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De Silva L, Baysari M, Keep M, Kench P, Clarke J. Patient initiated radiology requests: proof of wellness through images. Aust J Prim Health 2023; 29:670-678. [PMID: 37614071 DOI: 10.1071/py22247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Traditionally, general practitioners (GPs) have initiated the need for, and ordered, radiological tests. With the emergence of consumer-centred care, patients have started to request scans from doctors on their own initiative. Consumeristic health care has shifted the patient-doctor dyadic relationship, with GPs trending towards accommodating patients' requests. METHODS A mixed method analysis was conducted using a survey instrument with open ended questions and concurrent interviews to explore participants' responses from their requests for radiological studies from GPs. Themes emerging from both qualitative and quantitative methodologies were mapped onto the Andersen Newman Model (ANM). RESULTS Data were analysed for 'predisposing,' 'need' and 'enabling' elements of the ANM model and were correspondingly mapped to patient's requests for radiological referrals according to the elements of the ANM. Participants expressed anxiety about their health, were confident in the types of radiological scans they desired and typically indicated the need for evidence of good health. Their desire for such requested scans was often enabled through prior exposure to health information and the experience of specific symptoms. Requests came with the expectation of validation, and if these requests were denied, participants indicated that they would seek another doctor who would oblige. CONCLUSIONS In our modest study of Australian patients, participants were well informed about their health. Exposure to information seems to create a sense of anxiousness prior to visiting the doctor. Individuals sought visual proof of wellness through imaging, and doctors in return often accommodated patient requests for radiological studies to appease patients' needs and to maintain workflow.
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Affiliation(s)
- Lizzie De Silva
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Avenue, Camperdown, NSW 2006, Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, Sydney, NSW 2006, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building D18, Camperdown, NSW 2006, Australia
| | - Peter Kench
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Avenue, Camperdown, NSW 2006, Australia
| | - Jillian Clarke
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Avenue, Camperdown, NSW 2006, Australia
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De Silva L, Baysari M, Keep M, Kench P, Clarke J. Patients' requests for radiological imaging: A qualitative study on general practitioners' perspectives. Health Expect 2023; 26:2453-2460. [PMID: 37587771 PMCID: PMC10632629 DOI: 10.1111/hex.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND With the increasing availability of information, patients are becoming more informed about radiology procedures and requesting imaging studies. This qualitative study aims to explore factors that influence general practitioners' (GPs) decisions to fulfil patient requests for imaging studies during clinical consultation. METHODS Semi-structured interviews were conducted with 10 GPs working across five private medical centres in Northwest Sydney. Conventional content analysis was used with emergent themes to identify GPs perspectives. RESULTS Six themes stood out from the interviews with GPs fulfilling patient requests for imaging studies. They included four pertaining to patient factors: patient expectations, 'therapeutic scans', 'impressive labels' and entitled. Two further themes pertained to the GP perspective and included defensive medicine, and 'new patients'. Requests are fulfilled from anxious or health-obsessed patients, with GPs worrying about litigation if they refuse. However, GPs decline requests from patients with entitlement attitudes or during first visits. DISCUSSION The findings suggest that GPs struggle to balance their responsibilities as gatekeepers of imaging with patients' expectations of request fulfilment. Clear guidelines on the appropriate use of diagnostic imaging and its limitations could help patients understand its proper use and ease anxiety. Additionally, education and training for GPs could help them manage patient expectations and provide appropriate care. PATIENT CONTRIBUTIONS Patients, service users, caregivers, people with lived experiences or members of the public were not directly involved in the design, conduct, analysis or interpretation of the study. However, our study was conducted in primary care facilities where the GPs were interviewed about patients' requests for diagnostic imaging based on their own initiatives. GPs' perspectives in managing patient expectations and healthcare utilisation were explored within the Australian Medicare system, where medical imaging and image-guided procedures come at little to no cost to the individual. The study findings contribute to a better understanding of the challenges faced by GPs in dealing with patient consumerism and requests for diagnostic imaging, as well as factors influencing request fulfilment or denial. Insights gained from this study may inform future research about delivering patient-centred care within a similar context.
