. Cycle 3 led to a statistically significant improvement with 2.6% fewer patients undergoing an abdominal X-ray and a 24.6% increase in indicated abdominal X-rays. This improvement was sustained in cycle 4.
CONCLUSIONS
Promoting graded assertive communication is an effective means of helping junior doctors to challenge seniors requesting non-indicated abdominal X-rays.
Topics: Hospitalization; Humans; Medical Staff, Hospital; Radiography, Abdominal; Retrospective Studies; X-Rays
PubMed: 35653316
DOI: 10.12968/hmed.2021.0603 -
The Turkish Journal of Pediatrics 2022To evaluate the predictability of clinical and radiological findings in the diagnosis of malrotation.
BACKGROUND
To evaluate the predictability of clinical and radiological findings in the diagnosis of malrotation.
METHODS
Between 2010 and 2020, children with presumptive diagnosis of malrotation were included. The demographic features, clinical and radiological findings, operative findings and outcome were recorded. The upper gastrointestinal series (UGIS) were evaluated by two radiologists. All parameters were correlated with surgical findings to evaluate the predictability.
RESULTS
Seventy patients were included. The presenting symptom was bilious vomiting in 29 cases (41.4%), and atypical symptoms (non-bilious vomiting, food refusal, etc.) in 40 cases (57%). One of the cases (1.6%) was asymptomatic and diagnosed incidentally during UGIS. 52 cases had abdominal X-ray and 14 (26.9%) of them were normal. Doppler ultrasonography (US) (n=20) revealed evidence of malrotation in 13 cases (65%). The location of duodenojejunal junction (DJJ) in UGIS was compatible with malrotation in 33 cases. 48 (61%) cases underwent surgical exploration; 35 cases had malrotation and seven cases had midgut volvulus. Median followup time was one year (0.5-7 years). Volvulus has recurred in one case and another case operated for volvulus died because of short bowel syndrome. The statistical analysis for predictability revealed that bilious vomiting (sensitivity: 57.1%, specificity: 82.1%), Doppler US (sensitivity: 92.3%, specificity: 75%) and right-sided DJJ in UGIS (sensitivity: 96.8%, specificity: 75%) have highest predictability.
CONCLUSIONS
The bilious vomiting, Doppler US findings and right-sided DJJ have the highest predictability to confirm the diagnosis. However, presenting with atypical symptoms and having atypical or normal findings in UGIS do not rule out malrotation.
Topics: Child; Humans; Intestinal Volvulus; Radiography, Abdominal; Ultrasonography; Vomiting
PubMed: 36082638
DOI: 10.24953/turkjped.2021.5019 -
Applied Radiation and Isotopes :... Dec 2023Undertaking medical imaging examinations on obese patients can present practical challenges. Choosing optimal imaging protocols can be difficult, especially when...
INTRODUCTION
Undertaking medical imaging examinations on obese patients can present practical challenges. Choosing optimal imaging protocols can be difficult, especially when promoting the ALARA principle. The aim of this study was to assess the effects of increasing body part thickness on image quality (IQ) and effective dose (ED) during upper abdominal radiography. A secondary aim was to determine the optimum exposure settings for larger sized patients.
METHODS
Underweight, standard, overweight and obese abdomen sizes were simulated using an anthropomorphic upper abdomen phantom, without and with additional fat layers (6, 10 and 16 cm). Phantoms were imaged using a variety of tube potentials (70-110 kVp), automatic exposure control (AEC) and a source-to-image distance of 120 cm. IQ was assessed visually using a relative visual grading analysis (VGA) method. Radiation dose was evaluated by calculating the ED using the Monte Carlo PCXMC 2.0 computer program.
RESULTS
IQ values showed a statistical reduction (p = 0.006) with increasing phantom size across all examined tube potentials. The highest IQ scores (3.3, 2.8, 2.5 and 2.2, respectively) were obtained at 70/75 kVp for all phantom thicknesses. As tube potential increased the IQ was also shown to decrease. ED showed a statistically significant increase (p < 0.001) with increasing phantom thicknesses.
CONCLUSION
Higher EDs were evident when applying lower tube potentials. Using an AEC with high tube potentials (105/110 kVp) can lead to a considerable decrease in ED with acceptable IQ when undertaking upper abdomen radiography on patients with large body part thicknesses.
IMPLICATION FOR PRACTICE
Applying higher values of tube potentials for patients who have a thicker abdomen can lead to decreased ED.
Topics: Humans; Radiation Dosage; Radiography; Radiography, Abdominal; Phantoms, Imaging; Obesity
PubMed: 37806283
DOI: 10.1016/j.apradiso.2023.111060 -
Abdominal Radiology (New York) Jun 2021
Topics: Humans; Radiography, Abdominal; Radiology
PubMed: 33484282
DOI: 10.1007/s00261-020-02941-5 -
Emergency Radiology Dec 2014The aims of this study are to audit the ordering of abdominal radiographs (AXR) in the emergency department (ED) and evaluate the current practices, knowledge and...
