Quantitative planar and volumetric cardiac measurements using 64 mdct and 3t mri vs. Standard 2d and m-mode echocardiography: does anesthetic protocol matter?

Cross‐sectional imaging of the heart utilizing computed tomography and magnetic resonance imaging (MRI) has been shown to be superior for the evaluation of cardiac morphology and systolic function in humans compared to echocardiography. The purpose of this prospective study was to test the effects of two different anesthetic protocols on cardiac measurements in 10 healthy beagle dogs using 64‐multidetector row computed tomographic angiography (64‐MDCTA), 3T magnetic resonance (MRI) and standard awake echocardiography. Both anesthetic protocols used propofol for induction and isoflourane for anesthetic maintenance. In addition, protocol A used midazolam/fentanyl and protocol B used dexmedetomedine as premedication and constant rate infusion during the procedure. Significant elevations in systolic and mean blood pressure were present when using protocol B. There was overall good agreement between the variables of cardiac size and systolic function generated from the MDCTA and MRI exams and no significant difference was found when comparing the variables acquired using either anesthetic protocol within each modality. Systolic function variables generated using 64‐MDCTA and 3T MRI were only able to predict the left ventricular end diastolic volume as measured during awake echocardiogram when using protocol B and 64‐MDCTA. For all other systolic function variables, prediction of awake echocardiographic results was not possible (P = 1). Planar variables acquired using MDCTA or MRI did not allow prediction of the corresponding measurements generated using echocardiography in the awake patients (P = 1). Future studies are needed to validate this approach in a more varied population and clinically affected dogs

Suction against resistance: a new breathing technique to significantly improve the blood flow ratio of the superior and inferior vena cava

Objectives: Optimal contrast within the pulmonary artery is achieved by the maximum amount of contrast-enhanced blood flowing through the superior vena cava (SVC), while minimum amounts of non-contrasted blood should originate from the inferior vena cava (IVC). This study aims to clarify whether "suction against resistance” might optimise this ratio. Methods: Phase-contrast pulse sequences on a 1.5T MRI magnet were used for flow quantification (mean flow (mL/s), stroke volume (Vol) in the SVC and IVC in volunteers. Different breathing manoeuvers were analysed repeatedly: free breathing; inspiration; expiration; suction against resistance, and Valsalva. To standardise breathing commands, volunteers performed suction and Valsalva manoeuvers with an MR-compatible manometer. Results: Suction against resistance was associated with a significant drop of the IVC/SVC flow quotient (1.63 [range 1.3-2.0] p  0.05). Conclusions: Suction against resistance caused a significant drop in the IVC/SVC quotient. Theoretically, this breathing manoeuver might significantly improve the enhancement characteristics of CT angiography. Key Points: • Suction provokes reduction in blood flow in the inferior vena cava. • Ratio between the inferior and superior vena cava blood flow diminished during suction. • Manometer used during breathing standardises MR phase-contrast blood flow measurements

Humor in radiological breast cancer screening: a way of improving patient service?

BACKGROUND Breast cancer screening is essential in detecting breast tumors, however, the examination is stressful. In this study we analyzed whether humor enhances patient satisfaction. METHODS In this prospective randomized study 226 patients undergoing routine breast cancer screening at a single center during October 2020 to July 2021 were included. One hundred thirty-two were eligible for the study. Group 1 (66 patients) received an examination with humorous intervention, group 2 (66 patients) had a standard breast examination. In the humor group, the regular business card was replaced by a self-painted, humorous business card, which was handed to the patient at the beginning of the examination. Afterwards, patients were interviewed with a standardized questionnaire. Scores between the two study groups were compared with the Mann-Whitney U test or Fisher's exact test. P-values were adjusted with the Holm's method. Two-sided p-values < 0.05 were considered significant. RESULTS One hundred thirty-two patients, 131 female and 1 male, (mean age 59 ± 10.6 years) remained in the final study cohort. Patients in the humor group remembered the radiologist's name better (85%/30%, P < .001), appreciated the final discussion with the radiologist more (4.67 ± 0.73-5;[5, 5] vs. 4.24 ± 1.1-5;[4, 5], P = .017), felt the radiologist was more empathetic (4.94 ± 0.24-5;[5, 5] vs.4.59 ± 0.64-5;[4, 5], P < .001), and rated him as a humorous doctor (4.91 ± 0.29-5;[5, 5] vs. 2.26 ± 1.43-1;[1, 4], P < .001). Additionally, patients in the humor group tended to experience less anxiety (p = 0.166) and felt the doctor was more competent (p = 0.094). CONCLUSION Humor during routine breast examinations may improve patient-radiologist relationship because the radiologist is considered more empathetic and competent, patients recall the radiologist's name more easily, and value the final discussion more. TRIAL REGISTRATION We have a general approval from our ethics committee because it is a retrospective survey, the patient lists for the doctors were anonymized and it is a qualitative study, since the clinical processes are part of the daily routine examinations and are used independently of the study. The patients have given their consent to this study and survey

