bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prenatal prediction of respiratory distress syndrome by multimodality approach using 3D lung ultrasound, lung-to-liver intensity ratio tissue histogram and pulmonary artery Doppler assessment of fetal lung maturity
Authors: Khalifa Yasmin Essameldin abdalla , Aboulghar Mona M , Hamed Soha T , Tomerak Rania H , Asfour Ahmed M , Kamal Eman F 
Published: September 2021

Objective: Studying the correlation of different lung parameters, using three-dimensional ultrasound (3D US) with fetal lung maturity (FLM) to predict the development of neonatal respiratory distress syndrome (RDS). Methods: Three-dimensional ultrasound was done to record the fetal lung volume (FLV), fetal lung-to-liver intensity ratio (FLLIR) and the main pulmonary artery (MPA) blood flow parameters; pulsatility index (PI), resistive index (RI) and acceleration time-to-ejection time ratio (At/Et), to 218 women between 32 and 40 weeks gestational age within 24 h from labor. Results: Of 218 fetuses examined, final analysis was done for 143 fetuses. Thirty eight (26.5%) were diagnosed with RDS. The MPA PI and RI were significantly higher in fetuses diagnosed with RDS compared with those without (2.51 ± 0.33 and 0.90 ± 0.03 cm/s versus 1.96 ± 0.20 and 0.84 ± 0.01 cm/s; p value < 0.001 and <0.001 respectively). MPA At/Et was significantly lower (0.24 ± 0.04 vs 0.35 ± 0.04; p value < 0.001). FLLIR was significantly lower (1.04 ± 0.07 vs 1.18 ± 0.11; p value < 0.001), and the mean FLV was significantly smaller (28.23 ± 5.63, vs 38.87 ± 4.68 cm3; p value < 0.001). Conclusion: Main pulmonary artery (PI, RI, At/Et ratio), FLIIR, and mean FLV can be used as reliable predictors of neonatal RDS. Advances in knowledge: 3D ultrasound VOCAL technique, ultrasound tissue histogram and pulmonary artery Doppler are reliable tools for prenatal prediction of fetal lung maturity.
Occupational radiation exposure in doctors: an analysis of exposure rates over 25 years
Authors: Sharkey Amy R , Gambhir Parthivi , Saraskani Sepas , Walker Ross , Hajilou Ashcaan , Bassett Paul , Sandhu Navneet , Croasdale Peter , Honey Ian , Diamantopoulos Athanasios , Goh Vicky 
Published: September 2021

Objectives: Healthcare professionals’ occupational exposure to ionising radiation may be increasing due to increasing use of imaging and image-guided intervention. This study aims to assess the occupational exposure of doctors over a 25-year period at an NHS teaching hospital. Methods: Dosemeter measurements were collected prospectively from 1995 to 2019. Two retrospective analyses were performed over time (first including all measurements, second excluding “zero-dose” measurements), and by speciality. Group comparisons were undertaken using multilevel linear regression; a p-value <0.05 was deemed significant. Results: 8,892 measurements (3,983 body, 1,514 collar, 649 eye, 2,846 hand), of which 3,350 were non-zero measurements (1,541 body, 883 collar, 155 eye, 771 hand), were included. Whole dataset analysis found a significant decrease in exposure for radiologists and cardiologists, as measured by body, hand and collar dosemeters over the last 25 years (p < 0.01 for all). The non-zero readings reflect the whole cohort analysis except in the case of eye dosemeters, which showed a significant decrease in exposure for cardiologists (p < 0.01), but a significant increase for radiologists and surgeons/anaesthetists (p < 0.01 for both). Conclusions: Whilst ionising radiation remains an occupational risk for doctors, the overall decreasing trend in occupational exposure is reassuring. However, a significant rise in eye dose for radiologists, surgeons and anaesthetists is concerning, and close monitoring is required to prevent future issues. Advances in knowledge: This paper is one of few evaluating the occupational radiation exposure to doctors over a 25-year period, showing that although most dosemeter measurements reflect decreasing exposure, the increase in eye exposure warrants caution.
A case-control study of airborne dissemination of bacteria during CT colonography
Authors: Taylor Alasdair , Williams Craig , Brown Amy 
Published: September 2021

