Background: Justification is the process of weighing the potential benefit of the exposure against potential detriment for that individual. Its role has been largely delegated to imaging professionals. Nevertheless, j...Background: Justification is the process of weighing the potential benefit of the exposure against potential detriment for that individual. Its role has been largely delegated to imaging professionals. Nevertheless, justification process involves referring physicians, radiographers and radiologists. Objective: To assess the knowledge of referring physicians regarding justification of irradiating examinations in medical imaging at the university-affiliated hospitals in Yaoundé Cameroon. Materials and Methods: A questionnaire (18 questions) based on the French guide for the proper use of medical imaging tests in relation to the justification of irradiating examinations, was self-administered to 151 referring physicians in Yaounde (Cameroon) between October 2012 and January 2013. The pre-tested questionnaire was completed in the presence of the investigator. A scoring system was then adopted with a total of 15 points from the level of knowledge on justification which could be classified as satisfactory or not. Results: Referring physicians were 75 (49.7%) GPs, 53 (35.1%) residents and 23 (15.2%) specialists. Knowledge on justification was unsatisfactory for 79.5% of referring physicians with no significant difference in terms of professional experience (p = 0.95) or specialty (p = 0.119). The concepts of “useful exam” and “justified exam” were not known by 113 (74.8%) and 95 (62.9%) practitioners. MRI was selected as irradiating by 62 (41.1%), SPECT and PET-scan as non-radiating examinations by 98 (64.9%) and 115 (76.1%) participants. The main reasons for repeating a giving radiology exam were: unsatisfactory interpretation, unknown of where it was performing and poor quality exam respectively for 23 (15.2%), 37 (24.5%) and 43 (28.5%) referring physicians. Justification was the responsibility of the referring physician alone for 57% of respondent. Only 11 clinicians knew the reference of “Justification-Optimization-Limitation” to radiation protection. Conclusion: The knowledge of physicians on radiating medical procedures and justification of requests for these procedures is inadequate. Training in radiation protection and the introduction of guidelines for the proper use of imaging tests could improve physicians’ justification of radiating examinations.展开更多
Background: Ultrasonography (US) is the best diagnostic tool in the initial assessment of thyroid nodule. Giving its appropriateness and accessibility, ultrasound-based thyroid imaging reporting and data systems (TIRA...Background: Ultrasonography (US) is the best diagnostic tool in the initial assessment of thyroid nodule. Giving its appropriateness and accessibility, ultrasound-based thyroid imaging reporting and data systems (TIRADS) classifications have been developed with main goal to standardize reporting and facilitate communication between practitioners, and to indicate when fine-needle aspiration biopsy (FNAB) should be performed. Objective: To determine the reliability of Russ’ modified TIRADS classification in predicting thyroid malignancy. Materials and Methods: It was a cross sectional study carried out at Centre Hospitalier de Lagny, Marne La Vallée (France). Consecutive records of patients with focal thyroid nodules on ultrasound (US) for which US-guided FNAB was performed and pathology results were available, from January 2007 to August 2012, were selected for review. The risk of malignancy of each TIRADS category was determined and correlation with pathology assessed. Statistical performances of some US features were also assessed. The threshold for statistical significance was set at 0.05. Results: A total of 430 records of patients were eligible. Twenty-three out of 430 (5.3%) nodules were malignant. The risk of malignancy of the TIRADS categories were as follows: TIRADS2 0%, TIRADS3 2.2%, TIRADS4A 5.9%, TIRADS4B 57.9%, TIRADS5 100% (Gamma statistic = 0.85;Spearman correlation = 0.30, Pearson’s R = 0.37, p Conclusion: Russ’ modified TIRADS classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adoption and use.展开更多
