Clinical image quality assessment and mean glandular dose for full field digital mammography

This study aims to assess the image quality (IQ) of 12 mammographic units and to identify units with potential optimisation needs. Data for 350 mammography examinations meeting inclusion criteria were collected retrospectively from April 2021 to April 2022. They were categorised based on the medical reports into 10 normal cases, 10 cases displaying calcifications and 10 cases presenting lesions. Two radiologists assessed the IQ of 1400 mammograms, evaluating system performance per Boitaet al's study and positioning performance following European guidelines. To measure agreement between the two radiologists, the Cohen's Kappa coefficient (κ) was computed, quantifying the excess of agreement beyond chance. The visual grading analysis score (VGAS) was computed to compare system and positioning performance assessments across different categories and facilities. Median average glandular dose (AGD) values for cranio caudal and medio lateral oblique views were calculated for each category and facility and compared to the national diagnostic reference levels. The health facilities were categorised by considering both IQ VGAS and AGD levels. Inter-rater agreement between radiologists ranged from poor (κ< 0.20) to moderate (0.41 <κ< 0.60), likely influenced by inherent biases and distinct IQ expectations. 50% of the facilities were classified as needing corrective actions for their system performance as they had IQ or high AGD that could increase recall rate and radiation risk and 50% of the health facilities exhibited insufficient positioning performance that could mask tumour masses and microcalcifications. The study's findings emphasise the importance of implementing quality assurance programs to ensure optimal IQ for accurate diagnoses while adhering to radiation exposure guidelines. Additionally, comprehensive training for technologists is essential to address positioning challenges. These initiatives collectively aim to enhance the overall quality of breast imaging services, contributing to improved patient care.

[Comparison of fertiloscopy versus laparoscopy in the exploration of the infertility: analysis of the literature]

BACKGROUND

Fertiloscopy is a recent technique designed to explore the tubo-ovarian axis in unexplained infertility. It is a simple outpatient technique, allowing to perform operative procedures, but its position relative to laparoscopy is yet to be defined.

MATERIAL AND METHODS

A thorough and extensive bibliographical search was undertaken to fully embrace the question, challenging Medline at the National Library of Medicine, Cochrane Library, National Guideline Clearinghouse, Health Technology Assessment Database. All the retrieved articles were classified as either descriptive or comparative studies and evaluated on a set of criteria.

RESULTS

Most of the papers described case series coming from a few teams, focusing mainly on the technical aspect of the procedure, like the access rate to the posterior cul-de-sac, the success rate in visualizing the pelvis, the complications rate (mainly rectal perforation), and its operative performance in drilling ovaries for resistant polycystic ovarian syndrome. Comparative studies numbered six trials. They all followed the same design, fertiloscopy preceding conventional laparoscopy in patients taken as their own control. The concordance rate between the two modalities reaches 80% in terms of tubal pathology, adherences and endometriosis, with an estimated reduction of laparoscopies varying from 40% to 93%.

CONCLUSION

The current literature shows a concordance between fertiloscopy and conventional laparoscopic findings for certain parameters in cases of tubal pathology, adherences and endometriosis. The relative positions of these two modalities in unexplained infertility still remain elusive.

[Giant venous malformation of the tongue: the value of Surgiflo]

Cavernous hemangiomas are rare congenital venous malformations having propensity for the head and neck. These venous malformations, especially the large and intraoral ones, may cause severe symptoms requiring aggressive treatment. Today, the main treatment is based on sclerotherapy, associated or no with surgery. We report on a patient presenting an enormous venous malformation of the face and tongue, which was treated successfully in our department by embolization, sclerotherapy and maxillo-facial surgery, with a special focus on Surgiflo in our technique.

Thyroidectomy in patients at high-risk of bleeding: can it be safely performed?

AIM

This study evaluated the safety of thyroid surgery in patients where anticoagulation was unavoidable or in patients with coagulopathy.

METHODS

The records of all patients having high risk of bleeding at the time of thyroidectomy (July 2000 and March 2005) were retrospectively reviewed to evaluate intraoperative and postoperative bleeding.

RESULTS

Ten patients were studied. Thyroid lobectomy with isthmusectomy (N=3) and bilateral thyroidectomy (N=7) were performed. Intraoperative surgical hemostasis was meticulous using ligasure vessel sealing system. Patients were divided in 3 groups. Group I (N=2) had small-vessel vasculitis, underwent thyroidectomy under full heparinization. Heparin therapy was continued until full anticoagulation by oral anticoagulants. Group II (N=2) had a documented congenital coagulation defect, had a pre and postoperative special protocols. Group III (N=6) underwent simultaneous thyroid and cardiac surgery (e.g.: intraoperative full heparinization and postoperative antiplatelet therapy in some cases). No extra-bleeding was noted on surgical reports. In the postoperative period, one patient developed a superficial small hematoma in the neck that resolved spontaneously. Transient unilateral laryngeal nerve palsy and transient hypocalcemia were seen in one and two patients respectively.

CONCLUSIONS

Thyroidectomy in patients with coagulopathy is feasible with low risk of bleeding if meticulous hemostasis, particularly using ligasure vessel sealing system, is respected.

[Hydatid disease diagnosed following a pulmonary embolism]

Hydatidosis is a parasitic disease found worldwide, particularly in Mediterranean countries, caused by Echinococcus granulosis infection. Humans are an intermediate and accidental host in the cycle of this parasite. The hydatid pulmonary arterial embolism is extremely rare, usually arising in the heart or the liver. We report a case of hydatid pulmonary embolism explored with multidetector scanner and MRI, and confirmed at pathology of the operative specimen. To our knowledge, this is the first case of inaugural hydatid pulmonary arterial embolism found on CT scan establishing the diagnosis of the disease in a patient who had no other location of hydatid cyst.

[Intradural vertebral dissection: case report and literature review]

Vertebro-basilar dissections represent a rare but severe cause of posterior vascular accident and constitute 3 to 7% of non-traumatic subarachnoid hemorrhage. Digital angiography is classically the standard method for diagnosing of arterial dissections but CT and MR angiography are recently widely used as non-invasive and accurate ways of diagnosis. We report a case of atypical subarachnoid hemorrhage, with focus on contribution of the different techniques.