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BMJ Case Reports Jul 2017A 23-year-old woman presented to the emergency department after manually inserting foreign bodies into the urinary bladder through her urethra. A plain abdominal film of...
A 23-year-old woman presented to the emergency department after manually inserting foreign bodies into the urinary bladder through her urethra. A plain abdominal film of the kidneys, ureters and bladder confirmed three radio-opaque densities in the urinary bladder. She was taken to the operating room where cystourethroscopy was performed. At cystoscopy 2 'corn-on-the-cob' skewers and 1 battery were identified but were too large to be retrieved safely with a grasper through the protective sheath. The objects were grasped with a 'sponge-holding forceps' (placed alongside the cystoscope) and extracted one at a time. A psychiatric consultation was sought and the patient was diagnosed and treated for borderline personality disorder. Unusual genitourinary activity (UGUA) has been described for several centuries and is characterised by the deposition of foreign objects in the genitalia. The most common incentive for UGUA is sexual stimulation, but psychiatric disorders and intoxication are also associated. Management involves retrieval of foreign bodies and evaluation of psychosocial factors.
Topics: Adult; Borderline Personality Disorder; Cystoscopy; Female; Foreign Bodies; Genitalia, Female; Humans; Radiography, Abdominal; Urethra; Urinary Bladder; Young Adult
PubMed: 28739565
DOI: 10.1136/bcr-2017-220297 -
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 -
Abdominal Radiology (New York) Nov 2019To provide an overview of complete mesocolic excision, along with a review of the relevant vascular anatomy and locoregional staging concepts, for abdominal radiologists. (Review)
Review
OBJECTIVE
To provide an overview of complete mesocolic excision, along with a review of the relevant vascular anatomy and locoregional staging concepts, for abdominal radiologists.
RESULTS
Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer has emerged as a technique that has growing interest in surgical oncology. Specific anatomic considerations and patterns of nodal spread have thus gained clinical significance, and should be familiar to abdominal radiologists. This review article provides an overview of CME with CVL, and discusses some of the important anatomic considerations in patients with colon cancer that are relevant to radiologists.
CONCLUSION
Knowledge of CME with CVL and the relevant anatomic and staging considerations is important for abdominal radiologists, as this surgical technique becomes increasingly utilized.
Topics: Colectomy; Colonic Neoplasms; Humans; Ligation; Mesocolon; Neoplasm Staging; Radiography, Abdominal
PubMed: 31049615
DOI: 10.1007/s00261-019-02037-9 -
The British Journal of Radiology Jul 2021This study aimed to conduct objective and subjective comparisons of image quality among abdominal computed tomography (CT) reconstructions with deep learning...
Superior objective and subjective image quality of deep learning reconstruction for low-dose abdominal CT imaging in comparison with model-based iterative reconstruction and filtered back projection.
OBJECTIVE
This study aimed to conduct objective and subjective comparisons of image quality among abdominal computed tomography (CT) reconstructions with deep learning reconstruction (DLR) algorithms, model-based iterative reconstruction (MBIR), and filtered back projection (FBP).
METHODS
Datasets from consecutive patients who underwent low-dose liver CT were retrospectively identified. Images were reconstructed using DLR, MBIR, and FBP. Mean image noise and contrast-to-noise ratio (CNR) were calculated, and noise, artifacts, sharpness, and overall image quality were subjectively assessed. Dunnett's test was used for statistical comparisons.
RESULTS
Ninety patients (67 ± 12.7 years; 63 males; mean body mass index [BMI], 25.5 kg/m) were included. The mean noise in the abdominal aorta and hepatic parenchyma of DLR was lower than that in FBP and MBIR ( < .001). For FBP and MBIR, image noise was significantly higher for obese patients than for those with normal BMI. The CNR for the abdominal aorta and hepatic parenchyma was higher for DLR than for FBP and MBIR ( < .001). MBIR images were subjectively rated as superior to FBP images in terms of noise, artifacts, sharpness, and overall quality ( < .001). DLR images were rated as superior to MBIR images in terms of noise ( < .001) and overall quality ( = .03).
CONCLUSIONS
Based on objective and subjective comparisons, the image quality of DLR was found to be superior to that of MBIR and FBP on low-dose abdominal CT. DLR was the only method for which image noise was not higher for obese patients than for those with a normal BMI.
ADVANCES IN KNOWLEDGE
This study provides previously unavailable information on the properties of DLR systems and their clinical utility.