Objectives: The COVID-19 pandemic has highlighted the importance of aerosol spread of infection. We have conducted a study to detect bacterial contamination of room surfaces and room air during CT colonography and confirm the efficacy of room disinfection procedures carried out between examinations. Methods: Systematic sampling of the CT examination couch and horizontal surfaces 1 m and 3 m from the couch was performed before and after patient examinations. A 1 m3 sample of room air was obtained during patient examinations. Samples were processed using routine laboratory methods. A case–control study design was used (30 CT colonography and 30 routine body CT scans). Results: Evidence of airborne dissemination of bacteria was detected in >30% of CT colonography examinations and <10% of control examinations (p = 0.01). No pathogenic bacteria were detected in surface samples taken before patient examinations. Conclusion: The room disinfection policy in use in our CT department is effective in eliminating pathogenic bacteria from surfaces in the patient environment. CT colonography causes contamination of room air with enteric bacteria in a significant proportion of cases. Advances in knowledge: CT colonography may possibly be an aerosol-generating procedure. Larger-scale investigation is needed to fully evaluate this potential infection risk.
MRI-guided focal boost to dominant intraprostatic lesion using volumetric modulated arc therapy in prostate cancer. Results of a phase II trial
Authors: Zapatero Almudena , Roch Maria , Castro Tejero Pablo , Büchser David , Martin de Vidales Carmen , González Saturnino , Rodríguez Pablo , San Jose Luis Alberto , Celada Guillermo , Murillo Maria Teresa 
Published: September 2021

Objective:
To determine morphological and biological control as well as toxicity and quality of life (QoL) of men with localized prostate cancer (PCa) treated with MRI-guided focal boost radiotherapy.

Material and Methods:
30 patients with PCa and a visible dominant intraprostatic lesion (DIL) identified on mpMRI were included in a prospective Phase II trial. Matching point registration of planning CT and T2W, diffusion-weighted and a gradient-recalled echo (GRE) MRI images made in treatment position was used for prostate and tumour delineation. Treatment consisted on 35 daily fractions of 2.17 Gy with a concomitant focal boost to the DIL of 2.43 Gy using volumetric modulated arc therapy (VMAT) and image-guided radiation therapy (IGRT) with intraprostatic fiducial markers. Biochemical failure was analysed using PSA nadir +2 ng/mL criteria and local control using mpMRI evaluation at 6–9 months following RT. Acute and late toxicity were defined according to CTCAE v.4.0 and RTOG/EORTC scales and QoL was assessed using IPSS, EPIC short-form and UCLA-PCI questionnaires.

Results:
The median radiation dose to the prostate was 77.6 Gy (IQR 77.3–78.1), and to the DIL was 85.5 Gy (IQR 85.0–86.0). With a median follow up of 30.0 months (IQR 25.5–40.27), all patients remain free of biochemical relapse. An mpMRI complete response was observed in 25 patients during the first post-treatment evaluation at 6 months. The remaining five patients achieved a complete disappearance of the DIL both on T2 and DWI on the second mpMRI performed at 9 months following treatment. Six out of 30 (20%) patients presented acute Grade 2 urinary toxicity with no Grade 3 acute complications. Acute rectal toxicity was only found in 2 (6.6%) patients (both Grade 1). Only late Grade 1 urinary and rectal complications were observed in 3/30 patients, respectively, with no Grade 2 or more late toxicity. The urinary, bowel and sexual bother EPIC scores were slightly and insignificantly increased in the first 3 months post-treatment, returning to normal afterwards.

Conclusions:
mpMRI-guided focal boost using VMAT hypofractionated technique is associated with an excellent morphological and functional response control and a safe toxicity profile.

Advances in knowledge:
In the present trial, we examined the potential role of mpMRI for radiological assessment (functional and morphological) of treatment response in high-risk prostate cancer patients treated with MRI-guided focal radiotherapy dose intensification to dominant Intraprostatic lesion.
Duration of acute esophageal toxicity in concomitant radio-chemotherapy for non-small cell lung cancer with different fractionation schedules
Authors: Socha Joanna , Wasilewska-Teśluk Ewa , Stando Rafal , Kuncman Lukasz , Kepka Lucyna 
Published: September 2021

