Assessment of Lumbar Spine Disc Degeneration in Coherence to Pfirrman Grades and Oswestry Disability Index

Introduction: Intervertebral disc (IVD) degeneration (IDD) is one of the main causes of low back pain (LBP). Standardized diagnostic algorithms for adequate estimation and classification of changes of lumbar discs are mandatory before starting with therapy.Methods: One hundred patients who were indicated for lumbar magnetic resonance imaging (MRI) were included in the study. Pfirrmann grading system was used for the determination of IDD, while the visual analog scale (VAS) is used for evaluation of the intensity of LBP. To quantification of disability for LBP, we used the Oswestry Disability Index (ODI).Result: Results showed higher Pfirrmann grades II and III for L2/L3 and L3/L4 lumbar levels and lower scores at L4/L5 and L5/S1. The analysis also showed low scores at the L2/3 and L3/4 lumbar level for Pfirrmann grades IV and V, and there was an increased at more inferior lumbosacral levels L4/5 and L5/S1. There was a significant correlation between Pfirrmann grades and ODI (p = 0.24) as well as VAS (p = 0.16).Conclusion: Higher Pfirrmann grades correlated with increased ODI and VAS. Therefore, MRI can be used as a strong indicator of clinical appearance, but it is important to take into consideration that LBP should be correlated with clinical features. By summing Pfirrmann grades of all lumbar intervertebral levels in each patient, we can get more accurate insight for the status of the lumbar spine

Effects of axial loaded magnetic resonance imaging of lumbar spine on dural sac and lateral recesses

Introduction: Axial-loaded magnetic resonance imaging (MRI), which can simulate an upright position of the patient may cause a significant reduction of the dural sac cross-sectional area (DCSA) compared with standard MRI, thus providing valuable information in the assessment of the lumbar spinal canal. The purpose of this study was to investigate excessiveness of the change in DCSA and depth of lateral recesses (DLRs) before and after axial-loaded imaging in relation to body mass index (BMI) of the subjects.Methods: Twenty patients were scanned to evaluate DCSA and DLR at three consecutive lumbar spine intervertebral disc levels (L3/4, L4/5, and L5/S1) on conventional-recumbent MRI, and after axial loading were applied.Results: Axial-loaded MRI demonstrates a significant difference of DSCA in comparison to conventional MRI. Furthermore, results show a significant correlation between the DCSA and BMI on level L3/L4, both before and after axial loading MRI. With axial loading, there is a reduction of DSCA of 12.2%, 12.1%, and 2.1% at the levels L3/L4, L4/L5, and L5/S1, respectively. After axial loading has been applied, the depth of the neural foramen has been reduced by an average of 10.1%.Conclusion: Axial-loaded MRI reduces DCSA and DLRs in comparison to standard MRI. Information obtained in this way may be useful to explain the patient’s symptomatology and may provide an additional insight that can influence the treatment decision plan accordingly

Benefits of low-dose carotid CT angiography in stroke patients

Introduction: Computed tomography angiography (CTA) represents the gold standard as a method for the diagnosis of carotid artery diseases. The current topic is the use of CTA for the evaluation of carotid arteries with a reduction in the dose of contrast agent and dose of ionizing radiation, which, with adequate preparation, would enable the use of this method in some risk groups. The aim of this study was to evaluate the feasibility and image quality of a new low-dose CTA protocol in comparison with a standard protocol. Methods: Forty patients with recumbent ischemic stroke were included in the study, twenty of whom underwent lowdose CTA, and the remaining twenty underwent a standard CTA protocol of the carotid arteries. Results: No significant difference was found between the mean values of CT number (Hounsfield unit), signal-to-noise ratio, contrast-to-noise ratio, and subjective assessment of image quality in the comparison of the control and experimental groups. CT dose index, volume, and dose length product were significantly lower in patients who underwent lowdose carotid CTA. There was no significant difference in the degree of carotid stenosis between color Doppler and CTA. Conclusion: The use of the low-dose protocol for carotid CTA allows the application of this method in risk groups, in which it was previously not possible to perform, with the same image quality in comparison with the standard protocol

Fifteen years of occupational exposure monitoring in the Federation of Bosnia and Herzegovina

The personal dosimetry in Bosnia and Herzegovina started in 1960. After a brief interruption in 1990s, the dosimetry service resumed in 1999. Until 2013, the Radiation Protection Centre of the Institute of Public Health of Federation of Bosnia and Herzegovina has been the only institution in the country that could provide this service. In 2013, this Center covered more than 70 % (1,485) of all radiation workers in the country. They mostly worked in medical institutions (1,417 or 95.4 %), while others are exposed to radiation sources in industry and veterinary radiology. From 1999 to 2013, the majority of annual doses were less than 1 mSv (96.2 %). There are no registered cases of exceeding the annual dose limit (20 mSv). The results analysis shows the reduction of individual doses in last five years. Newly adopted practices in medicine, such as the positron emission tomography, could cause the increase of doses in the years to come

