Radiography student comparison performing lumbar and thoracic spine imaging

Introduction: General radiography is a common imaging technique and X-ray examinations of the thoracic and lumbar spine are among the most frequent procedures undertaken. The aim of this research was to investigate the success rate, dose-area product (DAP), and effective dose values of 1st and 2nd cycle radiographer students performing X-ray imaging of the thoracic and lumbar spine using a phantom. Methods: The students were divided into four groups according to the year of study (1st, 2nd, and 3rd years of 1st cycle degree, and all 2nd cycle degree students). They were asked to perform imaging of thoracic and lumbar spine on the phantom in both anteroposterior and lateral projections where IQ and DAP measurements were collated. The study was blind, so they did not know about the purpose of the study. Results: First, we have inspected the acceptability rate of the images performed. The highest success rate of performing an optimal image was discovered with the 2nd cycle degree students where the 1st year students had the most difficulties there. In the second part, DAP and effective dose values were compared, only for the acceptable images in which case the 1st and 2nd years, students of the 1st cycle degree were most successful. Conclusion: Based on that, we can conclude, that the 2nd cycle degree students had the lowest rejection rate regarding the optimal image quality, which was the price of using a larger primary X-ray field which leads to higher dose values

The comparison of thoracic and lumbar spine imaging performed by students of radiologic technology

Uvod: Rentgenska slikanja prsne in ledvene hrbtenice, so med najpogostejšimi rentgenskimi preiskavami in tudi med najbolj sevalno obremenjujočimi preiskavami v klasični rentgenski diagnostiki. Dozo lahko ustrezno znižamo s pravilnim omejevanjem in centriranjem polja in izbiro ustreznih parametrov slikanja in pri tem dobimo diagnostično ustrezno sliko. Namen: V magistrski nalogi nas je zanimalo, kako uspešni so študentje radiološke tehnologije pri zajemanju vseh anatomskih struktur in kolimiranju ter centriranju polja pri slikanju ledvene in prsne hrbtenice na fantomu. Kot posledico centriranja in omejevanja polja pri tehnično uporabnih slikah smo opazovali še DAP vrednost, vrednosti efektivnih doz in doz na izbrane organe, v smislu kakovosti rentgenske slike pa smo primerjali vrednosti ekspozicijskega indeksa (EI). Metode dela: V tej magistrski nalogi smo izvedli eksperimentalno metodo z izvajanjem meritev na rentgenskem aparatu Zdravstvene fakultete. V študiji je sodelovalo 124 študentov, ki so na fantomu PBU 60 so izvedli slikanje ledvene in prsne hrbtenice v dveh projekcijah. Meritve smo obdelali v programu PCXMC 2.0 in IBM SPSS STATISTICS 20. Rezultati: Pri prsni hrbtenici ni bilo razlik v tehnični uporabnosti pri AP projekciji, so bile pa razlike signifikantne pri tokovnem sunku, DAP in efektivni dozi. Največje doze so bile pri študentih druge stopnje. DAP vrednosti in vrednosti efektivnih doz študentov so bile veliko nižje od priporočenih. Pri stranski projekciji prsne hrbtenice ni bilo signifikantnih razlik v tehnični uporabnosti, so bile pa razlike v velikosti polja statistično značilne. DLR za DAP iz literature je za okoli 90% višji od povprečnih vrednosti v tej študiji. Pri AP projekciji ledvene hrbtenice pri tehnični uporabnosti študentje 1. letnika statistično značilno (p<0,001) odstopajo od drugih skupin, kjer so bile tudi pri tokovnem sunku, razlike statistično značilne. Pri stranski projekciji ledvene hrbtenice so razlike v tehnični uporabnosti slik med letniki statistično značilne (p<0,001). Pri primerjavi z literaturo so ponovno vrednosti, ki so jih dobili študentje veliko nižje od priporočenih. Razprava in zaključek: V tej študiji, na koncu ne moramo izbrati enega letnika, za katerega lahko rečemo, da je boljši od ostalih, saj tudi, če so bili 1. letniki bolj uspešni pri omejevanju polja in posledično tudi nižjih dozah, so imeli več neuporabnih slik kot 2. stopnja, kar bi lahko pomenilo, da če bi morali neuporabne slike ponavljati, bi bila na koncu celokupna doza celo višja od druge stopnje, čeprav je imela v večini najvišje doze.Introduction: X-ray imaging of the chest and lumbar spine are among the most common X-ray examinations and have the highest doses in classic X-ray diagnostics. The dose can be reduced by proper field collimation and centring and correct exposure parameters, while still retaining proper image quality. Purpose: The purpose of this research is to see the percentage of technically useful images and to determine, if there are significant differences in x-ray fields collimation and doses between radiography students within technically acceptable images. Methods: We used an experimental method, where our 124 subjects took 4 x ray images of the PBU 60. The measurements were processed in PCXMC 2.0 and IBM SPSS STATISTICS 20 program. Results: With the thoracic spine in AP view, the differences were not significant when comparing the frequencies of technically useful images, but they were statistically significant in DAP, mAs values and effective dose comparison, where 1st year students had the lowest values. When compared to the values suggested in literature, the student values were much lower. With the lateral view of the thoracic spine, the differences were significant only with the field size and a few organ doses within technically acceptable images. When we compared the values to literature, the students got drastically lower values again. With the AP view of the lumbar spine the differences were significant when comparing frequencies of technically acceptable images, where 1st years students had the most difficulties. The differences were also significant when comparing mAs values. With the lateral view of the lumbar spine, the frequencies of technically acceptable images were significant again and 1st year students had the most problems here as well. There were also significant differences in field size and in some cases of organ doses. The DAP and effective doses were again much lower than the suggested values from literature. Discussion and conclusion: With this research, we found out that the percentage of diagnostically useful images was the highest in post-graduate group, but in some cases within the acceptable images they had the highest dose values, so we cannot say that one group exceeds all. It would be interesting to redo this research in a few years and to compare these results with similar research from abroad

