Advances in ENT imaging

Over the last ten years or so radiology has shown dramatic technological developments especially in cross sectional imaging and the investigation and management of the complex ENT patient has benefitted enormously. Plain radiographs are being utilised less and less as their limitations are becoming more apparent and various studies have shown for example a 75% discrepancy between plain sinus radiographs and coronal sinus CT in children1,2 . The incorporation of small and flexible ultrasound transducers with high-resolution imaging into the tips of endoluminal catheters has allowed good quality endoluminal ultrasound. Recently endolaryngeal ultrasound has been clinically evaluated in 38 patients with a variety of laryngeal pathology including vocal fold polyps, laryngeal cysts, chronic laryngitis, epithelial dysplasia and cancer 5 . Using this technique tumour size and infiltration could be measured and involvement of the thyroid cartilage or anterior commissure could be visualised. Not surprisingly it was not able to detect any specific changes in the sonographic picture of patients suffering from chronic laryngitis, epithelial dysplasia or microinvasive cancer. Although these results are encouraging, its relative lack of availability will result in it only having a limited role in evaluating laryngeal pathology.peer-reviewe

UK and Ireland Joint Advisory Group (JAG) consensus statements for training and certification in diagnostic endoscopic ultrasound (EUS)

Background and Aims: International endoscopy societies vary in their approach for credentialing individuals in endoscopic ultrasound (EUS) to enable independent practice; however, there is no consensus in this or its implementation. In 2019, the Joint Advisory Group on GI Endoscopy (JAG) commissioned a working group to examine the evidence relating to this process for EUS. The aim of this was to develop evidence-based recommendations for EUS training and certification in the UK.Methods: Under the oversight of the JAG quality assurance team, a modified Delphi process was conducted which included major stakeholders from the UK and Ireland. A formal literature review was made, initial questions for study were proposed and recommendations for training and certification in EUS were formulated after a rigorous assessment using the Grading of Recommendation Assessment, Development and Evaluation tool and subjected to electronic voting to identify accepted statements. These were peer reviewed by JAG and relevant stakeholder societies before consensus on the final EUS certification pathway was achieved.Results: 39 initial questions were proposed of which 33 were deemed worthy of assessment and finally formed the key recommendations. The statements covered four key domains, such as: definition of competence (13 statements), acquisition of competence (10), assessment of competence (5) and postcertification mentorship (5). Key recommendations include: (1) minimum of 250 hands-on cases before an assessment for competency can be made, (2) attendance at the JAG basic EUS course, (3) completing a minimum of one formative direct observation of procedural skills (DOPS) every 10 cases to allow the learning curve in EUS training to be adequately studied, (4) competent performance in summative DOPS assessments and (5) a period of mentorship over a 12-month period is recommended as minimum to support and mentor new service providers.Conclusions: An evidence-based certification pathway has been commissioned by JAG to support and quality assure EUS training. This will form the basis to improve quality of training and safety standards in EUS in the UK and Ireland.</p

Focal Spot, Winter 1984/85

https://digitalcommons.wustl.edu/focal_spot_archives/1039/thumbnail.jp

Bodies of Seeing: A video ethnography of academic x-ray image interpretation training and professional vision in undergraduate radiology and radiography education

This thesis reports on a UK-based video ethnography of academic x-ray image interpretation training across two undergraduate courses in radiology and radiography. By studying the teaching and learning practices of the classroom, I initially explore the professional vision of x-ray image interpretation and how its relation to normal radiographic anatomy founds the practice of being ‘critical’. This criticality accomplishes a faculty of perceptual norms that is coded and organised and also, therefore, of a specific radiological vision. Professionals’ commitment to the cognitivist rhetoric of ‘looking at’/‘pattern recognition’ builds this critical perception, a perception that deepens in organisation when professionals endorse a ‘systematic approach’ that mediates matter-of-fact thoroughness and offers a helpful critical commentary towards the image. In what follows, I explore how x-ray image interpretation is constituted in case presentations. During training, x-ray images are treated with suspicion and as misleading and are aligned with a commitment to discursive contexts of ‘missed abnormality’, ‘interpretive risk’, and ‘technical error’. The image is subsequently constructed as ambiguous and that what is shown cannot be taken at face value. This interconnects with reenacting ideals around ‘seeing clearly’ that are explained through the teaching practices and material world of the academic setting and how, if misinterpretation is established, the ambiguity of the image is reduced by embodied gestures and technoscientific knowledge. By making this correction, the ambiguous image is reenacted and the misinterpretation of image content is explained. To conclude, I highlight how the professional vision of academic x-ray image interpretation prepares students for the workplace, shapes the classificatory interpretation of ab(normal) anatomy, manages ambiguity through embodied expectations and bodily norms, and cultivates body-machine relations