Anterior cruciate ligament (ACL) rupture is one of the most frequently encountered traumatic ligamentous lesions of the knee. Several intrinsic and extrinsic factors are linked to this lesion. Anatomical factors incre...Anterior cruciate ligament (ACL) rupture is one of the most frequently encountered traumatic ligamentous lesions of the knee. Several intrinsic and extrinsic factors are linked to this lesion. Anatomical factors increase the anterior translation of the knee and thus promote the stretching and rupture of the anterior cruciate ligament. Objectives: To determine the anatomical risk factors favouring ACL rupture by comparing morphometric parameters of patients with knee ACL rupture to patients without ACL rupture, as well as the intercondylar notch index and the tibial slopes of the two groups and describing the ruptured ACLs and associated signs. Materials and Methods: We conducted a case-control descriptive analytical study in imaging centres of the General Henri Mondor of Aurillac Hospital Centre in France (CHM) and the Jordan Medical Centre of Yaoundé in Cameroon (CMJ). MRI exam protocols included T1 SE, T2 SE, proton density and Fat Sat sequences, with slices in all three planes. Morphometry knee variables measured in our study were: intercondylar notch index and the tibial slopes. These measurements were obtained from images stored in DICOM format and post processing software OsiriX MD®for CMJ patients and Explore®for CHM patients. Results: The study included 92 individuals, 38 in the case group and 54 in the control group. The mean age was 36.6 years for both groups;35.5 years for the cases and 37.4 years for the controls. The sex ratio was 1.87 men for 1 woman in both groups;2.16 men for 1 woman for the case group. 53% of ACL ruptures are partial, with the predominant direct sign being morphologic and signal abnormalities of the ACL. The most significant indirect sign of ACL rupture was mirror-image bone contusion that was observed in 47.3% of cases. In the case group, the mean lateral tibial slope was 4.003°, whereas it was 2.92°in the control group. The comparison of means was estimated at approximately 0.039 (p Conclusion: The increase in the lateral tibial slope was a risk factor for anterior cruciate ligament rupture in our study population. Intercondylar notch index and medial tibial slope did not show any statistical significant difference.展开更多
Background: Pregnant women are important stakeholders regarding prenatal ultrasound (US) scanning. Their specific needs and preferences have to be ascertained by healthcare providers to ameliorate service delivery. Ob...Background: Pregnant women are important stakeholders regarding prenatal ultrasound (US) scanning. Their specific needs and preferences have to be ascertained by healthcare providers to ameliorate service delivery. Objective: To assess the pregnant woman’s expectations during routine prenatal US scan and her perspective ofUSsafety during pregnancy in a Central African obstetric population. Methods: A cross-sectional descriptive survey of consenting pregnant women who reported for routine prenatal US scan using an anonymous questionnaire. A convenient sample of 200 participants was adopted. Results: Thirty-three (16.8%) respondents (on a total of 196) declared they had never done anUSscan. One hundred and eleven (58.4%) on a total of 190 stated that they had not received any information on what ultrasonography is all about. Before theUSscan the respondents would like to receive information on the aim or purpose of ultrasonography, possible inconveniences or risks, and on how to prepare before the scan. The most reported expectations were assurance of the wellbeing of the fetus (58%), gender determination (44.5%) and information on fetal position (20.5%). Thirty-four respondents considered ultrasonography as not perfectly safe for the mother or the “baby”, with the relevant reasons being the use or production of some potentially harmful “rays”. Conclusion: Pregnant women would want to be assured of the wellbeing of the fetus, the gender and position during routine prenatal US. They however need to be informed of its purpose and safety.展开更多
Purpose: Despite irradiation, CT-scan remains an important diagnostic tool in epilepsy in poor countries where MRI is neither available nor affordable. But many causes of epilepsy are not accessible to CT-scan and thi...Purpose: Despite irradiation, CT-scan remains an important diagnostic tool in epilepsy in poor countries where MRI is neither available nor affordable. But many causes of epilepsy are not accessible to CT-scan and this technique remains expensive for many poor families in countries with limited resources. The aim of this study was to determine clinical or electroencephalogram variables which could predict brain CT-scan abnormalities in childhood epilepsy. Methods: It was a cross-sectional study including 151 epileptic children who underwent head CT-scan from October 2011 to march 2012, in one university-affiliated hospital in Cameroon (YGOPH). The data collected were clinical, type of seizure, Electroencephalogram and head CT-scans results. Independent predictive factors for CT abnormalities were sought by logistic regression. A p value : Of the 151 children, 54.3% (82/151) were boys (sex ratio: 1.18 M/1F). The median age was 54 months [2 - 190 months];74.8% of children were more than 2 years old but at the onset of epilepsy they were 2 years old or less. Birth asphyxia, mental retardation and neurologic deficit were