NIHR Signal Imaging is the only way to diagnose blood clots in pregnancy
No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines.
Published on 13 March 2018
read full document at https://discover.dc.nihr.ac.uk/portal/article/4000969/imaging-is-the-only-way-to-diagnose-blood-clots-in-pregnancy
Showing posts with label imaging. Show all posts
Showing posts with label imaging. Show all posts
Monday, 5 February 2018
UHCW publication: Micro-CT for quantitative toolmark analysis of sharp force trauma to bone
The cutting edge - Micro-CT for quantitative toolmark analysis of sharp force trauma to bone.
Norman, D G; Watson, D G; Burnett, B; Fenne, P M; Williams, M A; et al.
Forensic science international 2018 February Vol. 283: 156-172.
Abstract
Toolmark analysis involves examining marks created on an object to identify the likely tool responsible for creating those marks (e.g., a knife). Although a potentially powerful forensic tool, knife mark analysis is still in its infancy and the validation of imaging techniques as well as quantitative approaches is ongoing. This study builds on previous work by simulating real-world stabbings experimentally and statistically exploring quantitative toolmark properties, such as cut mark angle captured by micro-CT imaging, to predict the knife responsible. In Experiment 1 a mechanical stab rig and two knives were used to create 14 knife cut marks on dry pig ribs. The toolmarks were laser and micro-CT scanned to allow for quantitative measurements of numerous toolmark properties. The findings from Experiment 1 demonstrated that both knives produced statistically different cut mark widths, wall angle and shapes. Experiment 2 examined knife marks created on fleshed pig torsos with conditions designed to better simulate real-world stabbings. Eight knives were used to generate 64 incision cut marks that were also micro-CT scanned. Statistical exploration of these cut marks suggested that knife type, serrated or plain, can be predicted from cut mark width and wall angle. Preliminary results suggest that knives type can be predicted from cut mark width, and that knife edge thickness correlates with cut mark width. An additional 16 cut marks walls were imaged for striation marks using scanning electron microscopy with results suggesting that this approach might not be useful for knife mark analysis. Results also indicated that observer judgements of cut mark shape were more consistent when rated from micro-CT images than light microscopy images. The potential to combine micro-CT data, medical grade CT data and photographs to develop highly realistic virtual models for visualisation and 3D printing is also demonstrated. This is the first study to statistically explore simulated real-world knife marks imaged by micro-CT to demonstrate the potential of quantitative approaches in knife mark analysis. Findings and methods presented in this study are relevant to both forensic toolmark researchers as well as practitioners. Limitations of the experimental methodologies and imaging techniques are discussed, and further work is recommended.
Full text available at
Norman, D G; Watson, D G; Burnett, B; Fenne, P M; Williams, M A; et al.
Forensic science international 2018 February Vol. 283: 156-172.
Abstract
Toolmark analysis involves examining marks created on an object to identify the likely tool responsible for creating those marks (e.g., a knife). Although a potentially powerful forensic tool, knife mark analysis is still in its infancy and the validation of imaging techniques as well as quantitative approaches is ongoing. This study builds on previous work by simulating real-world stabbings experimentally and statistically exploring quantitative toolmark properties, such as cut mark angle captured by micro-CT imaging, to predict the knife responsible. In Experiment 1 a mechanical stab rig and two knives were used to create 14 knife cut marks on dry pig ribs. The toolmarks were laser and micro-CT scanned to allow for quantitative measurements of numerous toolmark properties. The findings from Experiment 1 demonstrated that both knives produced statistically different cut mark widths, wall angle and shapes. Experiment 2 examined knife marks created on fleshed pig torsos with conditions designed to better simulate real-world stabbings. Eight knives were used to generate 64 incision cut marks that were also micro-CT scanned. Statistical exploration of these cut marks suggested that knife type, serrated or plain, can be predicted from cut mark width and wall angle. Preliminary results suggest that knives type can be predicted from cut mark width, and that knife edge thickness correlates with cut mark width. An additional 16 cut marks walls were imaged for striation marks using scanning electron microscopy with results suggesting that this approach might not be useful for knife mark analysis. Results also indicated that observer judgements of cut mark shape were more consistent when rated from micro-CT images than light microscopy images. The potential to combine micro-CT data, medical grade CT data and photographs to develop highly realistic virtual models for visualisation and 3D printing is also demonstrated. This is the first study to statistically explore simulated real-world knife marks imaged by micro-CT to demonstrate the potential of quantitative approaches in knife mark analysis. Findings and methods presented in this study are relevant to both forensic toolmark researchers as well as practitioners. Limitations of the experimental methodologies and imaging techniques are discussed, and further work is recommended.