Topics: Adult; Aged; Aged, 80 and over; Artifacts; Contrast Media; Deep Learning; Female; Humans; Liver; Male; Middle Aged; Radiographic Image Interpretation, Computer-Assisted; Radiography, Abdominal; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34142867
DOI: 10.1259/bjr.20201357 -
Frontiers in Endocrinology 2021To identify long-term reproducible texture features (TFs) of spinal computed tomography (CT), and characterize variations with regard to gender, age and vertebral level...
PURPOSE
To identify long-term reproducible texture features (TFs) of spinal computed tomography (CT), and characterize variations with regard to gender, age and vertebral level using our automated quantification framework.
METHODS
We performed texture analysis (TA) on baseline and follow-up CT (follow-up duration: 30-90 days) of 21 subjects (8 females, 13 males, age at baseline 61.2 ± 9.2 years) to determine long-term reproducibility. TFs with a long-term reproducibility error Δ<5% were further analyzed for an association with age and vertebral level in a cohort of 376 patients (129 females, 247 males, age 62.5 ± 9.2 years). Automated analysis comprised labeling and segmentation of vertebrae into subregions using a convolutional neural network, calculation of volumetric bone mineral density (vBMD) with asynchronous calibration and TF extraction. Variance measures the spread of the gray-level distribution in an image while Entropy reflects the uniformity of gray-levels. Short-run emphasis (SRE), Long-run emphasis (LRE), Run-length non-uniformity (RLN) and Run percentage (RP) contain information on consecutive voxels of a particular grey-level, or grey-level range, in a particular direction. Long runs (LRE) represent coarse texture while short runs (SRE) represent fine texture. RLN reflects similarities in the length of runs while RP reflects distribution and homogeneity of runs with a specific direction.
RESULTS
Six of the 24 extracted TFs had Δ<5% (Variance, Entropy, SRE, LRE, RLN, RP), and were analyzed further in 4716 thoracolumbar vertebrae. Five TFs (Variance,SRE,LRE, RLN,RP) showed a significant difference between genders (p<0.001), potentially being caused by a finer and more directional vertebral trabecular microstructure in females compared to males. Variance and Entropy showed a significant increase from the thoracic to the lumbar spine (p<0.001), indicating a higher degree and earlier initiation of trabecular microstructure deterioration at lower spinal levels. The four higher-order TFs showed significant variations between spine regions without a clear directional gradient (p ≤ 0.001-0.012). No TF showed a clear age dependence. vBMD differed significantly between genders, age groups and spine regions (p ≤ 0.001-0.002).
CONCLUSION
Long-term reproducible CT-based TFs of the thoracolumbar spine were established and characterized in a predominantly older adult study population. The gender-, age- and vertebral-level-specific values may serve as foundation for osteoporosis diagnostics and facilitate future studies investigating vertebral microstructure.
Topics: Age Factors; Aged; Bone Density; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lumbar Vertebrae; Male; Middle Aged; Multidetector Computed Tomography; Neural Networks, Computer; Radiography, Abdominal; Sex Factors; Thoracic Vertebrae
PubMed: 35154004
DOI: 10.3389/fendo.2021.792760 -
Abdominal Radiology (New York) Jun 2021
Topics: Humans; Radiography, Abdominal; Radiology
PubMed: 33484282
DOI: 10.1007/s00261-020-02941-5 -
Journal of Digital Imaging Apr 2018Computed tomography (CT) scans usually include some disadvantages due to the nature of the imaging procedure, and these handicaps prevent accurate abdomen segmentation....
Computed tomography (CT) scans usually include some disadvantages due to the nature of the imaging procedure, and these handicaps prevent accurate abdomen segmentation. Discontinuous abdomen edges, bed section of CT, patient information, closeness between the edges of the abdomen and CT, poor contrast, and a narrow histogram can be regarded as the most important handicaps that occur in abdominal CT scans. Currently, one or more handicaps can arise and prevent technicians obtaining abdomen images through simple segmentation techniques. In other words, CT scans can include the bed section of CT, a patient's diagnostic information, low-quality abdomen edges, low-level contrast, and narrow histogram, all in one scan. These phenomena constitute a challenge, and an efficient pipeline that is unaffected by handicaps is required. In addition, analysis such as segmentation, feature selection, and classification has meaning for a real-time diagnosis system in cases where the abdomen section is directly used with a specific size. A statistical pipeline is designed in this study that is unaffected by the handicaps mentioned above. Intensity-based approaches, morphological processes, and histogram-based procedures are utilized to design an efficient structure. Performance evaluation is realized in experiments on 58 CT images (16 training, 16 test, and 26 validation) that include the abdomen and one or more disadvantage(s). The first part of the data (16 training images) is used to detect the pipeline's optimum parameters, while the second and third parts are utilized to evaluate and to confirm the segmentation performance. The segmentation results are presented as the means of six performance metrics. Thus, the proposed method achieves remarkable average rates for training/test/validation of 98.95/99.36/99.57% (jaccard), 99.47/99.67/99.79% (dice), 100/99.91/99.91% (sensitivity), 98.47/99.23/99.85% (specificity), 99.38/99.63/99.87% (classification accuracy), and 98.98/99.45/99.66% (precision). In summary, a statistical pipeline performing the task of abdomen segmentation is achieved that is not affected by the disadvantages, and the most detailed abdomen segmentation study is performed for the use before organ and tumor segmentation, feature extraction, and classification.