respectively associated in 62.4%, 54.3% and 51.7% of cases. Eighty-five had focal epilepsy (56.3%), 61.6% had abnormal head CT-scan, 68.9% had abnormal EEG, with no significant gender difference. The factors most significantly associated with abnormal head CT-scan were: child age ≤ 2 years, maternal hypertension/eclampsy, cerebral palsy, and child microcephaly, with 89% to 92% abnormal CT. The two independent predictors of abnormal CT were patients’ age ≤ 2 years and microcephaly. The two main CT-scan lesions were cerebral atrophy (28.5%) and brain infarct (16.6%). None of these abnormalities was correlated to any type of epilepsy. Conclusion: Almost two-thirds of head CT-scan performed in epileptic children are abnormal in our setting. Patients of 2 years old or less and those with microcephaly are very likely to have brain anomalies on CT-scan. The most common brain lesions are atrophy, cerebral infarction and porencephalic cavities. Action to reduce birth asphyxia may lead to the reduction of the incidence of epilepsy in children.展开更多
Objective: To assess the importance of incidental extraspinal findings on Magnetic Resonance Imaging of the lumbar spine in two hospital facilities. Materials and Methods: It was a descriptive and retrospective study ...Objective: To assess the importance of incidental extraspinal findings on Magnetic Resonance Imaging of the lumbar spine in two hospital facilities. Materials and Methods: It was a descriptive and retrospective study from November 2015 to March 2016. The records of patients who had done a Magnetic Resonance Imaging (MRI) scan of the lumbar spine were re-read in search of incidental findings. The incidental findings found were classified using Colonography Reporting and Data System(C-RADS) classification of extracolonic lesions to assess clinical significance. The prevalence of incidental findings was calculated for each facility, as well as the distribution according to age, the organs involved and the clinical importance. A non-detection rate was calculated by confronting the findings of the study with the original reports. Results: The prevalence of incidental findings was respectively 33% (19 out of 36) in Jordan Medical Center (JMC) in Yaounde and 27.74% (106 out of 292) in Jacques Monod Hospital. The extraspinal incidental findings were classified mainly as extracolonic 2 (E2): 58% in each facility. The percentage detection of incidental findings was 5% at JMS and 1.7% at Jacques Monod Hospital. Conclusion: Extraspinal incidental findings are frequent in both hospitals. However, the rate of detection remains very low.展开更多
文摘Background: Justification is the process of weighing the potential benefit of the exposure against potential detriment for that individual. Its role has been largely delegated to imaging professionals. Nevertheless, justification process involves referring physicians, radiographers and radiologists. Objective: To assess the knowledge of referring physicians regarding justification of irradiating examinations in medical imaging at the university-affiliated hospitals in Yaoundé Cameroon. Materials and Methods: A questionnaire (18 questions) based on the French guide for the proper use of medical imaging tests in relation to the justification of irradiating examinations, was self-administered to 151 referring physicians in Yaounde (Cameroon) between October 2012 and January 2013. The pre-tested questionnaire was completed in the presence of the investigator. A scoring system was then adopted with a total of 15 points from the level of knowledge on justification which could be classified as satisfactory or not. Results: Referring physicians were 75 (49.7%) GPs, 53 (35.1%) residents and 23 (15.2%) specialists. Knowledge on justification was unsatisfactory for 79.5% of referring physicians with no significant difference in terms of professional experience (p = 0.95) or specialty (p = 0.119). The concepts of “useful exam” and “justified exam” were not known by 113 (74.8%) and 95 (62.9%) practitioners. MRI was selected as irradiating by 62 (41.1%), SPECT and PET-scan as non-radiating examinations by 98 (64.9%) and 115 (76.1%) participants. The main reasons for repeating a giving radiology exam were: unsatisfactory interpretation, unknown of where it was performing and poor quality exam respectively for 23 (15.2%), 37 (24.5%) and 43 (28.5%) referring physicians. Justification was the responsibility of the referring physician alone for 57% of respondent. Only 11 clinicians knew the reference of “Justification-Optimization-Limitation” to radiation protection. Conclusion: The knowledge of physicians on radiating medical procedures and justification of requests for these procedures is inadequate. Training in radiation protection and the introduction of guidelines for the proper use of imaging tests could improve physicians’ justification of radiating examinations.