Full text available at
Friday, 26 January 2018
Interventional radiology leaders release guidance to help speed up rollout of vital life-changing stroke treatment
The Supplementary Guidance to Facilitate the Training of Interventional Radiology Consultants to Undertake Stroke Thrombectomy has been produced by The Royal College of Radiologists, the British Society of Interventional Radiology, the British Society of Neuroradiologists and the UK Neurointerventional Group, to help hospitals train more specialist radiologists to perform life-changing stroke thrombectomy treatment.
Wednesday, 24 January 2018
Point-of-care creatinine tests before contrast-enhanced imaging [MIB 136]
New: Medtech innovation briefing
POC creatinine tests allow rapid measurements of creatinine levels using very small samples of whole blood, serum, plasma or a combination of these. The devices used for these tests are either handheld or table-top and need blood from either finger-prick or venous/arterial samples. The method of analysis can vary with some devices using test cartridges and some using test strips.
The focus of this briefing is POC creatinine testing to assess kidney function in people who are scheduled to have contrast-enhanced imaging. Testing is important because contrast materials such as iodine or gadolinium can cause kidney injury, particularly in high-risk patients and those with known kidney dysfunction. If patients do not have a recent creatinine measurement, their imaging may be cancelled and rescheduled. Alternatively, they may have unenhanced imaging – which is less reliable – or the planned contrast agent may be given, risking kidney injury. Current practice varies; a recent UK survey estimated that up to 20% of hospitals only check creatinine levels before imaging in people known to be at high risk of kidney injury (Harris et al. 2016).
POC creatinine tests allow rapid measurements of creatinine levels using very small samples of whole blood, serum, plasma or a combination of these. The devices used for these tests are either handheld or table-top and need blood from either finger-prick or venous/arterial samples. The method of analysis can vary with some devices using test cartridges and some using test strips.
The focus of this briefing is POC creatinine testing to assess kidney function in people who are scheduled to have contrast-enhanced imaging. Testing is important because contrast materials such as iodine or gadolinium can cause kidney injury, particularly in high-risk patients and those with known kidney dysfunction. If patients do not have a recent creatinine measurement, their imaging may be cancelled and rescheduled. Alternatively, they may have unenhanced imaging – which is less reliable – or the planned contrast agent may be given, risking kidney injury. Current practice varies; a recent UK survey estimated that up to 20% of hospitals only check creatinine levels before imaging in people known to be at high risk of kidney injury (Harris et al. 2016).
Wednesday, 27 December 2017
Novel application of three-dimensional technologies in a case of dismemberment
Forensic Sci Int. 2016 Dec 2;270:139-145. doi: 10.1016/j.forsciint.2016.11.040. [Epub ahead of print]
This case study reports the novel application of three-dimensional technologies such as micro-CT and 3D printing to the forensic investigation of a complex case of dismemberment. Micro-CT was successfully employed to virtually align severed skeletal elements found in different locations, analyse tool marks created during the dismemberment process, and virtually dissect a charred piece of evidence. High resolution 3D prints of the burnt human bone contained within were created for physical visualisation to assist the investigation team. Micro-CT as a forensic radiological method provided vital information and the basis for visualisation both during the investigation and in the subsequent trial making it one of the first examples of such technology in a UK court.