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Affiliation(s)
- Lizzie De Silva
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, Charles Perkins Centre D17Faculty of Medicine and HealthSydneyNew South WalesAustralia
| | - Melanie Keep
- Sydney School of Health SciencesFaculty of Medicine and HealthCamperdownNew South WalesAustralia
| | - Peter Kench
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Jillian Clarke
- Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
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Jimenez YA, Gray F, Di Michele L, Said S, Reed W, Kench P. Can simulation-based education or other education interventions replace clinical placement in medical radiation sciences? A narrative review. Radiography (Lond) 2023; 29:421-427. [PMID: 36809689 PMCID: PMC9938927 DOI: 10.1016/j.radi.2023.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/30/2023] [Accepted: 02/04/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES In response to increasing student enrolment and workload pressures from the Covid-19 pandemic, a recent focus on health student preparation programs has been on curricula adaptations and replacement of clinical placement time with alternative education activities. The aim of the narrative review was to explore the current evidence relating to education activities in Medical Radiation Sciences (MRS) used to replace clinical placements or part of clinical placements. Medline, CINAHL and Web of Science databases were used to search for articles published between 2017 and 2022. Data from the literature was summarised into (1) planning and development of clinical replacement learning activities in MRS, (2) evaluation of clinical replacement activities, and (3) benefits and challenges of clinical replacement in MRS. KEY FINDINGS Planning and development of clinical replacement learning activities in MRSrequires support from a wide range of stakeholders, and evidence from activities already implemented exists. Activities largely encompass an institution-specific focus. Developed clinical replacement activities use a blended approach, with simulation-based education (SBE) as a main teaching platform. Evaluation of clinical replacement activities are largely focused on students' achievement of learning objectives relating to practical and communication skills. Emerging evidence based on small student samples shows that clinical and clinical replacement activities provide similar results in terms of learning objectives. CONCLUSION Benefits and challenges of clinical replacement in MRS are similar to those presented in the other health professions. The balance between quality and quantity of teaching and learning experiences for clinical skill development in MRS needs to be further investigated. IMPLICATIONS FOR PRACTICE To meet the dynamic challenges of the health care environment and MRS profession, a major goal in the future will be to affirm the benefit of clinical replacement activities for MRS students.
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Affiliation(s)
- Y A Jimenez
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia.
| | - F Gray
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
| | - L Di Michele
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
| | - S Said
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
| | - W Reed
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
| | - P Kench
- Faculty of Medicine and Health, Discipline of Medical Imaging Science, Susan Wakil Health Building (D18), Western Avenue, University of Sydney, NSW 2006, Australia
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De Silva L, Baysari M, Keep M, Kench P, Clarke J. Patient requests for radiological services: An Australian study of patient agency and the impact of online health information. Health Promot J Austr 2022; 34:437-442. [PMID: 36054419 DOI: 10.1002/hpja.647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED The Internet has been instrumental in patients' knowledge about health and medicine through increasing consultation of online sources that advocate self-management. For example, those patients who request referrals from their doctors for tests and procedures in radiology. Such patient-initiated referral requests can devolutionise the traditional model of health care. This study aimed to understand individuals who sought online health information (OHI) and whether requests for radiological referrals were the result of OHI seeking. METHODS The individuals targeted were those who have had a radiological procedure in the past 5 years. Using an online survey tool, individuals completed a 20-min anonymous survey. Included in the survey was a validated digital health literacy measurement scale, eHEALS. RESULTS Those who scored higher on the eHEALS measure were likely to be under 55 years of age and were more inclined to request radiological referrals. Though they were not concerned with the credibility of sourced websites, most secured the desired outcome from their requests. CONCLUSION Overall, this study indicates that patients are consulting online sites for health information, and individuals with higher digital literacy scores are asking doctors for referrals for radiological tests and procedures. These findings confirm our anecdotal experience in radiology departments. So what?: In conducting this study, we hope to better inform radiology and other health practitioners of the way OHI is impacting clinical practice.
