Development of Nursing Research in Saudi Arabia: Implications for Policies and Practice

Background: Nursing research in Saudi Arabia can be evaluated based on productivity as well as the quality of publications. The scope of scientific inquiry in nursing research expands to include clinical, health system, and outcome-based research, education, and administration. Aim: The purpose of this article is to track the development of nursing research in the Kingdom of Saudi Arabia. Design: Systematic review. Methods: This study used keywords, databases including MEDLINE, CINAHL, and PubMed to search for published articles on nursing in Saudi Arabia. The search resulted in the identification of 681 publications, from which 360 articles met the inclusion criteria and were included in the review. Results: The highest percentage of studies (56.7% of articles) focused on nursing clinical practice, and 76.0% of the studies were conducted in a hospital setting, followed by an educational setting. Most of the studies were quantitative and non-funded. More than 50.0% of the studies were first authored by Saudi scholars. Conclusions: This study concluded that nursing research in Saudi Arabia is still in its infancy, with notable improvements in the last 5 years. This correlated with an increasing number of nurses holding postgraduate degrees. With the Saudi government's strong support, the number of scientific research papers published on Saudi nursing has steadily increased over the last year.

Management of unusual complications of modified rhomboid/Limberg procedure by interventional radiology guidance; A case report and literature review

BACKGROUND

Fragmentation of the surgical drain is an unusual negative consequence of using a drainage system postoperatively. Even though it is rare, multiple management approaches were documented in the literature.

CASE PRESENTATION

A 19-year-old male patient who had a history of recurrent pilonidal sinus disease that was operated on twice 4 months apart. He presented to our hospital for postoperative follow-up, during which the inserted drain was assessed. While withdrawing the drain, part of it was damaged and missed. The location of the misplaced drain was assessed by a lumbosacral region computed tomography (CT) scan. The decision was made to proceed with less invasive methods using interventional radiology techniques to avoid wide excision and incision reopening complications and prolonged healing time. A fluoroscopy procedure was performed to create three-dimensional anterolateral, frontal posterior views. Then the fragmented drain was retrieved successfully by a minimally invasive technique. The postoperative period was uneventful.

DISCUSSION

Drain fragmentation and/or dislodgement is a highly challenging event that requires highly innovative intervention. Multiple treatment options are available as open surgery techniques and endoscopic approaches.

CONCLUSION

This case highlights the potential role of fluoroscopy as an outstanding effective choice that could be carried out promptly and safely at the bedside under local anesthetic and reduce the patient's hospital stay.

Technical complications with tooth-supported fixed dental prostheses (FDPs) of different span lengths: an up to 15-year retrospective study

BACKGROUNDS

Long-span dental bridges may cause excessive load on abutment teeth and the periodontal area, which may lead to bridge fractures or periodontal problems. However, some reports have revealed that short- and long-span bridges can provide a similar prognosis. This clinical study aimed to investigate the technical complications associated with fixed dental prostheses (FDPs) of different span lengths.

METHODS

All patients with previously cemented FDPs were clinically examined during their follow-up visits. Several data related to FDPs were registered, such as design, material type, location, and type of complication. The main clinical factors analyzed were technical complications. Life table survival analyses were performed to calculate the cumulative survival rate of FDPs when technical complications were detected.

RESULTS

The study examined 229 patients with a total number of 258 prostheses and an average of 98 months of follow-up. Seventy-four prostheses suffered from technical complications, and the most common complication was ceramic fracture or chipping (n = 66), while loss of retention occurred in 11 prostheses. The long-term evaluation of long-span prostheses revealed a significantly higher technical complication rate compared to short-span prostheses (P = ,003). The cumulative survival rate for short-span FDPs was 91% in year 5, 68% in year 10, and 34% in year 15. For long-span FDPs, the cumulative survival rate was 85% in year 5, 50% in year 10, and 18% in year 15.

CONCLUSION

Long-span prostheses (5 units or more) can be associated with a higher technical complication rate compared to short-span prostheses after long-term evaluation.

