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To evaluate whether an imaging classifier for radiology practice can improve lung nodule classification and follow-up.A machine learning classifier was developed and trained using imaging data from the National Lung Screening Trial (NSLT) to produce a malignancy risk score (malignancy Similarity Index [mSI]) for individual lung nodules. In addition to NLST cohorts, external cohorts were developed from a tertiary referral lung cancer screening program data set and an external nonscreening data set of all nodules detected on CT. Performance of the mSI combined with Lung-RADS was compared with Lung-RADS alone and the Mayo and Brock risk calculators.We analyzed 963 subjects and 1,331 nodules across these cohorts. The mSI was comparable in accuracy (area under the curve = 0.89) to existing clinical risk models (area under the curve = 0.86-0.88) and independently predictive in the NLST cohort of 704 nodules. When compared with Lung-RADS, the mSI significantly increased sensitivity across all cohorts (25%-117%), with significant increases in specificity in the screening cohorts (17%-33%). When used in conjunction with Lung-RADS, use of mSI would result in earlier diagnoses and reduced follow-up across cohorts, including the potential for early diagnosis in 42% of malignant NLST nodules from prior-year CT scans.A computer-assisted diagnosis software improved risk classification from chest CTs of screening and incidentally detected lung nodules compared with Lung-RADS. mSI added predictive value independent of existing radiological and clinical variables. These results suggest the generalizability and potential clinical impact of a tool that is straightforward to implement in practice.

Purpose: We investigated virtual reality (VR) during a 2-week, undergraduate, radiology elective to determine if it improved learning outcomes and user satisfaction. Methods: Eighteen students enrolled between August 2021 and February 2022. Each student had a collaborative Zoom teaching session with a preceptor using a Picture Archive and Communications System (PACS)-like viewing system Online DICOM Image Navigator (ODIN), followed by a teaching session using a VR, Digital Imaging and Communications in Medicine (DICOM) viewer (SieVRt). After each teaching session, the students independently reviewed 8 imaging cases and completed case related questions. The students completed a survey, rating their subjective experiences using ODIN and SieVRt. Results: There was no difference in total test scores between the two learning strategies. However, students did perform statistically better on two of five questions designed to test the detection/measurement capabilities of SieVRt vs ODIN. Students stated that they preferred using SieVRt over ODIN and agreed that they were able to view subtle imaging findings and abnormalities better using SieVRt. However, students found that some of the functions of SieVRt (measuring angles/lengths, and multitasking) were difficult. There were technical challenges with VR and minor undesirable physical effects (dizziness, nausea, etc.). Conclusions: Virtual reality has the potential to enhance radiology education by providing an immersive and engaging experience. Objectively, students were able to perform two tasks better with SieVRt. Subjectively, the VR platform received favourable reviews from students for a variety of features. There were reported technical and physical challenges related to using VR. Future developments in VR systems should focus on improving the user experience.

Highlights Abstract Background: Totally implanted venous access devices, or ports, are safe and durable, allowing for long-term venous access. Port insertion in the upper extremity is associated with high rates of technical success and few complications. This retrospective review evaluates complication rates of power injectable ports in the upper arm preformed at a tertiary academic institution. Methods: A single center retrospective review of all patients undergoing arm port implantation between October 1, 2017, and January 30, 2019, were included. A minimum of 11 months of data was reviewed for each subject. A total of 165 subjects were initially enrolled. Results: The most frequent indication for port insertion was malignancy (n = 157). Port insertion technical success rate was 99.4%. There was no significant difference in port-related complications by gender, malignancy, clinical indication for placement, or arm used for implantation. Rates of infection (5.5%), mechanical malfunction (6.7%), device removal (10%) and arterial injury (0%) were similar to previously reported values. The rate of port-related venous thrombosis was 8.6%, exceeding previously reported values. Conclusion: Venous thrombosis was increased using this arm port. The polyurethane catheter material may play a role in this. Further work is warranted to investigate venous thrombosis for this device that incorporates information about insertion vein size and insertion vein characteristics.

Telerobotic ultrasound technology allows radiologists and sonographers to remotely provide ultrasound services in underserved areas. This study aimed to compare costs associated with using telerobotic ultrasound to provide ultrasound services in rural and remote communities to costs associated with alternate models.A cost-minimization approach was used to compare four ultrasound service delivery models: telerobotic ultrasound (Model 1), telerobotic ultrasound and an itinerant sonographer (Model 2), itinerant sonographer without telerobotic ultrasound (Model 3), and travel to another community for all exams (Model 4). In Models 1-3, travel was assumed when exams could not be successfully performed telerobotically or by an itinerant sonographer. A publicly funded healthcare payer perspective was used for the reference case and a societal perspective was used for a secondary non-reference case. Costs were based on the literature and experience using telerobotic ultrasound in Saskatchewan, Canada. Costs were expressed in 2020 Canadian dollars.Average cost per ultrasound exam was $342, $323, $368, and $478 for Models 1, 2, 3, and 4, respectively, from a publicly funded healthcare payer perspective, and $461, $355, $447, and $849, respectively, from a societal perspective. In one-way sensitivity analyses, Model 2 was the lowest cost from a payer perspective for communities with population2075 people, distance350 km from the nearest ultrasound facility, or47% of the population eligible for publicly funded medical transportation.Health systems may wish to consider solutions such as telerobotic ultrasound and itinerant sonographers to reduce healthcare costs and improve access to ultrasound in rural and remote communities.

Patients living in many rural and remote areas do not have readily available access to ultrasound services because of a lack of sonographers and radiologists in these communities. The objective of this study was to determine the feasibility of using telerobotic ultrasound to establish a service delivery model to remotely provide access to diagnostic ultrasound in rural and remote communities.Telerobotic ultrasound clinics were developed in three remote communities more than 500 km away from our academic medical center. Sonographers remotely performed all ultrasound examinations using telerobotic ultrasound systems, and examinations were subsequently interpreted by radiologists at an academic medical center. Diagnostic performance was assessed by each interpreting radiologist using a standardized reporting form. Patient experience was assessed through quantitative and qualitative analysis of survey responses. Operational challenges and solutions were identified.Eighty-seven telerobotic ultrasound examinations were remotely performed and included in this study, with the most frequent examination types being abdominal (n = 35), first-trimester obstetrical (n = 26), and second-trimester complete obstetrical (n = 12). Across all examination types, 70% of telerobotic ultrasound examinations were sufficient for diagnosis, minimizing travel or reducing wait times for these patients. Ninety-five percent of patients would be willing to have another telerobotic ultrasound examination in the future. Operational challenges were related to technical infrastructure, human resources, and coordination between clinic sites.Telerobotic ultrasound can provide access to diagnostic ultrasound services to underserved rural and remote communities without regular ultrasound services, thereby reducing disparities in access to care and improving health equity.

