Humor in radiological breast cancer screening: a way of improving patient service?

BACKGROUND Breast cancer screening is essential in detecting breast tumors, however, the examination is stressful. In this study we analyzed whether humor enhances patient satisfaction. METHODS In this prospective randomized study 226 patients undergoing routine breast cancer screening at a single center during October 2020 to July 2021 were included. One hundred thirty-two were eligible for the study. Group 1 (66 patients) received an examination with humorous intervention, group 2 (66 patients) had a standard breast examination. In the humor group, the regular business card was replaced by a self-painted, humorous business card, which was handed to the patient at the beginning of the examination. Afterwards, patients were interviewed with a standardized questionnaire. Scores between the two study groups were compared with the Mann-Whitney U test or Fisher's exact test. P-values were adjusted with the Holm's method. Two-sided p-values < 0.05 were considered significant. RESULTS One hundred thirty-two patients, 131 female and 1 male, (mean age 59 ± 10.6 years) remained in the final study cohort. Patients in the humor group remembered the radiologist's name better (85%/30%, P < .001), appreciated the final discussion with the radiologist more (4.67 ± 0.73-5;[5, 5] vs. 4.24 ± 1.1-5;[4, 5], P = .017), felt the radiologist was more empathetic (4.94 ± 0.24-5;[5, 5] vs.4.59 ± 0.64-5;[4, 5], P < .001), and rated him as a humorous doctor (4.91 ± 0.29-5;[5, 5] vs. 2.26 ± 1.43-1;[1, 4], P < .001). Additionally, patients in the humor group tended to experience less anxiety (p = 0.166) and felt the doctor was more competent (p = 0.094). CONCLUSION Humor during routine breast examinations may improve patient-radiologist relationship because the radiologist is considered more empathetic and competent, patients recall the radiologist's name more easily, and value the final discussion more. TRIAL REGISTRATION We have a general approval from our ethics committee because it is a retrospective survey, the patient lists for the doctors were anonymized and it is a qualitative study, since the clinical processes are part of the daily routine examinations and are used independently of the study. The patients have given their consent to this study and survey

Renal sympathicolysis by CT-guided periarterial injection of vincristin and guanethidine in pigs to evaluate innovative treatment options for resistant hypertension

