Search

Background: 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. Method(s): 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. Result(s): Of the 2479 CTCAs included, full-field imaging revealed nodules in 358 patients (13.9%). The nodules were generally small (73% <6 mm), 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. Conclusion(s): 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.Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

Introduction: Sonographers of a large, metropolitan health service were trained and credentialed in extended focussed assessment by sonography in trauma in preparation for a potential mass casualty incident. Given the prior ultrasound experience of this cohort, the suitability of an abbreviated credentialing pathway based upon that required for emergency physicians was evaluated. Method(s): A training and credentialing process to teach extended focussed assessment by sonography in trauma was planned for sonographers. The model was based upon existing credentialing requirements for emergency physicians. The project was undertaken in two stages, using a "train the trainer" approach. The initial stage trained and credentialed a group of senior sonographer trainers. This group then supported the training and credentialing of the wider sonographer cohort. Result(s): Twenty-eight qualified sonographers were successfully trained and credentialed in extended focussed assessment by sonography in trauma scanning. Practical competency assessment demonstrated 100% (28/28) pass rate. Image interpretation assessment results also demonstrated 100% (28/28) pass rate. Conclusion(s): An abbreviated model is suitable for the training and credentialing of sonographers in extended focussed assessment by sonography in trauma, given their pre-existing ultrasound skills and knowledge.Copyright © 2019 Australasian Sonographers Association

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. Method(s): 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. Result(s): 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<0.001). The most frequent ANA patterns were homogenous (47.4%) and nucleolar (23.3%). ANA titres were as follows; 1:160 (41.4%), 1:320 (15.3%), 1:640 (13.1%) and 1:1280 (29.2%). 7,875 (21.4%) of tests were repeat tests.

Introduction: We studied whether: (1) a quality-focused thyroid fine needle aspiration (FNA) service reduced the non-diagnostic (ND) rate of FNA; (2) the implementation of thyroid FNA selection criteria resulted in higher proportion of Bethesda V and VI cytology and malignant histopathology; and (3) impact of radiologist's level of experience on ND rates. Method(s): The imaging and pathology computer databases were retrospectively searched for all patients who had thyroid FNAs at our hospitals from July 2004 to December 2016. Result(s): Three hundred thirty-eight and 609 patients in pre-thyroid and post-thyroid service groups, respectively, were evaluated. The ND rate of 36.7% in pre-thyroid service was significantly higher than post-thyroid service at 14.6% (p < 0.0001). The rates of Bethesda V and VI cytology in the pre-thyroid service group did not differ significantly from the post-thyroid group (p = 0.266; p = 0.069). There was no significant difference in the histopathologic malignancy rates between the two groups (p = 0.531). There was no significant difference in the ND rates of radiologists with varying experience (p = 0.873). Discussion(s): On-site cytology improved the ND rate of ultrasound-guided thyroid FNA. Implementation of FNA selection criteria did not alter the rates of Bethesda V and VI cytology and malignant histopathology. The experience of radiologists did not significantly influence ND rates.Copyright © 2018 Australasian Sonographers Association

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. Method(s): 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. Result(s): 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(s): 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.Copyright © 2017 The Royal Australian and New Zealand College of Radiologists

Objective/Background: For over 20 years ED clinician trauma and AAA sonography has been accepted practice, however processes for credentialing and support of emergency physician ultrasound aren't standardised in many health services. In 2013 Monash Health implemented a governance structure in order to increase emergency physician uptake of sonography and ensure that the practice met high and reproducible sonographic standards. Method(s): A hospital executive sponsored oversight committee with representatives from Diagnostic Imaging and Emergency Medicine was formed to govern the education and quality activities of the programme. The committee was tasked with ensuring compliance in programme induction, training in image acquisition and interpretation, result archiving and recording, competency evaluation, and clinical quality outcomes. Instrumental to the success of the programme was a dedicated sonographer for ongoing "hands-on" training, image review and result correlation with other modalities. Result(s): The established governance framework for emergency physician ultrasound is recognised and supported by the Health Service and incorporated within the emergency physician's scope of practice. Currently 93 clinicians have performed over 1300 studies meeting verifiable quality framework standards. Conclusion(s): A formal governance structure with interdisciplinary stakeholder membership is a useful institution to provide a clear pathway to a new skill implementation programme. Future directions with other disciplinary integration (e.g. Intensive Care Medicine), development in echocardiography/IVC and RUQ scanning, research using the large data base created and development of a sabbatical programme with the continued governance structure are seen as the next step.

Summary: We investigated the effect of playing regular golf and HRT on lumbar and thoracic vertebral bone parameters (measured by QCT) in 72 post-menopausal women. The main finding of this study was that there was positive interaction between golf and HRT on vertebral body CSA and BMC at the thoracic 12 and lumbar 2 vertebra but not the third and seventh thoracic vertebras. Introduction: Identifying specific exercises that load the spine sufficiently to be osteogenic is an important component of primary osteoporosis prevention. The aim of this study was to determine if in postmenopausal women regular participation in golf resulted in greater paravertebral muscle mass and improved vertebral bone strength. Method(s): Forty-seven postmenopausal women who played golf regularly were compared to 25 controls. Bone parameters at the mid-vertebral body were determined by QCT at spinal levels T3, T7, T12 and L2 (cross-sectional area (CSA), total volumetric BMD (vBMD), trabecular vBMD of the central 50% of total CSA, BMC and cortical rim thickness). At T7 and L2, CSA of trunk muscles was determined. Result(s): There was a positive interaction between golf and HRT for vertebral CSA and BMC at T12 and L2, but not at T3 or T7 (p ranging < 0.02 to 0.07). Current HRT use was associated with a 10-15% greater total and trabecular vBMD at all measured vertebral levels. Paravertebral muscle CSA did not differ between groups. Vertebral CSA was the bone parameter significantly related to muscle CSA. Conclusion(s): These findings provide preliminary evidence that playing golf may improve lower spine bone strength in postmenopausal women who are using HRT. © 2007 International Osteoporosis Foundation and National Osteoporosis Foundation.