UHCW Research: Brian A. Burnett
See also Corrigendum to "Novel application of three-dimensional technologies in a case of dismemberment" [Forensic Sci. Int. 270C (2017) 139-145].
This case study reports the novel application of three-dimensional technologies such as micro-CT and 3D printing to the forensic investigation of a complex case of dismemberment. Micro-CT was successfully employed to virtually align severed skeletal elements found in different locations, analyse tool marks created during the dismemberment process, and virtually dissect a charred piece of evidence. High resolution 3D prints of the burnt human bone contained within were created for physical visualisation to assist the investigation team. Micro-CT as a forensic radiological method provided vital information and the basis for visualisation both during the investigation and in the subsequent trial making it one of the first examples of such technology in a UK court.
UHCW Research: Brian A. Burnett
See also Corrigendum to "Novel application of three-dimensional technologies in a case of dismemberment" [Forensic Sci. Int. 270C (2017) 139-145].
A prospective, observational cohort study of patients presenting to an emergency department with acute shoulder trauma: the Manchester emergency shoulder (MESH) project
Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography.
UHCW Research: Charles E. Hutchinson
Thursday, 21 December 2017
Breast screening guidance
Public Health England has updated the following guidance:
Breast screening: guidance for breast screening mammographers
Breast screening: repeat mammograms
NHS breast screening programme procedures to collect, monitor and report repeat mammographic examinations.
Breast screening: women wanting to attend service out of area
Breast screening: guidance for breast screening mammographers
Guidance on the mammographic aspects (both clinical and technical) of breast screening QA and the quality control of radiographic procedures.
Breast screening: repeat mammograms
NHS breast screening programme procedures to collect, monitor and report repeat mammographic examinations.
Breast screening: women wanting to attend service out of area
Guidance for breast screening providers on dealing with requests from women who ask to be screened outside their area.
Tuesday, 19 December 2017
Gadolinium contrast agents and risk of tissue accumulation—removal of Omniscan and intravenous Magnevist from February; restrictions to use of other linear agents
From 1 February 2018, intravenous forms of gadodiamide (Omniscan) and gadopentetic acid (also known as gadopentetate dimeglumine; intravenous Magnevist) linear contrast agents for MRI will no longer be licenced and any remaining stock will be recalled from the market. The authorised indication of the linear agents gadobenic acid (also known as gadobenate dimeglumine; MultiHance) and gadoxetic acid (Primovist) will be limited to delayed phase liver imaging only.
Friday, 15 December 2017
Ultrasonography of occipital arteries to diagnose giant cell arteritis: a case series and literature review
Clin Rheumatol. 2017 Dec 12. doi: 10.1007/s10067-017-3946-5. [Epub ahead of print]
We describe four cases of giant cell arteritis (GCA) that presented with occipital headache in the last 6 months. Typical ultrasound features of GCA were found in the occipital arteries which helped to confirm the diagnosis. One patient had already suffered significant visual loss by the time the diagnosis was made, reflecting the similarity in prognosis to the more typical GCA patients. These cases prompted a review of the literature to evaluate the evidence regarding the use of occipital artery ultrasonography in the investigation of GCA. We searched PubMed, Google Scholar and Web of Science and identified 17 papers but only four of these were relevant studies. The studies available show that typical features of GCA can be detected in the occipital arteries using ultrasonography. They also suggest that ultrasonography can detect changes in the occipital arteries when temporal arteries are not involved. However, occipital artery abnormalities were less common than temporal artery abnormalities in GCA. We advocate maintaining a high index of suspicion for GCA in patients presenting with atypical features, such as occipital headache. Ultrasonography has a vital role to play in the diagnosis of these patients. We recommend priority imaging of the affected area to facilitate prompt and accurate diagnosis of GCA, especially when atypical vessels are involved.
UHCW Research: Pinnell J, Tiivas C, Perkins P, Blake T, Saravana S and Dubey S.