Introduction: Venous access is a crucial element in chemotherapy delivery. It remains unclear whether cancer patients prefer a port to a peripherally inserted central catheter (PICC). Our study aimed to assess cancer patients’ satisfaction with their venous access device and to compare the quality of life (QoL) of subjects with a PICC to those with a port. Methods: In this prospective cohort study, EORTC QLQ-C30, and a locally developed quality of life survey (QLAVD), designed to assess satisfaction with venous access devices, were administered to breast or colorectal cancer patients over a one-year period following the device insertion. Mixed effects models were used to assess changes on mean scores at different time points. Results: A total of 101 patients were recruited over a three-year period, (PICC group, n = 50, port group, n = 51). Survey response rates for months one and three were 72% and 48%, respectively. Overall, no significant differences were noted between the two groups in relation to EORTC QOL. At three months, the mean pain scores were 3.5 ± 2.3 for the port and 1.3 ± 0.75 for PICC (&lt, 0.001). The mean score for a negative effect of the venous access device on psychosocial well-being was 6.0 ± 4.1 for PICC and 3.0 ± 2.7 for the port (p = 0.005). Complications related to PICCs occurred in 38% patients versus 41% with a port (p &gt, 0.24). Conclusions: Although subjects with a port experienced more pain during the device insertion or access for chemotherapy, it had a smaller negative impact on psychosocial scores than the PICC. No significant differences in complications rates were observed between the two devices.

Introduction: Venous access is a crucial element in systemic therapy delivery. PICCs are usually more easily and quickly inserted. It remains unclear whether cancer patients prefer a port to a PICC. Our study aimed to assess cancer patients’ satisfaction with their venous access device and to compare the QOL of subjects with a PICC to those with a port. Methods: In this prospective cohort study, EORTC QLQ-C30 and a locally developed QOL survey, designed to assess satisfaction with venous access devices, were administered to breast cancer (BC) or colorectal cancer patients up to four times over a 1-year period. Mixed effects models were used controlling for other covariates to assess changes on mean scores at different time points. Results: A total of 101 patients were recruited, 50 (BC, 29) in PICC and 51 (BC, 35) in port group. Survey response rates for months 1 and 3 were, 72% and 48%, respectively. Overall, no significant differences were noted between the two groups in relation to EORTC QOL constructs. Mixed effect model showed that patients with a PICC had significantly lower pain score estimate compared to patients with a port (β= -1.98, 95% CI: -0.92 - -3.05, p0.24). Overall, 8% patients with a PICC vs. 12% with a port developed DVT (p=NS). Conclusions: Although patients with a port experience more pain, it had a smaller negative impact on psychosocial scores than the PICC. No significant difference in device satisfaction or complications rates was observed between the two devices. Citation Format: Shahid Ahmed, Brent Burbridge, Lynn Dwernychuk, Ha Le, Tehmina Asif, Hyun Lim. Comparison of the quality of life (QOL) of patients with an arm vein port (TIVAD) versus a peripherally inserted central catheter (PICC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-49.

Objectives: Exposure to radiology in undergraduate medical education is often restricted by other curriculum demands. Designing an effective radiology elective for medical students who choose to supplement their education can be challenging as it is often a passive observership-style elective. In this study, we examined the impact of incorporating an online learning platform and electronic book into radiology electives to stimulate active learning. Materials and Methods: We enrolled 23 students who pursued a 2-week diagnostic radiology elective at our institution. Their radiology knowledge prior to the elective was assessed using 2 pretests. Students had opportunities to work with radiologists to review clinical imaging, attend academic rounds, and learn from the online learning resources. Their knowledge after the elective was assessed by readministering the 2 tests as “posttests.” Students also ranked their perception of the elective experience and educational resources on a Likert scale from 1 to 5. Results: There were statistically significant increases of 13.4% ( P < .0001) in mean test 1 scores and 6.8% in mean test 2 scores ( P = .001). Students also had favorable perceptions of the radiology elective experience and rated the electronic book (median score: 5 of 5) and online learning platform (4.5 of 5) as valuable educational resources. Conclusion: The implementation of an electronic book and online learning platform improved knowledge in radiology and resulted in positive student perceptions of the elective experience. This supports the use of online resources to facilitate independent self-learning for future radiology electives.

Highlights Larger, arm port polyurethane catheters have more potential for: ○ Venous thrombosis ○ Multivessel venous thrombosis ○ Access vein occlusive thrombosis Arm port venous thrombosis is more frequent than suspected and is asymptomatic

INTRODUCTION: The use of diagnostic radiology images while teaching has been proven to enhance student learning. The incorporation of images in the Digital Imaging and Communications in Medicine (DICOM) format has been hindered by the lack of integrated, DICOM image-compatible, viewing software. BACKGROUND: A project was developed to facilitate the migration of clinical diagnostic radiology images, in their native DICOM format into the curriculum at the undergraduate level, including the Medical School, while anonymizing the images and presenting them in a way that simulates a clinical Picture Archive and Communication System (PACS). These images can be directly incorporated into Blackboard Learn or into other applications using embedded URLs. DISCUSSION: A teaching file server was deployed using the Medical Imaging Resource Community–Teaching File System (MIRC-TFS) platform. An HTML5, DICOM image viewing server was developed and deployed. Plugins were created to integrate the anonymized images in the MIRC-TFS server with the HTML5 DICOM viewer and Blackboard Learn. The solution was deployed at an undergraduate level. CONCLUSION: This project has resulted in the successful development and deployment of a variety of solutions, including an HTML 5 DICOM viewer, that has allowed for the incorporation of anonymized DICOM images from a clinical imaging repository into the undergraduate curriculum.

Ultrasound imaging is an essential component of healthcare services. This study sought to explore perceptions of access, and factors which shape access, to ultrasound imaging in two northern, remote, Indigenous communities in Canada. Using interpretive description as a methodological approach and a multi-dimensional conceptualisation of access to care as a theoretical framework, 15 semi-structured interviews were conducted in the northern Canadian communities of Stony Rapids and Black Lake, Saskatchewan. All participants had an obstetrical or non-obstetrical ultrasound exam performed in the past 10 years. Interviews were audio recorded and interview transcripts were analysed using constant comparative analysis. Geographic isolation from imaging facilities was a central barrier to participants accessing ultrasound imaging. Other barriers became apparent when participants had to travel for ultrasound, including fear of air travel, isolation from family, financial means, and unfamiliarity with larger cities. Barriers such as family and work responsibilities were exacerbated by the barrier of geography. Participants overcame these barriers as they were motivated by potential diagnostic benefits of ultrasound imaging. This study highlights disparities in access to ultrasound for northern, remote, Indigenous populations. Future efforts to improve access to imaging should consider barriers of distance to imaging facilities and strategies to bridge these barriers.

Access to sonographers and sonologists is limited in many communities around the world. Telerobotic sonography (robotic ultrasound) is a new technology to increase access to sonography, providing sonographers and sonologists the ability to manipulate an ultrasound probe from a distant location and remotely perform ultrasound examinations. This narrative review discusses the development of telerobotic ultrasound systems, clinical studies evaluating the feasibility and diagnostic accuracy of telerobotic sonography, and emerging use of telerobotic sonography in clinical settings. Telerobotic sonography provides an opportunity to provide real-time ultrasound examinations to underserviced rural and remote communities to increase equity in the delivery of diagnostic imaging.

