The Use of Medical Imaging Request Forms as Trigger Tools to Detect Intra-Hospital Adverse Events: A Pilot Study

Aim: To evaluate the contribution of medical imaging request forms as trigger tools to detect patient adverse event (AE) occurring during hospitalization. Material and Methods: This is a retrospective study in a single institution. Between January and June 2019, the hospital information system (HIS) was fetched for request forms of radiological examinations performed for inpatients >48 hours after the admission date. The investigated request forms were: Doppler ultrasound of the upper limbs, Doppler ultrasound of the lower limbs, and the repetition of three consecutive requests of chest radiographs within 24 hrs, to detect upper or lower limb venous thrombosis, or AEs related to the respiratory system, respectively. Patients’ medical charts and radiological examinations were evaluated to document the presence or absence of an AE. The frequencies of AEs in the three groups of trigger tools were compared to corresponding control groups, matched according to age, sex and length of stay. Results: Among a total of 2798 hospital admissions during the study period, there were 74 files triggered by the three types of radiological request forms. There were 6/24 AE (25%) related to upper limb venous thrombosis, 4/33 (12.1%) AE related to lower limb venous thrombosis, and 6/17 (35.3%) AE related to the respiratory system. For all the trigger tools, the frequency of AE in the study groups was significantly higher than that in the control groups. Conclusion: Medical imaging requests could be used as potential trigger tools to detect adverse events related to hospital stay

EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

APPLICATIONS DE LA THEORIE DES SYSTEMES DYNAMIQUES NON LINEAIRES A LA CARACTERISATION DE SIGNAUX BIOMEDICAUX ET A LEUR MODELISATION

LA THEORIE DES SYSTEMES DYNAMIQUES NON LINEAIRES TRAITE DU COMPORTEMENT DE SYSTEMES DETERMINISTES, DONT LA SENSIBILITE AUX CONDITIONS INITIALES REND IMPOSSIBLE TOUTE PREDICTION A LONG TERME. LES OUTILS DE CETTE THEORIE, POUVANT EXPLIQUER LES PROPRIETES D'ADAPTABILITE DE L'ORGANISME, SONT APPLIQUES AUX SIGNAUX CARDIAQUES, DU GRELE ET VASCULAIRES. LA RECONSTRUCTION DE L'ESPACE DES ETATS ET LES APPLICATIONS DE 1 E R RETOUR AUTORISENT LA CARACTERISATION GEOMETRIQUE DE RYTHMES ATYPIQUES ET LA DECOMPOSITION DES FLUCTUATIONS DU RYTHME EN VARIABILITE MULTI-TEMPORELLES, PERMETTANT DE DISTINGUER DES RYTHMES FETALS FAIBLEMENT VARIABLES CHEZ DES FTUS EN SOMMEIL ET EN ETAT DE SOUFFRANCE. LA QUANTIFICATION DES VARIABILITES DE LA PRESSION DANS L'INTESTIN GRELE CONDUIT A UNE DISTINCTION ENTRE TEMOINS ET SUJETS DYSPEPTIQUES. LES PROCESSUS DE DEVELOPPEMENT DE L'ORGANISME ENGENDRENT SOUVENT DES STRUCTURES FRACTALES. L'INDICE D'AUTO-SIMILARITES D'UN SIGNAL RR DONNANT UNE MESURE DE LA VARIABILITE CARDIAQUE, AUGMENTE CHEZ DES SUJETS ATTEINTS D'UNE FIBRILLATION. LA MODELISATION PAR UN SYSTEME D'EQUATIONS DIFFERENTIELLES ORDINAIRES DES SIGNAUX PHYSIOLOGIQUES EST A ENVISAGER DES QUE DES COUPLAGES APPARAISSENT ENTRE LES VARIABLES D'ETAT DU SYSTEME. IL DEVIENT POSSIBLE D'OBTENIR UNE MODELISATION PHENOMENOLOGIQUE DE LA VARIABLE MESUREE. LA MODELISATION DE L'ECG MENE A LA CONCLUSION QUE LE SYSTEME CARDIAQUE TEND A SE COMPORTER COMME UN SYSTEME DYNAMIQUE DE DIMENSION VOISINE DE CINQ. LA MODELISATION DE LA PRESSION ET DU DIAMETRE ARTERIEL A MONTRE QUE LE SYSTEME VASCULAIRE ETAIT DE FAIBLE DIMENSION ET QUE LE DIAMETRE ETAIT L'OBSERVABLE DYNAMIQUE A RETENIR. ENFIN, L'EQUIVALENCE DIFFEOMORPHIQUE CONSISTE A EPROUVER LA CONNECTION ENTRE UN OBJET PLONGE DANS L'ESPACE DES PHASES ORIGINAL ET SON IMAGE PLONGEE DANS UN ESPACE DES ETATS RECONSTRUITS, EN TESTANT LES PROPRIETES MATHEMATIQUES DE TRANSFORMATION DE L'UN A L'AUTRE. L'EQUIVALENCE DYNAMIQUE ENTRE DES SYSTEMES CHAOTIQUES (HENON, ROSSLER, LORENZ) ET LES RECONSTRUCTIONS INDUITES PAR LEURS VARIABLES EST ETUDIEE INDEPENDEMMENT DE LA DIMENSION DE RECONSTRUCTION. IL EN RESULTE UN CLASSEMENT DES VARIABLES PAR DEGRE D'OBSERVABILITE ET UNE DISCUSSION SUR L'EQUIVALENCE DES VARIABLES DANS LE PROBLEME DE L'OBSERVABILITE DE LA DYNAMIQUE ORIGINALE.ROUEN-BU Sciences (764512102) / SudocROUEN-BU Sciences Madrillet (765752101) / SudocSudocFranceF

