Dose and noise in abdominal computed tomography examinations

Background: Dose reduction in computed tomography (CT) examinations was an idea of the Co-rdinated Research Project (CRP) "Dose Reduction in Computed Tomography (CT) while maintaining Diagnostic Confidence", supported by the International Agency of Atomic Energy (IAEA) in the years 2003-2005. Participation in the CRP inspired the authors' attempts to elaborate a method for optimization of CT abdominal procedures allowing reduce a dose to patient with saving diagnostically satisfying image quality. The paper presents the algorithm together with clinical verification of the results of the study. Material/Methods: Two types of single-slice CT scanners were used for the investigations. The images recorded for patients undergoing routine abdomen examinations and then these obtained with modified exposure parameters were analyzed. The influence of the changed tube outputs on image quality was checked using Catphan 424 phantom. Results: As the result no statistically significant difference between the measured noise in clinical images for patients examined at routine and modified settings (within the same weight category) was observed. Conclusions: The conclusion was that at routine (screening) abdomen examinations, the dose may be reduced up to 50% with saving diagnostically satisfying image quality

Successful Stepwise Development of Patient Research Partnership: 14 years’ experience of actions and consequences in Outcome Measures in Rheumatology (OMERACT)

There is increasing interest in making patient participation an integral component of medical research. However, practical guidance on optimizing this engagement in healthcare is scarce. Since 2002, patient involvement has been one of the key features of the Outcome Measures in Rheumatology (OMERACT) international consensus effort. Based on a review of cumulative data from qualitative studies and internal surveys among OMERACT participants, we explored the potential benefits and challenges of involving patient research partners in conferences and working group activities. We supplemented our review with personal experiences and reflections regarding patient participation in the OMERACT process. We found that between 2002 and 2016, 67 patients have attended OMERACT conferences, of whom 28 had sustained involvement; many other patients contributed to OMERACT working groups. Their participation provided face validity to the OMERACT process and expanded the research agenda. Essential facilitators have been the financial commitment to guarantee sustainable involvement of patients at these conferences, procedures for recruitment, selection and support, and dedicated time allocated in the program for patient issues. Current challenges include the representativeness of the patient panel, risk of pseudo-professionalization, and disparity in patients’ and researchers’ perception of involvement. In conclusion, OMERACT has embedded long-term patient involvement in the consensus-building process on the measurement of core health outcomes. This integrative process continues to evolve iteratively. We believe that the practical points raised here can improve participatory research implementation

The validation of a new measure quantifying the social quality of life of ethnically diverse older women: two cross-sectional studies

<p>Abstract</p> <p>Background</p> <p>To our knowledge, the available psychometric literature does not include an instrument for the quantification of social quality of life among older women from diverse ethnic backgrounds. To address the need for a tool of this kind, we conducted two studies to assess the initial reliability and validity of a new instrument. The latter was created specifically to quantify the contribution of a) social networks and resources (e.g., family, friends, and community) as well as b) one's perceived power and respect within family and community to subjective well-being in non-clinical, ethnically diverse populations of older women.</p> <p>Methods</p> <p>In Study 1, we recruited a cross-sectional sample of primarily non-European-American older women (<it>N </it>= 220) at a variety of community locations. Participants were administered the following: a short screener for dementia; a demographic list; an initial pool of 50 items from which the final items of the new Older Women's Social Quality of Life Inventory (OWSQLI) were to be chosen (based on a statistical criterion to apply to the factor analysis findings); the Single Item Measure of Social Support (SIMSS); and the Medical Outcome Study 36-item Short-Form Health Survey (MOS SF-36). Study 2 was conducted on a second independent sample of ethnically diverse older women. The same recruitment strategies, procedures, and instruments as those of Study 1 were utilized in Study 2, whose sample was comprised of 241 older women with mostly non-European-American ethnic status.</p> <p>Results</p> <p>In Study 1, exploratory factor analysis of the OWSQLI obtained robust findings: the total variance explained by one single factor with the final selection of 22 items was over 44%. The OWSQLI demonstrated strong internal consistency (<it>α </it>= .92, <it>p </it>< .001), adequate criterion validity with the SIMSS (<it>r </it>= .33; <it>p </it>< .01), and (as expected) moderate concurrent validity with the MOS SF-36 for both physical (<it>r </it>= .21; <it>p </it>< .01) and mental (<it>r </it>= .26; <it>p </it>< .01) quality of life. In order to confirm the validity of the 22-item OWSQLI scale that emerged from Study 1 analyses, we replicated those analyses in Study 2, although using confirmatory factor analysis. The total variance accounted for by one factor was about 42%, again quite high and indicative of a strong single-factor solution. Study 2 data analyses yielded the same strong reliability findings (i.e., <it>α </it>= .92, <it>p </it>< .001). The 22-item OWSQLI was correlated with the SIMSS (<it>r </it>= .27, <it>p </it>< .001) in the expected direction. Finally, correlations with the MOS SF- 36 demonstrated moderate concurrent validity for physical (<it>r </it>= .14; <it>p </it>< .01) and mental (<it>r </it>= .18; <it>p </it>< .01) quality of life, as expected.</p> <p>Conclusions</p> <p>The findings of these two studies highlight the potential for our new tool to provide a valid measure of older women's social quality of life, yet they require duplication in longitudinal research. Interested clinicians should consider using the OWSQLI in their assessment battery to identify older women's areas of lower versus higher social quality of life, and should establish the maximization of patients' social quality of life as an important therapeutic goal, as this variable is significantly related to both physical and mental health.</p

