Informed consent in diagnostic radiology practice: Where do we stand?

We review the evolution of the concept of informed consent from a radiology standpoint, the current international guidelines on the need for obtaining consent in diagnostic radiology practice, and the current Indian scenario, focusing on both practical and medicolegal aspects. We discuss the concept of patient information sheet with signature, a potential way forward benefiting both patients and radiologists

Ileosigmoid knot: A case report

The ileosigmoid knot is an uncommon but life-threatening cause of closed loop intestinal obstruction. Its treatment is different from a simple volvulus in that it has to be operated upon immediately. Preoperative CT scan diagnosis and prompt treatment can lead to a good outcome. Findings of simultaneous ileal and sigmoid ischemia with non-ischemic colon interposed in between should, in an appropriate clinical setting, indicate this condition. The presence of the whirl sign, medially deviated distal descending colon and cecum, and mesenteric vascular structures from the superior mesenteric vessels that converge toward the sigmoid colon on CT scan help clinch the diagnosis

Awareness of Health Care Workers Regarding Prophylaxis for Prevention of Transmission of Blood-Borne Viral Infections in Occupational Exposures

Context: There has been a need to assess the awareness of health care professionals regarding post exposure prophylaxis for various blood-borne viral infections. Aims: To study and compare the awareness regarding transmission and post-exposure prophylaxis (PEP) for prevention of transmission of HIV, Hepatitis B virus and Hepatitis C virus amongst medical (Resident Medical Officers- RMOs and Interns) and paramedical professionals (nurses and technicians).Settings and Design: Cross-sectional study at a tertiary health care hospital in Mumbai (INDIA) with a medical college.Methods and Materials: A total of 304 RMOs (Resident Medical Officers), 100 interns, 201 nurses and 50 technicians answered a structured questionnaire. Their responses were analyzed as percentages. Inter-group comparisons were performed using the chi-square method between junior & senior RMOs, RMOs & nurses, RMOs & interns and RMOs & technicians.Statistical analysis used: Chi-square test (p value of <0.05 was considered to be significant).Results: Knowledge about the fact that the exposed site must be immediately washed with soap and water was higher in RMOs and interns (73.03% and 83% respectively) as compared to nurses and technicians (40.8% and 58% respectively). Awareness about the basic and expanded HIV PEP regimens was lower in RMOs (35.2% and 20% respectively) than interns (62% and 24%). Knowledge about whom to contact for PEP was good among the RMOs, interns and nurses (55.9%, 83% and 57.7% respectively) but low amongst technicians (20%). 18.1% of the RMOs, 24% of interns, 19.4% of nurses and 10% of technicians have had prior occupational exposure.Conclusions: Knowledge base of the nurses and technicians lagged behind that of the RMOs. The knowledge of interns was comparable and in many aspects better than that of RMOs. The knowledge base of junior (1st and 2nd year) and senior (3rd and 4th year) RMOs was similar. The study indicates the need to reinforce the knowledge of RMOs regarding various aspects of PEP and to undertake more training workshops for the same amongst nurses and technicians

Meningioma and cavernous angioma following childhood radiotherapy

Prophylactic cranial irradiation has been a part of multimodality management of acute lymphoblastic leukemia (ALL). With optimum treatment and the resultant long-term cure rates, long-term side effects of radiation including radiation-induced neoplasms have been increasingly unearthed. We report a rare case of development of both a meningioma and a cavernous angioma following prophylactic cranial irradiation as a part of treatment of ALL. Regular follow-up and high index of suspicion for late radiation sequelae after treatment are therefore justifiable in leukemia survivors with history of prophylactic cranial irradiation

A hairy situation: trichobezoar presenting with intussusception, and intestinal and biliary perforation in a child