Einleitung: 30 – 40 % der Erwachsenen in Industrieländern weisen eine arterielle Hypertonie auf. Von einem weiteren Anstieg der Prävalenz ist auszugehen. Trotz gravierender Langzeitfolgen und einer Verdopplung der Mortalität bei einem Blutdruckanstieg um 20/10 mmHg ist nur ein geringer Anteil der Patienten suffizient eingestellt. 12 – 50 % aller Patienten gelten als therapierefraktär. Die renale Denervation mittels Katheter-basierter Radiofrequenzablation stellt ein innovatives und vielversprechendes Therapieverfahren für diese Patientengruppe dar. Die Wirksamkeit wurde jedoch in aktuellen Studien kontrovers diskutiert. Dies bereitet Wege für alternative Methoden der renalen Denervation. Ziel dieser Arbeit ist die Evaluation der Machbarkeit, Sicherheit und Effektivität der renalen Denervation durch perkutane periarterielle Applikation von Vincristin oder Guanethidin. Methoden: An jeweils sechs Schweinen erfolgte unter Vollnarkose eine CT- gesteuerte perkutane Injektion von 0,1 mg Vincristin oder 90 mg Guanethidin unilateral um eine Nierenarterie. Die Gegenseite diente als Kontrolle. Blutdruckmessungen und abdominale CT-Scans wurden prä- und postinterventionell und nach zwei Wochen vor Euthanasie durchgeführt. Der Noradrenalingehalt der Nieren wurde als funktioneller Parameter der Sympathikolyse bestimmt. Die Nierenarterien und umgebende Strukturen wurden mikroskopisch auf histomorphologische Korrelate renaler Denervation und Nebenwirkungen untersucht. Ergebnisse: Mit einer Ausnahme in der Guanethidin-Gruppe konnte bei allen Schweinen eine technisch erfolgreiche Substanzapplikation um die Nierenarterie durchgeführt werden. Für die mit Vincristin behandelten Nieren wurde ein mittlerer Noradrenalinabfall von 53 % (p < 0,01) gegenüber den Kontrollen nachgewiesen. Alle mit Vincristin behandelten Nierenarterien zeigten histomorphologisch eine nervale Degeneration. In der Guanethidin- Gruppe konnten keine signifikanten Unterschiede des Noradrenalingehaltes oder der Histomorphologie zwischen behandelter und unbehandelter Seite nachgewiesen werden. Insgesamt gab es keine postinterventionellen Komplikationen. Weder makroskopisch noch mikroskopisch ließen sich interventionsbedingte unerwünschte Nebenwirkungen nachweisen. Schlussfolgerung: Die CT-gesteuerte perkutane periarterielle Substanzapplikation ist ein technisch praktikables und sicheres Verfahren. Die Applikation von Vincristin war effektiv im Sinne der renalen Denervation. Die vorgestellte Technik kann eine vielversprechende Alternative zu Katheter-basierten Methoden darstellen. Weitere Untersuchungen in Tierversuchen und am Menschen mit Evaluation der Langzeitverläufe sind notwendig.Introduction: 30 – 40 % of the adult-population in industrialized countries suffer from arterial hypertension. This number will increase in the near future. Despite severe consequences and a doubling in mortality through an increase in blood pressure by 20/10 mmHg a large group of patients lack sufficient therapy. 12 – 50 % suffer from resistant hypertension. Renal denervation through catheter-based radio frequency ablation is an innovative and promising option for those patients. However, its efficacy has been questioned in the latest findings of current studies. Hence, alternative techniques are of great interest. The purpose of this study was to evaluate the feasibility, safety and efficacy of renal denervation through percutaneous periarterial delivery of vincristine and guanethidine. Methods: 12 pigs underwent the CT-guided needle placement and consecutive unilateral application of either 0,1 mg vincristine or 90 mg guantehidine to one renal artery under general anesthesia. Measurement of blood pressure and abdominal CT-scans were done pre- and post-intervention as well as two weeks later prior to euthanasia. The levels of noradrenalin within the renal tissue was determined as an indicator for successful sympathicolyses. Furthermore the renal artery was examined histologically to identify evidence of renal denervation and damage to the artery itself and its surrounding tissue. Results: In all but one pig of the guanethidine group, successful substance delivery to the renal artery was performed. In vincristine-treated pigs there was a mean drop of 53 % (p < 0,01) of noradrenalin levels, in comparison between the treated and untreated sides. Histological evidence of renal denervation could be found in all vincristine-treated pigs accordingly. There was no significant reduction in noradrenalin levels in guanethidine-treated pigs, neither was there any evidence of histological renal denervation. There were no serious adverse events nor was there any sign of damage to the renal artery or surrounding tissue under histopathological assessment. Conclusion: Percutaneous periarterial CT-guided substance application is safe, feasible and in the case of vincristine, effective. It could be a promising alternative to catheter-based approaches on renal denervation. However, further research in animal and human studies is necessary to evaluate long-time effects

T2-weighted Dixon MRI of the spine: A feasibility study of quantitative vertebral bone marrow analysis