The flipped classroom has been gaining momentum within medical education circles. Pre-class assignments are an important component of this pedagogical approach. In this study, a section of the introductory course to veterinary medical imaging was taught using a flipped classroom, and the effectiveness of two different pre-classroom assignments was evaluated. The pre-classroom assignments consisted of either short videos or readings. Both had similar content, which included basic information about pulmonary patterns of disease on chest radiographs. Learning outcomes were assessed by in-classroom and final examination questions. Student learning self-assessments and student satisfaction were also evaluated via an online survey. Students in the video group answered more of the in-classroom questions correctly (71% video vs. 63% reading group; p = .01) and had higher scores on the final examination (83% video vs. 75% reading group; p = .02). There was also a higher student satisfaction with the videos versus the reading assignment. However, we found no significant difference in the student self-assessments of learning or participation in class. An additional finding of this study related to the ongoing difficulties students were having with the learning objectives, including differentiating a pathological process from a normal, or normal variant, recognizing the different pulmonary patterns, and developing a differential diagnoses list, despite the pre-classroom assignments and large group learning sessions. This speaks to the difficulty in developing confidence in pulmonary pattern recognition on chest radiographs, a skill that requires considerable training and time investment.

Objectives To determine the feasibility of a telerobotic approach to remotely perform prenatal sonographic examinations. Methods Thirty participants were prospectively recruited. Participants underwent a limited examination (assessing biometry, placental location, and amniotic fluid; n = 20) or a detailed examination (biometry, placental location, amniotic fluid, and fetal anatomic survey; n = 10) performed with a conventional ultrasound system. This examination was followed by an equivalent examination performed with a telerobotic ultrasound system, which enabled sonographers to remotely control all ultrasound settings and fine movements of the ultrasound transducer from a distance. Telerobotic images were read independently from conventional images. Results The mean gestational age ± SD of the 30 participants was 22.9 ± 5.3 weeks. Paired-sample t tests showed no statistically significant difference between conventional and telerobotic measurements of fetal head circumference, biparietal diameter, or single deepest vertical pocket of amniotic fluid; however, a small but statistically significant difference was observed in measurements of abdominal circumference and femur length (P 0.90) between telerobotic and conventional measurements of all 4 biometric parameters. Of 21 fetal structures included in the anatomic survey, 80% of the structures attempted across all patients were sufficiently visualized by the telerobotic system (range, 57%-100% per patient). Ninety-seven percent of patients strongly or somewhat agreed that they would be willing to have another telerobotic examination in the future. Conclusions A telerobotic approach is feasible for remotely performing prenatal sonographic examinations. Telerobotic sonography (robotic telesonography) may allow for the development of satellite ultrasound clinics in rural, remote, or low-volume communities, thereby increasing access to prenatal imaging in underserved communities.

Background: The safety of power-injectable implanted arm ports is well established, but there is insufficient data to conclude that image quality of computed tomography resulting from contrast introduced via the port is of equal quality to images derived from contrast introduced via traditional peripheral access. The objective of this study was to determine whether the image quality of computed tomography pulmonary embolism and computed tomography aorta studies would differ when injecting contrast via an implanted arm port vs a peripheral intravenous site. We hypothesized that injecting via an implanted arm port would produce better-quality images, the result of more appropriate timing and less streak artifact. Methods: Scans from a provincial database search for patients who underwent a computed tomography pulmonary embolism or aorta study with contrast injection via the implanted arm port and thin section images available, were reviewed (pulmonary embolism studies n = 3, aorta studies n = 3). Only a limited number of patients were available for review because there are currently few patients with these ports in place and we limited evaluation to thin section images. Comparison was made with 6 control patients who did not have a port and had received a peripheral arm intravenous contrast injection for these study types. Objective measurements included signal-to-noise ratio and contrast-to-noise ratio of the pulmonary arteries (4 sites) and aorta (2 sites) as appropriate for scan type. Subjective analysis of image quality was performed by 2 radiologists. Results: Although sample size was limited, the implanted arm port group had similar or higher mean signal-to-noise ratio and contrast-to-noise ratio values at all sites. Subjective assessments showed the implanted arm port group to have similar or better opacification and diagnostic confidence; similar or less streak artifact was also observed at each of the sites. Conclusions: These exploratory results suggest that studies with implanted arm port injection can generate high-quality images on both objective and subjective assessment, similar to, or possibly better than, images generated from usual peripheral intravenous access for contrast injection.

Background: Insertion of totally implanted venous access devices; that is, port systems, in the forearm is an option for long-term venous access. To better understand the radiology literature reported for this anatomic location, we performed a search for, and an analysis of, previous publications related to forearm implantation of these devices by interventional radiology department personnel. Materials and Methods: A review of the literature was performed for articles describing radiology implantation of forearm ports. Articles published between 1990 and 2015 were reviewed. Results: Eleven articles were found that met the review criteria. None were randomized studies and only 1 was a prospective study. All of the other studies were retrospective reviews of a variety of different port devices. An analysis of these articles was performed. Conclusions: Forearm port implantation had high technical success rates (range, 98%–100%; mean, 99.7%). A wide variety of complications were encountered, none of which exceeded the Society of Interventional Radiology threshold levels for complications associated with port insertion. A subset of the studies were upper arm venipunctures with the port catheter and housing subsequently implanted in the forearm distal to the antecubital fossa.

Background: Patients in our health region received 1 of 2 different arm ports, totally implanted venous access devices (TIVADs), for the management of their malignancies. One of the ports was a nonpower-injectable design and the other was power-injectable. Infusion nurses most commonly access TIVADs in our health region. It was our goal to evaluate infusion nursing access events for these 2 different TIVADs to determine whether nurses experienced any practical, or functional, differences based on port design. Methods: For this quality assurance project a locally designed, paper-based, questionnaire was developed and administered. Infusion nurses completed the questionnaire after they had accessed an arm TIVAD for intravenous chemotherapy. Sequential access events were tracked for 2 months. Results: There were no statistically significant differences in the responses related to the 2 different TIVAD designs. Identifying the type of implanted TIVAD for each access event in the study group provided some challenges for the infusion nurses. Eighteen nonpower-injectable ports were erroneously identified as power-injectable. Conclusions: The results illustrate that our local cancer center infusion nurses were a very experienced group who have been able to adapt to the 2 different arm TIVAD designs. There was no statistically different access event parameters for the 2 different port designs. Additional end-user education may be warranted to improve port design identification.

Osteonecrosis, also known as avascular necrosis, is a condition that causes significant morbidity and loss of function. It is a common complication seen with supraphysiological steroid use. Early diagnosis is critical as it impacts prognosis. We report a 20-year-old man who developed bilateral osteonecrosis of the hip following 6 years of low-dose steroid replacement therapy for panhypopituitarism secondary to a transsphenoidal resection of a growth hormone-secreting pituitary macroadenoma. The patient presented with several weeks of right-sided hip pain and significant loss of function. X-ray and MRI showed bilateral osteonecrosis of the hips with the right side more severely affected than the left. He was initiated on analgesics and bisphosphonates and underwent right hip total arthroplasty followed 1 year later by left hip arthroplasty. Postsurgery, the patient is mobilising well and his pituitary hormones are well balanced. He continues on low-dose glucocorticoid replacement which will continue lifelong.

