To repeat or not to repeat: Radiologists demonstrated more decisiveness than their fellow radiographers in reducing the repeat rate during mobile chest radiography

INTRODUCTION

Radiologists and radiographers play a complementary role in providing an optimal image quality with decrease radiation dose and proper diagnosis during chest radiographs. We aim Investigate years of experience among radiologists and radiographers on perception of image quality and its impact on repeat rate when evaluating portable pediatric chest radiographs.

METHODS

IRB approved retrospective study consisted of randomly selected images (n = 131) of pediatric portable chest radiographs. Images were blindly assessed by four radiologists and four radiographers. Readers were asked to assess qualitative and quantitative image quality by rating: image quality, decision to repeat and image technique. All data was compared employing Pearson's Correlation, Visual grading characteristic (VGC) and Cohens' kappa analyses.

RESULTS

Image quality: Radiologists (88.4%) rated images as excellent significantly more than radiographers (11.6%), and radiographers (90.1%) as poor significantly more than radiologists (9.9%) (p < 0.05). Repeat: Radiologists (57%) decided not to repeat images significantly more than radiographers (43%) (p < 0.05). Image technique: Radiologists rated images as acceptable (65%) and excellent (97.7%) significantly more than radiographers (35% and 2.3% respectively) (p < 0.05), whereas radiographers (84%) assessed image technique as poor significantly more than radiologists (16%) (p < 0.05). VGC: radiographers had slightly better qualitative evaluation of image quality than radiologists. An association between image quality (p < 0.002) and repeat decision (p < 0.044) with years of experience was established when comparing years of experience with image assessment rubric, while no association was noted with image technique (p < 0.9).

CONCLUSION

Radiologists demonstrated more decisiveness than their fellow radiographers in reducing the repeat rate of portable pediatric chest radiographs. Interestingly, years of experience only seem to affect image technique and image quality assessment among radiologists.

IMPLICATIONS FOR PRACTICE

Continuous education of radiographers and close collaboration with radiologists is crucial to achieve optimal image quality and low radiation doses.

Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual-A Rare Complication of Varicella-Zoster Virus Reactivation

Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult—a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies.

Neuronal plasticity in a case with total hemispheric lesion

RATIONALE

The adult brain maintains the ability for reorganization or plasticity throughout life. Non-invasive techniques such as functional magnetic resonance imaging (f-MRI), Transcranial Magnetic Stimulation (TMS) and magnetoencephalography could be used to show recovery of function after stroke.

OBJECTIVE

Explanation of neuronal plastisity and intra-hemisferic reorganization with functional recovery of a case who has total extensive damage on the left hemisphere. case report: Twenty-five years old female patient was admitted to our hospital with a right-sided sequel hemiparesis and homonymous hemianopia. She had right-sided paresia after an inguinal hernia operation when she was one and a half years old. On neurological examination she was speaking fluently, and cooperated on complicated comments. Motor examination revealed right-sided spastic hemiparesis predominant on distal parts and right sided visual field defect. But she was continuing her activity of daily livings without help. Her detailed neuropsycological examination revealed mild cognitive dysfunction. Cranial MRI showed total left hemisphere encephalomalasia. Right hemisphere function was noticed on task-related brain activation during voluntary movement of her right leg (she was not capable of performing right hand function tasks by herself ) on functional MRI.

CONCLUSION

Cerebral lesions in the early life can be compensated with the unaffected hemisphere by the neuronal reorganisation and a patient with complete left hemisphere lesion such as our patient can speak, maintain her life without assistance but with mild cognitive decline, compared with elderly stroke patients.