Study of correlations between CT properties of retrieved cerebral thrombi with treatment outcome of stroke patients

BACKGROUND: All the patients with suspected stroke are directed to whole-brain CT scan. The purpose of this scan is to look for early features of ischemia and to rule out alternative diagnoses than stroke. In case of ischemic stroke, CT diagnostics (including CT angiography) is used mainly to locate the occlusion and its size, while the Hounsfield Units (HU) values of the thrombus causing the stroke are usually overlooked on CT scan or considered not important. The aim of this study was to demonstrate that the HU value is relevant and can help in better treatment planning. PATIENTS AND METHODS: There were 25 patients included in the study, diagnosed with ischemic stroke in the middle cerebral artery (MCA) territory. In all patients, systemic thrombolysis was not successful and the mechanical recanalization was needed. The retrieved thrombi were also analyzed histologically for the determination of red blood cells (RBC) proportion. CT of the proximal MCA (M1) segment was analyzed for average HU value and its variability both in the occluded section and the symmetrical normal site. These CT parameters were then statistically studied for the possible correlations with different clinical, histological and procedure parameters using the Linear Regression and the Pearson correlation coefficient. RESULTS: Relevant positive correlations were found between average HU value of thrombus and outcome modified Rankin Scale (mRS), initial mRS, number of passes with thrombectomy device as well as RBC proportion. CONCLUSIONS: Results of the present study suggest that measured HU values in CT images of the cerebral thrombi may help in the assessment of thrombus compaction and therefore better treatment planning

Correlations between computer-tomographic and magnetic-resonance characteristics of artificial blood clots in a brain circulation model