Clinical radiological investigations of the lacrimal systems and the mandibular joints

My thesis on clinical radiological investigations of the lacrimal systems and mandibular joints is based on the experience gained in the last fifteen years as consultant radiologist to the Plastic Surgery and Jaw Injuries Centre of East Grinstead in Sussex. Injuries of the lacrimal systems and mandibular joints were associated with cases admitted to the centre, and as time went by disorders of these particular systems alone were referred in increasing numbers from far and wide for diagnosis and treatment. In both systems a substantial influencing factor upon the number of cases encouraged to the centre was the fact that satisfactory routine radiological methods of examination of these systems were established, and a clinical liason had grown up between myself as radiologist and the ophthalmic and dental surgeons

Correlation between HRCT Temporal Bone Findings and Surgical Findings in Patients with Chronic Suppurative Otitis Media

INTRODUCTION: Chronic otitis media [COM] is an inflammation of the middle ear cleft of long duration. It involves inflammation of the mastoid air cell system also due to its anatomical connection to the middle ear. Due to the location of the tympanomastoid compartment, separated from the middle and posterior cranial fossae by thin bony partitions, otitis media has the potential for intracranial extension. So it is very important to know the location and extent of the disease before planning surgical management. Radiological examination of the temporal bone helps us to achieve this objective. The various modalities of temporal bone imaging are conventional radiography, CT scan and MRI. The petrous temporal bone is a complex structure containing the middle and inner ear and various contained structures like the ossicles. This challenges the limits of resolution by imaging techniques. Good spatial resolution by imaging to allow adequate demonstration of these bony structures in the middle and inner ears has made management of otitis media much simpler these days. AIMS AND OBJECTIVES OF THE STUDY: 1. To study the findings of HRCT temporal bone in patients with chronic otitis media with and without cholesteatoma. 2. To evaluate the extent of pathological process and sites of involvement of the middle ear and the mastoid air cell system in these patients. 3. To study the relationship of the tympanomastoid compartment to the adjacent , critical neurovascular structures. 4. To evaluate the results of our study and compare with similarly published studies. MATERIALS AND METHODS: The present work was undertaken to study the radiological findings of temporal bone in patients diagnosed as having chronic otitis media at Government Rajaji Hospital attached to the department of ENT, Madurai Medical College, Madurai between December 2011 and November 2012. Methods of collection of data: Sample size: A minimum of 50 patients were enrolled for the study. 50 patients with Chronic otitis media presenting to ENT outpatient department at Government Rajaji Hospital attached to Madurai Medical College were taken up for study. As soon as the patient presented to the hospital, detailed clinical history and examination were carried out as per the proforma prepared. Laboratory investigations were done. All patients were subjected to HRCT temporal bones, 1mm axial and coronal slices. Once the radiological findings were noted and extent of disease established, management was done accordingly. Inclusion Criteria: 50 patients of both sexes and all age groups presenting with chronic otitis media. Exclusion criteria: 1. Patients with previous surgery for chronic otitis media were excluded. 2. Chronic otitis media requiring MRI and, 3. Patients with a history of prior temporal bone trauma were excluded. All patients entering the present study underwent certain investigations. CONCLUSION: Chronic suppurative otitis media is a disease entity that an otorhinolaryngologist encounters frequently in his day to day practice. HRCT temporal bones is emerging as an imaging tool that would guide the surgeon regarding the extent and location of the pathology in these patients such that the appropriate line of management can be chalked out in the mind of the treating surgeon. The study conducted at our centre regarding the role of CT temporal bones in patients with CSOM with respect to the variables like ossicular erosion- malleus handle, malleus head, incus; facial canal dehiscence, LSCC erosion, mastoid cortex dehiscence, cholesteatoma, and anatomical variants like Korner‟s septum, high jugular bulb and forward lying sigmoid sinus were as follows. It showed excellent correlation for anatomical variantions like Korner‟s septum, anteriorly placed sigmoid sinus; good correlation for ossicular destruction – incus being the most commonly eroded ossicle. A moderate correlation was seen in cases of diagnosis of cholesteatoma on CT and on table. CT was found to be more accurate in detection of atticoantral pathology when there were associated changes of bony destruction. CT temporal bones was not found to be so reliable for predicting facial canal dehiscence and lateral semicircular canal dehiscence due to the partial averaging effects of the imaging modality. HRCT temporal bones is a useful preoperative tool in patients who present with chronic suppurative otitis media due to - Its ability to demonstrate fine bony details, - delineation of important adjacent anatomical structures and avoid inadvertent injury, - plan the surgical approach, - detect complications, - aids in good and effective surgical clearance

Focal Spot, Spring 1988

https://digitalcommons.wustl.edu/focal_spot_archives/1048/thumbnail.jp