Radiography最新文献_第7页

Effect of iodinated contrast media enhancement on size-specific dose estimates in emergency thoracic CT 碘化造影剂增强对急诊胸部CT大小特异性剂量估计的影响

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-31 DOI: 10.1016/j.radi.2025.103308

A. Khallouqi , H. Sekkat , A. Halimi , Y. Madkouri , O. El Rhazouani

Introduction

Accurate estimation of patient radiation dose is crucial in emergency computed tomography (CT), where rapid multiphase imaging is routine. The Size-Specific Dose Estimate (SSDE) incorporates patient size using the water-equivalent diameter (Dw), but standard calculations assume patient size remains constant across scan phases. Contrast administration, however, modifies tissue attenuation and may alter both Dw and SSDE.

Methods

A retrospective analysis of 100 consecutive emergency thoracic CT examinations was conducted, each including non-contrast (C–) and contrast-enhanced (C+) phases. Automatic tube-current modulation was applied for all acquisitions. From 22,000 slice-level observations, the scanner-reported volume CT dose index (CTDIvol), Dw, size-specific conversion factor (f), and SSDE were calculated using AAPM-recommended equations. Phase-wise comparisons were performed using paired t-tests.

Results

Mean SSDE increased from 11.64 ± 1.11 mGy (C–) to 11.96 ± 1.17 mGy (C+), a statistically significant 2.7 % rise (p < 0.001). The apparent cause was a 3.4 % decrease in Dw (21.98 mm → 21.24 mm, p < 0.001), reflecting higher post-contrast attenuation interpreted as smaller patient size. This led to a 2.8 % increase in f, further amplified by the scanner's compensatory increase in tube current.

Conclusion

SSDE is a dynamic rather than static parameter, increasing systematically during contrast-enhanced thoracic CT because of both algorithmic artefacts and real modulation of scanner output. Reliance on a single averaged SSDE across multiphase protocols may underestimate patient dose.

Implications for practice

Phase-specific SSDE reporting provides a more accurate and transparent assessment of patient radiation exposure in emergency CT. Integrating automated, phase-resolved SSDE computation into dose-management systems would enhance clinical decision-making, support protocol optimization, and improve adherence to the ALARA principle in daily radiology practice.

在急诊计算机断层扫描（CT）中，准确估计病人的辐射剂量是至关重要的，在急诊计算机断层扫描中，快速多相成像是常规的。尺寸特定剂量估算（SSDE）使用水当量直径（Dw）纳入患者尺寸，但标准计算假设患者尺寸在扫描阶段保持恒定。然而，造影剂可以改变组织衰减，并可能改变Dw和SSDE。方法回顾性分析连续100例急诊胸部CT检查结果，各检查包括非对比期（C -）和增强期（C+）。自动管电流调制应用于所有采集。根据22,000个切片水平的观察结果，使用aapm推荐的公式计算扫描仪报告的体积CT剂量指数（CTDIvol）、Dw、尺寸特异性转换因子(f)和SSDE。采用配对t检验进行阶段性比较。结果平均SSDE由11.64±1.11 mGy （C -）上升至11.96±1.17 mGy (C+)，上升2.7%，差异有统计学意义（p < 0.001）。明显的原因是Dw下降3.4% (21.98 mm→21.24 mm, p < 0.001)，反映了更高的对比后衰减解释为更小的患者尺寸。这导致f增加2.8%，扫描仪的管电流补偿性增加进一步放大。结论ssde是一个动态参数，而不是静态参数，在胸部CT增强过程中，由于算法伪影和扫描仪输出的真实调制，ssde会系统地增加。在多期方案中依赖单一平均SSDE可能会低估患者的剂量。实践意义特定阶段的SSDE报告为急诊CT患者辐射暴露提供了更准确和透明的评估。在剂量管理系统中集成自动化的、分相的SSDE计算将增强临床决策，支持方案优化，并在日常放射学实践中提高对ALARA原则的遵守。

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引用次数: 0

Comment on "Convolutional neural network application for automated lung cancer detection on chest CT using google AI studio". 点评“基于b谷歌AI studio的卷积神经网络在胸部CT肺癌自动检测中的应用”

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-27 DOI: 10.1016/j.radi.2025.103293

I A Bolaños Bermúdez

引用次数: 0

Evaluating the shoulder toolkit impact on usability, workload, and confidence in novice and expert ultrasound users 评估肩工具包对可用性的影响，工作量，以及新手和专家超声用户的信心

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-26 DOI: 10.1016/j.radi.2025.103291

S. Duhig , A. McKenzie , T. Lakiang , D. Turner

Introduction

Point-of-care ultrasound (POCUS) is widely used for musculoskeletal assessment, yet novice users often lack confidence and consistency. The Shoulder Toolkit (STK) was developed to provide a structured framework for shoulder ultrasound. This study compared the STK with traditional methods among novice and expert users.