The aims of this study are to audit the ordering of abdominal radiographs (AXR) in the emergency department (ED) and evaluate the current practices, knowledge and attitudes of emergency physicians with regard to ordering AXRs in patients presenting with acute abdominal pain. A retrospective study was undertaken at an ED of a tertiary hospital in Tasmania using clinical notes on patient presenting with acute abdominal pain who underwent an AXR. The study also included a short questionnaire, which assessed emergency physicians' knowledge of current imaging guidelines and clinical practice when ordering an AXR. During the study period, 108 patients satisfied the selection criteria, and the AXR was reported as normal in 76 % (n = 82; p value <0.05), non-specific in 12 % (n = 13; p value <0.05) and abnormal in 12 % (n = 13; p value <0.05) of patients. Of those patients, 25 % (n = 27) of the AXRs did not meet indications listed in the Diagnostic Imaging Pathways published by the Western Australia Department of Health and were found not to benefit patient care. Of the 19 doctors who completed the survey, only 16 % (n = 3) were aware of any clinical guidelines for imaging in this setting. Current guidelines should be followed when ordering imaging for patients with acute abdominal pain to minimise unnecessary patient radiation exposure, avoid delays in diagnosis and definitive patient management, reduce costs and therefore increase efficiency in ED.
Topics: Abdomen, Acute; Abdominal Pain; Emergency Service, Hospital; Female; Guidelines as Topic; Humans; Male; Middle Aged; Radiation Pneumonitis; Radiography, Abdominal; Surveys and Questionnaires
PubMed: 24880255
DOI: 10.1007/s10140-014-1244-y -
Scientific Reports Oct 2020This study aimed to verify a deep convolutional neural network (CNN) algorithm to detect intussusception in children using a human-annotated data set of plain abdominal...
This study aimed to verify a deep convolutional neural network (CNN) algorithm to detect intussusception in children using a human-annotated data set of plain abdominal X-rays from affected children. From January 2005 to August 2019, 1449 images were collected from plain abdominal X-rays of patients ≤ 6 years old who were diagnosed with intussusception while 9935 images were collected from patients without intussusception from three tertiary academic hospitals (A, B, and C data sets). Single Shot MultiBox Detector and ResNet were used for abdominal detection and intussusception classification, respectively. The diagnostic performance of the algorithm was analysed using internal and external validation tests. The internal test values after training with two hospital data sets were 0.946 to 0.971 for the area under the receiver operating characteristic curve (AUC), 0.927 to 0.952 for the highest accuracy, and 0.764 to 0.848 for the highest Youden index. The values from external test using the remaining data set were all lower (P-value < 0.001). The mean values of the internal test with all data sets were 0.935 and 0.743 for the AUC and Youden Index, respectively. Detection of intussusception by deep CNN and plain abdominal X-rays could aid in screening for intussusception in children.
Topics: Abdomen; Algorithms; Area Under Curve; Child, Preschool; Deep Learning; Diagnostic Tests, Routine; Female; Humans; Infant; Infant, Newborn; Intussusception; Male; Mass Screening; Neural Networks, Computer; ROC Curve; Radiographic Image Interpretation, Computer-Assisted; Radiography, Abdominal; Reproducibility of Results; Retrospective Studies
PubMed: 33067505
DOI: 10.1038/s41598-020-74653-1 -
Radiology Jun 2015Large-bowel obstruction is an abdominal emergency with high morbidity and mortality rates if left untreated. Although abdominal radiography is usually the initial... (Review)
Review
Large-bowel obstruction is an abdominal emergency with high morbidity and mortality rates if left untreated. Although abdominal radiography is usually the initial imaging study performed in patients suspected of having large-bowel obstruction, it may not be sufficient to distinguish obstruction from other causes of colonic dilatation. Computed tomography is the imaging method of choice as it can establish the diagnosis and cause of large-bowel obstruction. A contrast agent enema may be used to confirm or exclude large-bowel obstruction. In this review, the imaging findings in multiple causes of large-bowel obstruction are illustrated and compared with acute colonic pseudo-obstruction.
Topics: Diagnosis, Differential; Humans; Intestinal Obstruction; Intestine, Large; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 25997131
DOI: 10.1148/radiol.2015140916 -
Pediatric Radiology Feb 2018Default pediatric protocols on many digital radiography systems are configured based on patient age. However, age does not adequately characterize patient size, which is...
BACKGROUND
Default pediatric protocols on many digital radiography systems are configured based on patient age. However, age does not adequately characterize patient size, which is the principal determinant of proper imaging technique. Use of default pediatric protocols by inexperienced technologists can result in patient overexposure, inadequate image quality, or repeated examinations.