Introduction Venous access devices are essential for the provision of care for patients requiring chemotherapy. Totally implanted venous access devices (TIVADs), also known as ports, are an option for infusion care. Medical devices have an impact upon patient quality of life. We assessed the impact on quality of life and satisfaction with their venous device, for patients with a chest TIVAD versus an upper arm TIVAD. Materials and methods Sequential subjects were administered a questionnaire, “Quality of Life Assessment, Venous Device - Port (QLAVD-P)” at the time of their TIVAD removal. All subjects consented to complete the questionnaire and volunteered for this assessment. The TIVADs were all implanted and removed in the medical imaging department. Results Between March 1, 2014 and August 30, 2015, 127 subjects completed the QLAVD-P. At the time of their port removal, 51 had chest ports while 76 had arm ports. There were some negative features of the chest ports that were statistically significant in comparison to the arm ports. Most of the subjects felt that their port had a positive impact upon their treatment and they would have another port inserted if required for future treatment. Discussion Quality of life for those requiring intravenous chemotherapy is very important. This should be considered when selecting an infusion device. Venous ports were positively received by the subjects in our study and there were fewer negative impacts upon subject satisfaction and quality of life for those with upper-arm devices.

Purpose Placement of arm ports, or totally implanted venous access devices, is a common practice in our interventional radiology suite. We implant a miniaturized port in the upper arm for the provision of long-term chemotherapy. We hypothesized that there was general satisfaction with these arm ports and they have a minimal negative impact on quality of life. In this study we aimed to assess our hypotheses. Methods We surveyed subjects, who having previously received an arm port for chemotherapy to treat a malignancy, attended the interventional room for its removal. The survey assessed the port's effect on lifestyle, the degree of device-related pain, the acceptance of the port, and the willingness to have another port in the future. Results Survey responses from 77 subjects were reviewed. On a scale of 1 (most negative) to 10 (most positive), respondents indicated that the port system was a very positive enhancement to their treatment (satisfaction = 9.2 ± 2.0 and positivity = 8.8 ± 2.2). The port had little impact on daily activities. The mean score for the likelihood of choosing to have another port placed if additional treatment was required was 9.1 ± 2.1. Discussion The arm port in this study did not negatively impact subject satisfaction and quality of life for this cohort. Most subjects rated the device utility highly and felt that the port was a positive enhancement to their treatment, one that they would possibly utilise again in future, if need be.

We relate our experience with the Cook (Cook Medial Inc., Bloomington, IN, USA), triple-lumen hyperalimentation (HAS) catheter for treatment related to autologous stem-cell transplant. Nineteen HAS catheters were implanted in the right jugular vein, and tunneled to the right anterior chest wall, under imaging guidance. Retrospectively, we reviewed each catheter. Three patient's experienced “ballooning” of the middle (white) lumen of the HAS catheter during routine use. We assessed, time in situ, follow-up imaging, chemotherapy regimen, possibility of systemic or device infection, tissue pathology of the patient's malignancy, and other factors to attempt to determine if there were any associations that could explain the catheter lumen failure. After this pilot study of the HAS-catheter in these 19 patients, we discontinued use of this device at our facility due to mechanical problems of ballooned and obstructed middle lumens. There was no obvious cause, or association, detected to explain the ballooning identified.

Health care–associated infections (HCAIs) are a significant concern for both health care workers (HCWs) and patients. They are a major contributing factor of disease in industrialized countries, and are responsible for significant morbidity, mortality, and a direct annual financial loss of $6-7 billion in North America alone. They are an increasingly challenging health issue due to multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci among others, along with an increasing number of susceptible patients. Over the last three decades, the risk of HCAIs has increased in the radiology department (RD) in part because of an increased number of patients visiting the department and an increase in the utilization of imaging modalities. In this review, we will discuss how patients and staff can be exposed to HCAIs in the RD, including contaminated inanimate surfaces, radiology equipment, and associated medical devices. As the role of medical imaging has extended from primarily diagnosis to include more interventions, the implementation and development of standardized infection minimization protocols and infection control procedures are vital in the RD, particularly in interventional radiology. With globalisation and the rapid movement of people regionally, nationally, and globally, there is greater risk of exposure to contagious diseases such as Ebola, especially if infected patients are undiagnosed when they travel. For effective infection control, advanced training and education of HCWs in the RD is essential. The purpose of this article is to provide an overview of HCAIs as related to activities of the RD. We will discuss the following major topics including the variety of HCAIs commonly encountered, the role of the RD in HCAIs, transmission of infections to patients and HCWs in the RD, standard infection prevention measures, and the management of susceptible/infected patients in the RD. We shall also examine the role of, and the preparedness of, HCWs, including RD technologists and interventional radiologists, who may be exposed to undiagnosed, yet infected patients. We shall conclude with a brief discussion of the role of further research related to HCAIs. Learning Objectives After the completion of this review article, the readers will • Understand the exposure and role of radiology department in health care–associated infections, • Know the causes/modes/transmission of infections in radiology department, • Be conscious of standard disinfection protocols, • Be aware of current and future strategies required for the effective control of health care–associated infection in the radiology department. This is a CME article and provides the equivalent of 2 hours of continuing education that may be applied to your professional development credit system. A 10-question multiple-choice quiz follows this reading. Please note that no formalized credit (category A) is available from CAMRT .

