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England A, Rawashdeh M, Moore N, Young R, Curran G, McEntee MF. More sustainable use of iodinated contrast media - Why? Radiography (Lond) 2024; 30 Suppl 1:74-80. [PMID: 38991461 DOI: 10.1016/j.radi.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES Based on a narrative review of the literature to 1) assess the need for and 2) report methods to help deliver a sustainable approach to iodinated contrast media (ICM) administration. KEY FINDINGS Acute ICM shortages have been noted in the literature. As demand for contrast-enhanced imaging continues to increase and access to raw materials becomes more limited, such events may increase. Evidence from the literature has documented a range of iodinated contrast reduction strategies. These include individualised contrast-media dosing, multi-dose bulk ICM vials, switching to alternative modalities or the increased use of non-contrast examinations. The optimisation of imaging parameters, the use of saline chasers, and alternative contrast agents should be further considered. Given the rising concerns regarding the presence and effects of ICMs in waste and drinking water, further consideration of strategies for managing waste and excreted ICMs are starting to emerge. CONCLUSIONS Sustainable ICM practices are needed to help avoid supply shortages and to help protect our environment. Such practices must be led and supported locally, nationally, and internationally. Sustainable ICM practices must be reflected within professional Standards of Proficiencies and be adopted by all members of the multidisciplinary team. IMPLICATIONS FOR PRACTICE Changes to working practices surrounding the sustainable use of ICMs will likely become commonplace. New methods to ensure optimised ICM dosage with minimal wastage will be more heavily featured in departmental practices. Correct disposal of waste and excreted ICMs will also form part of future changes to practice.
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Affiliation(s)
- A England
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland.
| | - M Rawashdeh
- Department of Medical Imaging Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - N Moore
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - R Young
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - G Curran
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland
| | - M F McEntee
- Discipline of Medical Imaging & Radiation Therapy, University College Cork, Cork, Ireland; Faculty of Health Sciences, University of Southern Denmark, Denmark; Faculty of Medicine, University of Sydney, Australia
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Abstract
OBJECTIVE. This article aimed to assess changing use of brain imaging tests among patients with Alzheimer disease and vascular dementia who visited U.S. emergency departments (EDs) between 2006 and 2014. MATERIALS AND METHODS. Using the largest publicly available all-payer ED database, the Nationwide Emergency Department Sample, we identified a weighted cohort of 427,705 individuals with Alzheimer disease and 33,743 individuals with vascular dementia who visited U.S. EDs between 2006 and 2014. Logistic regression analyses were performed to identify factors associated with use. RESULTS. Between 2006 and 2014, ED visits among patients with Alzheimer disease and vascular dementia declined by 24.7% and 20.3%, respectively. However, there was a significant increase in utilization rates of head CT (from 4.4% to 11.1% in patients with Alzheimer disease and from 1.5% to 2.9% in patients with vascular dementia) and brain MRI (from 0.04% to 0.5% in patients with Alzheimer disease and 0.0% to 0.1% in those with vascular dementia) in the same time period. Among patients with Alzheimer disease, age, median income in patient ZIP code, day of the week of the ED visit, hospital teaching status, and hospital geographic region were significant predictors of imaging use. Among patients with vascular dementia, insurance type and hospital classification (urban vs rural) were significant predictors of imaging use. CONCLUSION. Despite declining ED visits, ED brain imaging in patients with Alzheimer disease and vascular dementia has increased. Various patient-specific and hospital-specific factors contribute to differential utilization rates.
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Recommendations for Standardizing Thorax PET-CT in Non-Human Primates by Recent Experience from Macaque Studies. Animals (Basel) 2021; 11:ani11010204. [PMID: 33467761 PMCID: PMC7830664 DOI: 10.3390/ani11010204] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023] Open
Abstract
Despite the possibilities of routine clinical measures and assays on readily accessible bio-samples, it is not always essential in animals to investigate the dynamics of disease longitudinally. In this regard, minimally invasive imaging methods provide powerful tools in preclinical research. They can contribute to the ethical principle of gathering as much relevant information per animal as possible. Besides, with an obvious parallel to clinical diagnostic practice, such imaging platforms are potent and valuable instruments leading to a more refined use of animals from a welfare perspective. Non-human primates comprise highly relevant species for preclinical research to enhance our understanding of disease mechanisms and/or the development of improved prophylactic or therapeutic regimen for various human diseases. In this paper, we describe parameters that critically affect the quality of integrated positron emission tomography and computed tomography (PET-CT) in non-human primates. Lessons learned are exemplified by results from imaging experimental infectious respiratory disease in macaques; specifically tuberculosis, influenza, and SARS-CoV-2 infection. We focus on the thorax and use of 18F-fluorodeoxyglucose as a PET tracer. Recommendations are provided to guide various stages of PET-CT-supported research in non-human primates, from animal selection, scan preparation, and operation, to processing and analysis of imaging data.
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Wang F, Zhou P, Li K, Mamtilahun M, Tang Y, Du G, Deng B, Xie H, Yang G, Xiao T. Sensitive imaging of intact microvessels in vivo with synchrotron radiation. IUCRJ 2020; 7:793-802. [PMID: 32939271 PMCID: PMC7467167 DOI: 10.1107/s2052252520008234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/22/2020] [Indexed: 05/13/2023]
Abstract
Early stages of diseases, including stroke, hypertension, angiogenesis of tumours, spinal cord injuries, etc., are closely associated with the lesions of microvasculature. Rodent models of human vascular diseases are extensively used for the preclinical investigation of the disease evolution and therapy with synchrotron radiation. Therefore, non-invasive and in vivo X-ray imaging with high sensitivity and clarity is desperately needed to visualize the microvessels in live-animal models. Contrast agent is essential for the in vivo X-ray imaging of vessels and angiomatous tissue. Because of the non-rigid motion of adjacent tissues, the short circulation time and the intermittent flow of contrast agents in vessels, it is a great challenge for the traditional X-ray imaging methods to achieve well defined images of microvessels in vivo. In this article, move contrast X-ray imaging (MCXI) based on high-brightness synchrotron radiation is developed to overcome the intrinsic defects in conventional methods. Experiments with live rodents demonstrate the practicability of the MCXI method for sensitive and intact imaging of microvessels in vivo.
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Affiliation(s)
- Feixiang Wang
- Shanghai Synchrotron Radiation Facility/Zhangjiang Laboratory, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201204, People’s Republic of China
| | - Panting Zhou
- Neuroscience and Neuroengineering Research Center, Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, People’s Republic of China
| | - Ke Li
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, People’s Republic of China
- University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
| | - Muyassar Mamtilahun
- Neuroscience and Neuroengineering Research Center, Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, People’s Republic of China
| | - Yaohui Tang
- Neuroscience and Neuroengineering Research Center, Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, People’s Republic of China
| | - Guohao Du
- Shanghai Synchrotron Radiation Facility/Zhangjiang Laboratory, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201204, People’s Republic of China
| | - Biao Deng
- Shanghai Synchrotron Radiation Facility/Zhangjiang Laboratory, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201204, People’s Republic of China
| | - Honglan Xie
- Shanghai Synchrotron Radiation Facility/Zhangjiang Laboratory, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201204, People’s Republic of China
| | - Guoyuan Yang
- Neuroscience and Neuroengineering Research Center, Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, People’s Republic of China
| | - Tiqiao Xiao
- Shanghai Synchrotron Radiation Facility/Zhangjiang Laboratory, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201204, People’s Republic of China
- Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, People’s Republic of China
- University of Chinese Academy of Sciences, Beijing 100049, People’s Republic of China
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