Uvod in pregled literature: Neravnovesje v delovanju hemostaze lahko povzroči možgansko kap, ki spada med najpogostejše vzroke smrti in invalidnosti. Ishemično možgansko kap povzročajo trombi, katerih lastnosti vplivajo na izid zdravljenja. Optimiziranje protokola obravnave kapi je nujno za boljši izid zdravljenja, kjer za slikovno diagnostiko večinoma uporabljamo CT, čeprav se je MR izkazal za boljšo metodo. Ne glede na slikovno diagnostiko doslej ta ni dajala poudarka ugotavljanju lastnosti trombov. Cilj in namen raziskave: Z namenom nadaljnjega optimiziranja protokola obravnave kapi, smo raziskali možnost CT in MR meritev za definicijo strukture umetnih trombov, hkrati smo želeli ugotovitve umestiti tudi v klinično okolje, kjer smo opazovali povezave med CT in MR lastnostmi zapore ter kliničnimi parametri in parametri zdravljenja dejanskih pacientov. Metode in materiali: Najprej, smo preiskovali učinkovitost MR in CT analize pri definiranju strukture umetnih trombov. V kliničnem delu so bili obravnavani pacienti s potrjeno ishemično možgansko kapjo, kjer so uspešno odstranili trombe in jih analizirali z MR ter histološko. Od pacientov smo pridobili še klinične podatke in podatke zdravljenja ter obdelali CT slike, kjer smo pridobili in vivo meritve CT števil trombov. Vse smo ustrezno statistično obdelali. Rezultati in Razprava: MR difuzijske in CT meritve pri umetnih trombih so uspešno razlikovale med eritrocitnimi in trombocitnimi trombi, hkrati so bile vse meritve občutljive na spremembe v deležu eritrocitov. V klinični študiji smo ugotovili pomembne korelacije med variabilnostjo difuzije in trajanjem mehanske rekanalizacije, odstopanjem v povprečnem CT številu in številom prehodov pri trombektomiji, dolžino tromba, deležu eritrocitov in drugimi dejavniki. V primeru, da bi MR diagnostika dosegala ustrezno prostorsko ločljivost pri sprejemljivem času slikanja, bi bila bolj uporabna pri definiranju lastnosti trombov, saj je občutljiva na molekularne spremembe, med tem ko CT zgolj zazna spremembe v absorpciji. Sklepi: Nadaljnjo optimiziranje obravnave kapi je lahko mogoče in naša raziskava je lahko podlaga za nadaljnjo raziskovalno delo na tem področju, kjer napredek v CT (spektralni CT) in MR diagnostiki nakazuje, da se lahko bolj osredotočimo tudi na lastnosti trombov.Introduction: Haemostatic imbalance can cause stroke, which is one of the leading causes of death and disability. Ischemic stroke is caused by thrombi, whose properties can affect treatment outcome. Optimising stroke diagnosis and treatment protocol is essential for better outcome, where in imaging diagnostics CT is most commonly used, although MR has been proven to be more efficient. Regardless of the diagnostic imaging modality used, presently no emphasis is put on definition of thrombi properties. Objectives: With the aim of further optimising the stroke protocol, we investigated the possibility of CT and MR measurements in defining the structure of artificial thrombi. We also wanted to apply these findings clinically, where we observed correlations between CT and MR properties of thrombi with treatment and clinical parameters of actual patients. Methods and materials: Firstly, we investigated effectiveness of NMR and CT analysis in defining the structure of artificial thrombi. In the clinical part, patients with confirmed ischemic stroke had successfully removed thrombi, which were later analysed by MR and histology. Clinical and treatment data were also obtained, as well as CT numbers from the corresponding CT images of thrombi. All data were appropriately statistically analysed. Results and discussion: MR diffusion and CT measurements of artificial thrombi successfully differentiated between RBC and platelet thrombi and all measurements were sensitive to changes in RBC proportion. In the clinical study, we found significant correlations between the variability of diffusion and the duration of mechanical recanalization, deviation in mean CT number and the number of passes with the thrombectomy device, length of the thrombus, RBC proportion, and other factors. If MR diagnostics would achieve adequate spatial resolution with an acceptable imaging time, it would be more useful in defining thrombus properties, as it is sensitive to molecular changes, while CT only detects changes in absorption. Conclusions: Further optimization of stroke treatment is possible, and our study can serve as a basis for further research in this area, where advances in CT (spectral CT) and MR diagnostics suggest that we can focus more on thrombi properties

An Intermodal Correlation Study among Imaging, Histology, Procedural and Clinical Parameters in Cerebral Thrombi Retrieved from Anterior Circulation Ischemic Stroke Patients

The precise characterization of cerebral thrombi prior to an interventional procedure can ease the procedure and increase its success. This study investigates how well cerebral thrombi can be characterized by computed tomography (CT), magnetic resonance (MR) and histology, and how parameters obtained by these methods correlate with each other as well as with the interventional procedure and clinical parameters. Cerebral thrombi of 25 patients diagnosed by CT with acute ischemic stroke were acquired by mechanical thrombectomy and, subsequently, scanned by a high spatial-resolution 3D MRI including T1-weighted imaging, apparent diffusion coefficient (ADC), T2 mapping and then finally analyzed by histology. Parameter pairs with Pearson correlation coefficient more than 0.5 were further considered by explaining a possible cause for the correlation and its impact on the difficulty of the interventional procedure and the treatment outcome. Significant correlations were found between the variability of ADC and the duration of the mechanical recanalization, the deviation in average Hounsfield units (HU) and the number of passes with the thrombectomy device, length of the thrombus, its RBC content and many others. This study also demonstrates the clinical potentials of high spatial resolution multiparametric MRI in characterization of thrombi and its use for interventional procedure planning