Childhood obesity has reached epidemic proportions in Canada. According to the 2009–2011 Canadian Health Measures Survey, close to one-third of children aged 5–17 years (approximately 1.6 million children) were classified as overweight (19.8%) or obese (11.7%).1 As the percentage of obese children increases, so too does the percentage of obese children visiting the emergency department (ED). Sivet2 has demonstrated that appendicitis is the most common condition in children requiring emergency abdominal surgery and, therefore, one of the most commonly screened diseases in children presenting to the ED with abdominal pain. The rising rate of obesity among pediatric ED patients, combined with the frequency of appendicitis, presents a growing quandary for the managing physician. The morbidity and mortality associated with a perforated appendix leads the physician to vigilance in ruling out appendicitis, typically via history, physical examination and laboratory tests, followed by diagnostic imaging, typically in the form of ultrasonography. Unfortunately, obesity also constitutes an independent predictor for a nondiagnostic ultrasound.3 This leads the surgeon to either treat the patient based on clinical findings or to order additional imaging, typically in the form of abdominal computed tomography (CT). According to a recent Canadian study, these diagnostic difficulties result in obese children suspected of having appendicitis being 3 times more likely to receive abdominal CT than nonobese children.4 Other than the increased rate of CT, the authors found no significant difference in outcomes between the 2 groups. As a result, they suggested that obese pediatric patients with suspected appendicitis and nondiagnostic ultrasounds should receive abdominal CT more frequently than nonobese patients. While this recommendation appears logical based on the evidence, several issues make such a suggestion dubious in the absence of further evidence. The study did not quantify what contribution these CT scans made to patient diagnosis and management. It is difficult to truly evaluate the role of CT in the management of pediatric appendicitis in the absence of such data. This is especially true given the conclusions of 3 previous studies.5–7 Two of them5,6 argued that the increased use of CT among pediatric patients with appendicitis has not contributed substantially to a lower rate of negative appendectomies and may in fact increase perforation rates. The third study7 argued that focused appendiceal CT does not increase the accuracy of diagnosis compared with history, physical examination and laboratory studies. Furthermore, the ionizing radiation delivered by abdominal CT has been increasingly identified as a contraindication for CT imaging in the pediatric population. According to one estimate, a single occurrence of abdominal CT in a child imparts a lifetime risk of radiation-induced cancer of 26.1 per 100 000 in girls and 20.4 per 100 000 in boys.8 These potentially negative health outcomes led the Canadian Association of Radiologists to recommend that, when ultrasounds are nondiagnostic and clinical suspicion for appendicitis is high, surgeons consider treating without further imaging (i.e., CT).9 These disparate claims necessitate that the influence of CT on the diagnosis of pediatric appendicitis be quantified so that informed management decisions can be made. The influence of abdominal CT on the diagnosis and treatment of obese pediatric patients with suspected appendicitis is currently unknown. This information is important because it will allow surgeons to make better evidence-based decisions when considering the impact a CT scan may or may not have on a pediatric patient’s diagnosis and management. One study conducted in an adult population10 indicated that CT imaging rarely changed management in patients whose presentations were highly suspicious for appendicitis, but frequently changed management if the clinical diagnosis was indeterminate. However, this study did not include children, and did not differentiate based on weight, both of which are key determinants in the present discussion. A previous pediatric study11 compared outcomes of obese and nonobese patients with appendicitis; however, this study examined outcomes only from patients who underwent appendectomy, did not include a focus on the role of CT in those outcomes and failed to use the most appropriate measurement for classifying obesity — body mass index (BMI) — when categorizing patients (instead, the study used standard deviations from mean weight for age). We were therefore interested in accomplishing 2 main objectives with this study. The first was to quantify abdominal CT rates and purposes among both obese and nonobese pediatric patients with suspected appendicitis. After identifying which abdominal CT scans were ordered to confirm or rule out the preliminary clinical diagnosis of appendicitis, our second objective was to quantify and analyze the influence those scans had on the preliminary clinical diagnosis of appendicitis for both obese and nonobese pediatric patients.

Introduction: Placement of totally implanted venous access devices, or port systems, in the upper arm is becoming a common practice in interventional radiology. To gain a better understanding of the literature in this area, we performed a search for and analysis of previous publications related to upper arm implantation of these devices by members of interventional radiology departments. Methods: A review of the literature pertaining to upper arm port systems implanted in human beings by members of interventional radiology departments was performed, assessing publications between the years 1992 and 2014. Only English-language publications were assessed. Results: Eighteen publications met selection criteria during the time frame reviewed. None of the studies used a prospective, randomized design; rather, all studies consisted of case–cohort descriptions of outcomes for a single device or for multiple devices. Analysis of the available literature for interventional radiology-inserted arm ports was performed. The technical success rate ranged between 93.7% and 100%, with an average of 98.9%. Conclusions: The high technical success rate of arm port implantation and the elimination of the potential for pneumothorax, hemothorax, catheter pinch-off syndrome, and subclavian and carotid artery injury are strengths of the arm implantation strategy. There was wide variation in the rates of complications detected, in addition to inconsistent study design and study implementation strategies.

Purpose: Vein port systems are often used for infusion therapy. Safe access of these devices is necessary to ensure optimal device performance and the minimization of possible complications. We assessed the utility of YouTube for learning vein port access technique. Materials and methods: The YouTube video database was searched for video files demonstrating vein port access technique. A scoring tool was developed to acquire objective data about the adherence of the operator to accepted access technique. Results: Fifty-one YouTube videos were assessed for their value for learning vein port access technique. Using a scoring tool with a maximum score of 36, the scores for the 51 videos ranged from 7 to 32 (mean score =18.7). The best scores were for videos recorded as instructional videos by nurses and patients, with scores ranging from 17 to 32 (mean score =24.0). Conclusions: There was considerable variability in the utility and value of the videos reviewed. Some videos were very informative and instructional, some were very uninformative, and some conveyed incorrect information that could lead to device failure and undue complications related to inappropriate port access technique. Health care providers, patients, and other caregivers should be very skeptical of the value of YouTube videos demonstrating medical techniques and should only accept the information provided if it is from a reputable source, which can often be very difficult to ascertain.

Objective Dabigatran etexilate mesylate (dabigatran) is a novel, orally ingested, competitive antithrombin anticoagulant recently approved for clinical use in Canada (Pradax) and the United States (Pradaxa). Guidelines or clinical protocols were sought discussing the management of dabigatran before invasive radiology procedures. Evidence A literature search was performed (2002-2012) to determine if there were any publications discussing bleeding complications related to dabigatran and invasive radiology and/or any guidelines discussing the management of dabigatran before invasive radiology procedures. Five publications were identified related to the management of dabigatran before surgical or invasive procedures. Discussion There were no radiology-specific guidelines for the management of dabigatran before invasive radiology procedures. Guidelines related to surgical intervention and neurointervention were available. Conclusion Dabigatran must be included in the list of medications that are screened for before invasive radiology procedures. Guidance is provided for the discontinuation of this medication before invasive radiology procedures.

Purpose The study sought to assess the feasibility of performing adult abdominal examinations using a telerobotic ultrasound system in which radiologists or sonographers can control fine movements of a transducer and all ultrasound settings from a remote location. Methods Eighteen patients prospectively underwent a conventional sonography examination (using EPIQ 5 [Philips] or LOGIQ E9 [GE Healthcare]) followed by a telerobotic sonography examination (using the MELODY System [AdEchoTech] and SonixTablet [BK Ultrasound]) according to a standardized abdominal imaging protocol. For telerobotic examinations, patients were scanned remotely by a sonographer 2.75 km away. Conventional examinations were read independently from telerobotic examinations. Image quality and acceptability to patients and sonographers was assessed. Results Ninety-two percent of organs visualized on conventional examinations were sufficiently visualized on telerobotic examinations. Five pathological findings were identified on both telerobotic and conventional examinations, 3 findings were identified using only conventional sonography, and 2 findings were identified using only telerobotic sonography. A paired sample t test showed no significant difference between the 2 modalities in measurements of the liver, spleen, and diameter of the proximal aorta; however, telerobotic assessments overestimated distal aorta and common bile duct diameters and underestimated kidney lengths ( P values < .05). All patients responded that they would be willing to have another telerobotic examination. Conclusions A telerobotic ultrasound system is feasible for performing abdominal ultrasound examinations at a distant location with minimal training and setup requirements and a moderate learning curve. Telerobotic sonography (robotic telesonography) may open up the possibility of remote ultrasound clinics for communities that lack skilled sonographers and radiologists, thereby improving access to care.