Sudden unilateral eye pain with vision loss related to carotid stump syndrome; A case report and literature review

INTRODUCTION AND IMPORTANCE

Carotid stump syndrome (CSS) is a rare cause of recurrent ipsilateral cerebrovascular accidents (CVAs) resulting from completely occluded internal carotid artery (ICA). In this condition, hemodynamic and embolic risks are related to cerebral and retinal ischemic strokes.

PRESENTATION OF CASE

A 65-year-old gentleman with multiple comorbidities, presented to our hospital with a sudden painful unilateral vision loss of the right eye. Head CT was done upon arrival, showing no evidence of ischemic or hemorrhagic brain insult and multiple right frontoparietal old infarct lesions were detected. Central retinal artery occlusion diagnosis was confirmed by an ophthalmologist. CT angiogram of the brain and carotids was done and revealed an obliterated, thrombosed, and non-opacified right internal carotid artery from the carotid bifurcation up to intracranial petrous/foramen lacerum. After taking the patient's surgical consent, right carotid stump endarterectomy and ligation of the stump under general anesthesia was done and the postoperative period was uneventful.

CLINICAL DISCUSSION

CSS is an uncommon underlying etiology, causing recurrent stroke events. The clinical features of this syndrome include cerebral and ophthalmology symptoms. Diagnosis of CSS relies on imaging modalities. Internal carotid artery stump surgical excision through the ipsilateral ECA endarterectomy is the gold standard for CSS treatment.

CONCLUSION

Despite being a rare entity, CSS is a treatable cause of retinal embolic events TIAs. Therefore, it is important to raise awareness of such condition. The presented case demonstrates the diagnosis, management and prognosis of CSS.

Uprighting a mesially tilted molar using customized titanium healing abutment of an adjacent osseointegrated implant

This case report evaluates the use of a customized healing abutment of a dental implant to upright a mesially tilted molar using elastic separating rings. The external surface of the healing abutment was roughened by air particle abrasion, and a flowable composite was applied as a collar around it. The size of the resin collar was increased several times during the molar uprighting treatment by replacing the elastic ring. The uprighting procedure was evaluated after 2 months using radiographic and clinical evaluations. After treatment, the mesiodistal space above the implant was increased from 6 mm to 9 mm as follows: 2 mm by uprighting the second molar and 1 mm by mesial shifting the second premolar, and then a screw-retained zirconia crown was placed to restore the implant. The healing abutment of the implant can be modified by adding a resin collar and used as orthodontic anchorage for uprighting the adjacent tilted molar to facilitate the prosthetic procedure. Neither special instruments nor an orthodontic background are required for this minor tooth movement.

Secondary caries in fixed dental prostheses: Long-term clinical evaluation

OBJECTIVES

Even with excellent fixed dental prostheses (FDPs), there will be a substantial risk of biological complications, such as caries, if proper oral hygiene is not maintained. This study aimed to evaluate the risks of developing secondary caries with FDPs in relation to the patient oral hygiene status.

MATERIAL AND METHODS

Clinical and radiographic examinations were performed for patients to collect data related to their FDP complications and oral hygiene status. The main clinical parameter analyzed was secondary caries. Complications such as a fracture, debonding, or the need for endodontic therapy were also analyzed. The interval survival rate and the cumulative survival rate of FDPs from the time of treatment to the time of follow-up were analyzed.

RESULTS

A total of 423 patients (with a total of 1116 FDPs) were examined in this study, with a mean age of 43.7 years and a mean follow-up time of 7 years. Regarding complications, secondary caries was detected in 94 FDPs (8.4%), fracture (or chipping) in 85 (7.6%) cases, need for endodontic treatment in 42 cases (3.7%), and debonding in four (0.3%) cases. Secondary caries was found in nine out of 219 FDPs (4%) in patients with good oral hygiene, 35 out of 634 FDPs (5.5%) in patients with fair oral hygiene, and 50 out of 272 FDPs (18.4%) in patients with poor oral hygiene (p ≤ .001).

CONCLUSIONS

Good oral hygiene has a great influence on reducing the risk of secondary caries in patients with FDPs. The occurrence of secondary caries is a common complication in patients with poor oral hygiene.