Methods

Thirty-three participants (17 novices, 16 experts) performed standardized shoulder examinations using both traditional methods and the STK. Outcomes included participant confidence, satisfaction, usability (System Usability Scale, SUS), user experience (UXS), net promoter score (NPS), workload (NASA-TLX), and image quality (5-point scale). Assessments were conducted pre- and post-examination.

Results

Novices demonstrated significant confidence gains with the STK compared to both pre-examination and traditional methods (p < 0.001). Novice satisfaction was higher with the STK (p = 0.002), whereas experts preferred traditional methods (p = 0.023). Usability increased for all users with the STK (p = 0.003), with novices showing marked improvements (p < 0.001). Experts rated traditional usability higher than novices (p = 0.010), though no group differences were observed for the STK. Novices expressed stronger preference for the STK across learnability, efficiency, utility, and satisfaction (all p < 0.005), with higher likelihood to recommend (p = 0.003). NASA-TLX scores indicated lower mental demand with the STK (p < 0.001), alongside performance and frustration differences between novices and experts under traditional and STK conditions. Experts achieved higher image quality scores than novices (p < 0.001).

Conclusion

The STK enhanced novice confidence, satisfaction, usability, and reduced workload compared to traditional methods, while experts favored traditional examination.

Implications for practice

The STK offers a structured, user-friendly approach that may accelerate novice skill acquisition and promote consistency in musculoskeletal ultrasound, supporting wider adoption of POCUS in clinical practice.

医疗点超声（POCUS）广泛用于肌肉骨骼评估，但新手用户往往缺乏信心和一致性。肩部工具包（STK）的开发是为了提供肩部超声的结构化框架。本研究在新手和专家用户中比较了STK与传统方法。方法33名参与者（17名新手，16名专家）采用传统方法和STK方法进行标准化肩部检查，结果包括参与者信心、满意度、可用性（系统可用性量表，SUS）、用户体验（UXS）、净推荐值（NPS）、工作量（NASA-TLX）和图像质量（5分制）。评估分别在考试前后进行。结果与预检和传统方法相比，新手对STK的信心有了显著提高（p < 0.001）。新手对STK的满意度更高（p = 0.002），而专家更喜欢传统方法（p = 0.023）。使用STK的所有用户的可用性都有所提高（p = 0.003），新手表现出明显的改善（p < 0.001）。专家对传统可用性的评价高于新手（p = 0.010），尽管在STK方面没有观察到组间差异。新手在可学习性、效率、效用和满意度方面对STK表现出更强的偏好（p < 0.005），并且推荐的可能性更高（p = 0.003）。NASA-TLX分数表明，在STK条件下，新手和专家在传统条件和STK条件下的表现和挫败感存在差异（p < 0.001）。专家的图像质量得分高于新手（p < 0.001）。结论与传统考试方法相比，STK提高了新手的自信心、满意度、可用性，减少了工作量，而专家更青睐传统考试方法。STK提供了一种结构化的、用户友好的方法，可以加速新手技能的习得，促进肌肉骨骼超声的一致性，支持POCUS在临床实践中的广泛采用。

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引用次数: 0

Reply to: "comment on 'convolutional neural network application for automated lung cancer detection on chest CT using Google AI Studio'". 回复：“关于“b谷歌AI Studio在胸部CT上卷积神经网络用于肺癌自动检测”的评论”。

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-26 DOI: 10.1016/j.radi.2025.103296

Z Aljneibi, S Almenhali, L Lanca

引用次数: 0

Redefining roadmap imaging in interventional radiology: A roadmap acquisition mode (RAM)/mask recall mode (MRM) classification for standardization and interventional radiographer empowerment. 重新定义介入放射学中的路线图成像：标准化和介入放射技师授权的路线图获取模式(RAM)/掩膜召回模式（MRM）分类。

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-24 DOI: 10.1016/j.radi.2025.103292

L Federico, A Roletto, S Panci, L Manzo, D Montefoschi, L Marcucci, M Tosato, R Gerasia

Introduction: Roadmap imaging is a cornerstone of interventional radiology, providing real-time navigation through contrast-enhanced vascular overlays. However, the terminology and implementation of this technology, particularly regarding the distinction between real-time Roadmap Acquisition Mode (RAM) and retrospective Mask Recall Mode (MRM), vary inconsistently across vendors. This can hinder training, limit reproducibility, and reduce the optimal use of roadmap imaging in high-stakes procedures.