Purpose To compare the complications experienced for 2 different brands of peripherally inserted central venous catheters (PICC), Cook Turbo-Ject and the Bard PowerPICC Solo2. The rationale for this project revolved around concern that one of the PICCS in question had high rates of complications. Methods A prospective clinical trial was conducted after obtaining approval from the University of Saskatchewan Human Research Ethics Committee. All PICCs were implanted at the Royal University Hospital Medical Imaging Department by an interventional radiologist. Patient randomization was achieved by alternating the brand of PICC implanted in sequential patients. All the subjects were inpatients from a single surgical ward. Patients were excluded from the study if they had a known uncorrected coagulopathy, or if they were being treated for venous thrombosis. This project was financially supported by the Summer Student Research Fund, College of Medicine, University of Saskatchewan. Results A total of 53 PICCs (25 Bard and 28 Cook) were inserted over the study period. The mean PICC dwell time was 23.3 days for both the Bard and Cook PICCs, respectively. No statistically significant differences were detected in study group demographics, technical placement of the PICCs, or in the complications encountered. Discussion Both the Cook Turbo-Ject and the Bard PowerPicc Solo2 PICCs provided acceptable venous access for a wide variety of clinical indications.

Objective To determine the utilisation of diagnostic imaging (radiology) as a department and/or imaging medium in the teaching of anatomy at the Canadian undergraduate medical education level. Methods The study objectives were achieved through the use of a questionnaire and a literature review. The anatomy department head at each English-based Canadian Medical School was contacted, and the individual most responsible for anatomy teaching in the medical school curriculum was identified. This individual was subsequently asked to complete a questionnaire that evaluated the involvement of radiology for anatomy teaching in their curriculum. Results The use and integration of radiology is a common practice in the teaching of anatomy in Canadian undergraduate medicine. Although the methods and extent of its use varied among institutions, every English-based Canadian medical school, except one, was using diagnostic imaging material in their instruction of anatomy. Furthermore, half of the institutions had a radiologist as a faculty member of their anatomy department to help teach and to use imaging to its full potential. Discussion This audit of anatomy departments suggests that diagnostic imaging has an important role to play in anatomy teaching in Canadian English-speaking medical schools.

Many medical schools use learning management systems (LMSs) to give students access to online lecture notes, assignments, quizzes, and other learning resources. LMSs can also be used to provide access to digital radiology images, potentially improving preclinical teaching in anatomy, physiology, and pathology while also allowing students to develop interpretation skills that are important in clinical practice. However, it is unclear how radiology images can best be stored, imported, and displayed in an LMS. We developed University of Saskatchewan Radiology Courseware (USRC), a new web application that allows course designers to import images into pages linked to BlackBoard Learn, a popular LMS. Page content, including images, annotations, captions, and supporting text, are stored as teaching cases on a MIRC (Medical Imaging Resource Center) server. Course designers create cases in MIRC, and then create a corresponding page in BlackBoard by modifying an HTML template so that it holds the URL of a MIRC case. When a user visits the page in BlackBoard, the page requests content from the MIRC case, reformats the text for display in BlackBoard, and loads an image viewer plug-in that allows students to view and interact with the images stored in the case. The USRC technology can be used to reformat MIRC cases for presentation in any website or in any learning management system that supports custom pages written in HTML with embedded JavaScript.

OBJECTIVE. The purpose of this article is to discuss some of the implications of methicillin-resistant Staphylococcus aureus (MRSA) for the radiology department. CONCLUSION. MRSA is an infectious organism that has been increasing in prevalence and has presented a challenge to hospitals worldwide due to its drug resistance and propensity to cause serious infections. The radiology department is a site of high patient traffic and regularly encounters MRSA-positive patients. Guidelines for implementation of MRSA infection control practices are available and should be adapted to the radiology department. A summary of recommendations for MRSA infection control in the radiology department is provided.

Postpartum hemorrhage is a major cause of maternal mortality. Though uncommon, uterine artery pseudoaneurysm can follow uterine dilatation and curettage (D + C) and needs to be considered in the differential diagnosis. This 30-year-old G1P1 woman presented with right upper quadrant pain and vaginal bleeding. She was afebrile but her white blood count was significantly increased (22.2×109 /L). One week prior, she had undergone a Cesarean delivery which was complicated by hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP), fetal dystocia, and chorioamnionitis. Uterine dilatation and curettage (D & C) and placement of a Bakri intrauterine balloon, performed for suspected retained products of conception, failed to control her postpartum bleeding. The patient wished to have a hysterectomy only as a last resort in order to preserve fertility. Emergency uterine artery angiography revealed a left uterine artery pseudoaneurysm and contrast extravasation. The patient was successfully treated with selective embolization. Computed tomography (CT) later revealed dehiscence of her uterine Cesarean section incision with an intra-abdominal fluid collection. This collection was drained. She also developed disseminated intravascular coagulopathy (DIC) syndrome as well as multiple pulmonary emboli which were both successfully treated. We discuss this unique case of uterine artery pseudoaneurysm with associated uterine dehiscence.

Purpose To evaluate the hypothesis that power-injectable totally implanted venous access devices (TIVADs) situated in the arm are associated with more frequent complications and complication-related removal than non–power-injectable arm TIVADs among adult cancer patients. Materials and Methods In this single-center trial, 211 adult chemotherapy patients were randomized to receive either a power-injectable or a non–power-injectable arm TIVAD. Follow-up involved a standardized telephone interview 1 week after insertion, followed by a chest X-ray, arm X-ray, and Doppler ultrasound at 3 months and 12 months. Online complication reporting was also provided by patients and care providers for a minimum of 1 year. The primary end point was removal for port-related complications; the secondary end point was the occurrence of any port-related complication. Results Forty-two complications occurred (19.9% of patients), precipitating the removal of 6 power-injectable ports and 7 standard ports. Time-to-removal did not differ between TIVAD types (hazard ratio 0.75, 95% confidence interval [CI] 0.25–2.24; P = .61). Complications were related to thrombosis, infection, or mechanical issues, with no statistical difference between groups for overall occurrence (23.1% vs 17.0%, odds ratio 1.47, 95% CI 0.74–2.92; P = .27); however, by type of complication, thrombosis occurred more frequently among power-injectable TIVAD patients (15.2% vs 6.1%, odds ratio 2.79, 95% CI 1.04–7.44; P = .03). Conclusions There was no difference in port-related complication occurrence or complication-related removal when using the arm power-injectable port compared with the non–power-injectable port among cancer patients.

DICOM is the standard file format for medical imaging; however, storage, transmission and viewing of these images over the internet for teaching and learning purposes outside of the clinical settin...

