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Introduction The aim of this study was to determine the incidence of lateral incisor root resorption associated with impacted maxillary canines and determine predisposing factors that may be used to predict its occurrence. Methods Cone beam computerised tomographic images of 133 patients presenting with 186 impacted canines were examined for lateral incisor root resorption. A control sample consisted of 30 lateral incisors on the side of the non-impacted canine. The studied canine-associated variables were gender, type of impaction, location of the canine both meso-distally and vertically and the long axis angulation to the midline. Axial images were primarily used to diagnose resorption. Results The estimated percentage of lateral root resorption in the sample was 17% (range 11.8– 23.9%) confirmed at a 95% confidence interval. A significant association was observed between the level of overlap of the canine across the lateral incisor, measured in sectors, and the probability of lateral incisor root resorption. The probability approximately doubled for each additional sector of canine overlap. No other significant association was noted related to all the other variables examined. Conclusions The incidence of lateral incisor root resorption associated with impacted maxillary canines was lower in the present study compared with many previous reports. However, resorption remains a common clinical finding. In order to screen for lateral incisor resorption, it is recommended that a cone beam image be prescribed when there is a mesial overlap of an impacted canine across the lateral incisor midline.

Background Minimising unnecessary tests is a global health economic priority with multiple initiatives in place to avoid inappropriate healthcare utilisation(1) and harm. Anti-nuclear antibody (ANA) testing is frequently performed as a diagnostic test for autoimmune conditions, such as systemic lupus erythematosus (SLE) or as a screening test in patients with inflammatory or musculoskeletal symptoms. The value of serial testing in the monitoring of such conditions is unclear and false positive tests can lead to unnecessary further investigation and increased patient anxiety(2) Objectives To evaluate the frequency of repeated ANA testing as a prelude to Electronic Medical Record (EMR) test alert design in an Australian healthcare network. The primary endpoint was calculation of the total cost associated with repeated testing and whether a longitudinal change in ANA resulted in any new ANA associated rheumatological diagnoses. Our secondary endpoint was the examination of baseline ANA testing behaviours. Methods We retrospectively analysed data from a multi-centre tertiary health network in Melbourne, Australia across a 7-year period (19 March 2011 to 23 July 2018). ANA and other autoimmune test results were obtained from the hospital pathology system with a positive ANA cut off set at 1:160. Clinical information was sourced from clinical information systems on patients who had a change in ANA result from negative to positive on repeat testing. The associated cost of repeated ANA testing was calculated based on the baseline cost to the public system. Results A total of 36,715 ANA tests (excluding 980 cancelled same-day requests) were performed in 28,840 patients. Of these, 14,058 (38.3%) were positive with females accounting for 9,265 (65.9%, p Conclusion Repeat ANA testing after a negative result had limited utility in the diagnosis of ANA associated rheumatological conditions with a positive predictive value of only 0.01, and resulted in high cost. New technology and clinical alert systems may help reduce unnecessary testing with potential significant direct cost savings when extrapolated across the Australian healthcare system. References [1] Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA. ‘Choosing Wisely’: a growing international campaign. BMJ Qual Saf. 2015;24(2):167-74. [2] Abeles AM, Abeles M. The clinical utility of a positive antinuclear antibody test result. The American journal of medicine. 2013;126(4):342-8. Disclosure of Interests Ai Li Yeo: None declared, Jason Ong: None declared, Kathryn Connelly: None declared, Suong Le: None declared, Ronnie Ptasznik: None declared, Jane Ross: None declared, Eric F. Morand Grant/research support from: AstraZeneca, Bristol Myers Squibb, Janssen, Merck Serono, and UCB, Consultant for: AstraZeneca, Eli Lilly, Janssen, and Merck Serono, Speakers bureau: AstraZeneca, Michelle Leech: None declared

Introduction Point-of-care ultrasound (PoCUS) is a rapidly growing area, providing physicians with a valuable diagnostic tool for patient assessment. This paper describes a collaborative model, utilising radiology department ultrasound expertise, to train and credential physicians in PoCUS. A 6-year experience of the implementation and outcomes of the programme established within the emergency departments of a large, multi-campus hospital network are presented. Methods A collaborative model was initially developed and implemented between radiology and emergency departments. Key elements of the programme included hospital executive support, close collaboration with stakeholders, resource allocation, appointment of a sonographer educator, clear scope of practise and robust quality processes. Results Participation grew from 36 emergency physicians in 2011 to 96 physicians in 2016. A total 11064 scans were logged with the programme in the 6-year period. Routine quality audit of 61.8% (6836/11064) of all scans included 2836 Focussed Assessment by Sonography in Trauma (FAST) and 1422 Abdominal Aortic Aneurysm (AAA) examinations. False-positive or false-negative diagnoses occurred in 3.6% (102/2836) FAST and 1.3% (19/1422) AAA cases. No adverse clinical outcomes were reported to involve programme-compliant scans. Conclusion A collaborative model to train and credential physicians in PoCUS has been successfully implemented. The programme grew significantly, produced excellent quality outcomes and resolved many issues of potential conflict related to PoCUS.

Computed tomography (CT) coronary angiogram (CTCA) is commonly used for diagnostic evaluation of low-moderate risk patients due to its excellent performance and cost-effectiveness. However, previous cost analyses have not factored in the burden of management of pulmonary nodules, which are a common occurrence. We sought to describe the frequency and characteristics of lung nodules on CTCA in an Australian tertiary hospital, and to assess cost impacts.Consecutive CTCAs performed in the calendar year 2012 were retrospectively identified from the imaging department database. Subjects were excluded if they were under the age of 35, had known malignancy or findings identified prior to CTCA. Patients were stratified on smoking history and nodule size.Of the 2479 CTCAs included, full-field imaging revealed nodules in 358 patients (13.9%). The nodules were generally small (73%6mm), multiple (63%) and in the lower lobe (83.4%). There was no significant difference when stratified for smoking, with 60% of nodules detected in never-smokers. A minimum of 445 subsequent scans was required for nodule surveillance, resulting in an additional overall cost of $63.62 per CTCA. Limited-Field-of-View (L-FOV) would have identified only 22 nodules, with a cost of $6.14 for every CTCA performed, a cost saving of $57 per patient.Indeterminate pulmonary nodules are a common incidental finding on CTCA and prevalence appears to be independent of smoking status. There is a consequent significant cost burden that has not previously been recognised. Use of L-FOV reduces the number of nodules identified, with a significant cost benefit, but this has to be balanced against the ethical and medico-legal issues inherent in not reconstructing the irradiated lung.