Topics: Abdomen; Digestive System Diseases; Humans; Image Interpretation, Computer-Assisted; Radiography, Abdominal; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 29067570
DOI: 10.1007/s10278-017-0032-0 -
BMJ Case Reports Jan 2020Laparoscopic pancreatoduodenectomy (LPD) is increasingly performed worldwide as an alternative to the open conventional method, with the aim of advancing recovery....
Laparoscopic pancreatoduodenectomy (LPD) is increasingly performed worldwide as an alternative to the open conventional method, with the aim of advancing recovery. Because of its recent introduction, little is known about late surgical complications from this procedure. Here, we describe a case of a 76-year-old woman who underwent LPD with end-to-side gastrojejunostomy and presented with pain in the right upper quadrant of the abdomen 6 months thereafter. CT showed signs of an internal herniation. Elective diagnostic laparoscopy demonstrated a hernia of the efferent loop in Petersen's space. The loop was repositioned and Petersen's space was closed. The patient was discharged on the same day. Apart from a short readmission for nausea and vomiting, which were managed conservatively, the patient recovered without any further complications. Internal herniation should be considered in patients with abdominal complaints following LPD.
Topics: Aged; Female; Hernia, Abdominal; Humans; Laparoscopy; Pancreaticoduodenectomy; Radiography, Abdominal
PubMed: 31996382
DOI: 10.1136/bcr-2019-232475 -
The British Journal of Radiology Jun 2019Dual energy CT (DECT) has evolved into a commonly applied imaging technique in clinical routine due to its unique post-processing opportunities for improved evaluation... (Review)
Review
Dual energy CT (DECT) has evolved into a commonly applied imaging technique in clinical routine due to its unique post-processing opportunities for improved evaluation of all body areas. Reconstruction of virtual monoenergetic imaging (VMI) series has shown beneficial effects for both non-contrast and contrast-enhanced DECT due to the flexibility to calculate low-keV VMI reconstructions to increase contrast and iodine attenuation, or to compute high-keV VMI reconstructions to reduce beam-hardening artefacts. The goal of this review article is to explain the technical background of VMI and noise-optimized VMI+ algorithms and to give an overview of useful clinical applications of the VMI technique in DECT of various body regions.
Topics: Algorithms; Artifacts; Cardiovascular System; Head; Humans; Lung; Musculoskeletal System; Neck; Noise; Radiography, Abdominal; Tomography, X-Ray Computed; User-Computer Interface
PubMed: 30919651
DOI: 10.1259/bjr.20180546 -
Singapore Medical Journal May 2016A 16-year-old Chinese male patient presented with constipation lasting five days, colicky abdominal pain, lethargy, weakness and body aches. He was able to pass flatus....
A 16-year-old Chinese male patient presented with constipation lasting five days, colicky abdominal pain, lethargy, weakness and body aches. He was able to pass flatus. Abdominal radiography showed a distended stomach causing inferior displacement of the transverse colon. Computed tomography revealed a dilated oesophagus, stomach and duodenum up to its third portion, with a short aortomesenteric distance and narrow angle. There was also consolidation in the lungs bilaterally. Based on the constellation of clinical and imaging findings, a diagnosis of superior mesenteric artery syndrome complicated by aspiration pneumonia was made. The patient was subsequently started on intravenous hydration, nasogastric tube aspiration and antibiotics. Following stabilisation of his acute condition, a nasojejunal feeding tube was inserted and a feeding plan was implemented to promote weight gain. The clinical presentation, differentials, diagnosis and treatment of superior mesenteric artery syndrome are discussed.
Topics: Adolescent; Aged; Child; China; Duodenum; Enteral Nutrition; Fluoroscopy; Gastrointestinal Tract; Humans; Male; Mesenteric Arteries; Pneumonia, Aspiration; Radiography, Abdominal; Superior Mesenteric Artery Syndrome; Syndrome; Tomography, X-Ray Computed; Vomiting
PubMed: 27212130
DOI: 10.11622/smedj.2016093