Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Radiology training in United Kingdom: current status.

Clinical radiology has always been one of the most competitive specialties in UK. Due to the increasing demand for radiology services the number of training posts in the UK has been increased. Clinical radiology training takes 5 years and requires completion of the Fellowship of Royal College of Radiologists (FRCR) exams, adequate evidence to demonstrate completion of the curriculum and successful appraisals. On completing training and receiving the Certificate for Completion of Training (CCT) a select proportion of trainees choose to embark on a fellowship program. This gives trainees the opportunity to further develop their subspecialty interest generating a high level of confidence in diagnostic and procedural skills

Magnetic resonance imaging of cardiac tumors: part 2, malignant tumors and tumor-like conditions.

Cardiovascular magnetic resonance imaging (CMRI) is the reference noninvasive imaging technique for assessment and characterization of a suspected cardiac or juxta-cardiac mass. The multiplanar assessment of anatomy, tissue composition, and functional impact afforded by CMRI allows for early differentiation between a nonneoplastic mass and a tumor mass, be it benign or malignant. Malignant cardiac tumors have a poor prognosis; however, early detection and characterization confer some survival advantage, enabling early instigation of chemotherapy and/or consideration of a surgical debulking procedure. Cardiac metastases are far more common than primary tumors and are an important consideration in patients with disseminated disease. Angiosarcoma accounts for the majority of primary malignant lesions. Less common primary malignant cardiac tumors include sarcomas with myofibroblastic differentiation, lymphoma, rhabdomyosarcoma, pericardial mesothelioma, and pericardial synovial sarcoma. A number of benign masses and normal anatomical variants can cause confusion to the inexperienced observer and must be recognized to avoid unnecessary intervention. These include intracardiac thrombus, bronchogenic and pericardial cysts, and anatomical structures, such as the Crista terminalis and moderator band

Cardiac aneurysms and diverticula: magnetic resonance and computed tomography appearances.

Echocardiography is the first-line imaging modality for assessment of structural heart disease but magnetic resonance imaging and multi-detector computed tomography are being increasingly used for cardiac morphologic assessment. Aneurysms and diverticulae of the cardiac chambers and related structures represent a diverse group of conditions with varying etiologies and clinical manifestations. This article reviews the magnetic resonance imaging and multi-detector computed tomography features of these lesions with consideration of the emerging role that cross-sectional imaging has to play in their evaluation. Radiologists should be familiar with the salient imaging appearances of these conditions to facilitate optimal patient management

Acute Myocarditis and ST-Segment Elevation.

We report a case of focal myocarditis in a young boy mimicking acute ST-segment elevation MI. He presented with chest pain and the EKG changes were consistent with infero-laeral ST-segment elevation MI. Coronary angiogram revealed smooth arteries with no obstruction. Troponin was significantly elevated and the echocardiogram exhibited mildly impaired LV function with hypokinetic inferior and lateral walls. Subsequently performed cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis by exhibiting classic features of delayed gadolinium enhancement in the epi and mid-myocardial regions of the lateral wall sparing the sub-endocardial region. This case exhibits the use of cardiac magnetic resonance imaging for diagnosis in such scenarios as often if the angiogram is normal other differential diagnosis are often speculated without actual evidence

Magnetic resonance imaging of cardiac tumors: part 1, sequences, protocols, and benign tumors.

Cardiovascular magnetic resonance imaging (CMRI) is the reference noninvasive technique for assessment and characterization of a suspected cardiac or juxta-cardiac mass. The multiplanar assessment of anatomy, tissue composition, and functional impact afforded by CMRI allows for early differentiation between a nonneoplastic mass and a tumor mass, be it benign or malignant. CMRI has superior tissue contrast resolution compared with competing noninvasive imaging modalities (echocardiography and multidetector computed tomography). A number of different imaging sequences are employed for a comprehensive CMRI assessment. Black-blood prepared sequences are mainly used for tissue characterization and assessment of lesion enhancement characteristics. Bright blood prepared sequences provide functional information, such as lesion mobility and impact on adjacent valves and chambers. Atrial myxoma is the most common primary benign cardiac tumor and can present with obstructive or embolic phenomena. Fibroelastomas are smaller lesions that do not alter hemodynamic function but can cause symptoms secondary to systemic embolization. Less common benign cardiac tumors include lipoma, fibroma, hemangioma, paraganglioma, and cystic tumor of the atrioventricular nodal region

Sinus of valsalva aneurysms: assessment with cardiovascular MRI.

OBJECTIVE The aim of this article is to present the role of cardiovascular MRI in the assessment of sinus of Valsalva aneurysms. An imaging protocol is described, along with a systematic approach to interpret MR findings and a synopsis of key findings. CONCLUSION Radiologists should have a systematic approach to the assessment and evaluation of sinus of Valsalva aneurysms to facilitate optimal patient management

Antisynthetase syndrome: a case report.

The case is about a 48-year-old man with one week history of progressively worsening shortness of breath and reduced exercise tolerance. Laboratory investigations revealed raised ESR, creatine kinase (CK) and positive anti-aminoacyl-transfer RNA synthetase. High resolution computed tomography (HRCT) chest showed prominent mediastinal lymph nodes and scattered lung nodules. These findings along with clinical features and investigations confirmed the diagnosis of antisynthetase syndrome (ASS). The radiological investigations proved to be the key step in diagnosis and management of this case

A comparative analysis of noncontrast flow-spoiled versus contrast-enhanced magnetic resonance angiography for evaluation of peripheral arterial disease.

Initial results show good agreement between FBI-MR angiography and Gd-MR angiography in the diagnosis of peripheral arterial disease, making FBI a potential alternative in patients with renal impairment. FBI showed highest accuracy in the above knee vessels. Technological refinements are required to improve accuracy for assessing the calf and pedal vessels