文摘Background: Ultrasonography (US) is the best diagnostic tool in the initial assessment of thyroid nodule. Giving its appropriateness and accessibility, ultrasound-based thyroid imaging reporting and data systems (TIRADS) classifications have been developed with main goal to standardize reporting and facilitate communication between practitioners, and to indicate when fine-needle aspiration biopsy (FNAB) should be performed. Objective: To determine the reliability of Russ’ modified TIRADS classification in predicting thyroid malignancy. Materials and Methods: It was a cross sectional study carried out at Centre Hospitalier de Lagny, Marne La Vallée (France). Consecutive records of patients with focal thyroid nodules on ultrasound (US) for which US-guided FNAB was performed and pathology results were available, from January 2007 to August 2012, were selected for review. The risk of malignancy of each TIRADS category was determined and correlation with pathology assessed. Statistical performances of some US features were also assessed. The threshold for statistical significance was set at 0.05. Results: A total of 430 records of patients were eligible. Twenty-three out of 430 (5.3%) nodules were malignant. The risk of malignancy of the TIRADS categories were as follows: TIRADS2 0%, TIRADS3 2.2%, TIRADS4A 5.9%, TIRADS4B 57.9%, TIRADS5 100% (Gamma statistic = 0.85;Spearman correlation = 0.30, Pearson’s R = 0.37, p Conclusion: Russ’ modified TIRADS classification is reliable in predicting thyroid malignancy. More evidence is nevertheless necessary for widespread adoption and use.
文摘Anterior cruciate ligament (ACL) rupture is one of the most frequently encountered traumatic ligamentous lesions of the knee. Several intrinsic and extrinsic factors are linked to this lesion. Anatomical factors increase the anterior translation of the knee and thus promote the stretching and rupture of the anterior cruciate ligament. Objectives: To determine the anatomical risk factors favouring ACL rupture by comparing morphometric parameters of patients with knee ACL rupture to patients without ACL rupture, as well as the intercondylar notch index and the tibial slopes of the two groups and describing the ruptured ACLs and associated signs. Materials and Methods: We conducted a case-control descriptive analytical study in imaging centres of the General Henri Mondor of Aurillac Hospital Centre in France (CHM) and the Jordan Medical Centre of Yaoundé in Cameroon (CMJ). MRI exam protocols included T1 SE, T2 SE, proton density and Fat Sat sequences, with slices in all three planes. Morphometry knee variables measured in our study were: intercondylar notch index and the tibial slopes. These measurements were obtained from images stored in DICOM format and post processing software OsiriX MD®for CMJ patients and Explore®for CHM patients. Results: The study included 92 individuals, 38 in the case group and 54 in the control group. The mean age was 36.6 years for both groups;35.5 years for the cases and 37.4 years for the controls. The sex ratio was 1.87 men for 1 woman in both groups;2.16 men for 1 woman for the case group. 53% of ACL ruptures are partial, with the predominant direct sign being morphologic and signal abnormalities of the ACL. The most significant indirect sign of ACL rupture was mirror-image bone contusion that was observed in 47.3% of cases. In the case group, the mean lateral tibial slope was 4.003°, whereas it was 2.92°in the control group. The comparison of means was estimated at approximately 0.039 (p Conclusion: The increase in the lateral tibial slope was a risk factor for anterior cruciate ligament rupture in our study population. Intercondylar notch index and medial tibial slope did not show any statistical significant difference.