The impact of a 12-hour educational program on nurses' knowledge and attitudes regarding pain management: a quasi-experimental study

Background

Proper pain assessment is fundamental to effective pain management. Training nursing staff is critical for improving pain assessment competence and patient clinical outcomes. However, there is a dearth of research examining interventions that can enhance nurses’ knowledge and attitudes toward pain management, especially in Saudi Arabia. Thus, this study aimed to evaluate the effectiveness of a structured education program on nurses’ knowledge and attitudes towards pain management.

Methods

A quasi-experimental design was used. The study sample included 124 registered nurses working in intensive care or inpatient units in Saudi Arabia. Data were collected between March and September 2021 using a knowledge and attitudes survey regarding pain, satisfaction with and self-confidence in learning, and the learning self-efficacy scale for clinical skills.

Results

Nurses showed moderate levels of knowledge and attitudes regarding pain before (M = 20.3, SD = 4.80) pain management education, which were significantly higher after the intervention (M = 22.2, SD = 5.09, t = 2.87, p < .01). Before the intervention, nurses with a baccalaureate degree had more knowledge and better attitudes regarding pain management than diploma nurses (t = 3.06, p < .01). However, there was no significant difference between the two groups after the intervention (p > .05), indicating that the education was effective in enhancing nurses’ knowledge and attitudes, regardless of nursing education level. Nurses in this study had high mean scores for self-confidence in learning (M = 35.6, SD = 4.68, range = 18–40), self-learning efficacy (M = 52.9, SD = 7.70, range = 25–60), and satisfaction with learning (M = 22.2, SD = 3.24, range: 10–25).

Conclusion

Regular pain education programs can improve nurses’ knowledge and attitudes. Increasing the breadth and depth of educational courses, alongside appropriate training, competency-based assessment, and pain education programs, is also recommended. Future research should consider the subjectivity and individualized nature of nursing by including patient satisfaction surveys to measure the improvement in nurses’ knowledge and attitudes from the patient perspective.

Effect of full arch two scanning techniques on the accuracy of overdenture conventional and CAD/CAM Co-Cr bars

This work evaluates the internal and marginal adaptation of implant-assisted overdenture cobalt–chromium (Co–Cr) bars manufactured using conventional as well as CAD/CAM subtractive and selective laser melting (SLM) utilizing two scanning techniques. Methods: An edentulous study model containing four dental implants placed at teeth sites 36, 33, 43, and 46 was used. The study cast was scanned and compared to the virtual casts developed from two scanning techniques, straight and zigzag motion, using the in silico superimposition process. Then, conventional techniques were used to produce full-arch bars that were compared to the bars fabricated using the two scanning techniques and CAD/CAM subtractive and additive techniques. Results: The conventional impression and casting techniques had the smallest marginal gap among the groups (P-value < 0.05). The CAD/CAM subtractive milling techniques in groups II and III had significantly smaller marginal gaps than SLM technique used in groups IV and V (P-value < 0.05). The analysis of the internal gap within each group showed statistically significant differences between different implant sites in all groups (P-value < 0.001), except when using the conventional impression and casting techniques in group I (P-value = 0.20). Conclusion: The conventional impression and fabrication techniques were better than the digital impression and CAD/CAM subtractive and additive techniques for the fabrication of full-arch bars. However, both straight and zigzag scanning techniques and the CAD/CAM subtractive technique had marginal and internal gaps that were within clinically accepted ranges, and the SLM was found to be unsuitable for long-span framework fabrication with either scanning technique used.

Content Classification Tasks with Data Preprocessing Manifestations

Deep reinforcement learning has a major hurdle in terms of data efficiency. We solve this challenge by pretraining an encoder with unlabeled input, which is subsequently finetuned on a tiny quantity of task-specific input. We use a mixture of latent dynamics modelling and unsupervised goal-conditioned RL to encourage learning representations that capture various elements of the underlying MDP. Our approach significantly outperforms previous work combining offline representation pretraining with task-specific finetuning when limited to 100k steps of interaction on Atari games (equivalent to two hours of human experience) and compares favourably with other pretraining methods that require orders of magnitude more data. When paired with larger models and more diverse, task-aligned observational data, our methodology shows great promise, nearing human-level performance and data efficiency on Atari in the best-case scenario.