Assessing quality of care for the dying from the bereaved relatives’ perspective: using pre-testing survey methods across seven countries to develop an international outcome measure

Background: The provision of care for dying cancer patients varies on a global basis. In order to improve care, we need to be able to evaluate the current level of care. One method of assessment is to use the views from the bereaved relatives. Aim: The aim of this study is to translate and pre-test the ‘Care Of the Dying Evaluation’ (CODETM) questionnaire across seven participating countries prior to conducting an evaluation of current quality of care. Design: The three stages were as follows: (1) translation of CODE in keeping with standardised international principles; (2) pre-testing using patient and public involvement and cognitive interviews with bereaved relatives; and (3) utilising a modified nominal group technique to establish a common, core international version of CODE. Setting/participants: Hospital settings: for each country, at least five patient and public involvement representatives, selected by purposive sampling, fed back on CODETM questionnaire; and at least five bereaved relatives to cancer patients undertook cognitive interviews. Feedback was collated and categorised into themes relating to clarity, recall, sensitivity and response options. Structured consensus meeting held to determine content of international CODE (i-CODE) questionnaire. Results: In total, 48 patient and public involvement representatives and 35 bereaved relatives contributed to the pre-testing stages. No specific question item was recommended for exclusion from CODETM. Revisions to the demographic section were needed to be culturally appropriate. Conclusion: Patient and public involvement and bereaved relatives’ perceptions helped enhance the face and content validity of i-CODE. A common, core international questionnaire is now developed with key questions relating to quality of care for the dying

Number of active detector rows and quality of image in computed tomography

Background: Rapid technical development of Computed Tomography (CT) means usage the modern, fast scanners which possibilities are not always known by users. A common conviction is the high number of detectors is equivalent to an accurate investigation of sub-millimetre slices of patient body and detection of such small-size lesions. Aim of the paper was to compare an imaging possibilities of the two CT scanners of the same vendors which differ only the configuration of detectors in use. (The group of 48 rows of detector is physically the same for the both scanners.) Material/Methods: Quality of images was controlled using Catphan series 500. The high- contrast resolution, lowcontrast resolution and signal-to-noise ratio were evaluated for images recorded at the constant reconstruction thickness of 5 mm. Results: A precision of imaging was evaluated on the basis signal-to-noise ratio (SNR) in relation to CT Dose Index. The lowest SNR at satisfying visualisation of the low-contrast objects was slightly above 5. The corresponding CT Dose Index was over 5mGy. Care-dose option decreases SNR to nearly 2 what follows unacceptable visualisation of low-contrast objects. Conclusions: on the basis the results for the both scanners was found that high number of active detector rows help to achieve a better visualisation of low-contrast objects under condition of higher CT Dose Index values. The space resolution does not change with the detector configuration

Number of active detector rows and quality of image in computed tomography

Background: Rapid technical development of Computed Tomography (CT) means usage the modern, fast scanners which possibilities are not always known by users. A common conviction is the high number of detectors is equivalent to an accurate investigation of sub-millimetre slices of patient body and detection of such small-size lesions. Aim of the paper was to compare an imaging possibilities of the two CT scanners of the same vendors which differ only the configuration of detectors in use. (The group of 48 rows of detector is physically the same for the both scanners.) Material/Methods: Quality of images was controlled using Catphan series 500. The high- contrast resolution, lowcontrast resolution and signal-to-noise ratio were evaluated for images recorded at the constant reconstruction thickness of 5 mm. Results: A precision of imaging was evaluated on the basis signal-to-noise ratio (SNR) in relation to CT Dose Index. The lowest SNR at satisfying visualisation of the low-contrast objects was slightly above 5. The corresponding CT Dose Index was over 5mGy. Care-dose option decreases SNR to nearly 2 what follows unacceptable visualisation of low-contrast objects. Conclusions: on the basis the results for the both scanners was found that high number of active detector rows help to achieve a better visualisation of low-contrast objects under condition of higher CT Dose Index values. The space resolution does not change with the detector configuration

Factors affecting exposure level for medical staff during orthopedic procedures under fluoroscopic control

Background: Extended control of staff exposure in interventional radiology has been legally required over the last few years. This is determined by a number of factors, including the type of procedure, technical conditions and methodology. In orthopedic procedures fluoroscopy is used to control surgical reconstructions. An influence of particular factors on the registered values of doses received by the members of medical team performing osteosynthesis for limb fractures is presented in this paper. Material and Methods: Doses received by individual interventional team members performing specific functions, operator, assisting physicians and scrub nurse, during a series of the procedures were measured. Each person was equipped with 4 dosimetric tools, containing thermoluminescent dosimeters, to measure the equivalent doses for the eyes, hand skin and the neck (outside the shield) and to evaluate effective doses. The investigations were performed in operational theatres of 3 hospitals in Łódź. Results: The equivalent doses per one procedure for the eyes and hand skin of the operator were 0.029–0.073 mSv and 0.366–1.604 mSv, respectively. Significantly higher doses were noted during the procedures of intramedullary osteosynthesis, especially for the operator. An average age and body mass index (BMI) of patients treated in the monitored hospitals did not differ statistically. Conclusions: Based on the dosimetric measurements the following conclusions can be drawn: in orthopedic procedures of interventional radiology (IR) the exposure of the staff is mostly determined by the type of procedure and more precisely by its complexity and by the optimized use of X-ray unit, including pulsed fluoroscopy. It is also revealed that the operator is the most exposed person in the interventional team. Med Pr 2017;68(1):75–8