Objective. The aims of this double-blind, randomized, placebo-controlled trial were to determine whether ultrasound-guided extracorporeal shock wave therapy (ESWT) reduced pain and improved function in patients with lateral epicondylitis (tennis elbow) in the short term and intermediate term. Methods. Sixty-eight patients from community-based referring doctors were randomized to receive 3 ESWT treatments or 3 treatments at a subtherapeutic dose given at weekly intervals. Seven outcome measures relating to pain and function were collected at followup evaluations at 6 weeks, 3 months, and 6 months after completion of the treatment. The mean changes in outcome variables from baseline to 6 weeks, 3 months, and 6 months were compared for the 2 groups. Results. The groups did not differ on demographic or clinical characteristics at baseline and there were significant improvements in almost all outcome measures for both groups over the 6-month followup period, but there were no differences between the groups even after adjusting for duration of symptoms. Conclusion. Our study found little evidence to support the use of ESWT for the treatment of lateral epicondylitis and is in keeping with recent systematic reviews of ESWT for lateral epicondylitis that have drawn similar conclusions. The Journal of Rheumatology Copyright © 2008. All rights reserved.

Background: Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. Method(s): The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. Result(s): A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. Conclusion(s): The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection. © 2012 De Silva et al.

Neonatal cranial ultrasound is routinely performed to screen preterm infants for complications of prematurity. A key component of this examination is the measurement of the lateral ventricles to identify and monitor ventriculomegaly. This study assesses the two-dimensional (2-D) interobserver error of neonatal cranial lateral ventricle measurements on 40 neonates who were undergoing cranial ultrasound in the neonatal intensive care unit. Three-dimensional (3-D) volumes were obtained using a matrix transducer. Lateral ventricle (LV) measurements were subsequently measured on a departmental 3-D workstation by two workstation sonographers. The interobserver error of this technique was calculated and compared with the conventional 2-D technique. Both techniques demonstrated acceptable interobserver variability although the established 2-D technique had less variation. This identifies a potential role for 3-D analysis in the neonatal cranial ultrasound examination. It also affirms the potential of 3-D ultrasound in performing similar small measurements in other clinical settings. © 2012 World Federation for Ultrasound in Medicine & Biology.

Objective: Patellar tendon injury, defined by tendon abnormality (TA) on imaging and by pain, is common among volleyball players, but little is known about change in this injury over a volleyball season. Increased activity in the season compared with the off season may result in the development of TA and/or pain. This study investigated the behaviour of TA and pain over a competitive volleyball season. Method(s): Tendon abnormality and pain were measured in 101 volleyball players at the beginning and end of a season. Pain was measured with the single leg decline squat test, which loads the patellar tendon, and TA was detected with ultrasound imaging. Hours of weekly activity were measured and compared during the season and the off season. The proportion of tendons that underwent development and resolution in TA and/or pain over the season was investigated. Result(s): Hours of weekly activity was greater during the season than in the off season. Most of the tendons investigated (66.3%) did not undergo a change in TA or pain over the season. Tendon abnormality and/or pain developed in 16.6% of tendons and resolved in 11.2%. Conclusion(s): The tendons of volleyball players respond variably to the increased load over the season. Change in TA and pain does not appear to be entirely dependent upon load.

Background: This study examined whether patellar tendon vascularity could be quantified accurately in the clinical setting using colour Doppler ultrasonography. Methods: A sonographer and two radiologists visually estimated tendon vascularity in millimetres in 74 tendons during ultrasound (US) examination and from hard copy films. These estimates were then compared to the length of vessels measured from the digital image in millimetres and the correlation between them was determined. A subset of 16 tendons was used to compare the estimates of vascularity by two examiners at US examination. Results: The estimation of vascular length at US examination correlated highly with the measured vascular length (r = 0.92; 95% confidence interval (CI) 0.87 to 0.94), as did the length estimated from the films (r = 0.94; 95% CI 0.9 to 0.96). The correlation between examiners was 0.84 (95% CI 0.51 to 0.94) for the estimates made during US examination and 0.85 (95% CI 0.59 to 0.95) for the vessel lengths measured from the digital images. Conclusions: These excellent correlations indicate that tendon vascularity can be reliably estimated using colour Doppler ultrasonography and tendon vascularity could therefore be used by clinicians to rate clinical change. This method of quantifying tendon vascularity could also be used in research to investigate the effects of tendon treatments on vascularity.

Background: This study investigated changes in tendon vascularity in 102 (67 men and 35 women) volleyball players over a 6 month competitive season. Methods: Athletes were examined with both grey scale ultrasound and standardised colour Doppler settings. Vessel length and pain were measured each month on five separate occasions. Vascular tendons were divided into (i) those that were vascular on all occasions (persistent vascularity) and (ii) those that were vascular on more than two but less than five occasions (intermittent vascularity). Results: A total of 41 of the 133 abnormal tendons were vascular on two or more occasions. Of these, 16 had persistent vascularity and 25 had intermittent vascularity. There was no significant difference in the prevalence of vascularity between men and women. None of the tendons had a pattern of vascularity over the season that could be clearly interpreted as the onset or resolution of vascularity. Subjects with changes in both tendons were more likely to have persistent vascularity (p = 0.045). Vessels were longer in tendons with persistent vascularity (p<0.000) and pain was significantly greater (p = 0.043) than in tendons with intermittent vascularity. Tendons with intermittent vascularity had similar pain scores on all days, whether or not they had detectable blood flow.