Objectives: In our previous prospective trial on accelerated hypofractionated concomitant radiochemotherapy (AHRT-CHT) for non-small-cell lung cancer (NSCLC), the incidence of grade ≥3 acute esophageal toxicity (AET) was similar to that reported for conventionally fractionated concomitant radiochemotherapy (CFRT-CHT), but its duration was prolonged. Thus, we aimed to compare the duration of grade ≥3 AET between AHRT-CHT and CFRT-CHT. Methods: Clinical data of 76 NSCLC patients treated with CFRT-CHT (60–66 Gy/2 Gy) during 2015–2020 were retrospectively compared with the data of 92 patients treated with AHRT-CHT (58.8 Gy/2.8 Gy) in the prospective trial. The maximum grade of AET, incidence, and duration of grade ≥3 AET were the end points. Univariate and multivariate analyses were applied to correlate clinical and treatment variables with these end points. Results: Neither the maximum grade of AET (p = 0.71), nor the incidence of grade ≥3 AET (p = 0.87) differed between the two groups. The number of CHT cycles delivered (2 vs 1, p = 0.005) and higher esophagus mean BED (p = 0.009) were significant predictors for a higher maximum grade of AET; older age was a significant predictor for higher incidence of grade ≥3 AET (p = 0.03). The median duration of grade ≥3 AET in AHRT-CHT and CFRT-CHT group was 30 days (range 5-150) vs 7 days (range 3–20), respectively, p = 0.0005. In multivariate analysis, only the AHRT-CHT schedule (p=0.003) was a significant predictor for a longer duration of grade ≥3 AET. Conclusion Despite similar incidence of grade ≥3 AET, its duration is significantly prolonged in NSCLC patients treated with AHRT-CHT compared to CFRT-CHT. Advances in knowledge Reporting only the rate of grade ≥3 AET in clinical trials may underestimate the real extent of the esophageal toxicity; its duration should also be routinely reported.
Diagnostic performance of radiologists with different levels of experience in the interpretation of MRI of the placenta accreta spectrum disorder
Authors: Ghezzi Caroline Lorenzoni Almeida , Silva Cristiano Kohler , Casagrande Aline Spader , Westphalen Stephanie Sander , Salazar Cristiano Caetano , Vettorazzi Janete 
Published: September 2021

Objectives: There have been no investigations on the association between previous abdominopelvic MRI experience without placental MRI experience and diagnostic accuracy of placenta accreta spectrum (PAS). To evaluate the diagnostic performance of radiologists with different experience levels in interpreting PAS-related MRI findings. Methods: This retrospective study included 60 women who underwent MRI for placental assessment between 2016 and 2020. MR images were reviewed by four radiologists who were blinded to the clinical outcomes and had different experience levels in interpreting PAS-related MRI findings. The radiologists’ diagnostic performance was evaluated according to the pathologic and surgical outcomes. Simple κ statistics were calculated to determine agreement among the radiologists. Results: Of 60 women, 46 were diagnosed with PAS. The maternal age mean ± SD was 33.0 years ± 5.0 for the PAS absent group and 36.0 ± 4.3 for the PAS present group (p = 0.013). Overall, the most experienced radiologist had the highest sensitivity (100%, 95% confidence interval (CI): 92.3–100%) and NPV (100%, 95% CI: 63.1–100%) in PAS diagnoses. However, the PPV and specificity were independent of experience. The most experienced radiologist had the highest diagnostic accuracy in PAS (90%, 95% CI: 79.5–96.2%) and placenta percreta (95%, 95% CI: 86.1–99.0%). There was a strong association between definitive PAS diagnoses and the highest experience level. The κ values for the interobserver agreement regarding PAS diagnoses were 0.67 for the most experienced radiologist (p < 0.001) and 0.38, 0.40, and 0.43 for the other radiologists (p = 0.001) and regarding placenta percreta diagnoses were 0.87 for the senior radiologist (p < 0.001) and 0.63, 0.57, and 0.62 for the other radiologists (p < 0.001). Conclusion: Previous experience in interpreting PAS-related MRI findings plays a significant role in accurately interpreting such imaging findings. Previous abdominopelvic MRI experience without specific placental MRI experience did not improve diagnostic performance. Advances in knowledge: We believe that our study makes a significant contribution to the literature and that this paper will be of interest to the readership of your journal because to the best of our knowledge, this study is the first in which the correlation between previous experience in abdominopelvic MRI with no specific experience in PAS-related MRI and diagnostic accuracy of radiologists has been explored. Our results could aid in setting up specialized multidisciplinary teams to assist women with PAS disorders.
Serial changes in tumour measurements and apparent diffusion coefficients in prostate cancer patients on active surveillance with and without histopathological progression
Authors: Sushentsev Nikita , Caglic Iztok , Rundo Leonardo , Kozlov Vasily , Sala Evis , Gnanapragasam Vincent J , Barrett Tristan 
Published: September 2021

Objective:
To analyse serial changes in MRI-derived tumour measurements and apparent diffusion coefficient (ADC) values in prostate cancer (PCa) patients on active surveillance (AS) with and without histopathological disease progression.

Methods:
This study included AS patients with biopsy-proven PCa with a minimum of two consecutive MR examinations and at least one repeat targeted biopsy. Tumour volumes, largest axial two-dimensional (2D) surface areas, and maximum diameters were measured on T 2 weighted images (T 2WI). ADC values were derived from the whole lesions, 2D areas, and small-volume regions of interest (ROIs) where tumours were most conspicuous. Areas under the ROC curve (AUCs) were calculated for combinations of T 2WI and ADC parameters with optimal specificity and sensitivity.

