Clinical utility of postprocessed low-dose radiographs in skeletal imaging

Objectives: Radiography remains the mainstay of diagnostic and follow-up imaging. In view of the risks and the increasing use of ionizing radiation, dose reduction is a key issue for research and development. The introduction of digital radiography and the associated access to image postprocessing have opened up new opportunities to minimize the radiation dosage. These advances are contingent upon quality controls to ensure adequate image detail and maintenance of diagnostic confidence. The purpose of this study was to investigate the clinical applicability of postprocessed low-dose images in skeletal radiography. Methods: In our study setting, the median radiation dose for full dose X-rays was 9.61 dGy*cm2 for pelvis, 1.20 dGy*cm2 for shoulder and 18.64 dGy*cm2 for lumbar spine exams. Based on these values, we obtained 200 radiographs for each anatomic region in four consecutive steps, gradually reducing the dose to 84%, 71%, 60% and 50% of the baseline using an automatic exposure control (AEC). 549 patients were enrolled for a total of 600 images. All X-rays were postprocessed with a spatial noise reduction algorithm. Two radiologists assessed the diagnostic value of the radiographs by rating the visualization of anatomical landmarks and image elements on a five-point Likert scale. A mean-sum score was calculated by averaging the two reader's total scores. Given the non-parametric distribution, we used the Mann-Whitney U test to evaluate the scores. Results: Median dosage at full dose accounted for 38.4%, 48 and 53.2% of the German reference dose area product for shoulder, pelvis and lumbar spine, respectively. The applied radiation was incrementally reduced to 21.5%, 18.4% and 18.7% of the respective reference value for shoulder, pelvis and lumbar spine. Throughout the study, we observed an estimable tendency of superior quality at higher dosage in overall image quality. Statistically significant differences in image quality were restricted to the 50% dose groups in shoulder and lumbar spine images. Regardless of the applied dosage, 598 out of 600 images were of sufficient diagnostic value. Conclusion: In digital radiography image postprocessing allows for extensive reduction of radiation dosage. Despite a trend of superior image detail at higher dose levels, overall quality and, more importantly, diagnostic utility of low-dose images was not significantly affected. Therefore, our results not only confirm the clinical utility of postprocessed low-dose radiographs, but also suggest a widespread deployment of this advanced technology to ensure further dose limitations in clinical practice. Advances in knowledge: The diagnostic image quality of postprocessed skeletal radiographs is not significantly impaired even after extensive dose reduction by up to 20% of the reference value

Telemedicine in the Emergency Department in the Era of COVID-19: Front-Line Experiences from 2 Institutions

During the COVID-19 pandemic, one of the major changes that has occurred in emergency medicine is the evolution of telemedicine. With relaxation of regulatory and administrative barriers, the use of this already available technology has rapidly expanded. Telemedicine provides opportunity to markedly decrease personal protective equipment (PPE) and reduce healthcare worker exposures. Moreover, with the convenience and availability of access to medical care via telemedicine, a more fundamental change in healthcare delivery in the United States is likely. The implementation of telemedicine in the emergency department (ED) in particular has great potential to prevent the iatrogenic spread of COVID-19 and protect health care workers. Challenges to widespread adoption of telemedicine include privacy concerns, limitation of physical examination, and concerns of patient experience. In this clinical review, we discuss ED telemedicine applications, logistics, and challenges in the COVID-19 era as well as recent regulatory and legal changes. In addition, examples of telemedicine use are described from 2 institutions. Examples of future applications of telemedicine within the realm of emergency medicine are also discussed

The Ursinus Weekly, April 11, 1949

Censorship cancels April fool issue • Debaters finish second in Ben Franklin tourney • Terror and humor to occupy evening of thespian talent • Weekly editors cancel year\u27s plans following last minute faculty demand • Betty Rilling pens winning May script for Ursinus coeds • Imre Kovacs urges Christian standards in Tuesday address • Should faculty exert control on Weekly ? • R. Mack named Bus Ad prexy; Gradwohl, McMillan get offices • Magazine names Ursinus in list of representative good colleges • Athletic Association to present annual minstrel show April 19 • Drummer and Schultz selected as headwaiters for coming year • Weekly offers fin to author of letter • Gaff , poll voted most controversial • Curtis scores close win in gala intramural night • Dennis named head of 1950 golf team; six matches carded • Softball belles aim to maintain record as five vets return • Fifteen man squad lifts coach\u27s hopes for winning season • Cox bows in AAU quarter-finals; Fords trip bruin nine 2-0 • Track vets sparkle in practice session with West Chester • Haverford\u27s Heberton hurls two-hitter; error costly for pitcher Ron Landes • Two letter winners, hopeful rookies vie for coed net spots • Coeds end schedule with decisive wins in hoop, pool tilts • Tischler, Harris cop leads in spring play • New \u27Weekly\u27 heads to be introduced at annual banquethttps://digitalcommons.ursinus.edu/weekly/1613/thumbnail.jp

HBP-enhancing hepatocellular adenomas and how to discriminate them from FNH in Gd-EOB MRI

BackgroundRecent studies provide evidence that hepatocellular adenomas (HCAs) frequently take up gadoxetic acid (Gd-EOB) during the hepatobiliary phase (HBP). The purpose of our study was to investigate how to differentiate between Gd-EOB-enhancing HCAs and focal nodular hyperplasias (FNHs). We therefore retrospectively included 40 HCAs classified as HBP Gd-EOB-enhancing lesions from a sample of 100 histopathologically proven HCAs in 65 patients. These enhancing HCAs were matched retrospectively with 28 FNH lesions (standard of reference: surgical resection). Two readers (experienced abdominal radiologists blinded to clinical data) reviewed the images evaluating morphologic features and subjectively scoring Gd-EOB uptake (25-50%, 50-75% and 75-100%) for each lesion. Quantitative lesion-to-liver enhancement was measured in arterial, portal venous (PV), transitional and HBP. Additionally, multivariate regression analyses were performed. ResultsSubjective scoring of intralesional Gd-EOB uptake showed the highest discriminatory accuracies (AUC: 0.848 (R#1); 0.920 (R#2)-p0.05). ConclusionEven in HBP-enhancing HCA, characterization of Gd-EOB uptake was found to provide the strongest discriminatory power in differentiating HCA from FNH. Furthermore, a lobulated appearance and a central scar are more frequently seen in FNH than in HCA

Two electron dynamics in photodetachment

We present the results of experimental studies of photon-negative ion interactions involving the dynamics of two electrons. Resonances associated with doubly excited states of Li^- and He^- have been observed using laser photodetachment spectroscopy. Total and partial photodetachment cross sections have been investigated. In the former case, the residual atoms are detected irrespective of their excitation state, while in the latter case only those atoms in specific states are detected. This was achieved by the use of a state selective detection scheme based on the resonant ionization of the residual atoms. In addition, in the case of Li^- photodetachment, the threshold behavior of the Li(2 ^2P)+e^-(ks) partial cross section has been used to accurately measure the electron affinity of Li