Power-Efficient Wireless Coverage Using Minimum Number of UAVs

Unmanned aerial vehicles (UAVs) can be deployed as backup aerial base stations due to cellular outage either during or post natural disaster. In this paper, an approach involving multi-UAV three-dimensional (3D) deployment with power-efficient planning was proposed with the objective of minimizing the number of UAVs used to provide wireless coverage to all outdoor and indoor users that minimizes the required UAV transmit power and satisfies users’ required data rate. More specifically, the proposed algorithm iteratively invoked a clustering algorithm and an efficient UAV 3D placement algorithm, which aimed for maximum wireless coverage using the minimum number of UAVs while minimizing the required UAV transmit power. Two scenarios where users are uniformly and non-uniformly distributed were considered. The proposed algorithm that employed a Particle Swarm Optimization (PSO)-based clustering algorithm resulted in a lower number of UAVs needed to serve all users compared with that when a K-means clustering algorithm was employed. Furthermore, the proposed algorithm that iteratively invoked a PSO-based clustering algorithm and PSO-based efficient UAV 3D placement algorithms reduced the execution time by a factor of ≈1/17 and ≈1/79, respectively, compared to that when the Genetic Algorithm (GA)-based and Artificial Bees Colony (ABC)-based efficient UAV 3D placement algorithms were employed. For the uniform distribution scenario, it was observed that the proposed algorithm required six UAVs to ensure 100% user coverage, whilst the benchmarker algorithm that utilized Circle Packing Theory (CPT) required five UAVs but at the expense of 67% of coverage density.

Evaluating the Accuracy of Dental Restorations Manufactured by Two CAD/CAM Milling Systems and Their Prototypes Fabricated by 3D Printing Methods: An In Vitro Study

PURPOSE

This in vitro study was conducted to evaluate the marginal accuracy of all-ceramic onlay restorations and prototypes fabricated using additive and subtractive methods.

MATERIALS AND METHODS

Ten typodont first molars were prepared and scanned two times using two different scanners: ARCTICA AutoScan (KaVo Dental) and CEREC Omnicam (Dentsply Sirona). The two groups of virtual models were used to design two groups of virtual onlay restorations using two different CAD software (n = 10 each group) and exported in STL files. Each group of STL files was converted to physical onlay restorations and prototypes by using three different methods; these included two additive manufacturing techniques, stereolithography apparatus (SLA) and digital light processing (DLP), and one subtractive technique, e.max milling using the KaVo Everest system and the Dentsply Sirona inLab MC X5. A digital microscope was used to evaluate the marginal fit around the onlay restorations or prototypes on the typodont teeth.

RESULTS

All evaluated groups showed mean marginal gaps between 59 and 84 μm. No statistically significant differences were found when comparing the marginal accuracy of onlay restorations fabricated by the subtractive method and onlay prototypes from the two additive methods, SLA (P = .70) and DLP (P = .21).

CONCLUSION

All the models evaluated produced marginal gaps within the reported acceptable clinical range. Thus, these subtractive and additive methods may be considered suitable for onlay restoration production.

Evaluation of bactericidal effects of ultraviolet light C irradiation on cariogenic bacteria: An in vitro study

Backgrounds

Ultraviolet light C (UVL-C) irradiation has demonstrated an antimicrobial action against various pathogens. This study aimed to evaluate the bactericidal effect of UVL-C irradiation against cariogenic oral bacteria (Streptococcus mutans) in single layers and colonies grown on solid surfaces.

Methods

Two different experiments were performed. In the first experiment, a single layer of Streptococcus mutans bacteria on agar plates was exposed to UVL-C irradiation at energies from 0 to 21 mWs/cm². The second experiment was conducted to inhibit viability of bacterial colonies on solid surfaces. The samples were derived from saliva from a patient where bacteria were grown on plastic strips and then exposed to UVL-C. The highest energy was 1050 mWs/cm².