We have found it very challenging to integrate images from our radiology digital imaging repository into the curriculum of our local medical school. Thus, it has been difficult to convey important knowledge related to viewing and interpreting diagnostic radiology images. We sought to determine if we could create a solution for this problem and evaluate whether students exposed to this solution were able to learn imaging concepts pertinent to medical practice.We developed University of Saskatchewan Radiology Courseware (USRC), a novel interactive web application that enables preclinical medical students to acquire image interpretation skills fundamental to clinical practice. This web application reformats content stored in Medical Imaging Resource Center teaching cases for BlackBoard Learn™, a popular learning management system. We have deployed this solution for 2 successive years in a 1st-year basic sciences medical school course at the College of Medicine, University of Saskatchewan. The "courseware" content covers both normal anatomy and common clinical pathologies in five distinct modules. We created two cohorts of learners consisting of an intervention cohort of students who had used USRC for their 1st academic year, whereas the nonintervention cohort was students who had not been exposed to this learning opportunity.To assess the learning experience of the users we designed an online questionnaire and image review quiz delivered to both of the student groups.Comparisons between the groups revealed statistically significant differences in both confidence with image interpretation and the ability to answer knowledge-based questions. Students were satisfied with the overall usability, functions, and capabilities of USRC.USRC is an innovative technology that provides integration between Medical Imaging Resource Center, a teaching solution used in radiology, and a Learning Management System.

The use of central venous catheters has increaseddramatically over the past 40 years [1]. These devices areessential for many clinical treatments including access forchemotherapy, antibiotics, and blood transfusions [2].Indwelling catheters terminating in a port are particularlyuseful for intermittent treatment for malignancies [3]. Ad-vantages include protection of the device from damage orinfection by the overlying skin and a reduction in veni-puncture injuries and infusion complications [1,4,5]. In thisstudy, we investigated the Angiodynamics Vortex Smart PortMini (Angiodynamic Inc, Manchester, GA). These portswere inserted into the upper arm with the tip of the attachedcatheter at the right atrial/superior vena cava junction. Thisparticular arm port model is approved for power injection ofcomputed tomography (CT) contrast agent, which hastraditionally not been possible with other arm ports. Becausearm ports are not typically used for contrast injection, theobjective of this study was to evaluate the image quality ofCTs obtained via arm port power injection compared withcontrast injection of a peripheral vein.MethodsWe performed a retrospective cohort study of patientswho had a power injectable arm port inserted between July2013 and June 2014. Ethics approval for this study was ob-tained from our local biomedical research committee(University of Saskatchewan) and data review was incompliance with provincial and national privacy legislation.Subjectswereidentifiedbyreviewingadatabaseofpatientswhohadundergonecontrast-enhancedCT(n¼54).Toreducevariability from timing of contrast bolus, we analysed onlyscans with a mixed phase of contrast (contrast present withinthesystemicarterialandportalvenoussystems).Theinclusioncriteria were patients who had a combined chest-abdomen-pelvis CT scan via an arm port injection, and who also had aprior CT scan of the same type with injectionvia a peripheralarm vein. Therefore, each subject served as his or her owncontrol. Eighteen subjects met these inclusion criteria.CT images were reviewed on Philips iSite RadiologyPicture Archive and Communication System (KoninklijkePhilips Electronics, Best, The Netherlands). Scan dates rangedbetween July 2012 and July 2014 with CT slice thicknessranging from 3.8-5 mm and volume CT dose index rangingfrom 2.2-20.43 mGy. CT scans were from 4 acute care centres(Royal University Hospital, Saskatoon City Hospital, CypressRegional Hospital, and Battlefords Union Hospital).Assessment of objective image quality was performedby measuring signal-to-noise (SNR) and contrast-to-noise(CNR) ratios, as described by Heyer et al [6]. SNR andCNR were determined at 3 anatomical levels: 1) aortic arch;2) main pulmonary artery (MPA) and right pulmonary artery(RPA); and 3) descending aorta and left atrium (Figure 1).The following equations were used for each structure, whereSI

A previous audit revealed a high frequency of adult fingers visualised on neonatal intensive care unit (NICU) chest radiographs—representing an example of inappropriate occupational radiation exposure. Radiation safety education was provided to staff and we hypothesised that the education would reduce the frequency of adult fingers visualised on NICU chest radiographs. Two cross-sectional samples taken before and after the administration of the education were compared. We examined fingers visualised directly in the beam, fingers in the direct beam but eliminated by technologists editing the image, and fingers under the cones of the portable x-ray machine. There was a 46.2% reduction in fingers directly in the beam, 50.0% reduction in fingers directly in the beam but cropped out, and 68.4% reduction in fingers in the coned area. There was a 57.1% overall reduction in adult fingers visualised, which was statistically significant (Z value − 7.48, P < 0.0001). This study supports radiation safety education in minimising inappropriate occupational radiation exposure.

While the vast majority of scholarship on Books of Hours focus on luxury manuscripts, concentrating almost entirely on the book’s artistic program and patronage, much less attention has been paid to the more workaday Books of Hours which were mass-produced for laity with the means and literacy to acquire and use them. The Morisset Hours, a manuscript Book of Hours in the University of Ottawa’s rare books library, is such book, and despite its poor condition and total lack of illumination or m...

An in vitro comparison of clot-trapping abilities of permanent and temporary inferior vena cava (IVC) filters.A flow model was used to simulate the IVC. Two permanent IVC filters, the titanium Greenfield and LG-Medical (LGM), were compared with two temporary filters, the Filcard International and Gunther. Clot sizes used were 2.5 x 2.5 mm, 2.5 x 5 mm, 5 x 5 mm, 5 x 10 mm, and 5 x 20 mm. Individual clots were presented to the filters with the simulated IVC in a horizontal or vertical orientation. Clot-trapping dynamics and pressure gradient changes during the injection of multiple, sequential clots were also examined.As clot size diminished, all filters trapped fewer clots; however, the temporary filters trapped more small clots than the permanent filters. Very little difference was observed in clot-trapping abilities among the filters for clots of 5 x 10 mm or greater. In the horizontal orientation, the permanent filters trapped 38% of all clots delivered, while the temporary filters trapped 73%, chi 2 = 24.8 (P.001). In the vertical orientation, the overall clot-trapping abilities of the filters improved, with the permanent filters trapping 73% of all clots delivered, while the temporary filters trapped 95%, chi 2 = 18 (P.001). During trapping of multiple clots, the temporary filters allowed fewer clots to pass.The temporary filters performed better than the permanent filters in both individual clot-trapping orientations. During multiple clot-trapping experiments, fewer clots were allowed to pass by the temporary filters. The temporary filters demonstrated the ability to capture clots both inside and outside the wire struts.