Results:
60 patients (30 progressors and 30 non-progressors) were included. In progressors, T 2WI-derived tumour volume, 2D surface area, and maximum tumour diameter had a median increase of +99.5%,+55.3%, and +21.7% compared to +29.2%,+8.1%, and +6.9% in non-progressors (p &lt; 0.005 for all). Follow-up whole-volume and small-volume ROIs ADC values were significantly reduced in progressors (−11.7% and −9.5%) compared to non-progressors (−6.1% and −1.6%) (p &lt; 0.05 for both). The combined AUC of a relative increase in maximum tumour diameter by 20% and reduction in small-volume ADC by 10% was 0.67.

Conclusion:
AS patients show significant differences in tumour measurements and ADC values between those with and without histopathological disease progression.

Advances in knowledge:
This paper proposes specific clinical cut-offs for T 2WI-derived maximum tumour diameter (+20%) and small-volume ADC (−10%) to predict histopathological PCa progression on AS and supplement subjective serial MRI assessment.
CT Hounsfield unit and histogram analysis for differentiation of recent versus remote vertebral compression fractures
Authors: Ryoo Chang Hyun , Chai Jee Won , Hong Sung Hwan , Choi Ja-Young , Yoo Hye Jin , Chae Hee Dong 
Published: September 2021

Objectives: The purpose of this study was to analyze the intraosseous tissue changes in recent vertebral compression fractures (VCFs) and to differentiate recent from remote VCFs using CT Hounsfield unit histogram analysis (HUHA). Methods: 65 patients with T11 to L3 VCFs were included. HUHA of 2 vertebral bodies (VBs)— a fractured VB and the closest lower-level unaffected VB—was done. The mean Hounsfield unit (HU) value and HU proportions of 5 ranges (HU ≤ 0, 0 < HU ≤ 50, 50 < HU ≤ 100, 100 < HU ≤ 150, and HU > 150) were obtained. Then, ΔHU value and ΔHU proportion were calculated by subtracting the values from the two vertebrae. Finally, the obtained values were compared between the recent and remote VCF groups and subjected to ROC curve analysis. Results: In recent VCF group, the ΔHU proportion (HU ≤ 0) corresponding to normal fatty marrow was lower (-0.17 vs 0.01) and the ΔHU proportion (HU > 150) representing trabecular bone was higher (0.23 vs 0.04) than in remote VCF group (p < 0.001). In the differentiation of recent from remote VCF, the ΔHU value and ΔHU proportion (HU > 150) showed high area under the curve (AUC, 0.939 and 0.912, respectively). Conclusion: CT HUHA demonstrated both trabecular bone and bone marrow changes in recent VCFs, and showed high diagnostic performance in differentiating between recent and remote VCFs. Advances in knowledge: With its vendor neutral applicability, CT HUHA can be used for the differentiation of recent and remote VCFs.
National Diagnostic Reference Level (DRL) for nuclear medicine computed tomography–positron emission tomography hybrid imaging studies for kuwait population: second phase dose audit-2019
Authors: Masoomi Michael , Al-Shammeri Iman , Al-Kandari Latifah , Elrahman Hany , Al-Shammeri Jehan 
Published: September 2021

Objective: Diagnostic reference levels (DRLs) for CT part of positron emission tomography-CT (PET-CT) examinations are limited. The study was aiming to execute the second phase of the national DRL in support of optimisation and dose reduction in State of KW. Methods: In this multicentre collaborative PET-CT study, oncology patient data were exclusively collected due to the National MOH Ethical Committee recommendation and limitation of the other studies. Median, Mean, SD, 75th, 25th percentiles as well as whole body (WB) effective dose (ED) were calculated. The study was UK-IPEM-based methodology and it was the second phase of the study in Kuwait. Results: Half body (HB) and WB scans were 65 and 35% of the total enterers (309). The third quartile dose–length product (DLP) (mGy x cm) and volumetric CT dose index (mGy) values for the HB (537, 5) were higher than the UK NDRL (400, 4.3) but were lower than the Swiss NDRL (620, 6) and the France NDRL (762, 7.7). Comparatively, the proposed NDRLs for the WB (684, 4.1) were lower than Swiss National Data (720, 5.0) though, the Swiss had about 5000 (HB) & 706 (WB), the UK had 370 (HB) and France had 1000 (HB) entries. Calculated ED varied from 4.1 to 10.2 mSv, (mean values = 6.9 mSv) for HB and from 2.6 to 7 mSv (mean value = 4.6 mSv). Conclusions: There was 9.1% improvement in NDRL for 2019, compared to 2018, but there is a continuous need for improving NDRL. Advances in knowledge: Data provided a trend of NDRL that is served as a national data bank for continuous optimisation.
Predicting factors for primary cervical cancer recurrence after definitive radiation therapy
Authors: Okubo Mitsuru , Itonaga Tomohiro , Saito Tatsuhiko , Shiraishi Sachika , Yunaiyama Daisuke , Mikami Ryuji , Sakurada Akira , Sugahara Shinji , Tokuuye Koichi , Saito Kazuhiro 
Published: September 2021