Methods: Eight expert radiographers conducted a narrative review using a triangulated approach that combined literature analysis, vendor manual review, and hands-on evaluation of five state-of-the-art angiography systems. They developed a vendor-neutral RAM vs. MRM classification across seven technical domains, supported by expert-consensus evaluation.

Results: The analysis revealed significant variability in roadmap terminology, system behaviour, and user interface design. Despite system-level differences, the systems could be consistently categorised according to their functional characteristics rather than their proprietary labels. RAM was defined by real-time acquisition with motion-adaptive overlays, while MRM referred to static, retrospectively acquired image masks. To help radiographers select the optimal modality for a given situation while taking into account anatomical dynamics, dose management, and procedural phase, a decision-making flowchart and practical guide were developed.

Conclusion: RAM and MRM are fundamentally distinct modalities that require different application timings and levels of operator expertise. A clear, standardized classification can support safer, more effective use of the roadmap, as well as streamline the procedure.

Implications for practice: This framework positions radiographers as active procedural leaders rather than technical executors. Standardizing roadmap terminology can promote cross-platform skills, improve communication within hybrid teams, and reinforce the interventional radiographer's role in providing dose-conscious, high-efficiency interventional care.

导读：路线图成像是介入放射学的基石，通过对比度增强的血管覆盖提供实时导航。然而，这项技术的术语和实现，特别是关于实时路线图获取模式（RAM）和回顾性掩码召回模式（MRM）之间的区别，在不同的供应商之间差异不一致。这可能会阻碍培训，限制再现性，并减少在高风险手术中路线图成像的最佳使用。方法：8位放射专家采用三角法对5种最先进的血管造影系统进行了综述，该方法结合了文献分析、供应商手工评审和实际评估。在专家共识评估的支持下，他们在七个技术领域开发了一个供应商中立的RAM与MRM分类。结果：分析揭示了路线图术语、系统行为和用户界面设计的显著可变性。尽管系统级别存在差异，但这些系统可以根据其功能特征而不是其专有标签进行一致的分类。RAM是通过实时采集运动自适应覆盖来定义的，而MRM是指静态的，回顾性获取的图像掩模。为了帮助放射技师在考虑解剖动力学、剂量管理和程序阶段的情况下选择最佳的模式，制定了决策流程图和实用指南。结论：RAM和MRM是截然不同的模式，需要不同的应用时间和操作人员的专业知识水平。清晰、标准化的分类可以支持更安全、更有效地使用路线图，并简化程序。对实践的启示：该框架将放射技师定位为积极的程序领导者，而不是技术执行者。标准化路线图术语可以促进跨平台技能，改善混合团队内部的沟通，并加强介入放射技师在提供剂量意识、高效介入护理方面的作用。

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引用次数: 0

Understanding implementation science in medical radiation sciences 了解医学放射科学中的实施科学。

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-23 DOI: 10.1016/j.radi.2025.103288

F. Manning, A. Hancock, R. Meertens, J. Ede

Objectives

Radiography, like many allied health professions, faces persistent challenges in translating evidence and innovation into routine clinical practice. Despite a strong foundation in evidence-based practice, the adoption of new technologies, protocols, and models of care is often inconsistent, delayed, or un-sustained. This paper introduces Implementation science, which offers a key, yet underutilised approach for advancing radiographic practice by focusing on how evidence-based interventions are adopted, integrated, and sustained in real-world settings.

Key findings

We present a conceptual overview of implementation science frameworks with particular relevance to radiography e.g. technology, devices and service improvement. Key frameworks considered include the Consolidated Framework for Implementation Research (CFIR), Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, the Theoretical Domains Framework (TDF), and Normalisation Process Theory (NPT). Each is appraised for its focus, strengths, and applicability to common implementation challenges in radiography. The frameworks highlight different but complementary perspectives, for example CFIR and TDF emphasise multilevel determinants of behaviour and RE-AIM structures evaluation of implementation outcomes. Applied examples from radiography and allied health illustrate how these approaches can be used to diagnose barriers, design strategies, and evaluate implementation efforts.