Imagerie par résonance magnétique de l’angiogenèse tumorale

Tumor angiogenesis induces the proliferation of immature blood vessels that are both heterogeneous and leaky. These characteristics can be demonstrated by measuring the perfusion parameters with MRI. Perfusion MRI is usually performed with in T1-weighted dynamic imaging after bolus injection of an exogenous contrast agent such as gadolinium chelate. The perfusion parameters are obtained by semi-quantitative or quantitative analysis of the enhancement curves in the tumor and the arterial input. Perfusion can also be assessed without injecting a contrast agent using arterial spin labeling techniques, diffusion MRI, or BOLD (blood oxygen level dependent) MRI. However, these latter methods are limited by a low signal-to-noise ratio and problems with quantification. The main indication for perfusion MRI is the assesment of antiangiogenic and aritivascular treatments. New possibilities for demonstrating angiogenic blood vessels are being opened by molecular imaging

Optimising TNM Staging of Patients with Prostate Cancer Using WB-MRI

Multiparametric Magnetic Resonance Imaging (mp-MRI) is the current standard of reference for the local staging of prostate cancer (PCa). On the other hand, despite the low sensitivity and specificity of Technetium Bone Scanning (BS) for the detection of bone metastases (BM) and of Body Computed Tomography CT for the detection of lymph node metastases (LNM), these techniques are routinely used, in the current clinical practice. Nevertheless, whole Body MRI (WB-MRI) and Positron Emission Tomography Computed Tomography (PET-CT) are emerging as robust tools for the staging of oncologic patients, including those with (PCa). The available techniques (BS, WB-MRI, PET, CT) for the detection of BM in oncologic patients were compared and showed striking center differences in terms of anatomic sequences and planes used. This heterogeneity and the long acquisition time of WB-MRI protocols - due to the addition of multiple anatomic sequences in different planes - questioned whether a single three dimensional (3D) sequence could replace the multiple anatomic sequences used for node and bone staging of PCa. We demonstrated that WB-MRI is a credible tool for the detection of bone and node metastasis. The second question addressed the possibility to obtain a complete TNM staging of PCa in a single MRI session. A WB-MRI protocol was developed to enable complete, T (local), N (regional) and M (distant) staging of PCa in a single session, in less than an hour. This 'all-in-one' protocol proved to be as efficient as the sum of exams currently in use for the staging of PCa (ie: mp-MRI of the prostate for 'T' staging, Thoraco-abdominal CT for 'N' staging and bone scintigraphy for 'M' staging)

Virtual unenhanced phase with spectral dual-energy CT: Is it an alternative to conventional true unenhanced phase for abdominal tissues?

