Faster magnetic resonance imaging in emergency room patients with right lower quadrant pain and suspected acute appendicitis

Purpose: Emergency Departments (ED) are becoming busier, with a resultant increase in the number of imaging referrals. The purpose of this study was to assess the diagnostic accuracy of an abbreviated two sequence magnetic resonance (MR) protocol for evaluating ED patients with right lower quadrant pain and suspected acute appendicitis, with a view to expediting patient turnaround times and imaging costs. Material and methods: Fifty patients (49 females, one male; mean age 25.4 ± 5.2 years) who underwent ED MR imaging from July 2014 to March 2015 for right lower quadrant pain were retrospectively reviewed. MR abdomen/pelvis was performed on 1.5 T MR obtaining axial T1 gradient echo in/out of phase, transverse fast spin echo T2 with fat sat/motion correction, axial/coronal T2 HASTE (half-Fourier acquisition single-shot turbo spin-echo), and axial DWI (diffusion-weighted imaging) sequences. Images were reviewed by two fellowship-trained radiologists on a five-point confidence scale. Mean acquisition/interpretation times for the standard departmental protocol and the proposed abbreviated MR protocol (comprising T2 HASTE and DWI images) were calculated. Sensitivity, specificity, and diagnostic accuracy for the abbreviated protocol against the full protocol were also calculated. Results: Mean scanning time for abbreviated protocol and standard protocol was calculated to be 21.1 minutes and 40.5 minutes, respectively. Mean interpretation time for abbreviated protocol for reader one and two was 4.1 ± 1.5 minutes and 4.5 ± 1.4 minutes, respectively, and for standard protocol was 8.1 ± 1.8 minutes and 7.1 ± 1.4 minutes, respectively. Sensitivity, specificity, and accuracy for the FAST protocol were calculated to be 100% each for reader one and 75%, 100%, and 94%, respectively, for reader two. Conclusions: The proposed abbreviated MR protocol has comparable diagnostic accuracy in diagnosing ED patients with right lower quadrant pain, with significant reduction in imaging/interpretation times. It thus has the potential to be implemented in ED imaging with significant reduction in patient turnaround times and costs

Interventional radiology and COVID-19: evidence-based measures to limit transmission

As we face an explosion of COVID-19 cases and deal with an unprecedented set of circumstances all over the world, healthcare personnel are at the forefront, dealing with this emerging scenario. Certain subspecialties like interventional radiology entails a greater risk of acquiring and transmitting infection due to the close patient contact and invasive patient care the service provides. This makes it imperative to develop and set guidelines in place to limit transmission and utilize resources in an optimal fashion. A multi-tiered approach needs to be devised and monitored at the administrative level, taking into account the various staff and patient contact points. Based on these factors, work site and health force rearrangements need to be in place while enforcing segregation and disinfection parameters. We are putting forth an all-encompassing review of infection control measures that cover the dynamics of patient care and staff protocols that such a situation demands of an interventional department

CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection

Here we report our experience of a neuroprotective adaptation of the technique of CT-guided radiofrequency (RF) ablation of spinal osteoid osteomas. Over 9 years seven patients underwent eight CT-guided RF treatments for osteoid osteoma. CT-guided RF ablation was performed with general anaesthesia. The lesion was heated to 90 degrees C for 2 min for two cycles by using a Cosman SMK TC-10 RF electrode. This was preceded by a bolus of room temperature sterile water (10 ml) injected through a 26G curved spinal needle into the exit foramen and adjacent epidural space for neuroprotection. The age of the patient, sex, lesion location, biopsy results and complications were recorded. All the biopsies (n = 7) demonstrated histological features of osteoid osteoma. All the procedures were technically successful. Clinical success was assessed up to 3 years post procedure. There was an 85% clinical success rate (6 of the 7 patients), with recurrence of a lesion at 6 months, necessitating a repeat procedure (successful). CT-guided percutaneous RF ablation of spinal osteoid osteoma preceded by bolus of sterile water, injected through a spinal needle into the exit foramen and adjacent epidural space for neuroprotection, is a safe and effective procedure

MR imaging of acute anterior cruciate ligament injuries

MRI of the knee has become an indispensable clinical tool in the management of chronic knee conditions. MRI for acute knee injuries is less well established but is becoming increasingly prevalent. MRI in acute ACL injuries is particularly useful for identifying associated injuries that will influence the early management of the patient. The aim of this paper is to describe the MRI findings of acute ACL tears, their commonly associated, and less common but serious associated injuries. Where available, the evidence for the sensitivity and specificity of these MRI features is presented. The contribution of these MRI findings to the management of the patient is discussed

Training on a vascular interventional simulator:an observational study

Radiology registrars were observed performing a left renal artery angioplasty using a proprietary training simulator up to five times during their first year of training. Total procedure time, fluoroscopy times, and metric information from the machine were recorded. Each step of the procedure was judged by an observer and a mistake profile was generated. Fifty-two runs were completed by 12 trainees. The mean procedure time decreased from 16.6 min to 9.8 min over the five runs. The number of mistakes ranged from zero to ten and the mean number of mistakes made varied from 0.7 to 2.6 per procedure without any particular trend. Our study demonstrates that training on the simulator does improve performance. The mistakes made throughout training indicates the potential benefit from further simulator training. It remains unclear how to integrate this form of training in current educational programs