Conclusion

Implementation science provides a rich methodological and theoretical toolkit for strengthening radiography research. By applying these frameworks, studies can move beyond questions of clinical efficacy to address the practical realities of translation, adoption and sustainability.

Implications for practice

Embedding implementation science within radiographic research, practice, and education can support more systematic and context-sensitive translation. This shift enables the profession to progress from demonstrating clinical potential to delivering sustained improvements in service delivery, patient safety, and professional practice.

目的：放射学，像许多联合卫生专业一样，在将证据和创新转化为常规临床实践方面面临着持续的挑战。尽管在循证实践中有着坚实的基础，但新技术、新方案和新护理模式的采用往往是不一致的、延迟的或不可持续的。本文介绍了实施科学，它通过关注如何在现实环境中采用、整合和维持基于证据的干预措施，为推进放射学实践提供了一个关键但尚未得到充分利用的方法。主要发现：我们提出了实施科学框架的概念性概述，特别是与放射学相关的技术，设备和服务改进。考虑的关键框架包括实施研究综合框架（CFIR），覆盖，有效性，采用，实施和维护（RE-AIM），不采用，放弃，扩大，传播和可持续性（NASSS）框架，理论领域框架（TDF）和正常化过程理论（NPT）。每一个都是评估其重点、优势和适用于放射照相常见的实现挑战。这些框架强调不同但互补的观点，例如CFIR和TDF强调行为的多层次决定因素，RE-AIM则强调对实施结果的评估。来自放射照相和联合医疗的应用示例说明了如何使用这些方法来诊断障碍、设计策略和评估实施工作。结论：实施科学为加强放射学研究提供了丰富的方法和理论工具。通过应用这些框架，研究可以超越临床疗效的问题，解决翻译、采用和可持续性的实际问题。实践意义：在放射学研究、实践和教育中嵌入实施科学可以支持更系统和上下文敏感的翻译。这种转变使专业从展示临床潜力发展到在服务提供、患者安全和专业实践方面持续改进。

{"title":"Understanding implementation science in medical radiation sciences","authors":"F. Manning, A. Hancock, R. Meertens, J. Ede","doi":"10.1016/j.radi.2025.103288","DOIUrl":"10.1016/j.radi.2025.103288","url":null,"abstract":"<div><h3>Objectives</h3><div>Radiography, like many allied health professions, faces persistent challenges in translating evidence and innovation into routine clinical practice. Despite a strong foundation in evidence-based practice, the adoption of new technologies, protocols, and models of care is often inconsistent, delayed, or un-sustained. This paper introduces Implementation science, which offers a key, yet underutilised approach for advancing radiographic practice by focusing on how evidence-based interventions are adopted, integrated, and sustained in real-world settings.</div></div><div><h3>Key findings</h3><div>We present a conceptual overview of implementation science frameworks with particular relevance to radiography e.g. technology, devices and service improvement. Key frameworks considered include the Consolidated Framework for Implementation Research (CFIR), Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, the Theoretical Domains Framework (TDF), and Normalisation Process Theory (NPT). Each is appraised for its focus, strengths, and applicability to common implementation challenges in radiography. The frameworks highlight different but complementary perspectives, for example CFIR and TDF emphasise multilevel determinants of behaviour and RE-AIM structures evaluation of implementation outcomes. Applied examples from radiography and allied health illustrate how these approaches can be used to diagnose barriers, design strategies, and evaluate implementation efforts.</div></div><div><h3>Conclusion</h3><div>Implementation science provides a rich methodological and theoretical toolkit for strengthening radiography research. By applying these frameworks, studies can move beyond questions of clinical efficacy to address the practical realities of translation, adoption and sustainability.</div></div><div><h3>Implications for practice</h3><div>Embedding implementation science within radiographic research, practice, and education can support more systematic and context-sensitive translation. This shift enables the profession to progress from demonstrating clinical potential to delivering sustained improvements in service delivery, patient safety, and professional practice.</div></div>","PeriodicalId":47416,"journal":{"name":"Radiography","volume":"32 2","pages":"Article 103288"},"PeriodicalIF":2.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Methodological trends of community-based participatory radiography research in Singapore 新加坡社区参与式放射学研究的方法学趋势

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-20 DOI: 10.1016/j.radi.2025.103289

A. Mohamed Afif , A.Y.H. Kee, C.P.Y. Lee

Introduction

Community-based participatory research (CBPR) is a vital methodological approach, especially within Singapore’s diverse population. CBPR facilitates engagement from various communities and stakeholders, ensuring relevance to population needs. However, current trends in CBPR within radiography remains unclear. This paper aims to review existing methodological trends in CBPR within radiography to inform future research directions and support translation to clinical practices in Singapore.