文摘Background: Pregnant women are important stakeholders regarding prenatal ultrasound (US) scanning. Their specific needs and preferences have to be ascertained by healthcare providers to ameliorate service delivery. Objective: To assess the pregnant woman’s expectations during routine prenatal US scan and her perspective ofUSsafety during pregnancy in a Central African obstetric population. Methods: A cross-sectional descriptive survey of consenting pregnant women who reported for routine prenatal US scan using an anonymous questionnaire. A convenient sample of 200 participants was adopted. Results: Thirty-three (16.8%) respondents (on a total of 196) declared they had never done anUSscan. One hundred and eleven (58.4%) on a total of 190 stated that they had not received any information on what ultrasonography is all about. Before theUSscan the respondents would like to receive information on the aim or purpose of ultrasonography, possible inconveniences or risks, and on how to prepare before the scan. The most reported expectations were assurance of the wellbeing of the fetus (58%), gender determination (44.5%) and information on fetal position (20.5%). Thirty-four respondents considered ultrasonography as not perfectly safe for the mother or the “baby”, with the relevant reasons being the use or production of some potentially harmful “rays”. Conclusion: Pregnant women would want to be assured of the wellbeing of the fetus, the gender and position during routine prenatal US. They however need to be informed of its purpose and safety.
文摘Purpose: Despite irradiation, CT-scan remains an important diagnostic tool in epilepsy in poor countries where MRI is neither available nor affordable. But many causes of epilepsy are not accessible to CT-scan and this technique remains expensive for many poor families in countries with limited resources. The aim of this study was to determine clinical or electroencephalogram variables which could predict brain CT-scan abnormalities in childhood epilepsy. Methods: It was a cross-sectional study including 151 epileptic children who underwent head CT-scan from October 2011 to march 2012, in one university-affiliated hospital in Cameroon (YGOPH). The data collected were clinical, type of seizure, Electroencephalogram and head CT-scans results. Independent predictive factors for CT abnormalities were sought by logistic regression. A p value : Of the 151 children, 54.3% (82/151) were boys (sex ratio: 1.18 M/1F). The median age was 54 months [2 - 190 months];74.8% of children were more than 2 years old but at the onset of epilepsy they were 2 years old or less. Birth asphyxia, mental retardation and neurologic deficit were respectively associated in 62.4%, 54.3% and 51.7% of cases. Eighty-five had focal epilepsy (56.3%), 61.6% had abnormal head CT-scan, 68.9% had abnormal EEG, with no significant gender difference. The factors most significantly associated with abnormal head CT-scan were: child age ≤ 2 years, maternal hypertension/eclampsy, cerebral palsy, and child microcephaly, with 89% to 92% abnormal CT. The two independent predictors of abnormal CT were patients’ age ≤ 2 years and microcephaly. The two main CT-scan lesions were cerebral atrophy (28.5%) and brain infarct (16.6%). None of these abnormalities was correlated to any type of epilepsy. Conclusion: Almost two-thirds of head CT-scan performed in epileptic children are abnormal in our setting. Patients of 2 years old or less and those with microcephaly are very likely to have brain anomalies on CT-scan. The most common brain lesions are atrophy, cerebral infarction and porencephalic cavities. Action to reduce birth asphyxia may lead to the reduction of the incidence of epilepsy in children.
文摘Objective: To assess the importance of incidental extraspinal findings on Magnetic Resonance Imaging of the lumbar spine in two hospital facilities. Materials and Methods: It was a descriptive and retrospective study from November 2015 to March 2016. The records of patients who had done a Magnetic Resonance Imaging (MRI) scan of the lumbar spine were re-read in search of incidental findings. The incidental findings found were classified using Colonography Reporting and Data System(C-RADS) classification of extracolonic lesions to assess clinical significance. The prevalence of incidental findings was calculated for each facility, as well as the distribution according to age, the organs involved and the clinical importance. A non-detection rate was calculated by confronting the findings of the study with the original reports. Results: The prevalence of incidental findings was respectively 33% (19 out of 36) in Jordan Medical Center (JMC) in Yaounde and 27.74% (106 out of 292) in Jacques Monod Hospital. The extraspinal incidental findings were classified mainly as extracolonic 2 (E2): 58% in each facility. The percentage detection of incidental findings was 5% at JMS and 1.7% at Jacques Monod Hospital. Conclusion: Extraspinal incidental findings are frequent in both hospitals. However, the rate of detection remains very low.
