Medical Students’ Knowledge of Indications for Imaging Modalities and Cost Analysis of Incorrect Requests, Shiraz, Iran 2011-2012

Medical imaging has a remarkable role in the practice of clinical medicine. This study intends to evaluate the knowledge of indications of five common medical imaging modalities and estimation of the imposed cost of their non-indicated requests among medical students who attend Shiraz University of Medical Sciences, Shiraz, Iran. We conducted across-sectional survey using a self-administered questionnaire to assess the knowledge of indications of a number of medical imaging modalities among 270 medical students during their externship or internship periods. Knowledge scoring was performed according to a descriptive international grade conversion (fail to excellent) using Iranian academic grading (0 to 20). In addition, we estimated the cost for incorrect selection of those modalities according to public and private tariffs in US dollars. The participation and response rate was 200/270 (74%). The mean knowledge score was fair for all modalities. Similar scores were excellent for X-ray, acceptable for Doppler ultrasonography, and fair for ultrasonography, CT scan and MRI. The total cost for non-indicated requests of those modalities equaled $104303 (public tariff) and$205581 (private tariff). Medical students at Shiraz University of Medical Sciences lacked favorable knowledge about indications for common medical imaging modalities. The results of this study have shown a significant cost for non-indicated requests of medical imaging. Of note, the present radiology curriculum is in need of a major revision with regards to evidence-based radiology and health economy concerns

Comparison of Inching Electrodiagnosis Method and Ultrasonographic Findings in the Determination of Median Nerve Entrapment Site in Carpal Tunnel Syndrome.

OBJECTIVE: The purpose of the study was to evaluate the diagnostic value of both inching method through the electrodiagnostic test and ultrasonographic assay in localizing the site of entrapment in patients with symptoms and signs of carpal tunnel syndrome. DESIGN: Thirty-two hands with confirmed carpal tunnel syndrome through electrodiagnostic test and 30 hands as control group were enrolled. For both groups, sensory and motor latencies by inching technique and cross-sectional area by ultrasonography were measured at the inching points. The statistical analysis was performed by SPSS software, and mean difference with 95% confidence interval was calculated. RESULTS: Mean of sensory peak latency with inching method and cross-sectional area by the ultrasonography was greater in case group compared with the control group (P < 0.05). We revealed a significant difference of antidromic sensory latency between two adjacent points belonging to the fifth and sixth segments. In orthodromic sensory and distal motor latency the sixth segment had statistically significant latency difference. Sixth and seventh points had the greatest cross-sectional area. Distal motor latency difference and cross-sectional area had the greatest sensitivity at the seventh point. CONCLUSIONS: In this study, we revealed the most sites of entrapment of the median nerve through carpal tunnel are 2- and 3-cm distal to the distal wrist crease

Comparison of breathing pattern and diaphragmatic motion in patients with unilateral cervical radiculopathy and asymptomatic group

Abstract Background The associations between neck pain and respiratory dysfunction were clarified in patients with neck pain. There is dearth of evidence on pulmonary dysfunction and diaphragmatic excursion in patients with unilateral cervical radiculopathy (CR). The purpose of this study was to compare the breathing pattern and diaphragmatic excursion in patients with unilateral CR with those in an asymptomatic group. Methods Twenty-five patients with unilateral CR and 25 asymptomatic individuals aged between 30 and 55 participated in this study. Diaphragmatic motion, breathing pattern, active cervical range of motion and kinesiophobia were investigated in both groups by using fluoroscopy, manual assessment of respiratory motion (MARM), cervical range of motion device, and Tampa scale of kinesiophobia. Statistical significance was set at 0.05. Results No statistically significant differences were found between the two groups with regard to sex, age and body mass index. The mean excursion of the hemi diaphragm on the involved side (the side of CR) was significantly lower than that on the uninvolved side in patients with unilateral CR with a large effect size. The excursion of the involved hemi diaphragm in patients was reduced compared to the matched hemi diaphragm in the control group. There was no significant difference between the hemi diaphragms excursion in the control group. The results of the MARM variables showed that the volume of breathing and the percentage rib cage motion in normal and deep breathing were significantly different between the two groups, but there was no significant difference in the balance of breathing between the two groups. Additionally, the active cervical range of motion was reduced in these patients in comparison to the control group, and it was less on the involved side than on the uninvolved side. Conclusion The results of this study revealed a dysfunctional breathing pattern in normal and deep breathing and a unilateral reduction in diaphragmatic excursion on the side of radiculopathy in patients with unilateral CR compared to the control group