Methods

A comprehensive review of published literature indexed from Singapore Health Services database from January 2014 to January 2025 was conducted. Two independent reviewers evaluated each study on its study design, data collection techniques, and analytical strategies. A third reviewer was consulted to reach consensus when discrepancies approach. Quantitative data were analysed using SPSS and thematic analysis was applied to identify methodological patterns in CPBR studies.

Results

A total of 1195 publications were retrieved. After exclusion, 68 radiography-related publications were included in the analysis. Of these, 38 (55.9 %) utilised CBPR approaches. Thematic analysis revealed four key themes: (1) diagnostic studies to evaluate or improve clinical protocols, (2) assessment of new/emerging technologies, (3) implementation of education approaches adapted into practice, and (4) workplace operations assessment and refinement.

Conclusion

CBPR plays a significant role in informing methodological approaches for research projects aimed at enhancing long-term clinical implementation outcomes in diverse populations.

Implication for practice

The CPBR approach is essential to future-proofing technological advancements and ensuring generalisability of research findings to meet population-specific needs.

以社区为基础的参与性研究（CBPR）是一种重要的方法论方法，特别是在新加坡多样化的人口中。CBPR促进了各个社区和利益攸关方的参与，确保了与人口需求的相关性。然而，目前放射学中CBPR的趋势仍不清楚。本文旨在回顾放射学中CBPR的现有方法学趋势，以告知未来的研究方向，并支持新加坡临床实践的翻译。方法对2014年1月至2025年1月新加坡卫生服务数据库收录的已发表文献进行综合分析。两名独立审稿人对每项研究的研究设计、数据收集技术和分析策略进行了评估。当出现差异时，咨询第三位审稿人以达成一致意见。采用SPSS软件对定量数据进行分析，并采用专题分析来确定CPBR研究的方法模式。结果共检索文献1195篇。排除后，68篇与放射学相关的出版物被纳入分析。其中38例（55.9%）采用CBPR方法。专题分析揭示了四个关键主题：(1)评估或改进临床方案的诊断研究；(2)评估新/新兴技术；(3)实施适应实践的教育方法；(4)工作场所操作评估和改进。结论cbpr在研究项目的方法学研究中发挥着重要作用，旨在提高不同人群的长期临床实施结果。CPBR方法对于未来的技术进步和确保研究成果的普遍性以满足特定人群的需求至关重要。

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引用次数: 0

Navigating sonographer work-integrated learning: A thematic analysis of workforce pressures, training barriers and student wellbeing 导航超声工作集成学习：劳动力压力，培训障碍和学生福利的专题分析

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-20 DOI: 10.1016/j.radi.2025.103290

P. Boucaut , R. Tunny , K. McMahon , B. Osborne , K. Lamb , J. Wardle , T. Reddan , C. Edwards

Introduction

Sonography Work-Integrated Learning (WIL) is increasingly challenged by workforce shortages, high service demands, and limited supervisory capacity. Despite WIL's critical role in sonographer education pathways, there is limited empirical understanding of how these pressures are experienced by trainees and clinical supervisors, whose insights are vital for shaping meaningful and practical reforms. This study addresses that gap.

Methods

Between July and November 2024, an online Qualtrics survey gathered insights from trainee sonographers and clinical supervisors across Australia who had participated in WIL within the past 12 months. Participants were recruited through professional contacts, sector networks and online platforms. Open-ended questions explored barriers, training challenges, support needs, and wellbeing. Responses were analyzed using reflexive thematic analysis to identify key themes.

Results

A total of 431 participants completed the survey: 266 clinical supervisors (62 %) and 165 trainee sonographers (38 %). Findings revealed that the clinical training environment is shaped by a complex interplay of structural, systemic, and institutional challenges, resulting in a network of interconnected pressures. These pressures place a substantial, and often underestimated, emotional and cognitive burden on sonography trainees. Respondents called for enhanced support systems, formal recognition and targeted training of clinical supervisors, and prioritization of educational outcomes and trainee wellbeing during WIL. The study underscores the need for sector-wide collaboration and sustained investment to address these challenges.