Results

Exposure to 21 mWs/cm² was bactericidal in single layers of Streptococcus mutans. The result for bacterial colonies on solid surfaces indicated only a bacteriostatic effect, even at energies of 1050 mWs/cm².

Conclusions

Ultraviolet light C exhibits bactericidal effects on single layers of Streptococcus mutans but has a limited effect on bacterial colonies in a biofilm. It is a matter of debate whether these in vitro results would have the same effect in clinical setting.

Clinical laboratory services for primary healthcare centers in urban cities: a pilot ACO model of ten primary healthcare centers

Background

Primary healthcare centers (PHC) ensure that patients receive comprehensive care from promotion and prevention to treatment, rehabilitation, and palliative care in a familiar environment. It is designed to provide first-contact, continuous, comprehensive, and coordinated patient care that will help achieve equity in the specialty healthcare system. The healthcare in Saudi Arabia is undergoing transformation to Accountable Care Organizations (ACO) model. In order for the Kingdom of Saudi Arabia (KSA) to achieve its transformational goals in healthcare, the improvement of PHCs’ quality and utilization is crucial. An integral part of this service is the laboratory services.

Methods

This paper presents a pilot model for the laboratory services of PHC's in urban cities. The method was based on the FOCUS-PDCA quality improvement method focusing on the pre-analytical phase of the laboratory testing as well as the Saudi Central Board for Accreditation of Healthcare Institutes (CBAHI) gap analysis and readiness within the ten piloted primary healthcare centers.

Results

The Gap analysis, revealed in-consistency in the practice, lead to lower the quality of the service, which was seen in the low performance of the chosen key performance indicators (KPI's) (high rejection rates, lower turn-around times (TAT) for test results) and also in the competency of the staff. Following executing the interventions, and by using some of the ACO Laboratory strategies; the KPI rates were improved, and our results exceeded the targets that we have set to reach during the first year. Also introducing the electronic connectivity improved the TAT KPI and made many of the processes leaner.

Conclusions

Our results revealed that the centralization of PHC's laboratory service to an accredited reference laboratory and implementing the national accreditation standards improved the testing process and lowered the cost, for the mass majority of the routine laboratory testing. Moreover, the model shed the light on how crucial the pre-analytical phase for laboratory quality improvement process, its effect on cost reduction, and the importance of staff competency and utilization.

Effects of the local administration of antibiotics on bone formation on implant surface in animal models: A systematic review and meta-analysis

Purpose

This review aimed to evaluate the effects of the local delivery of antibiotics incorporated in implant surfaces on some quantitative parameters of bone formation.

Materials and methods

An electronic search was undertaken in three databases (PubMed, Scopus, Embase) in addition to hand searching. The search was limited to animal experiments using endosseous implants combined with localized antibiotics release. Meta-analyses were performed for the percentages of bone volume (BV) and bone-to-implant contact (BIC).

Results

Nine studies met the inclusion criteria. Several methods were identified for local delivery of antibiotics at the bone-implant interface, but the most commonly used method was by coating (incorporating the implant surface with the antibiotic agents). Different antibiotic agents were used, namely bacitracin, doxycycline, enoxacin, gentamicin, minocycline, tobramycin, and vancomycin. There was no statistically significant difference in the percentage of BIC between implants with or without localized antibiotic release (P = 0.59). The meta-analysis revealed higher BV around implants coated with antibiotics compared to control groups (without antibiotics) (P < 0.01).

Conclusion

It is suggested that the local administration of antibiotics around implants did not adversely affect the percentage of direct bone contact around implants, with a tendency for a slightly better bone formation around implants when combined with local administration of antibiotics. It is a matter of debate whether these in vivo results will have the same effect in the clinical setting. However, the risk of bias of these studies may, to some extent, question the validity of these results.

Osseointegration effects of local release of strontium ranelate from implant surfaces in rats

BACKGROUND

Numerous studies have reported the beneficial effects of strontium on bone growth, particularly by stimulating osteoblast proliferation and differentiation. Thus, strontium release around implants has been suggested as one possible strategy to enhance implant osseointegration.