Intraoral dental x-ray radiography in Bosnia and Herzegovina: study for revising diagnostic reference level value

This paper presents the study that would allow a revision of the currently valid diagnostic reference level in intraoral dental X-ray radiography in Bosnia and Herzegovina. The study was conducted for six procedures that are used to capture incisor, premolar and molar teeth, of both maxilla and mandible, in adults. Measurements were performed on 41 intraoral X-ray devices, 20 of which were systems with digital image receptor and 21 film-based X-ray systems. In this study, incident air kerma (K-i) and air kerma-area product (P-KA) were used as patient dose descriptors. The third quartile (Q(3)) of the measured incident air-kerma values was used to compare with the current national diagnostic reference level (DRL) for intraoral dental procedures. The obtained results of Q(3) for both types of devices, with film-based and digital image receptors, have shown that the third quartile values are lower (3.5 and 1.2 mGy, respectively) than the current national DRL (7.0 mGy). Hence, new data can be used to re-establish the diagnostic reference levels in intraoral dental X-ray examinations in Bosnia and Herzegovina

Utilisation of 3D Printing in the Manufacturing of an Anthropomorphic Paediatric Head Phantom for the Optimisation of Scanning Parameters in CT

Computed tomography (CT) is a diagnostic imaging process that uses ionising radiation to obtain information about the interior anatomic structure of the human body. Considering that the medical use of ionising radiation implies exposing patients to radiation that may lead to unwanted stochastic effects and that those effects are less probable at lower doses, optimising imaging protocols is of great importance. In this paper, we used an assembled 3D-printed infant head phantom and matched its image quality parameters with those obtained for a commercially available adult head phantom using the imaging protocol dedicated for adult patients. In accordance with the results, an optimised scanning protocol was designed which resulted in dose reductions for paediatric patients while keeping image quality at an adequate level

Dose Descriptors and Assessment of Risk of Exposure-Induced Death in Patients Undergoing COVID-19 Related Chest Computed Tomography

For more than two years, coronavirus disease 19 (COVID-19) has represented a threat to global health and lifestyles. Computed tomography (CT) imaging provides useful information in patients with COVID-19 pneumonia. However, this diagnostic modality is based on exposure to ionizing radiation, which is associated with an increased risk of radiation-induced cancer. In this study, we evaluated the common dose descriptors, CTDIvol and DLP, for 1180 adult patients. This data was used to estimate the effective dose, and risk of exposure-induced death (REID). Awareness of the extensive use of CT as a diagnostic tool in the management of COVID-19 during the pandemic is vital for the evaluation of radiation exposure parameters, dose reduction methods development and radiation protection

Possibilities of differentiation of solitary focal liver lesions by computed tomography perfusion

Aim To evaluate possibilities of computed tomography (CT) perfusion in differentiation of solitary focal liver lesions based on their characteristic vascularization through perfusion parameters analysis. Methods Prospective study was conducted on 50 patients in the period 2009-2012. Patients were divided in two groups: benign and malignant lesions. The following CT perfusion parameters were analyzed: blood flow (BF), blood volume (BV), mean transit time (MTT), capillary permeability surface area product (PS), hepatic arterial fraction (HAF), and impulse residual function (IRF). During the study another perfusion parameter was analyzed: hepatic perfusion index (HPI). All patients were examined on Multidetector 64-slice CT machine (GE) with application of perfusion protocol for liver with i.v. administration of contrast agent. Results In both groups an increase of vascularization and arterial blood flow was noticed, but there was no significant statistical difference between any of 6 analyzed parameters. Hepatic perfusion index values were increased in all lesions in comparison with normal liver parenchyma. Conclusion Computed tomography perfusion in our study did not allow differentiation of benign and malignant liver lesions based on analysis of functional perfusion parameters. Hepatic perfusion index should be investigated in further studies as a parameter for detection of possible presence of micro-metastases in visually homogeneous liver in cases with no lesions found during standard CT protoco

Brašno - Kruh '13

The "Flour-Bread '13“ Congress topics were the following: breeding and quality of cereal grains, grain storage and milling technology, analytical and rheological methods, baking technology, improvers and additives, starch and modified starch, extrusion and pasta production, biscuit and pastry products, nutritional quality of cereals, cereal food safety and cereal based functional foods