Monte Carlo Study of Several Concrete Shielding Materials Containing Galena and Borated Minerals

Introduction: The heavyweight concretes have been widely used for constructing medical or industrial radiation facilities with photon sources. Materials and Methods: In this study, heavy concretes containing galena (PbS) and several borated minerals are proposed as suitable materials against photons. The shielding properties of 21 galena concretes containing seven borated minerals with three mixing patterns were evaluated using MCNP4C Monte Carlo code. The attenuation of the gamma radiation is computed under the conditions of narrow and beam geometries. The x-ray sources with 40, 60, 90, and 120 kVp and gamma rays of 99mTc, 131I, 137Cs, and 511 keV annihilation photons were considered. The photon flux values and the x-ray spectrum after applying all the concretes were compared to the ordinary ones. Regarding the results, more photon attenuations obtained by using high density concretes simulation in comparison to ordinary concrete. Results: The results revealed that the concretes containing orthopinokiolite as the borated material made by the third mixing pattern, had the most photon attenuation. According to the results, the shielding properties of the concretes containing different borated minerals were alike against high photon energies, whereas in low energy photons the attenuation depended on the type of borated mineral used in the concretes. Conclusion: The high-density heavy-weighted concretes could be effectively used as multi-purpose shield for radiotherapy rooms and nuclear reactors due to the borated minerals

The Use of Cluster Analysis by Partitioning around Medoids (PAM) to Examine the Heterogeneity of Patients with Low Back Pain within Subgroups of The Treatment Based Classification System

Background: Current evidence in low back pain (LBP) focuses on population av-erages and traditional multivariate analyses to find the significant difference between variables. Such a focus actively obscured the heterogeneity and increased errors. Cluster analysis (CA) addresses the mentioned shortcomings by calculating the degree of similarity among the relevant variables of the different objects. Objective: This study aims to evaluate the agreement between the treatment-based classification (TBC) system and the equivalent 3 cluster typology created by partitioning around medoids (PAM) analysis. Material and Methods: In this cross-sectional study, a convenient sample of 90 patients with low back pain (50 males and 40 females) aged 20 to 65 years was included in the study. The patients were selected based on the 21 criteria of 2007 TBC system. An equivalent 3 cluster typology (C3) was applied using PAM method. Co-hen’s Kappa was run to determine if there was agreement between the TBC system and the equivalent C3 typology. Results: PAM analysis revealed the evidence of clustering for a C3 cluster ty-pology with average Silhouette widths of 0.12. Cohen’s Kappa revealed fair agreement between the TBC system and C3 cluster typology (Percent of agreement 61%, Kappa=0.36, P<0.001). Selected criteria by PAM analysis were different with original TBC system. Conclusion: Higher probability of chance agreement was observed between two classification methods. Significant inhomogeneity was observed in subgroups of the 2007 TBC system