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Affiliation(s)
- Lizzie De Silva
- Discipline of Medical Imaging Science Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Ave Camperdown NSW Australia
| | - Melissa Baysari
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre D17 The University of Sydney Sydney NSW Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building D18 Camperdown NSW Australia
| | - Peter Kench
- Discipline of Medical Imaging Science Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Ave Camperdown NSW Australia
| | - Jillian Clarke
- Discipline of Medical Imaging Science Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown Campus, Western Ave Camperdown NSW Australia
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McCoombe K, Dobeli K, Meikle S, Llewellyn S, Kench P. Sensitivity of virtual non-contrast dual-energy CT urogram for detection of urinary calculi: a systematic review and meta-analysis. Eur Radiol 2022; 32:8588-8596. [PMID: 35763094 DOI: 10.1007/s00330-022-08939-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the sensitivity of dual-energy (DE) virtual non-contrast computed tomography (vNCT), generated from the excretory phase of a CT urogram, compared to true non-contrast CT (tNCT) for the detection of urinary calculi. METHODS A search of multiple medical literature databases was performed using predetermined search terms. Inclusion and exclusion criteria were applied, and bias risk was assessed by two independent reviewers using the quality assessment of diagnostic accuracy studies (QUADAS) tool. Collated estimates of sensitivity were generated, and sources of heterogeneity were identified and reviewed. RESULTS Thirteen studies (1760 patients; 1740 urinary calculi) were included for sensitivity assessment. Pooled sensitivity for urinary calculi on vNCT was 78.1% (95% CI: 70.2 to 85.0%); however, heterogeneity between studies was very high (I2 = 92.0%). Sources of heterogeneity between studies were explored through subgroup analysis by categorising studies according to slice thickness (≥ 2 mm and < 2 mm), use of oral hydration, and use of intravenous furosemide. Pooled sensitivity for detection of urinary calculi on vNCT for studies that used oral hydration and < 2 mm slice thickness was 92.2% (95% CI: 89.5 to 94.5%). Pooled specificity was not performed as true negatives were not reported in most studies. Potential sources of bias were identified in included studies. CONCLUSION vNCT demonstrated a moderate pooled sensitivity compared to tNCT for the detection of urinary calculi in split bolus CT urogram protocols. However, subgroup analysis suggests higher sensitivity when employing oral hydration and < 2 mm slice thickness or increment. KEY POINTS • vNCT demonstrated moderate pooled sensitivity for the detection of urinary calculi in split bolus CT urogram protocols. • Subgroup analysis suggested higher sensitivity with oral hydration and < 2 mm slice thickness or increment.
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Affiliation(s)
- Katherine McCoombe
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia. .,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Karen Dobeli
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Steven Meikle
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Stacey Llewellyn
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Peter Kench
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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Suchowerska N, Kench P, Rogers L, Estaves A, Gorjiara T, McKenzie D. OC-0682: CBCT dose prior to radiotherapy causes up to 15 times more cell death than predicted. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Suleiman ME, Brennan PC, Ekpo E, Kench P, McEntee MF. Integrating mammographic breast density in glandular dose calculation. Br J Radiol 2018; 91:20180032. [PMID: 29400552 PMCID: PMC6190790 DOI: 10.1259/bjr.20180032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This work proposes the use of mammographic breast density (MBD) to estimate actual glandular dose (AGD), and assesses how AGD compares to mean glandular dose (MGD) estimated using Dance et al method. METHODS A retrospective sample of anonymised mammograms (52,405) was retrieved from a central database. Technical parameters and patient characteristics were exported from the Digital Imaging and Communication in Medicine (DICOM) header using third party software. LIBRA (Laboratory for Individualized Breast Radiodensity Assessment) software package (University of Pennsylvania, Philadelphia, USA) was used to estimate MBDs for each mammogram included in the data set. MGD was estimated using Dance et al method, while AGD was calculated by replacing Dance et al standard glandularities with LIBRA estimated MBDs. A linear regression analysis was used to assess the association between MGD and AGD, and a Bland-Altman analysis was performed to assess their mean difference. RESULTS The final data set included 31,097 mammograms from 7728 females. MGD, AGD, and MBD medians were 1.53 , 1.62 mGy and 8% respectively. When stratified per breast thickness ranges, median MBDs were lower than Dance's standard glandularities. There was a strong positive correlation (R2 = 0.987, p < 0.0001) between MGD and AGD although the Bland-Altman analysis revealed a small statistically significant bias of 0.087 mGy between MGD and AGD (p < 0.001). CONCLUSION AGD estimated from MBD is highly correlated to MGD from Dance method, albeit the Dance method underestimates dose at smaller CBTs. Advances in knowledge: Our work should provide a stepping-stone towards an individualised dose estimation using automated clinical measures of MBD.