Trichobezoars are an uncommon cause of acute abdominal pain. We present a case of a 12-year-old girl with a history of a trichobezoar who presented to the emergency department with acute abdominal pain. Abdominal sonography was performed which suggested portal venous gas and showed complex peritoneal fluid. Subsequent computed tomography demonstrated both gastric and small bowel bezoars, with a jejunojejunal intussusception, and confirmed portal venous gas and complex ascites. At the time of surgery, there was evidence of intestinal and biliary perforation. Our case illustrates a constellation of complications in association with a long-standing trichobezoar

Impact of a standardized reporting format on the quality of MRI reports for rectal cancer staging

Background and Aims: Besides providing a surgical roadmap, rectal MRI plays a major role in treatment planning. We recently started using a structured template for reporting rectal cancer via MRI. We study the impact of using this template at our hospital in terms of number of essential imaging parameters described in the reports as compared to the pre-template free-text reports. Methods: A structured rectal MRI reporting template was created in consensus with members of the colorectal tumour board and was introduced in the department, which included 14 essential parameters to be mentioned in the reports. We conducted a retrospective analysis of rectal MRI reports of 100 cases with histologically proven rectal cancer, comprising 50 consecutive free-text reports before the template was introduced and 50 consecutive structured reports after its introduction, checking for the presence or absence of inclusion of the 14 parameters. An anonymous online feedback survey was conducted as well after the introduction of the template for the members of the colorectal tumour board. Results: Overall, the total number of parameters reported increased from a median value of 10 (range 6-13) to 14 (range 12-14). The common unreported parameters prior to template introduction included T staging, presence or absence of restricted diffusion, anterior peritoneal reflection (APR) involvement, and presence or absence of extramural vascular invasion; these were reported in 16%, 22%, 30% and 50% respectively. These improved to 98-100% reporting after template introduction. Maximum improvement was in T staging (16% to 98%) (P < 0.0001), restricted diffusion on DWI (from 22% to 100%) (P < 0.0001) and APR involvement (from 30% to 100%) (P < 0.0001). The most common unreported parameter after template introduction was the “tumoral T2 signal intensity” (unreported in 4% cases). The results of the survey were as follows: 100% felt a decreased need to talk to the radiologist to clarify the report, 81.8% felt an improvement in the quality of reporting as compared to free style reports, and 91% felt that the new template is easier to interpret. Conclusion: The introduction of a structured template for rectal cancer significantly improved the quality of rectal MRI reports, along with the satisfaction of referring providers

Response Assessment of Treated Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality worldwide, including in India. The incidence of HCC has been rising due to lifestyle diseases such as obesity, diabetes, non-alcoholic fatty liver disease (NAFLD), and alcoholic liver disease (ALD), as well as viral hepatitis infections. Various locoregional therapies (LRTs) are used to treat HCC, including thermal ablation, transarterial therapies, stereotactic body radiotherapy (SBRT), and transarterial radioembolization (TARE). Traditional response evaluation criteria like WHO and RECIST, which rely on size-based measurements, may not accurately assess treatment response to LRTs. To address this limitation, modified response evaluation criteria for solid tumors (mRECIST) and the LI-RADS treatment response algorithm (LR-TRA) have been developed. mRECIST assesses patient-level response, while LR-TRA provides lesion-level response assessment specifically for HCC treated with LRTs. This article discusses the imaging protocols for diagnosing HCC and the imaging appearances of treated lesions after different LRTs. It explains the criteria for categorizing treatment response, such as LR-TR viable, LR-TR non-viable, and LR-TR equivocal. It also highlights the challenges and future directions in response assessment, including the incorporation of ancillary findings, the assessment of patients receiving a combination of locoregional and systemic therapies, and the potential use of biomarkers like serum AFP, AFP-L3, and PIVKA-II. In conclusion, locoregional therapies have expanded the treatment options for HCC, and accurate response assessment is crucial for optimizing patient management. mRECIST and LR-TRA provide valuable tools for evaluating treatment response, and future updates are expected to address specific challenges and incorporate newer approaches like iRECIST and quantitative imaging assessment. Additionally, the use of biomarkers may complement imaging-based response assessment in the future