We describe four cases of giant cell arteritis (GCA) that presented with occipital headache in the last 6 months. Typical ultrasound features of GCA were found in the occipital arteries which helped to confirm the diagnosis. One patient had already suffered significant visual loss by the time the diagnosis was made, reflecting the similarity in prognosis to the more typical GCA patients. These cases prompted a review of the literature to evaluate the evidence regarding the use of occipital artery ultrasonography in the investigation of GCA. We searched PubMed, Google Scholar and Web of Science and identified 17 papers but only four of these were relevant studies. The studies available show that typical features of GCA can be detected in the occipital arteries using ultrasonography. They also suggest that ultrasonography can detect changes in the occipital arteries when temporal arteries are not involved. However, occipital artery abnormalities were less common than temporal artery abnormalities in GCA. We advocate maintaining a high index of suspicion for GCA in patients presenting with atypical features, such as occipital headache. Ultrasonography has a vital role to play in the diagnosis of these patients. We recommend priority imaging of the affected area to facilitate prompt and accurate diagnosis of GCA, especially when atypical vessels are involved.
UHCW Research: Pinnell J, Tiivas C, Perkins P, Blake T, Saravana S and Dubey S.
Friday, 1 December 2017
4th SSNAP Annual Report for 2016/2017 “Rising to the Challenge”
The fourth annual SSNAP report states that patients are getting much quicker access to the vital tests and treatment they need when they have a stroke, greatly improving their chances of recovery.
On the key indicators for stroke care, significant quality improvements have been made including on waiting times and specialist care. Improvements highlighted in the report since the first report four years ago include:
On the key indicators for stroke care, significant quality improvements have been made including on waiting times and specialist care. Improvements highlighted in the report since the first report four years ago include:
- Brain scanning times have improved with the numbers of patients scanned within 12 hours with more than 9 out of 10 (93.5 per cent) scanned within 12 hours, up from 84.6 per cent.
- Four out of five patients are assessed by a stroke specialised consultant physician within 24 hours.
- Almost nine out of 10 of eligible patients are receiving a clot busting drug thrombolysis, up from around seven in 10 two years ago. The numbers treated within one hour have risen from 53.2 per cent to 62.3 per cent.
- Nine out of 10 patients received a joint health and social care plan on discharge in 2016/17, compared to only seven out of 10 in 2013/14.
Tuesday, 7 November 2017
IR(ME)R annual report 2016
The Care Quality Commission (CQC) annual IR(ME)R report is a hugely useful document which provides imaging departments and cancer centres with invaluable learning about patient over-exposure to radiation used in vital imaging tests and cancer treatment.
Tuesday, 31 October 2017
Radiation dose monitoring software for medical imaging with ionising radiation [MIB127]
New: Medtech Innovation Briefing from NICE:
The technologies described in this briefing are 8 radiation dose monitoring software technologies that automatically gather and analyse information on patients' exposure to ionising radiation from medical imaging and X‑ray-guided procedures.
The innovative aspects are that dose-related data from medical imaging with ionising radiation can be systematically collected, monitored and analysed in a largely automated way. The technologies are designed to improve image quality while minimising radiation exposure to the patient.
Table 1 Summary of included technologies
Innovations
Current guidelines and arrangements
Population, setting and intended user
Costs
Resource consequences
The technologies described in this briefing are 8 radiation dose monitoring software technologies that automatically gather and analyse information on patients' exposure to ionising radiation from medical imaging and X‑ray-guided procedures.
The innovative aspects are that dose-related data from medical imaging with ionising radiation can be systematically collected, monitored and analysed in a largely automated way. The technologies are designed to improve image quality while minimising radiation exposure to the patient.
Thursday, 26 October 2017
Abstract ID: 139 Monte Carlo simulations for imaging in proton therapy
Physica Medica, Volume 42, Supplement 1, October 2017, Page 30
Proton therapy is rapidly gaining importance in the field of radiotherapy, because of its potential to deliver the planned dose over a small depth range and sparing dose to healthy tissue, when compared to conventional radiotherapy. Proton therapy, however, makes the need of new imaging modalities for treatment planning, based on direct measurements of tissue stopping power and eliminating the need to convert tissue density – as measured in conventional X-ray Computed Tomography) – to stopping power, upon which treatment planning is based[1]. The expected benefits of proton CT (pCT) for treatment planning in Proton Radiotherapy are producing great interest worldwide to develop instruments for clinical-quality pCT.