Objectives:
The study aimed to retrospectively investigate the apparent diffusion coefficient (ADC) of primary cervical cancer to examine the recurrence correlations in patients treated with radiotherapy (RT).

Methods:
The ADC of 31 patients with cervical cancer treated with RT were analyzed as possible risk factors for recurrence. A receiver operating characteristic (ROC) curve of the mean ADC (ADCmean) for the recurrence was generated to determine the cut-off value that yielded optimal sensitivity and specificity. The patient population was subdivided according to the risk factors for recurrence, and the disease-free survival (DFS) was analyzed. The following were investigated to explore the risk factors for recurrence: age, performance status, stage, pelvic lymph node metastasis, histologic tumor grade, maximal diameter of the primary tumor, chemotherapy, and ADCmean.

Results:
The median follow-up duration of the patients was 25 months. The recurrence was recognized in 9 (29%) of the 31 cases. The ROC analysis of recurrence showed that the area under the ADCmean curve was 0.889 (95% CI, 0.771–1.000; p = 0.001). The cut-off value of ADC mean was 0.900 × 10− 3 mm2/s, with a sensitivity of 86.4% and a specificity of 88.9%. By univariate analysis, the ADCmean was the only factor significantly associated with recurrence.

Conclusion:
The ADCmean of the primary tumor is a potential predictive factor for the recurrence in of cervical cancer.

Advances in knowledge:
The ADCmean of the primary tumor is a predictor of recurrence in patients with pre-treatment cervical cancer evaluation.
Diagnosis of cognitive disorders in primary health care in Poland
Authors: Chmiela Tomasz , Dobrakowski Paweł , Łabuz-Roszak Beata , Gorzkowska Agnieszka 
Published: September 2021

Cel pracyCelem niniejszej pracy była ocena wiedzy i postaw oraz zasad postępowania lekarzy podstawowej opieki zdrowotnej (POZ) w Polsce w zakresie przesiewowej diagnostyki w kierunku zaburzeń funkcji poznawczych u osób w wieku podeszłym.MetodaBadaniem objęto 175 lekarzy zatrudnionych w POZ. Wykorzystano walidowaną autorską ankietę. Badanie przeprowadzono metodą PAPI (bezpośredni wywiad z wykorzystaniem papierowej wersji kwestionariusza) oraz CAWI (wspomagany komputerowo wywiad przy pomocy strony internetowej).WynikiZdecydowana większość badanych (n=159; 91,4%) widziała celowość prowadzenia badań przesiewowych w kierunku zaburzeń poznawczych w grupie wiekowej >65 r.ż., jednak tylko 53 osoby (30,29%) uważały, że badania te powinny być prowadzone przez lekarzy POZ. Wg ankietowanych lekarzy główną przeszkodą w diagnostyce funkcji poznawczych jest brak czasu – tak uważało 142 (81,14%) respondentów. W sytuacji podejrzenia otępienia ankietowani zwykle zlecali badania laboratoryjne oraz kierowali pacjentów do specjalisty neurologa (n=111; 63,4%). Najbardziej znanymi skalami oceniającymi funkcje poznawcze były w badanej grupie Krótka Skala Oceny Stanu Psychicznego (ang. Mini Mental Status Examination, MMSE), którą znało 120 lekarzy (68,57%), oraz Test Rysowania Zegara (ang. Clock Drawing Test, CDT), który był znany 122 ankietowanym (69,71%).WnioskiLekarze POZ mają świadomość konieczności badań przesiewowych w kierunku zaburzeń poznawczych u seniorów. W chwili obecnej nie funkcjonują w ramach POZ mechanizmy umożliwiające właściwy wczesny screening w kierunku otępienia u osób z grupy ryzyka (tj.> 65 r.ż.). Opracowanie standardów wczesnego wykrywania zaburzeń poznawczych w ramach POZ w Polsce wydaje się pilną potrzebą.