PURPOSE: To compare attenuation measurements and image quality of virtual unenhanced phase (VUP) images with those of conventional true unenhanced phase (TUP) images on spectral dual energy computed tomography (DECT) with dual layer detector on abdominal tissues and to assess potential reduction in radiation dose. MATERIAL AND METHOD: A total of 295 patients (185 men, 110 women; mean age 61±17.6 [SD] years [range: 17-95 years]) who had undergone abdominal or thoraco-abdominal CT with pre- and post-contrast imaging (portal phase) with spectral DECT with dual layer detector were retrospectively analyzed. VUP images based on portal-venous phase DECT acquisition were generated. Regions of interest were defined in abdominal tissues (liver, spleen, kidney, muscle and fat) by two independent readers. Inter-technique agreement (VUP images vs. TUP images) on attenuation measurements was assessed. Signal-to noise ratio (SNR) and image quality of TUP and VUP images were compared. The radiation dose delivered to patients was compared with the radiation dose of protocols without TUP images. RESULTS: A total of 9880 ROIs were drawn in the abdominal tissues. The difference in mean attenuation values between TUP and VUP images was less than 15 HU in 98.3% and less than 10 HU in 92.3% of all measurements. VUP images overestimated attenuation in fat comparatively to TUP images. Image quality was evaluated as good or excellent in 77% (37/48) of TUP images and 54% (26/48) of VUP images. Using VUP images instead of TUP images could decrease the radiation dose by 32%. CONCLUSION: VUP images demonstrate good agreement with TUP images in different abdominals tissues and can be obtained with similar image quality as TUP. VUP images appear as an alternative to TUP images, resulting in reduction of radiation dose delivered to the patient

Semi-quantitative CT assessment of fracture healing: How many and which CT reformats should be analyzed?

To assess how many and which CT reformats of long bone non-unions should be analyzed to best approximate the analysis of a larger number of CT reformats obtained in the three orthogonal planes. We used 29 CT examinations of tibial or femoral non-unions to obtain 87 stacks of 7 CT reformats each in the coronal (n = 29), sagittal (n = 29) or transverse (n = 29) planes. Two independent radiologists scored two fracture sites on each CT reformat by using a Tomographic Union Score (TUS) (1: no callus, 2: non-bridging callus; 3: bridging immature callus; 4: bridging remodeled callus). The reference standard was the mean of the three TUS calculated from the cortical scores obtained on all the sagittal, coronal and transverse CT reformats. We determined the agreement (intra-class correlation coefficient (ICC) between the reference standard and 33 models combining one to seven CT reformats from one to three planes. The three best models were compared following a resampling procedure by a Wilcoxon's signed rank test. Three models combining two (mid-coronal and mid-sagittal), three (mid-coronal, mid-sagittal and mid-transverse) or four (two paramedian coronal and sagittal) CT reformats had the highest ICC (ICC ≥ 0.89) for both observers. After resampling, the model combining the two paramedian sagittal and coronal CT reformats statistically outperformed the two other models. Semi-quantitative analysis of the two paramedian sagittal and coronal CT reformats is an acceptable alternative to the analysis of more numerous reformats

Collapse-Related Bone Changes in Osteonecrotic Femoral Heads at Multidetector CT: Comparison between Femoral Heads with Limited and Advanced Collapse.

AIM: To assess the frequency of bone changes in resected osteonecrotic femoral head (ONFH) specimens at multidetector computed tomography (MDCT) and compare their frequencies between ONFH with limited or advanced collapse. METHOD: Fourteen ONFH were imaged using MDCT (n = 14) and microcomputed tomography ([µCT]; n = 8). Preoperative staging was performed using radiographs and MRI. Coronal reformats of MDCT images of the specimens were analyzed using the grid overlay method. There were 2,933 grid boxes containing cortical bone and 10,596 containing trabecular bone. Two MSK radiologists assessed in every grid box the presence of interface-related sclerosis, cortical bone interruption, trabecular bone interruption, and trabecular bone resorption. The frequency of grid boxes with bone changes at MDCT was calculated and compared between ONFH with limited (<1.5 mm) or advanced (≥1.5 mm) collapse. RESULTS: For both readers R1 and R2, there were 1111/10596 (10.5%) and 1362/10596 (12.9%) grid boxes with interface-related bone sclerosis, 557/2933 (19%) and 413/2933 (14.1%) with cortical bone interruption, 796/10596 (7.5%) and 665/10596 (6.3%) with trabecular bone interruption, and 331/10596 (3.1%) and 595/10596 (5.6%) with trabecular bone resorption. The frequency of grid boxes with cortical interruption and trabecular bone resorption was significantly higher in ONFH with advanced than in ONFH with limited collapse. There was no significant difference in frequency of grid boxes with trabecular interruption and interface-related bone sclerosis between ONFH with advanced or limited collapse. CONCLUSION: Cortical interruption and trabecular resorption, but not trabecular interruption, were more frequent in osteonecrotic femoral heads with advanced than with limited collapse

Multiparametric magnetic resonance imaging to differentiate high-grade gliomas and brain metastases.

Combining perfusion and visual texture parameters within a statistical classifier significantly improved the differentiation of a single brain MET and GBM