UHCW Research: SpyrosManolopoulos
Proton therapy is rapidly gaining importance in the field of radiotherapy, because of its potential to deliver the planned dose over a small depth range and sparing dose to healthy tissue, when compared to conventional radiotherapy. Proton therapy, however, makes the need of new imaging modalities for treatment planning, based on direct measurements of tissue stopping power and eliminating the need to convert tissue density – as measured in conventional X-ray Computed Tomography) – to stopping power, upon which treatment planning is based[1]. The expected benefits of proton CT (pCT) for treatment planning in Proton Radiotherapy are producing great interest worldwide to develop instruments for clinical-quality pCT.
UHCW Research: SpyrosManolopoulos
Wednesday, 25 October 2017
Radiation risk with digital mammography in breast screening
This review estimates the risks and benefits of breast screening in terms of number of deaths due to radiation-induced cancers and the number of lives saved due to digital breast screening in the NHS Breast Screening Programme (NHSBSP) in England.
Monday, 16 October 2017
Lifelong learning and building teams using peer feedback
This document from the Royal College of Radiologists outlines the processes and benefits of using both peer review and peer feedback within radiology departments.
Friday, 13 October 2017
Clinical radiology UK workforce census 2016 report
Key findings of the Clinical radiology UK workforce census 2016 report include;
- Nearly one-in-ten UK radiologist posts (8.5%) were vacant during 2016, nearly two-thirds of which (61%) were unfilled for a year or more
- The need for scans continues to grow. In England from 2013-16 the number of computed tomography (CT) and magnetic resonance imaging (MRI) scans respectively rose by more than 30% - three times more than the rate of workforce growth. Technological advances mean that these scans are more complex than ever before and take longer to interpret
- The high proportion of retirements versus new consultant numbers means the UK’s radiologist workforce will expand by just 1% year-on-year
- Last year, only 3% of NHS imaging departments were able to report all their patient scans within normal working hours
- The NHS spent nearly £88 million in 2016 paying for backlogs of radiology examinations to be reported – the same amount could have paid for at least 1,028 full-time consultants
Wednesday, 4 October 2017
Urinary tract infection in under 16s: diagnosis and management [CG54] / QS36
Updated. Guidanca from NICE. It covers diagnosing and managing first or recurrent upper or lower urinary tract infections in infants, children and young people. It aims to achieve more consistent clinical practice, based on accurate diagnosis and effective management.
This guideline includes recommendations on:
This guideline includes recommendations on:
- investigations and diagnosis
- acute management
- imaging tests
- surgical intervention
- follow-up
- information and advice for children, young people and parents or carers
Tuesday, 26 September 2017
New guidance on radiological investigations of suspected child abuse
The guidance, entitled “The Radiological Investigation of Physical Abuse in Children”, has been jointly produced by The Royal College of Radiologists (RCR) and the Society and College of Radiographers (SCoR), with input and endorsement from the Royal College of Paediatrics and Child Health (RCPCH).
It revamps initial guidance from 2008 and incorporates new evidence on child imaging techniques and follow-up protocols, as well as a series of new procedural templates to help radiologists, radiographers and referring paediatricians.
It revamps initial guidance from 2008 and incorporates new evidence on child imaging techniques and follow-up protocols, as well as a series of new procedural templates to help radiologists, radiographers and referring paediatricians.