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Affiliation(s)
- Moayyad E Suleiman
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
| | - Patrick C Brennan
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
| | - Ernest Ekpo
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
| | - Peter Kench
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
| | - Mark F McEntee
- Medical Radiation Sciences, The University of Sydney, Faculty of Health Sciences. Cumberland Campus, Lidcombe, NSW, Australia
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Lu Y, Fontaine K, Mulnix T, Onofrey JA, Ren S, Panin V, Jones J, Casey ME, Barnett R, Kench P, Fulton R, Carson RE, Liu C. Respiratory Motion Compensation for PET/CT with Motion Information Derived from Matched Attenuation-Corrected Gated PET Data. J Nucl Med 2018; 59:1480-1486. [PMID: 29439015 DOI: 10.2967/jnumed.117.203000] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/25/2018] [Indexed: 11/16/2022] Open
Abstract
Respiratory motion degrades the detection and quantification capabilities of PET/CT imaging. Moreover, mismatch between a fast helical CT image and a time-averaged PET image due to respiratory motion results in additional attenuation correction artifacts and inaccurate localization. Current motion compensation approaches typically have 3 limitations: the mismatch among respiration-gated PET images and the CT attenuation correction (CTAC) map can introduce artifacts in the gated PET reconstructions that can subsequently affect the accuracy of the motion estimation; sinogram-based correction approaches do not correct for intragate motion due to intracycle and intercycle breathing variations; and the mismatch between the PET motion compensation reference gate and the CT image can cause an additional CT-mismatch artifact. In this study, we established a motion correction framework to address these limitations. Methods: In the proposed framework, the combined emission-transmission reconstruction algorithm was used for phase-matched gated PET reconstructions to facilitate the motion model building. An event-by-event nonrigid respiratory motion compensation method with correlations between internal organ motion and external respiratory signals was used to correct both intracycle and intercycle breathing variations. The PET reference gate was automatically determined by a newly proposed CT-matching algorithm. We applied the new framework to 13 human datasets with 3 different radiotracers and 323 lesions and compared its performance with CTAC and non-attenuation correction (NAC) approaches. Validation using 4-dimensional CT was performed for one lung cancer dataset. Results: For the 10 18F-FDG studies, the proposed method outperformed (P < 0.006) both the CTAC and the NAC methods in terms of region-of-interest-based SUVmean, SUVmax, and SUV ratio improvements over no motion correction (SUVmean: 19.9% vs. 14.0% vs. 13.2%; SUVmax: 15.5% vs. 10.8% vs. 10.6%; SUV ratio: 24.1% vs. 17.6% vs. 16.2%, for the proposed, CTAC, and NAC methods, respectively). The proposed method increased SUV ratios over no motion correction for 94.4% of lesions, compared with 84.8% and 86.4% using the CTAC and NAC methods, respectively. For the 2 18F-fluoropropyl-(+)-dihydrotetrabenazine studies, the proposed method reduced the CT-mismatch artifacts in the lower lung where the CTAC approach failed and maintained the quantification accuracy of bone marrow where the NAC approach failed. For the 18F-FMISO study, the proposed method outperformed both the CTAC and the NAC methods in terms of motion estimation accuracy at 2 lung lesion locations. Conclusion: The proposed PET/CT respiratory event-by-event motion-correction framework with motion information derived from matched attenuation-corrected PET data provides image quality superior to that of the CTAC and NAC methods for multiple tracers.
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Affiliation(s)
- Yihuan Lu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Kathryn Fontaine
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Tim Mulnix
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - John A Onofrey
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Silin Ren
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | | | - Judson Jones
- Siemens Medical Solutions, Knoxville, Tennessee; and
| | | | - Robert Barnett
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Peter Kench
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Roger Fulton
- Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Richard E Carson
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut.,Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut.,Department of Biomedical Engineering, Yale University, New Haven, Connecticut
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Safina A, Lau L, Brennan P, Mello-Thoms C, Kench P, Ryan E, McEntee M, Rickard M. Precision imaging-its impact on image quality and diagnostic confidence in breast ultrasound examinations. Br J Radiol 2015; 88:20140340. [PMID: 26286642 DOI: 10.1259/bjr.20140340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the effect of noise-reducing innovation-precision imaging (PI)-on image quality and diagnostic efficacy in breast ultrasound. METHODS The study, which assessed four levels of PI from zero to three, consisted of two parts: image quality assessment and diagnostic efficacy evaluation. For the first part, 247 sets of ultrasound images displayed at each PI level were evaluated by 6 experienced breast imaging observers, by rating image quality using visual grading analysis on a 1-4 scale. For the diagnostic efficacy part 51 breast lesions were displayed at each PI level and scored 1-6 to generate a receiver operating characteristic (ROC) curve. These images were evaluated by radiologists and sonographers. Analyses were performed using non-parametric Friedman and Wilcoxon signed rank tests and a multireader multicase methodology. RESULTS Statistically, higher scores of image quality were observed with increased levels of PI than with the zero setting (p < 0.001). The ROC analysis did not demonstrate any significant change in diagnostic efficacy, with mean scores for all observers being 0.79, 0.80, 0.81 and 0.81 for settings zero, one, two and three, respectively. CONCLUSION This study suggested a perceived improvement in image quality with increasing levels of PI; however, no changes in diagnostic efficacy were noted. The importance of looking at the impact of new imaging technologies in a multifaceted way is emphasized. ADVANCES IN KNOWLEDGE To our knowledge, this is the first article investigating the impact of the PI algorithm on ultrasound image quality and breast lesion characterization.