Left and right ventricle assessment with Cardiac CT: validation study vs. Cardiac MR

Objectives To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters. Methods Seventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT and 2D cine b-SSFP (balanced- steady state free precession) SAX sequence for MR, and evaluated using dedicated software. Results CT and MR images showed good agreement: LV EF (Ejection Fraction) (52±14% for CT vs. 52±14% for MR; r0 0.73; p>0.05); RV EF (47±12% for CT vs. 47±12% for MR; r00.74; p>0.05); LV EDV (End Diastolic Volume) (74± 21 ml/m 2 for CT vs. 76±25 ml/m 2 for MR; r00.59; p>0.05); RV EDV (84±25 ml/m 2 for CT vs. 80±23 ml/m 2 for MR; r0 0.58; p>0.05); LV ESV (End Systolic Volume)(37±19 ml/m 2 for CT vs. 38±23 ml/m 2 for MR; r00.76; p>0.05); RV ESV (46±21 ml/m 2 for CT vs. 43±18 ml/m 2 for MR; r00.70; p>0.05). Intra- and inter-observer variability were good, and the performance of CT was maintained for different EF subgroups. Conclusions Cardiac CT provides accurate and reproducible LVand RV volume parameters compared with MR, and can be considered as a reliable alternative for patients who are not suitable to undergo MR. Key Points • Cardiac-CT is able to provide Left and Right Ventricular function. • Cardiac-CT is accurate as MR for LV and RV volume assessment. • Cardiac-CT can provide accurate evaluation of coronary arteries and LV and RV function

Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support

Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed

Gastrointestinal decontamination in the acutely poisoned patient

ObjectiveTo define the role of gastrointestinal (GI) decontamination of the poisoned patient.Data sourcesA computer-based PubMed/MEDLINE search of the literature on GI decontamination in the poisoned patient with cross referencing of sources.Study selection and data extractionClinical, animal and in vitro studies were reviewed for clinical relevance to GI decontamination of the poisoned patient.Data synthesisThe literature suggests that previously, widely used, aggressive approaches including the use of ipecac syrup, gastric lavage, and cathartics are now rarely recommended. Whole bowel irrigation is still often recommended for slow-release drugs, metals, and patients who "pack" or "stuff" foreign bodies filled with drugs of abuse, but with little quality data to support it. Activated charcoal (AC), single or multiple doses, was also a previous mainstay of GI decontamination, but the utility of AC is now recognized to be limited and more time dependent than previously practiced. These recommendations have resulted in several treatment guidelines that are mostly based on retrospective analysis, animal studies or small case series, and rarely based on randomized clinical trials.ConclusionsThe current literature supports limited use of GI decontamination of the poisoned patient

Development of cartographic literacy in ten-year-old pupils

The knowledge to use maps and different techniques and technologies for gathering, processing and presenting information about space is one of the fundamental educational objectives both in Slovenia and globally. In the theoretical part, we summarised from literature the key findings and examples of formal development of cartographic and spatial orientation skills in children to the sixth grade of primary school, as well as the selected new findings regarding way-finding and outdoor navigation, and examples of children’s mobile learning with the use of mobile navigation technology. In the empirical part, we determined the cartographic knowledge/skills in 122 ten-year-old pupils from six selected primary schools in Ljubljana and its surroundings, tested their spatial orientation skills and compared their effectiveness in the field use of a mobile navigation device and a paper map. The core of the research focused on the observation how the pupils as pedestrians found their way in a new environment with the aid of a mobile navigation device and how they perceived their surroundings. We used the structured direct observation of individual behaviour of pupils with participant observation in the field as well as the analysis of written and oral questionnaires. The comparison of successfulness with which the pupils walked their path with the aid of mobile navigation and a paper map shows that the use of a mobile navigator made them more independent and less prone to make mistakes. The majority of pupils were interested in working with mobile navigation and were able to use it successfully in the assignment of path-tracking to the destination already after a short (two-minute) demonstration. The pupils who successfully solve cartographic assignments in the classroom are not necessarily equally successful in using maps outdoors. In perceiving their surroundings, the pupils achieved better results using a paper map than using mobile navigation. Based on their recognition of visual motifs (photographs), the boys perceived the surroundings more effectively than the girls. Based on verbal communication, no differences between genders were observed. In the guidelines for the development of cartographic literacy in children we have highlighted the most important strengths and weaknesses of the use of mobile navigation and provided recommendations for teachers of cartographic contents for the first two educational periods of primary school. We have concluded that paper maps are still very useful and serve their purpose well in cartography instruction, but mobile navigation enable quality instruction as well. With regard to teaching objectives, it is necessary to assess what kind of support may better suit an individual purpose. It is reasonable to increase the share of outdoor education with cartographic and orientation assignments that are applicable in everyday life and reduce the share of pen-and-paper assignments in the classroom