Purpose To compare the measurements of fat fraction (FF) and in-phase vs. opposed-phase ratio between two-dimensional T2-weighted (T2W) spin-echo (SE) Dixon and three-dimensional (3D) T1-weighted (T1W) volume interpolated breath-hold examination (VIBE) Dixon sequences in malignant vertebral lesions and normal vertebral bone marrow. Materials and methods Thirty patients with focal vertebral malignancies (20 men, mean age, 67.3 ± 9.4 [SD] years; age range: 41–84 years) and 30 patients without malignant spinal disease (11 men, mean age, 70.1 ± 12.9 [SD]; age range: 53–93 years) were retrospectively included. Each patient underwent spine MRI at 1.5 Tesla including T2W SE and T1W VIBE 2-point Dixon sequences. Two readers independently performed 3D-volume of interest (VOI) and region of interest (ROI)-based FF and IO-ratio measurements of malignant lesions and normal vertebrae. Student t-test, Pearson correlation (r) test and two-way mixed model intraclass correlation coefficients (ICC) were used to compare measurements. Results T2W SE and T1W VIBE mean FF and IO-ratio were significantly smaller in malignancy compared to normal marrow, but there were significant differences of paired measurement mean values between T2W SE and T1W VIBE Dixon parameters in malignant lesions T2W SE VOI FF = 9%, T2W SE ROI FF = 7%, T2W SE IO-ratio = 4% vs. T1W VIBE VOI FF = 11%, T1W VIBE ROI FF = 9%, T1W VIBE IO-ratio = −2%, and in normal vertebrae T2W SE VOI FF = 74%, T2W SE ROI FF = 77%, T2W SE IO-ratio = 51% vs. T1W VIBE VOI FF = 67%, T1W VIBE ROI FF = 73%, T1W VIBE IO-ratio = 58% (each P comparing the paired T2W TSE and T1W VIBE parameter, respectively < 0.001). There was excellent positive correlation between T2 W SE and T1 W VIBE-FF (r ≥ 0.99) and VOI and ROI FF measurements for each sequence (r ≥ 0.99). Inter-reader agreement was excellent for all measurements (ICC ≥ 0.94 for all). Conclusion Calculation of T2W SE Dixon derived FF is feasible and gave valid results that help discriminate between malignant vertebral lesions and normal vertebral bone marrow

Dixon or DWI – Comparing the utility of fat fraction and apparent diffusion coefficient to distinguish between malignant and acute osteoporotic vertebral fractures

Purpose To compare fat fraction (FF) and apparent diffusion coefficient (ADC) as discriminators distinguishing malignant from acute/subacute osteoporotic vertebral fractures. Method 1.5 T MRIs of 42 malignant and 27 acute/subacute osteoporotic vertebral fractures (38 patients) were retrospectively reviewed. Two readers independently classified fractures as malignant or osteoporotic based on conventional imaging morphology. Diagnostic reader confidence was rated as confident or not confident. FF was derived from axial T1 gradient-echo 2-point Dixon MRI. ADC maps were calculated from axial b50 and b900 images. Both readers independently performed ROI measurements of mean FF and ADC of the same fractured vertebrae. FF and ADC values, corresponding ROC curves and optimized cut-off value performance were compared. Inter-reader agreement was analysed by calculation of intraclass correlation coefficients (ICCs). A p-value < 0.05 was deemed significant. Results Mean FF and ADC were significantly lower in malignant (9.5 % and 1.05 × 10−3 mm²/s) compared to osteoporotic fractures (32 % and 1.34 × 10−3 mm²/s, all p < 0.001). The optimal cut-off FF was 11.5 %, detecting malignant fractures with 86 %/89 % sensitivity/specificity. The optimal ADC cut-off of 1.04 × 10−3 mm/s² yielded 62 %/96 % sensitivity/specificity. FF AUC (0.93) was significantly larger than ADC AUC (0.82, p = 0.03). In the subgroup of nine cases reported with low expert reader confidence, the optimized cut-off specificities of FF (83 %) and ADC (83 %) exceeded reader specificity (50 %). There was excellent inter-reader agreement for mean FF (ICC = 0.99) and good agreement for mean ADC (ICC = 0.86) measurements. Conclusion FF and ADC can improve reader specificity to distinguish between malignant and acute or subacute osteoporotic vertebral fractures. As single discriminator, FF was superior to ADC.ISSN:0720-048XISSN:1872-772

Orthopaedic surgeons do not consult radiology reports. Fact or fiction?

Purpose: To find out how orthopaedic surgeons handle radiological reports and to identify ways to improve musculoskeletal radiology service and interdisciplinary communication. Method: An anonymised 14-question online survey was distributed among 27 orthopaedic departments in German-speaking parts of Europe. It was available to trainees and consultants between 22/10/2020 and 05/06/2021. The questionnaire collected information regarding the participants’ habits of consulting radiology reports depending on the imaging modality, reasons for not reading reports and asked for improvement recommendations for the radiology service. Results: 81 orthopaedists participated. 20% would never consult a plain radiograph report. In contrast, only 4% would never consult a CT report and no one claimed to never consult an MRI report. 43%, 67% and 86% would routinely consult radiology reports of radiographs, CT and MRI studies, respectively. Long time to report availability (24%), a general lack of time (19%) and too long texts (17%) were the most popular reasons for not consulting the reports. 62% of participants voted to sometimes disagree with the reports and in cases of opinion discrepancy 51% would always or often contact the radiologist. 64% preferred to be informed directly via phone about relevant unexpected findings. Most popular report improvement recommendations were more rapid report availability (24%), inclusion of significant images (19%) and inclusion of more angle and distance measurements (16%). In the free text column, a desire for direct interdisciplinary discussion of equivocal cases was often stated (30%). Conclusions: Concluding, this survey showed that orthopaedic surgeons routinely consult radiology reports. The participants expressed a desire for increased, direct interdisciplinary communication to solve equivocal cases and improve patient care.ISSN:0720-048XISSN:1872-772