Cerebral angiography is associated with a 0.45-4% risk of neurological complications and a less than 1% risk of permanent neurological deficit. Recently, air embolism has been implicated as a major cause of these complications. Cardiac catheterization is associated with a neurological complication rate of less than 1%; the predominant mechanism appears to be embolic. We used transcranial Doppler ultrasonography to detect high-intensity signals suspected to be related to air emboli, a potential cause of neurological complications in patients undergoing coronary and carotid angiography. We prospectively examined a total of 42 consecutive patients with transcranial Doppler ultrasound. Twenty-one patients underwent cerebral angiography, and 21 patients underwent cardiac catheterization. In both groups of patients, high-intensity bidirectional Doppler signals were recorded during different phases of angiography. High-intensity, longduration Doppler signals completely masking the background cardiac cycle signals were observed during machine-powered rapid injection of contrast medium with good correlation between the duration of Doppler signals and the duration of automated injection. In addition, high-intensity signals of much shorter duration were also observed during manual injection of saline or contrast medium and during catheter manipulation. In our study, the high-intensity Doppler signals recorded were identical in all patients who underwent cerebral and coronary angiography. No spontaneous emboli were seen. None of our 42 patients developed any type of neurological symptoms during or after the procedure. These high-intensity signatures do not represent air embolism exclusively; rather, they are likely a combination of turbulence in the bloodstream created during rapid injection, air emboli, and, perhaps, echogenicity of the contrast medium.

Purpose The authors describe their preliminary clinical experience with the Gunther temporary inferior vena cava (IVC) filter. Patients and Methods Seven women and 10 men, mean age 52 years (range, 19–85 years), were treated with the temporary IVC filter. Indications for filter placement were pulmonary embolism (PE) in four patients and iliofemoral deep venous thrombosis in six. In these patients anticoagulation was contraindicated because of planned major surgery. Filters were placed in four patients following massive PE and in three for prophylaxis following cranial trauma. Four patients had underlying malignant disease. Filters were introduced through the right common femoral vein in 14 patients, the left common femoral vein in two, and the left internal jugular vein in one. Results No patient developed recurrent PE with the filter in place. All filters were removed without complication 3–14 days (mean, 7 days) after placement. Two of the patients with underlying malignant disease required placement of a permanent filter. Two patients developed IVC thrombosis with the filter in place, and both developed recurrent PE after filter removal. Two patients developed insertion vein thrombosis. One patient developed a bleeding disorder that caused a massive hematoma at the insertion vein site, which may have contributed to her death. Conclusion The Gunther temporary filter can be used in selected patients; however, patients with underlying malignant disease may be more appropriately treated with a permanent filter. The temporary filter does not appear to reduce the rate of insertion vein and IVC thrombosis.

Purpose The authors describe their experience with LG-Medical (LGM [Vena Tech]) filter placement and follow-up. Patients and Methods LGM vena cava filters were placed in 63 patients. Follow-up was obtained by means of duplex sonography of the introduction vein and inferior vena cava (IVC) and abdominal radiography in 50 patients, and by means of autopsy in an additional four patients. In eight, only clinical follow-up was obtained and one patient was lost to follow-up. Results Major complications of placement occurred in three patients, all when the right internal jugular vein was used for introduction: In one patient a filter was inadvertently placed in the right renal vein and in two the filter failed to open fully. No serious complications of placement occurred when either the right or left common femoral veins were used. Pulmonary embolism (PE) recurred in four patients (6%) and was fatal in one. Septicemia from an infected filter was the probable cause of death in another patient. Introduction vein thrombosis occurred in five patients (8%) and was symptomatic in two (3%). Occlusion of the IVC occurred in 15 patients (24% of the total patient group, but 28% of those with objective follow-up) and was symptomatic in 12 (19%). Two patients with IVC occlusion had recurrent PE. Conclusion These data suggest that the rate of IVC occlusion is higher than most previous reports have suggested and that IVC occlusion may be a potentially serious complication.

This 55-year-old female had a chest X-ray during a follow-up visit for the management of her breast cancer. The chest X-ray demonstrated an embolized venous catheter superimposed upon the mediastinum. It was determined that the catheter of the patient's arm port had fractured and embolized to the pulmonary circulation. The catheter was retrieved, in the interventional radiology suite, under fluoroscopic guidance. The patient suffered no ill effects. Subsequently, one day later, the old vein port was removed and a new arm port and associated catheter were implanted to facilitate the delivery of the patient's ongoing chemotherapy.

Patients having undergone pelvic exenteration with urinary diversion can present with short- and long-term complications such as ureteral strictures, anastomotic leakage, calculi, or fluid collections (abscess, urinoma, lymphocele, or hematoma). A dehiscence resulting in a perineal urinary fistula is an uncommon late complication of urinary diversion surgery; surgical treatment for this complication is less desirable because of postsurgical or radiation-induced pelvic changes that can occur. As a result, nephrostomy or antegrade stenting of the kidneys is more viable. Retrograde ureteric stent insertion is discussed in relation to a patient suffering from ileal conduit dehiscence. The presence of these stents probably helped diminish the potential for complications during subsequent nephrostomy tube insertion.

Purpose A recent publication from our centre revealed a disturbing finding of a significant incidence of adult fingers seen on the pediatric intensive care unit (PICU) chest radiographs. This is inappropriate occupational exposure to diagnostic radiation. We hypothesized that the incidence of adult fingers on PICU chest radiographs would decline after radiation safety educational seminars were given to the medical radiation technologists and PICU staff. Methods The present study's objectives were addressed by using a pretest-posttest design. Two cross-sectional PICU chest radiograph samples, taken before and after the administration of radiation safety education for our medical radiation technologists and PICU staff, were compared by using a χ 2 test. Results There was a 61.2% and 76.9% reduction in extraneous adult fingers, directly exposed to the x-ray beam and those seen in the coned regions of the film, respectively, on PICU chest radiographs (66.7% reduction overall). This reduction was statistically significant (χ 2 = 20.613, P Conclusions Limiting unnecessary occupational radiation exposure is a critical issue in radiology. There was a statistically and clinically significant association between radiation safety education and the decreased number of adult fingers seen on PICU chest radiographs. This study provides preliminary evidence in favour of the benefit of radiation safety seminars. Abrege But Une recente publication de notre centre revele la presence d'un nombre anormalement eleve de doigts adultes sur les radiographies pulmonaires. Cela temoigne d'une radioexposition anormale des technologues en radiologie et du personnel des USPI. Nous avons fait l'hypothese que le nombre de cas diminuerait apres les seminaires sur la securite radiologique que ceux-ci ont suivis. Methodes La technique de mesure pretest post-test a ete utilisee dans le cadre de cette etude. Deux echantillons transversaux de radiographies pulmonaires prises dans une USPI avant et apres que nos technologues en radiologie et le personnel de l'USPI ont suivi la formation sur la securite radiologique ont ete compares a l'aide d'un test χ 2 . Resultats On a remarque une reduction de respectivement 61,2 % et 76,9 % de la presence de doigts adultes directement exposes aux rayons X et apparaissant dans les regions coniques des films) sur les radiographies pulmonaires prises a l'USPI, ce qui represente une baisse globale de 66,7 %. Cette reduction est significative d'un point de vue statistique (χ 2 = 20,613, P Conclusions La reduction de l'exposition professionnelle est un probleme critique en radiologie. Nous avons constate un lien statistique important entre la formation sur la securite radiologique et la baisse du nombre de doigts adultes apparaissant sur les radiographies pulmonaires prises a l'USPI. L'etude fournit des preuves preliminaires des bienfaits de la formation en securite radiographique.