Conclusion

WIL must be reimagined to foster supportive, effective learning environments that reflect the clinical environmental realities.

Implications for practice

Without urgent reforms, trainee sonographer wellbeing and workforce sustainability are at risk.

超声工作集成学习（WIL）日益受到劳动力短缺、高服务需求和有限监督能力的挑战。尽管WIL在超声医师教育途径中发挥着关键作用，但对实习生和临床主管如何经历这些压力的经验理解有限，他们的见解对于形成有意义和实际的改革至关重要。这项研究解决了这一差距。方法：在2024年7月至11月期间，一项在线Qualtrics调查收集了澳大利亚各地在过去12个月内参加过WIL的实习超声医师和临床监督员的见解。参与者是通过专业联系、行业网络和在线平台招募的。开放式问题探讨了障碍、培训挑战、支持需求和幸福感。使用反身性主题分析来分析回应，以确定关键主题。结果共431人完成调查，其中临床督导266人（62%），实习超声技师165人（38%）。研究结果表明，临床培训环境是由结构性、系统性和制度性挑战的复杂相互作用形成的，形成了一个相互关联的压力网络。这些压力给超声受训者带来了巨大的、往往被低估的情感和认知负担。受访者呼吁加强支持系统，对临床督导人员进行正式认可和有针对性的培训，并在临床实习期间优先考虑教育成果和实习生的福祉。该研究强调需要全部门合作和持续投资来应对这些挑战。结论必须重新构想人工智能，以培养反映临床环境现实的支持性、有效的学习环境。如果不进行紧急改革，实习超声医师的福祉和劳动力的可持续性将面临风险。

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引用次数: 0

Patients' radiation exposure during TIPS creation in a high-volume referral hospital. 大容量转诊医院TIPS创建期间患者的辐射暴露

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-19 DOI: 10.1016/j.radi.2025.103287

R Gerasia, R Miraglia, L Maruzzelli, D Coppolino, G Fiorello, C M Giacchetto, A Galante, C Celsa, C Cammà, V Calvaruso

Introduction: Transjugular Intrahepatic Portosystemic Shunt (TIPS) creation is one of the most complex and radiation-intensive procedures in abdominal interventional radiology. Radiation-induced skin injuries may occur at doses above 2 Gy. This study aimed to evaluate patient radiation exposure during TIPS performed in a single high-volume referral center (>20 procedures/year).

Methods: A retrospective review was conducted of 359 consecutive TIPS performed between July 2017 and December 2024. Real-time ultrasound guidance was systematically used for portal vein targeting. Radiation exposure was assessed using cumulative air kerma at the interventional reference point (Ka,r) and fluoroscopy time (XrT). Data were analyzed according to patient body mass index (BMI) and angiographic equipment.

Results: The mean Ka,r was 0.18 ± 0.22 Gy, with a maximum of 1.56 Gy. No patient exceeded the 2 Gy trigger level, and no skin injuries were reported at follow-up. Mean XrT was 775 ± 606 s, with only two cases exceeding 60 min (cumulative Ka,r 0.15 ± 0.18 Gy vs 0.24 ± 0.27 Gy, p = 0.0004). Obese patients showed higher Ka,r values (p < 0.0001), although none reached the 2 Gy threshold.

Conclusion: Radiation exposure during TIPS creation in this high-volume center remained consistently below thresholds associated with skin injury, even in obese or complex patients.

Implications for practice: Performing TIPS in high-volume referral centers with systematic ultrasound guidance and optimized low-dose protocols can maintain radiation exposure well below harmful thresholds with respect to tissue effects, even in complex patients. These findings emphasize not only the need for structured radiation protection strategies and centralization of complex procedures, but also the active involvement of all professionals responsible for radiation safety whose expertise is crucial in dose optimization and ensuring the highest standards of patient care. LEVELS OF EVIDENCE 2B: retrospective cohort study.

