Educating Radiologists About Pain

It is vital that radiologists understand pain. After all, it is the most common symptom that leads patients to seek medical care, and represents one of the most common indications for diagnostic and interventional radiological procedures 1, 2 and 3. In addition, radiological procedures can be a source of pain to patients, particularly in the context of interventional procedures 4 and 5. By gaining a better understanding of the nature, assessment, and effective management of pain, radiologists and radiology personnel can do a better job of caring for patients

Clinical submission of supernumerary head of adducter brevis muscle

Adductor brevis is an important member of the adductor family occupying the medial compartment of the thigh executing the function of adduction and medial rotation. Deviations from normal anatomy are unusual and rarely reported. A survey of anatomical archives revealed occasional mention of additional bellies of adductor brevis muscle. The present study reports a double belly of adductor brevis muscle (AB) found during a cadaveric dissection class for medical students. The left sided AB displayed two bellies disposed in the same plane. This case report attempts to present the clinical applications of supernumerary bellies of this important adductor muscle of the thigh. It is feasible to categorize these muscular variations upon specialized radiological procedures such as CT and MRI scans only if the radiologist possesses satisfactory understanding of variant anatomy of this region. It is thereafter inferred that upon recognition these muscles present a fair chance of being of utilitised in reconstructions. A biomechanical overview of the present anomaly is also attempte

Hypnosis for acute procedural pain: a critical review

Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions

Visualization of back pain data-A 3-D solution

Traditional approaches to gathering and visualizing pain data rely on two-dimensional (2-D) human body models, where different types of sensation are recorded with various monochrome symbols. We proposean alternative that uses a three-dimensional (3-D) representation of the human body, which can be marked in color to visualize and record pain data

Compression ultrasonography for false femoral artery aneurysms: Hypocoagulability is a cause of failure

Objectives:false femoral artery aneurysm is an occasional complication of percutaneous cardiovascular radiological procedures. Compression ultrasonography causes thrombosis non-invasively, reducing need for operative intervention. The technique fails in a proportion of cases. Analysis was undertaken to identify causes of failure.Design:prospective open study.Materials and Methods:patients presenting with false femoral artery aneurysm since 1984 were identified from a computerised database (BIPAS). Since 1993 compression ultrasonography has been performed as first line treatment according to a standard protocol. Prospectively collected ultrasonographic data and case notes were reviewed to identify causes of failed compression.Results:false femoral artery aneurysm occurred as a complication in 32/26 687 (0.12%) cardiovascular radiological procedures. Eighteen aneurysms were treated by compression. The technique was successful in 11/18 (61%) cases but primary failure occurred in seven cases. Six out of seven had bleeding abnormalities (Chi-squared analysis with Yates correction 10.55, p=0.0012), four were anticoagulated and compression was subsequently successful following reversal of warfarin therapy in three of these patients. In 4/18 cases surgical repair was necessary.Conclusions:compression ultrasonography is an effective treatment of false femoral aneurysms, however, hypocoagulability is a significant cause of failure. For patients in whom anticoagulation cannot be reversed, primary surgical repair should be considered

Unintended and accidental medical radiation exposures in radiology: guidelines on investigation and prevention

This paper sets out guidelines for managing radiation exposure incidents involving patients in diagnostic and interventional radiology. The work is based on collation of experiences from representatives of international and national organizations for radiologists, medical physicists, radiographers, regulators, and equipment manufacturers, derived from an International Atomic Energy Agency Technical Meeting. More serious overexposures can result in skin doses high enough to produce tissue reactions, in interventional procedures and computed tomography, most notably from perfusion studies. A major factor involved has been deficiencies in training of staff in operation of equipment and optimization techniques. The use of checklists and time outs before procedures commence, and dose alerts when critical levels are reached during procedures can provide safeguards to reduce risks of these effects occurring. However, unintended and accidental overexposures resulting in relatively small additional doses can take place in any diagnostic or interventional X-ray procedure and it is important to learn from errors that occur, as these may lead to increased risks of stochastic effects. Such events may involve the wrong examinations, procedural errors, or equipment faults. Guidance is given on prevention, investigation and dose calculation for radiology exposure incidents within healthcare facilities. Responsibilities should be clearly set out in formal policies, and procedures should be in place to ensure that root causes are identified and deficiencies addressed. When an overexposure of a patient or an unintended exposure of a foetus occurs, the foetal, organ, skin and/or effective dose may be estimated from exposure data. When doses are very low, generic values for the examination may be sufficient, but a full assessment of doses to all exposed organs and tissues may sometimes be required. The use of general terminology to describe risks from stochastic effects is recommended rather than calculation of numerical values, as these are misleading when applied to individuals

Common hepatic artery arising from the aorta – demonstration with multidetector CT angiography and its clinical importance

We present a case of a rare variation of the hepatic artery discovered during the routine examination of abdomen by computed tomography. This variation was showed by multidetector-row computed tomography (MDCT) in a 35-year-old man. There have been shown the common hepatic artery arising from the anterior surface of abdominal aorta, 4 mm inferior to the celiac trunk. We discussed clinical significances of this variation during radiological procedures and surgical operations

Hybrid Imaging in Head and Neck Sarcoidosis

To determine the prevalence of head and neck sarcoidosis (HNS) and evaluate the role of hybrid molecular imaging in HNS. Between 2010 and 2018, 222 patients with chronic sarcoidosis and presence of prolonged symptoms of active disease were referred to FDG PET/CT. Active disease was found in 169 patients, and they were all screened for the presence of HNS. All patients underwent MDCT and assessment of the serum ACE level. Follow-up FDG PET/CT examination was done 19.84 ± 8.98 months after the baseline. HNS was present in 38 out of 169 patients. FDG uptake was present in: cervical lymph nodes (38/38), submandibular glands (2/38), cerebrum (2/38), and bone (1/38). The majority of patients had more than two locations of disease. After FDG PET/CT examination, therapy was changed in most patients. Fourteen patients returned to follow-up FDG PET/CT examination in order to assess the therapy response. PET/CT revealed active disease in 12 patients and complete remission in two patients. Follow-up ACE levels had no correlation with follow-up SUVmax level (ρ = −0.18, p = 0.77). FDG PET/CT can be useful in the detection of HNS and in the evaluation of the therapy response. It may replace the use of non-purposive mounds of insufficiently informative laboratory and radiological procedures