Asymptomatic Atlantoaxial Subluxation in Rheumatoid Arthritis

This cross-sectional study is conducted to determine the prevalence of asymptomatic cervical spine subluxation in rheumatoid arthritis patients by plain radiographs and its relation to demographic and clinical characteristics, disease activity measures and medications. 100 rheumatoid arthritis patients (18 male and 82 female) were selected randomly, according to the American college of Rheumatology Criteria, who were under follow up in the rheumatology clinic. A complete history was taken, and physical examination has been done with focus on the cervical spine to determine their demographic data, disease duration, age of disease onset, drug history, swollen and tender joint counts, and ESR, Hb, CRP, RF levels. The disease activity of patients with rheumatoid arthritis was measured using the disease activity score 28. Radiographs of the cervical spine included lateral views taken in flexion, extension, neutral position of the neck and anterioposterior and odontoid projection view. Asymptomatic cervical spine subluxation was found in 17 of the 100 patients (17%). The prevalence of, anterior atlantoaxial subluxation, atlantoaxial impaction and subaxial subluxation was 10(10%), 5(5%) and 6(6%), respectively. Posterior subluxation was not detected. The only characteristic that showed meaningful relationship with cervical spine subluxation was CRP (P=0.036). Our results showed that patients with RA, who have cervical spine subluxation cannot be distinguished on the basis of symptoms. Cervical spine involvement is common and may be asymptomatic, indicating routine cervical spine imaging is needed in patients with RA

Clinical, laboratory, and chest CT features of severe versus non-severe pediatric patients with COVID-19 infection among different age groups

Abstract Background This study was performed with the intention of comparing the clinical, laboratory, and chest computed tomography (CT) findings between severe and non-severe patients as well as between different age groups composed of pediatric patients with confirmed COVID-19. Method This study was carried out on a total of 53 confirmed COVID-19 pediatric patients who were hospitalized in Namazi and Ali Asghar Hospitals, Shiraz, Iran. The patients were divided into two severe (n = 27) and non-severe (n = 28) groups as well as into other three groups in terms of their age: aged less than two years, aged 3–12 years and 13–17 years. It should be noted that CT scans, laboratory, and clinical features were taken from all patients at the admission time. Abnormal chest CT in COVID-19 pneumonia was found to show one of the following findings: ground-glass opacities (GGO), bilateral involvement, peripheral and diffuse distribution. Result Fever (79.2%) and dry cough (75.5%) were the most common clinical symptoms. Severe COVID-19 patients showed lymphocytosis, while the non-severe ones did not (P = 0.03). C-reactive protein (CRP) was shown to be significantly lower in patients aged less than two years than those aged 3–12 and 13–17 years (P = 0.01). It was shown also that O2 saturation experienced a significant increase as did patients’ age (P = 0.01). Severe patients had significantly higher CT abnormalities than non-severe patients (48.0% compared to 17.9%, respectively) (P = 0.02). Conclusion Lymphocytosis and abnormal CT findings are among the factors most associated with COVID-19 severity. It was, moreover, showed that the severity of COVID-19, O2 saturation, and respiratory distress were improved as the age of confirmed COVID-19 pediatric patients increased

How can additional ultrasonography screening improve the detection of occult breast cancer in women with dense breasts?

Purpose: Although mammography is a gold standard for breast cancer screening, the number of cancers that cannot be detected with mammography is substantial, especially in dense-breast (DB) women. Breast sonography can be a useful and powerful screening tool in these cases. The aim of this study is to assess the application of whole-breast sonography in the evaluation of breast lesions in women with DB tissue and estimate its accuracy in comparison with mammography. Material and methods: A total of 207 asymptomatic DB women participated in this study. The breast tissue density was assessed using ACR BI-RADS. Patients underwent high-resolution ultrasonography of the breast in addition to physical examination and mammography. Different risk factors were also assessed. Results: 152 of 207 (73.4%) cases who had mammography performed had DB, and 55 (26.6%) cases had very dense breasts (very DBs). None of the cases had a positive history of malignancy, while 19% of them had a positive history of breast cancer in first- or second-degree relatives. Conclusions: All findings were higher in cases with DB compared to very DBs except for fibroadenoma, which was detected more in cases with very DBs. Our study showed that the prevalence of different breast lesions had a significant relationship with the density of the breast. In our study, 48.3% of the cases were diagnosed with a lesion in their sonography result, although 81.0% of them were benign lesions, and the other 19.0% needed follow-up or biopsy evaluation. A substantial number of mammographically occult breast lesions, either benign or malignant, could be detected by ultrasound in DB tissue