Clinical radiology最新文献

Aim: Magnetic resonance imaging (MRI) is the preferred imaging modality for soft-tissue and nonossified bone in paediatric orthopaedics; however, the confines, noise, and prolonged duration may prove challenging. Sedation can mitigate these issues but introduces potential risks of allergic reactions and impact on neurocognitive development. Studies have demonstrated reduced anxiety following Certified Child Life Specialists (CCLSs) intervention during paediatric MRIs. This study presents one institution's experience with CCLS intervention in children undergoing MRIs.

Materials and methods: This single-centre retrospective study reviewed patients from 2016-2024 children aged 4-12 who underwent outpatient orthopaedic MRI were included. CCLS intervention, diagnosis associated with MRI, MRI region, and use of sedation were recorded. Patients were stratified into the pre-CCLS cohort and post-CCLS cohort, based on the presence of CCLS at the institution. Descriptive statistics analysed frequency of sedation.

Results: 1931 patients (2300 scans) were included, with a mean age of 10.0 ± 2.1 years: 708 patients (817 scans) in the pre-CCLS intervention cohort and 1224 patients (1483 scans) in the post-CCLS intervention cohort (one patient was in both groups). Overall, 7/1931 (0.4%) of patients, (7/2300 scans, 0.3%) required IV sedation. 108/1224 patients (116/1483 scans) in the post-CCLS cohort received CCLS intervention; of these, 0/108 patients (0/116 scans) required IV sedation. Mean age was significantly lower in patients receiving CCLS intervention versus no intervention (7.0 ± 2.1 vs 10.0 ± 2.0 years, P < 0.001).

Conclusion: overall sedation rate for children undergoing MRI with CCLS was 0%. Our positive experience supports CCLS as a potential therapeutic intervention for younger children to undergo MRI.

Aim: Vetting is an essential but often overlooked step in radiology workflow. No published data exist on time spent vetting in National Health Service radiology departments. This study aims to quantify vetting times, examine variation by professional role, outcome, modality and referral source and explores the relationship of vetting outcome to professional role and referral source.

Materials and methods: Between April and August 2025, 344 vetting episodes in two tertiary hospitals in the North East and North Cumbria Imaging Network were prospectively observed. Time taken to vet, professional role of the vetter, outcome, referral source, and modality were recorded.

Results: The median vetting time was 31 seconds (IQR: 44.5; range: 4-347). Residents spent the longest time per request (61s, IQR: 79). Vetting times were similar for radiographers/sonographers (30s, IQR: 36) and consultant radiologists (28.5s, IQR: 39). Approved requests were processed fastest (median: 33s) and cancelled requests took longest (71s). Vetting times differed across modalities (H = 91.50, df (5), P<.001), longest for computed tomography (42s) and nuclear medicine (39s), and shortest for ultrasound (11s). Referral source influenced vetting time: musculoskeletal interface clinic were quickest (14s), whereas hospital referral was slowest (44s). Vetting outcomes differed by role (X²(4, N=344) = 34.15, P<.001), with residents approving most requests. Outcomes were similar between consultants and radiographers/sonographers (X²(2, N=278) = 4.46, P=.11). Approval rates varied by referrals source (X²(8, N=344) = 106.93, P<.001)-lowest for general practice (GP) (62 %) and highest for accident and emergency (100 %).

Conclusion: Vetting consumes a substantial amount of time and resources. Quantifying and understanding vetting time are vital for workforce planning and optimising departmental efficiency.

Lung transplantation is an important therapeutic option for patients with end-stage lung disease, significantly improving survival and quality of life. Advances in surgical techniques and posttransplant care have contributed to improved outcomes. However, lung transplantation is associated with a range of complications that occur at different stages postoperatively. This article reviews the key indications for lung transplantation, common surgical techniques, and a major focus is placed on the complications that arise posttransplant, categorised by their timing: immediate, early, intermediate, and late. Radiologists play a pivotal role in identifying these complications, such as pulmonary torsion, primary graft dysfunction, infections, and chronic lung allograft dysfunction. Early recognition and intervention based on imaging findings are essential for improving patient outcomes and extending graft longevity. Understanding the imaging features and clinical manifestations of these complications is crucial in the multidisciplinary management of lung transplant recipients.

Aim: Neoplastic bone lesions show huge divergence. Accurate diagnosis is mandatory for optimal management. Computed tomography (CT) is of special importance in characterisation of bone tumuors, especially in complex anatomical areas and the axial skeleton. This study aimed to test the validity of applying American College of Radiology (ACR) Bone Reporting and Data System (Bone-RADS) in interpreting bony lesions on CT to gain evidence supporting its implementation as a standard in reporting and communication with orthopaedic surgeons.

Materials and methods: This retrospective study involved 336 patients (mean age; 30.3 ± 18.8, 190, 56.5% males) whose CT scans detected neoplastic bony lesions in the period from January 2021 to December 2024. Three radiologists independently reviewed CT exams and set Bone-RADS scores. Inter-reader agreement among the three readers was assessed, and validity of the results was tested.

Results: There were 227 benign, 16 intermediate, and 93 malignant lesions. The overall inter-reader agreement among two musculoskeletal radiologists and one nonmusculoskeletal radiologist was substantial to perfect (k: 0.66 to 1). The diagnostic performance for identifying intermediate or malignant lesions varied among radiologists with sensitivities ranging from 96.8% to 100%, specificities from 62.9% to 92.7%, and accuracies from 74.3% to 94%.

Conclusion: The implementation of ACR Bone-RADS for CT imaging demonstrates robust reproducibility, high sensitivity, and accuracy in characterising bone lesions, thereby enhancing diagnostic confidence and informing clinical decision-making. These findings support the adoption of ACR Bone-RADS as a uniform reporting framework for bone lesions identified on radiographic and CT examinations.

Aim: To report on initial experiences with cholangioscopies via an antegrade transhepatic approach by prior percutaneous insertion of a biliary drainage (PTBD) and tract dilation, describing indications, procedural characteristics, complication rates and peri-interventional laboratory changes.

Materials and methods: This retrospective, single-arm study reviewed patients undergoing cholangioscopy via a PTBD access route in a tertiary hepatobiliary center from September 2020 to June 2023. Data on demographics and prior surgeries as well as clinical indications, pathology, lab values and medical reports were collected for PTBD insertion, drainage upsizing and cholangioscopy procedures. Complications were classified using the CIRSE classification (grade ≥ 3a defined as major). Follow-up time was defined as the interval between cholangioscopy and the last clinical contact.

Results: Thirteen patients (61.5 % female, mean age 58.3 years) underwent 41 interventions, including 13 PTBD insertions, 15 upsizings, and 13 cholangioscopies. The most common indication was cholestasis for PTBD placement and suspected biliary malignancy for cholangioscopy. Technical success was achieved in all procedures. PTBD insertion was associated with decreased bilirubin levels and an increase in CRP, whereas after cholangioscopy CRP remained stable. Overall complication rates were 2.4 % (n=1, relevant cholangitis) for major complications and 17.1 % (n=7, clinically silent infections) for minor complications. Mean follow-up time was 537.5 ± 400.6 days.

Conclusion: Percutaneous antegrade cholangioscopy using PTBD as an access route appears to be a viable and safe alternative in patients in whom the usual endoscopic retrograde approach failed or is anatomically not accessible. Larger, preferably multicenter studies are required to validate these preliminary single-center findings.