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Affiliation(s)
| | - Louisa Lau
- 1 The Sydney Breast Clinic, Sydney, NSW, Australia
| | - Patrick Brennan
- 2 Medical Radiation Science, Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Claudia Mello-Thoms
- 2 Medical Radiation Science, Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Peter Kench
- 2 Medical Radiation Science, Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elaine Ryan
- 2 Medical Radiation Science, Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mark McEntee
- 2 Medical Radiation Science, Faculty of Health Sciences, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mary Rickard
- 1 The Sydney Breast Clinic, Sydney, NSW, Australia
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10
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Palamaras I, Kench P, Thomson P, Al-Dulaimi AH, Stevens HP, Robles W. An unusual presentation of a common disease. Dermatol Online J 2008; 14:4. [PMID: 18627706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We present a case of perforating granuloma annulare (PGA), in which we show the natural history of lesions and outline the different clinical types. Our patient responded well to intralesional triamcinolone acetonide 10mg/ml injections. Although she was otherwise well, PGA can be associated with diabetes mellitus in up to 17 percent of cases. Differential clinico-histopathological diagnosis, specifically in relation to necrobiosis lipoidica diabeticorum is being discussed. Treatment for PGA is difficult; apart from topical and/or intralesional steroids (clearance up to 54% in one case series), other options include Psoralen plus UVA (PUVA), systemic isotretinoin, chloroquine or hydroxylchloroquine, sulphapyridine, dapsone, topical application of imidazole creams, and liquid nitrogen. Spontaneous remission has also been reported in up to 77 percent in one case series.
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Affiliation(s)
- Ioulios Palamaras
- Department of Dermatology, Barnet and Chase Farm NHS Trust, London, UK
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Palamaras I, Kench P, Thomson P, Al-Dulaimi AH, Stevens HP, Robles W. An Unusual Presentation Of A Common Disease. Dermatol Online J 2008. [DOI: 10.5070/d341w716td] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
Molecular imaging refers to the use of non-invasive imaging techniques to detect signals that originate from molecules, often in the form of an injected tracer, and observe their interaction with a specific cellular target in vivo. Differences in the underlying physical principles of these measurement techniques determine the sensitivity, specificity and length of possible observation of the signal, characteristics that have to be traded off according to the biological question under study. Here, we describe the specific characteristics of single photon emission computed tomography (SPECT) relative to other molecular imaging technologies. SPECT is based on the tracer principle and external radiation detection. It is capable of measuring the biodistribution of minute (<10(-10) molar) concentrations of radio-labelled biomolecules in vivo with sub-millimetre resolution and quantifying the molecular kinetic processes in which they participate. Like some other imaging techniques, SPECT was originally developed for human use and was subsequently adapted for imaging small laboratory animals at high spatial resolution for basic and translational research. Its unique capabilities include (i) the ability to image endogenous ligands such as peptides and antibodies due to the relative ease of labelling these molecules with technetium or iodine, (ii) the ability to measure relatively slow kinetic processes (compared with positron emission tomography, for example) due to the long half-life of the commonly used isotopes and (iii) the ability to probe two or more molecular pathways simultaneously by detecting isotopes with different emission energies. In this paper, we review the technology developments and design tradeoffs that led to the current state-of-the-art in SPECT small animal scanning and describe the position SPECT occupies within the matrix of molecular imaging technologies.