Wednesday, 20 September 2017
OP27.07: Does imaging correlate with clinical findings for morbidly adherent placenta? An audit from University Hospitals Coventry and Warwickshire
Ultrasound Obstet Gynecol, 50: 137. doi:10.1002/uog.17953
The incidence of morbidly adherent placenta is rising secondary to the increasing Caesarean rate and advancing maternal age. The Royal College of Obstetricians and Gynecologists (RCOG) recommends that women with an anterior low placenta and a Caesarean section scar at 32 completed weeks gestation undergo further imaging with either ultrasonography and/or magnetic resonance imaging (MRI) to distinguish if there is likely placenta accreta. The aim of this audit was to determine if imaging correlated with clinical findings in our unit.
UHCW Research: L.J. Ewington, E.A. Swift and P. Parthasarathy
The incidence of morbidly adherent placenta is rising secondary to the increasing Caesarean rate and advancing maternal age. The Royal College of Obstetricians and Gynecologists (RCOG) recommends that women with an anterior low placenta and a Caesarean section scar at 32 completed weeks gestation undergo further imaging with either ultrasonography and/or magnetic resonance imaging (MRI) to distinguish if there is likely placenta accreta. The aim of this audit was to determine if imaging correlated with clinical findings in our unit.
UHCW Research: L.J. Ewington, E.A. Swift and P. Parthasarathy
EP04.37: Fetal persistent left superior vena cava: a case report and review of the literature
Ultrasound in Obstetrics & Gynecology; London
50.S1 (Sep 2017): 279-279.
We present a case of a fetal persistent left superior vena cava (PLSVC). A 34-year-old primigravida underwent a successful round of in vitro fertilisation. She was normally fit and well, the only medical history to note was loop excision of transformation zone six years prior to pregnancy. She had normal booking bloods and low risk Trisomy screening. However, her PAPP-A MoM came back at 0.21. At the twenty week anomaly scan she was found to have an abnormal four chamber heart view, and so was referred to the fetal medicine department where a discordance in atrial size was found and also an abnormal three vessel view. Therefore, she was referred to a tertiary centre. Here at 22+4 the fetus was found to have PLSVC draining into the coronary sinus. There were no obvious valvar or ventricular septal defects. As no other anatomical abnormalities were detected the couple deferred the decision for invasive testing. The pregnancy is still ongoing and further fetal medicine scans have been arranged. PLSVC has a prevalence of 0.3-0.5% of the general population and is thought to arise due to an in utero failure of development of the left cardinal vein. 60% of cases are associated with intra-cardiac anomalies and 37% of cases are associated with extra-cardiac anomalies. 12.5% of cases had a chromosomal abnormality. 21% of cases with isolated PLSVC can develop coarctation, therefore, follow-up scans are necessary in utero. Survival rates for isolated PLSVC are high as often the venous blood returns to the right atrium.
UHCW Research: L.J. Ewington and P. Parthasarathy
50.S1 (Sep 2017): 279-279.We present a case of a fetal persistent left superior vena cava (PLSVC). A 34-year-old primigravida underwent a successful round of in vitro fertilisation. She was normally fit and well, the only medical history to note was loop excision of transformation zone six years prior to pregnancy. She had normal booking bloods and low risk Trisomy screening. However, her PAPP-A MoM came back at 0.21. At the twenty week anomaly scan she was found to have an abnormal four chamber heart view, and so was referred to the fetal medicine department where a discordance in atrial size was found and also an abnormal three vessel view. Therefore, she was referred to a tertiary centre. Here at 22+4 the fetus was found to have PLSVC draining into the coronary sinus. There were no obvious valvar or ventricular septal defects. As no other anatomical abnormalities were detected the couple deferred the decision for invasive testing. The pregnancy is still ongoing and further fetal medicine scans have been arranged. PLSVC has a prevalence of 0.3-0.5% of the general population and is thought to arise due to an in utero failure of development of the left cardinal vein. 60% of cases are associated with intra-cardiac anomalies and 37% of cases are associated with extra-cardiac anomalies. 12.5% of cases had a chromosomal abnormality. 21% of cases with isolated PLSVC can develop coarctation, therefore, follow-up scans are necessary in utero. Survival rates for isolated PLSVC are high as often the venous blood returns to the right atrium.
UHCW Research: L.J. Ewington and P. Parthasarathy
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