AIM

This study aimed to evaluate whether the local release of strontium ranelate (Sr-ranelate) from implants coated with mesoporous titania could improve bone formation around implants in an animal model.

MATERIALS AND METHODS

Mesoporous titania (MT) thin coatings were formed utilizing the evaporation induced self-assembly (EISA) method using Pluronic (P123) with or without the addition of poly propylene glycol (PPG) to create materials with two different pore sizes. The MT was deposited on disks and mini-screws, both made of cp Ti grade IV. Scanning electron microscopy (SEM) was performed to characterize the MT using a Leo Ultra55 FEG instrument (Zeiss, Oberkochen, Germany). The MT was loaded with Sr-ranelate using soaking and the drug uptake and release kinetics to and from the surfaces were evaluated using quartz crystal microbalance with dissipation monitoring (QCM-D) utilizing a Q-sense E4 instrument. For the in vivo experiment, 24 adult rats were analyzed at two time points of implant healing (2 and 6 weeks). Titanium implants shaped as mini screws were coated with MT films and divided into two groups; supplied with Sr-ranelate (test group) and without Sr-ranelate (control group). Four implants (both test and control) were inserted in the tibia of each rat. The in vivo study was evaluated using histomorphometric analyses of the implant/bone interphase using optical microscopy.

RESULTS

SEM images showed the successful formation of evenly distributed MT films covering the entire surface with pore sizes of 6 and 7.2 nm, respectively. The QCM-D analysis revealed an absorption of 3300 ng/cm² of Sr-ranelate on the 7.2 nm MT, which was about 3 times more than the observed amount on the 6 nm MT (1200 ng/cm²). Both groups showed sustained release of Sr-ranelate from MT coated disks. The histomorphometric analysis revealed no significant differences in bone implant contact (BIC) and bone area (BA) between the implants with Sr-ranelate and implants in the control groups after 2 and 6 weeks of healing (BIC with a p-value of 0.43 after 2 weeks and 0.172 after 6 weeks; BA with a p-value of 0.503 after 2 weeks, and 0.088 after 6 weeks). The mean BIC and BA values within the same group showed significant increase among all groups between 2 and 6 weeks.

CONCLUSION

This study could not confirm any positive effects of Sr-ranelate on implant osseointegration.

Effects of Local Drug and Chemical Compound Delivery on Bone Regeneration Around Dental Implants in Animal Models: A Systematic Review and Meta-Analysis

PURPOSE

One of the suggested methods for enhancing osseointegration is the local application of drug agents around implant surfaces. The aim of this review was to evaluate the methods most commonly used for local drug and chemical compound delivery to implant sites and assess their influence on osseointegration.

MATERIALS AND METHODS

An electronic search was undertaken in three databases (PubMed, Scopus, Embase). The search was limited to animal experiments using endosseous implants combined with local drug delivery systems. Meta-analyses were performed for the outcome bone-to-implant contact (BIC).

RESULTS

Sixty-one studies met the inclusion criteria. Calcium phosphate (CaP), bisphosphonates (BPs), and bone morphogenetic proteins (BMPs) were the most commonly used chemical compounds. There were two main methods for local drug delivery at the bone-implant interface: (1) directly from an implant surface by coating or immobilizing techniques, and (2) the local application of drugs to the implant site, using carriers. There was a statistically significant increase in BIC for both local drug delivery methods (P = .02 and P < .0001, respectively) compared with the control methods. There was a statistically significant increase in BIC when CaP (P = .0001) and BMPs (P = .02) were either coating implants or were delivered to the implant site, in comparison to when drugs were not used. The difference was not significant for the use of BPs (P = .15).

CONCLUSION

It is suggested that the use of local chemical compound delivery systems around implants could significantly improve implant osseointegration in animal models. It is a matter of debate whether these in vivo results might have some significant effect in the human clinical setting in the long term.