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Affiliation(s)
- Steven R Meikle
- School of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Sydney, Australia
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13
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Abstract
Molecular imaging refers to the use of non-invasive imaging techniques to detect signals that originate from molecules, often in the form of an injected tracer, and observe their interaction with a specific cellular target in vivo. Differences in the underlying physical principles of these measurement techniques determine the sensitivity, specificity and length of possible observation of the signal, characteristics that have to be traded off according to the biological question under study. Here, we describe the specific characteristics of single photon emission computed tomography (SPECT) relative to other molecular imaging technologies. SPECT is based on the tracer principle and external radiation detection. It is capable of measuring the biodistribution of minute (<10(-10) molar) concentrations of radio-labelled biomolecules in vivo with sub-millimetre resolution and quantifying the molecular kinetic processes in which they participate. Like some other imaging techniques, SPECT was originally developed for human use and was subsequently adapted for imaging small laboratory animals at high spatial resolution for basic and translational research. Its unique capabilities include (i) the ability to image endogenous ligands such as peptides and antibodies due to the relative ease of labelling these molecules with technetium or iodine, (ii) the ability to measure relatively slow kinetic processes (compared with positron emission tomography, for example) due to the long half-life of the commonly used isotopes and (iii) the ability to probe two or more molecular pathways simultaneously by detecting isotopes with different emission energies. In this paper, we review the technology developments and design tradeoffs that led to the current state-of-the-art in SPECT small animal scanning and describe the position SPECT occupies within the matrix of molecular imaging technologies.
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Affiliation(s)
- Steven R Meikle
- School of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Sydney, Australia
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Affiliation(s)
- Noemi B A Roy
- Department of Haematology, Chase Farm Hospital, Enfield, UK.
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Dowd SB, Kench P. Radiologic science education in Australia. Radiol Technol 1995; 67:189-93. [PMID: 8570850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- S B Dowd
- University of Alabama at Birmingham, USA
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Sinclair GR, Evans CM, Kench P. Vascular lesion of the verumontanum. Br J Urol 1985; 57:111-2. [PMID: 3971097 DOI: 10.1111/j.1464-410x.1985.tb09001.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
A morphometric analysis has been made of the normal human pelvi-ureteric junction and upper ureter. There was found to be no anatomically definable pelvi-ureteric junction. Muscle bundles of renal pelvis and upper ureter run a spiral course and do not form clear-cut layers. There is a great normal variation of thickness of the renal pelvic and ureteric muscularis, as well as of the total thickness of these structures. Smaller, but sometimes still large differences, are seen between right and left pelvi-ureteric specimens of individual patients. Suggested normal ranges of thickness are: (1) Renal pelvis: total thickness 340-1300 micrometers, muscularis 270-1100 micrometer. (2) Upper ureter: total thickness 450-1000 micrometer, muscularis 240-790 micrometer. No neurones are present in the renal pelvis or upper ureter. The possible etiologies of pelvi-ureteric obstruction are discussed.
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Kench P. Registration of foreign-trained doctors. Med J Aust 1982; 1:249-50. [PMID: 7087844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ferguson LJ, Goldin AR, Kench P, Walsh JA. Fatal haematemesis from an aorto-oesophageal fistula of obscure aetiology: a case report. Aust N Z J Surg 1980; 50:412-4. [PMID: 6932858 DOI: 10.1111/j.1445-2197.1980.tb04153.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Endoscopy, aortography and laparotomy failed to demonstrate a high aorto-oesophageal fistula of obscure aetiology in a woman presenting with haematemesis. Recognition of Chiari's triad: mid-thoracic pain, sentinel arterial haemorrhage, and final exsanguination after a symptom-free interval, and therapeutic embolization as a mode of therapy, are discussed.
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Blumbergs PC, Kench P. Test and teach, number twenty-four. Diagnosis: tapeworm cyst wall, 4th ventricle. Pathology 1980; 12:390, 495-6. [PMID: 7432816 DOI: 10.3109/00313028009077100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
A case is described of analgesic nephropathy with papillary necrosis, calcification, osseous metaplasia and the development of papillary transitional cell carcinoma of the renal pelvis and ureter. Seven similar cases are summarized, and the literature briefly reviewed with particular reference to aetiological factors and associated clinical findings.
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French T, Kench P, Swanepoel A, Hewitson R, Gelb A. Achalasia with suppurative pericarditis. A case report. Am J Gastroenterol 1974; 62:536-9. [PMID: 4447104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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