More Space, Less Noise&mdash;New-generation Low-Field Magnetic Resonance Imaging Systems Can Improve Patient Comfort: A Prospective 0.55T&ndash;1.5T-Scanner Comparison

Objectives: The objectives of this study were to assess patient comfort when imaged on a newly introduced 0.55T low-field magnetic resonance (MR) scanner system with a wider bore opening compared to a conventional 1.5T MR scanner system. Materials and Methods: In this prospective study, fifty patients (mean age: 66.2 &plusmn; 17.0 years, 22 females, 28 males) underwent subsequent magnetic resonance imaging (MRI) examinations with matched imaging protocols at 0.55T (MAGNETOM FreeMax, Siemens Healthineers; Erlangen, Germany) and 1.5T (MAGNETOM Avanto Fit, Siemens Healthineers; Erlangen, Germany) on the same day. MRI performed between 05/2021 and 07/2021 was included for analysis. The 0.55T MRI system had a bore opening of 80 cm, while the bore diameter of the 1.5T scanner system was 60 cm. Four patient groups were defined by imaged body regions: (1) cranial or cervical spine MRI using a head/neck coil (n = 27), (2) lumbar or thoracic spine MRI using only the in-table spine coils (n = 10), (3) hip MRI using a large flex coil (n = 8) and (4) upper- or lower-extremity MRI using small flex coils (n = 5). Following the MRI examinations, patients evaluated (1) sense of space, (2) noise level, (3) comfort, (4) coil comfort and (5) overall examination impression on a 5-point Likert-scale (range: 1= &ldquo;much worse&rdquo; to 5 = &ldquo;much better&rdquo;) using a questionnaire. Maximum noise levels of all performed imaging studies were measured in decibels (dB) by a sound level meter placed in the bore center. Results: Sense of space was perceived to be &ldquo;better&rdquo; or &ldquo;much better&rdquo; by 84% of patients for imaging examinations performed on the 0.55T MRI scanner system (mean score: 4.34 &plusmn; 0.75). Additionally, 84% of patients rated noise levels as &ldquo;better&rdquo; or &ldquo;much better&rdquo; when imaged on the low-field scanner system (mean score: 3.90 &plusmn; 0.61). Overall sensation during the imaging examination at 0.55T was rated as &ldquo;better&rdquo; or &ldquo;much better&rdquo; by 78% of patients (mean score: 3.96 &plusmn; 0.70). Quantitative assessment showed significantly reduced maximum noise levels for all 0.55T MRI studies, regardless of body region compared to 1.5T, i.e., brain MRI (83.8 &plusmn; 3.6 dB vs. 89.3 &plusmn; 5.4 dB; p = 0.04), spine MRI (83.7 &plusmn; 3.7 dB vs. 89.4 &plusmn; 2.6 dB; p = 0.004) and hip MRI (86.3 &plusmn; 5.0 dB vs. 89.1 &plusmn; 1.4 dB; p = 0.04). Conclusions: Patients perceived 0.55T new-generation low-field MRI to be more comfortable than conventional 1.5T MRI, given its larger bore opening and reduced noise levels during image acquisition. Therefore, new concepts regarding bore design and noise level reduction of MR scanner systems may help to reduce patient anxiety and improve well-being when undergoing MR imaging

Additional file 1 of Humor in radiological breast cancer screening: a way of improving patient service?

Additional file 1: Figure S1. Standard Business Card: This is the standard business card, which was distributed to participants in the non-humor group. This card is used in all departments of the hospital