OBJECTIVE
To ensure diagnostic image quality at a well-managed patient radiation exposure by transitioning to thickness-based protocols for pediatric portable abdomen radiography.
MATERIALS AND METHODS
We aggregated patient thickness data, milliamperes (mAs), kilovoltage peak (kVp), exposure index (EI), source-to-detector distance, and grid use for all portable abdomen radiographs performed in our pediatric hospital in a database with a combination of automated and manual data collection techniques. We then analyzed the database and used it as the basis to construct thickness-based protocols with consistent image quality across varying patient thicknesses, as determined by the EI.
RESULTS
Retrospective analysis of pediatric portable exams performed at our adult-focused hospitals demonstrated substantial variability in EI relative to our pediatric hospital. Data collection at our pediatric hospital over 4 months accumulated roughly 800 portable abdomen exams, which we used to develop a thickness-based technique chart.
CONCLUSION
Through automated retrieval of data in our systems' digital radiography exposure logs and recording of patient abdomen thickness, we successfully developed thickness-based techniques for portable abdomen radiography.
Topics: Abdomen; Child; Clinical Protocols; Female; Humans; Male; Point-of-Care Systems; Quality Improvement; Radiography, Abdominal; Retrospective Studies
PubMed: 29130139
DOI: 10.1007/s00247-017-4025-4 -
Radiologic Clinics of North America Jul 2015Pancreatic and duodenal injuries are rare but life-threatening occurrences, often occurring in association with other solid organ injuries. Findings of pancreatic and... (Review)
Review
Pancreatic and duodenal injuries are rare but life-threatening occurrences, often occurring in association with other solid organ injuries. Findings of pancreatic and duodenal trauma on computed tomography and MR imaging are often nonspecific, and high levels of clinical suspicion and understanding of mechanism of injury are imperative. Familiarity with the grading schemes of pancreatic and duodenal injury is important because they help in assessing for key imaging findings that directly influence management. This article presents an overview of imaging of blunt and penetrating pancreatic and duodenal injuries, including pathophysiology, available imaging techniques, and variety of imaging features.
Topics: Abdominal Injuries; Diagnosis, Differential; Duodenum; Humans; Pancreas; Radiography, Abdominal; Tomography, X-Ray Computed
PubMed: 26046509
DOI: 10.1016/j.rcl.2015.02.009 -
Radiography (London, England : 1995) Feb 2022This study aims to identify optimal exposure parameters, delivering the lowest radiation dose while maintaining images of diagnostic quality for the antero-posterior...
INTRODUCTION
This study aims to identify optimal exposure parameters, delivering the lowest radiation dose while maintaining images of diagnostic quality for the antero-posterior (AP) abdomen x-ray projection in large patients with an AP abdominal diameter of >22.3 cm.
METHODOLOGY
The study was composed of two phases. In phase 1, an anthropomorphic phantom (20 cm AP abdominal diameter) was repetitively radiographed while adding 3 layers (5 cm thick each) of fat onto the phantom reaching a maximum AP abdominal diameter of 35 cm. For every 5 cm thickness, images were taken at 10 kVp (kilovoltage peak) intervals, starting from 80 kVp as the standard protocol currently in use at the local medical imaging department, to 120 kVp in combination with the use of automatic exposure control (AEC). The dose area product (DAP), milliampere-second (mAs) delivered by the AEC, and measurements to calculate the signal to noise ratio (SNR) and contrast to noise ratio (CNR) were recorded. Phase 2 included image quality evaluation of the resultant images by radiographers and radiologists through absolute visual grading analysis (VGA). The resultant VGA scores were analysed using visual grading characteristics (VGC) curves.
RESULTS
The optimal kVp setting for AP abdominal diameters at: 20 cm, 25 cm and 30 cm was found to be 110 kVp increased from 80 kVp as the standard protocol (with a 56.5% decrease in DAP and 76.2% in mAs, a 54.2% decrease in DAP and 76.2% decrease in mAs and a 29.2% decrease in DAP and 59.7% decrease in mAs, respectively). The optimal kVp setting for AP abdominal diameter at 35 cm was found to be 120 kVp increased from 80 kvp as the standard protocol (with a 50.7% decrease in DAP and 73.4% decrease in mAs). All this was achieved while maintaining images of diagnostic quality.
CONCLUSION
Tailoring the exposure parameters for large patients in radiography of the abdomen results in a significant reductions in DAP which correlates to lower patient doses while still maintaining diagnostic image quality.
IMPLICATIONS FOR CLINICAL PRACTICE
This research study and resultant parameters may help guide clinical departments to optimise AP abdomen radiographic exposures for large patients in the clinical setting.
Topics: Abdomen; Humans; Phantoms, Imaging; Radiation Dosage; Radiography, Abdominal; Signal-To-Noise Ratio
PubMed: 34544645
DOI: 10.1016/j.radi.2021.08.009