Measurement and analysis of patient attenuation correction factor during radioiodine therapy

The calculated dose rate from the radioiodine therapy patient should normally include a factor accounting for the attenuation and scatter of patient body tissues. The attenuation factor is currently neglected, and not applied in operational radiation protection. Realistic estimation of radiation dose rate levels from radioiodine therapy patients when properly performed will reduce operational cost and optimise institutional radiation protection practice. In this work, the existence of a patient body tissue attenuation factor is verified by comparing the dose rates measured from the radioiodine capsules immediately before administration with those measured from the patient immediately after administration. The correlation between the factors suspected to influence the patient body tissue attenuation and the measured dose rates from the patient normalised per unit activity is statistically analysed. The calculated attenuation correction factor based on authors' measurements was (0.55 ± 0.17). The measured dose rate per unit of radioactivity from the patient showed a negative correlation with their body mass index.

Trends in radiation protection of positron emission tomography/computed tomography imaging

Over the past decade, the number of positron emission tomography/computed tomography (PET/CT) imaging procedures has increased substantially. This imaging technique provides accurate functional and anatomical information, particularly for oncological applications. Separately, both PET and CT are considered as high-dose imaging modalities. With the increased use of PET/CT, one could expect an increase in radiation doses to staff and patients. As such, major efforts have been made to reduce radiation dose in PET/CT facilities. Variations in working techniques have made it difficult to compare published results. This study aimed to review the literature on proposed methods to reduce patient and staff dose in clinical PET/CT imaging. A brief overview of some published information on staff and patient doses will be analysed and presented. Recent trends regarding radiation protection in PET/CT imaging will be discussed, and practical recommendations for reducing radiation doses to staff and patients will be discussed and summarised. Generally, the CT dose component is often higher in magnitude than the dose from PET alone; as such, focusing on CT dose reduction will decrease the overall patient dose in PET/CT imaging studies. The following factors should be considered in order to reduce the patient's dose from CT alone: proper justification for ordering contrast-enhanced CT; use of automatic exposure control features; use of adaptive statistical iterative reconstruction algorithms; and optimisation of scan parameters, especially scan length. The PET dose component can be reduced by administration of lower activity to the patient, optimisation of the workflow, and appropriate use of protective devices and engineered systems. At the international level, there is wide variation in work practices among institutions. The current observed trends are such that the annual dose limits for radiation workers in PET/CT imaging are unlikely to be exceeded.

Patient entrance surface dose measurements using XR-QA2 Gafchromic films during micturating cystourethrography procedures

The aim of this study was to test the feasibility of using Gafchromic XR-QA2 films in the measurements of patient entrance surface dose (ESD) during the micturating cystourethrogram (MCUG) examination in paediatric patients. Radiochromic films were used to map the entrance dose and to identify the location of peak surface dose (PSD). Direct in vivo measurements of entrance dose were conducted by placing a radiochromic film between the patient and the examination table. The measured ESD values for the commonly performed MCUG fluoroscopic examinations at the authors' institution was in the range of 1.2-7.8 mGy and the PSD in the range of 1.2-8.5 mGy per MCUG procedure for patients with age ranging from 1 to 12 y old. Gafchromic films (XR-QA2) were found to be an efficient and practical dosimetry method that can be easily used to measure clinical patient entrance doses during fluoroscopically guided procedures and potentially in other diagnostic investigations.

In vivo evaluation of a novel implant coating agent: laminin-1

PURPOSE

The aim of this study was to assess the effect of implant coating with laminin-1 on the early stages of osseointegration in vivo.

MATERIALS AND METHODS

Turned titanium implants were coated with the osteoprogenitor-stimulating protein, laminin-1 (TL). Their osteogenic performance was assessed with removal torque, histomorphometry, and nanoindentation in a rabbit model after 2 and 4 weeks. The performance of the test implants was compared with turned control implants (T), alkali- and heat-treated implants (AH), and AH implants coated with laminin-1.

RESULTS

After 2 weeks, TL demonstrated significantly higher removal torque as compared with T and equivalent to AH. Bone area was significantly higher for the test surface after 4 weeks, while no significant changes were detected on the micromechanical properties of the surrounding bone.

CONCLUSIONS

Within the limitations of this study, our results suggest a great potential for laminin-1 as a coating agent. A turned implant surface coated with laminin-1 could enhance osseointegration comparable with a bioactive implant surface while keeping the surface smooth.