简介：经颈静脉肝内门静脉系统分流术（TIPS）的创建是腹部介入放射学中最复杂和辐射密集的手术之一。剂量超过2戈瑞时，可能发生辐射引起的皮肤损伤。本研究旨在评估在单个大容量转诊中心（bbb20例/年）进行TIPS期间患者的辐射暴露情况。方法：对2017年7月至2024年12月连续359例TIPS进行回顾性分析。系统应用实时超声引导门静脉定位。使用介入参考点（Ka,r）的累积空气角度和透视时间（XrT）评估辐射暴露。根据患者身体质量指数（BMI）和血管造影设备对数据进行分析。结果：平均Ka，r为0.18±0.22 Gy，最大值为1.56 Gy。无患者超过2 Gy触发水平，随访时无皮肤损伤报告。平均XrT为775±606 s，仅有2例超过60 min（累积Ka，r 0.15±0.18 Gy vs 0.24±0.27 Gy, p = 0.0004）。肥胖患者的Ka，r值较高（p < 0.0001），但没有患者达到2 Gy的阈值。结论：在这个高容量中心，即使在肥胖或复杂的患者中，TIPS创建期间的辐射暴露始终低于与皮肤损伤相关的阈值。实践意义：在大容量转诊中心，采用系统超声引导和优化的低剂量方案，即使在复杂的患者中，也可以将辐射暴露维持在远低于有害组织效应阈值的水平。这些发现强调，不仅需要结构化的辐射防护策略和复杂程序的集中化，而且还需要负责辐射安全的所有专业人员的积极参与，他们的专业知识对剂量优化和确保最高标准的患者护理至关重要。证据水平2B：回顾性队列研究。

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引用次数: 0

Departmental audit on immobilisation in a small cohort of patients with lower limb sarcoma 一个小队列下肢肉瘤患者固定治疗的部门审计

IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Radiography

Pub Date : 2025-12-19 DOI: 10.1016/j.radi.2025.103276

B. Tabet, C. David, S. Moinuddin, F. Le Grange, M. Ahmed, H. Grimes, D. Marsh, R. Simões

Introduction

The aim of this piece of work was to audit the immobilisation and Genital Displacement Device (GDD) setup for patients with limb sarcoma.

Methods

Ten male and ten female patients treated between 2022 and 2023 had their translational shifts retrospectively reviewed. Position of external genitalia was assessed on CBCTs against the outlined structure on the planning scan and categorised according to a traffic light system.

Results

581 images were reviewed in which 81.2 % of translational shifts were within tolerance. One patient had all shifts below 5 mm. However, three patients had 33.3 %, 44 % and 60 % of shifts out of tolerance. Overall, only 2.6 % of translational shifts were above 1 cm. The highest number of re-setups during a course of treatment was 3. PTV length, treatment site and number of shells were identified as impactful factors for large shifts. The GDDs performed well, with 92 % of CBCTs falling in the green or amber category, meaning that the genitals were not encroaching on the PTV. Only 3 CBCT's were categorised as red, with one patient requiring a re-setup due to position of external genitalia.

Conclusion

The shifts may be skewed due to 2 patients with large shifts. These patients could have benefited from systematic shift corrections as the magnitude and direction of the shifts were consistent. However, the immobilisation system is effective in the majority of patients. The GDDs were successful in limiting mobility of external genitalia in most cases.

Implications for practice

The clinical implementation of the traffic light system developed in this audit may be beneficial to standardise the analysis of the displacement of the genitals away from the PTV.

这篇文章的目的是审核肢体肉瘤患者的固定和生殖器移位装置（GDD）设置。方法回顾性分析2022 - 2023年间收治的10例男性和10例女性患者的转译转变情况。外生殖器的位置在cbct上根据规划扫描的轮廓结构进行评估，并根据交通灯系统进行分类。结果581张图像中，81.2%的平移位移在公差范围内。1例患者移位均小于5毫米。然而，有3例患者有33.3%、44%和60%的转移超出耐受性。总体而言，只有2.6%的平移位移超过1厘米。在一个疗程中，重新设置的最高次数为3次。PTV长度、处理地点和壳数被确定为大位移的影响因素。gdd表现良好，92%的cbct属于绿色或琥珀色，这意味着生殖器没有侵犯PTV。只有3个CBCT被归类为红色，其中一个患者由于外生殖器的位置需要重新设置。结论2例患者排班较大，排班可能出现偏斜。这些患者可以受益于系统的移位校正，因为移位的幅度和方向是一致的。然而，固定系统对大多数患者是有效的。在大多数情况下，GDDs成功地限制了外生殖器的活动。对实践的启示本审计中开发的红绿灯系统的临床实施可能有利于对生殖器远离PTV的位移的标准化分析。

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