Canadian Association of Radiologists Journal

To determine the utilisation of diagnostic imaging (radiology) as a department and/or imaging medium in the teaching of anatomy at the Canadian undergraduate medical education level.

The study objectives were achieved through the use of a questionnaire and a literature review. The anatomy department head at each English-based Canadian Medical School was contacted, and the individual most responsible for anatomy teaching in the medical school curriculum was identified. This individual was subsequently asked to complete a questionnaire that evaluated the involvement of radiology for anatomy teaching in their curriculum.

The use and integration of radiology is a common practice in the teaching of anatomy in Canadian undergraduate medicine. Although the methods and extent of its use varied among institutions, every English-based Canadian medical school, except one, was using diagnostic imaging material in their instruction of anatomy. Furthermore, half of the institutions had a radiologist as a faculty member of their anatomy department to help teach and to use imaging to its full potential.

This audit of anatomy departments suggests that diagnostic imaging has an important role to play in anatomy teaching in Canadian English-speaking medical schools.

The purpose of this study was to evaluate whether 3-dimensional (3D) volumetric acquisition of shoulder ultrasound (US) data for supraspinatus rotator cuff tears is as sensitive when compared with conventional 2-dimensional (2D) US and routine magnetic resonance imaging (MRI), and whether there is improved workroom time efficiency when using the 3D technique compared with the 2D technique.

In this prospective study, 39 shoulders underwent US and MRI examination of their rotator cuff to confirm the accuracy of both the 2D and 3D techniques. The difference in sensitivities was compared by using confidence interval analysis. The mean times required to obtain the 2D and 3D US data and to review the scans were compared by using a 1-tailed Wilcoxon test.

Sensitivity and specificity of 2D US in detecting supraspinatus full- and partial-thickness tears was 100% and 96%, and 80% and 100%, respectively, and similar values were obtained with 3D US at 100% and 100%, and 90% and 96.6%, respectively. Analysis of the confidence limits of the sensitivities showed no significant difference. The mean time (± SD) of the overall 2D examination of the shoulder, including interpretation was 10.02 ± 3.28 minutes, whereas, for the 3D examination, it was 7.08 ± 0.35 minutes. Comparison between the 2 cohorts when using a 1-tailed Wilcoxon test showed a statistically significant difference (P < .05).

3D US of the shoulder is as accurate as 2D US when compared with MRI for the diagnosis of full- and partial-thickness supraspinatus rotator cuff tears, and 3D US examination significantly reduced the time between the initial scan and the radiologist interpretation, ultimately improving workplace efficiency.

To document the prevalence and pattern of risk factors for contrast-induced nephrotoxicity (CIN) in an outpatient population referred for contrast-enhanced computed tomography (CT) (CECT) studies.

Over a 4-month period, 3261 patients presenting for CT studies were asked to consent to a survey of CIN risk factors. Among these patients, 957 were outpatients who received contrast material before the CT study. Demographic information and available serum creatinine (SCr) data for these patients were extracted from medical records and then analysed. A telephone questionnaire to document risk factors was administered to 200 of these patients, who were outpatients not referred from the emergency department or on dialysis.

Among the 200 surveyed patients, 69% reported risk factors for CIN or for kidney function impairment (low estimated glomerular filtration rate [eGFR]) at baseline. Among these patients, 43% reported multiple (2 or more) risk factors. Patients older than the mean age of 53 years had a higher incidence of having multiple risk factors when compared with those younger than this age. Patients with kidney function impairment at baseline had a higher incidence of having multiple risk factors when compared with those with normal kidney function. Among the patients with no SCr investigation in the 3 months preceding a CECT, 64% had multiple risk factors. In the study population of 957 outpatients undergoing CECT, 52% had SCr measurements within 3 months before the study. An eGFR of less than 60 mL/min/1.73 m² was found in 17% of the study population, and, in 0.6%, the eGFR was less than 30 mL/min/1.73 m².

In an ambulatory outpatient population, many patients presenting for outpatient CECT studies will have risk factors for CIN or for kidney function impairment (low eGFR) at baseline. Kidney function assessment, therefore, is indicated in this patient population before CECT.

Follow-up study to observe if provincial mean effective radiation dose for head, chest, and abdomen-pelvis (AP) computed tomographies (CTs) remained stable or changed since the initial 2006 survey.

Data were collected in July 2008 from Saskatchewan's 13 diagnostic CT scanners of 3358 CT examinations. These data included the number of scan phases and projected dose length product (DLP). Technologists compared projected DLP with 2006 reference data before scanning. Projected DLP was converted to effective dose (ED) for each head, chest, and AP CT. The total dose that the patients received with scans of multiple body parts at the same visit also was determined.

The mean (± SD) provincial ED was 3.4 ± 1.6 mSv for 1023 head scans (2.7 ± 1.6 mSv in 2006), 9.6 ± 4.8 mSv for 588 chest scans (11.3 ± 8.9 mSv in 2006), and 16.1 ± 9.9 mSv for 983 AP scans (15.5 ± 10.0 mSv in 2006). Single-phase multidetector row CT ED decreased by 31% for chest scans (9.5 ± 3.9 mSv vs 13.7 ± 9.7 mSv in 2006) and 17% for AP scans (13.9 ± 6.0 mSv vs 16.8 ± 10.6 mSv in 2006) and increased by 19% for head scans (3.2 ± 1.2 mSv vs 2.7 ± 1.5 mSv in 2006). The total patient dose was highest (33.8 ± 10.1 mSv) for the 20 patients who received head, neck, chest, and AP scans during a single visit. Because of increased utilisation and the increased CT head dose, Saskatchewan per capital radiation dose from CT increased by 21% between 2006 and 2008 (1.14 vs 1.38 mSv/person per year).

Significant dose and variation reduction was seen for single-phase CT chest and AP examinations between 2006 and 2008, whereas CT head dose increased over the same interval. These changes, combined with increased utilisation, resulted in per capita increase in radiation dose from CT between the 2 studies.

Sevoflurane anesthetic has recently been administered by anesthesiologists during voiding cystourethrograms in a centre where radiologists are not permitted to deliver pediatric sedation.

To determine whether sevoflurane is a satisfactory anesthetic agent for voiding cystourethrography in children.

Records of children undergoing voiding cystourethrogram while they were under sevoflurane were reviewed for anesthetic adverse effects and diagnostic quality of the cystourethrogram. The occurrence of on-table voiding and post-void residual bladder volume were documented and compared with an age- and sex-matched control group of children undergoing unsedated voiding cystourethrography. The caregivers were surveyed regarding the anesthetic experience.

A total of 91 children underwent sevoflurane voiding cystourethrography; there were no adverse cardiorespiratory events. Voiding was observed in 96%, with residual bladder volumes minimal in 38%, moderate in 32%, and large in 28% of anesthetized children, not significantly different from the control group. Vesicoureteral reflux was observed in 53% of examinations under sevoflurane. When children with a previous history of reflux or voiding cystourethrography were excluded in a comparison with age- and sex-matched controls, vesicoureteral reflux was observed in 38% of studies under sevoflurane and in 44% of studies in the control group, P = .69; 85% of caregivers of children with prior unsedated voiding cystourethrography found voiding cystourethrography with sevoflurane easier than without sevoflurane; 89% thought the anesthetic experience reduced their child's anxiety towards medical procedures.

No adverse events or effects on diagnostic quality of the pediatric voiding cystourethrogram were encountered when using sevoflurane. The majority of surveyed caregivers thought that anesthesia made voiding cystourethrography an easier experience for their child.