Background: Acute dyspnea in emergency departments (ED) requires prompt and accurate diagnosis due to its high mortality and readmission rates. Conventional diagnostic methods are resource-intensive and time-consuming. This study aimed to evaluate the diagnostic accuracy and time to diagnosis of combined heart and lung ultrasound (HeaLus) compared to standard emergency department evaluation in patients presenting with dyspnea.

Methods: A prospective study was conducted in a cohort of 61 patients at the ED of Danderyd Hospital, Sweden. HeaLus examinations were performed alongside routine investigations. Diagnostic performance of HeaLus and ED evaluation was assessed for accuracy, sensitivity, specificity, positive predictive value, and negative predictive value, and agreement using Kappa index. Median time to diagnostics was compared between HeaLus and ED evaluation using Mann-Whitney U-test.

Results: Heart failure was the most common diagnosis (20%) among patients presenting with dyspnea. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 95% (95% CI: [87%, 98%]), 98% (95% CI: [88%, 100%]), 90% (95% CI: [69%, 97%]), 95% (95% CI: [85%, 99%]), and 94% (95% CI: [74%, 99%]), respectively. The agreement between HeaLus and ED diagnoses was 0.88. Time to diagnosis was significantly reduced with HeaLus (21 min vs. 3 h and 28 min).

Conclusions: HeaLus offers rapid and accurate assessment of dyspnea. These results suggest that HeaLus could be valuable in optimizing patient management, particularly in settings with limited resources and long ED wait times.

Abdominal aortic aneurysms (AAA) are common, especially in men, and associated with a high mortality when ruptured. Clinical guidance for surgical repair is based on the maximum aortic diameter (>5.5 cm in men or 5 cm in women) but this is a poor indicator of clinical risk. Here, we examined micromechanical and biochemical properties of tissue excised from 21 patients undergoing repair for degenerative AAA using nanoindentation and biochemical assays (collagen elastin and glycosaminoglycans (GAGs)), along with 6 control aortic samples. AAA tissue properties were compared with peak wall stress (PWS), peak wall rupture risk (PWRR) localised rupture risk index (RRI) and wall stress (WS) determined from patient-specific finite element (FE) models, and with abdominal aortic calcification (AAC) scoring obtained from CT scans. The AAA samples had a lower median elastic modulus (72.4 kPa) and a higher IQR (86.8 kPa) relative to the controls (median 91.2 kPa, IQR 53.8 kPa). A heteroscedastic relationship was found in the AAA samples; patients with the highest median stiffness exhibited the largest IQR. Relative to controls, collagen was higher in the AAAs, whilst GAG and elastin were lower. Microcalcification was higher in the inner and middle layers of the vessel wall, matching the trend observed with stiffness. Correlative analysis showed that E was related to RRI but a complex, interplay of tissue properties contributed to overall PWRR. AAC was found to be inversely correlated with PWRR. Random forest modelling demonstrated that RRI is most influenced by E measured in the belly of the aneurysm, GAG, and collagen. In conclusion, micromechanical properties and calcification may be useful for patient-specific rupture risk prediction.

STATEMENT OF SIGNIFICANCE: Abdominal aortic aneurysms (AAA) are more prevalent with age, and rupture is associated with a high mortality rate. Maximum aortic diameter, the main clinical criteria for surgical repair is a poor indicator of rupture risk (RR). We used micromechanical and biochemical characterisation, and computational modelling to understand RR in degenerative AAAs. The tissue elastic modulus was found to be an indicator of RR as was the in vivo abdominal aortic calcification (AAC) score with the latter having an inverse relationship with RR. Collagen and glycosaminoglycans levels were also key to RR. We demonstrate that RR is better indicated by AAC and tissue elastic properties than conventional clinical markers such as diameter alone. These findings can be exploited for patient-specific RR determination.

Introduction: To minimise the risks associated with ionising radiation, it is necessary for all staff involved to employ specific techniques to reduce radiation exposure of the patient. These techniques include using compression during examinations of the pelvic region and lumbar spine, using a gonad shield, and asking women if they are pregnant. However, some staff do not use these techniques consistently. Increasing compliance requires determining why staff are non-compliant. Thus, this study aims to qualitatively investigate why radiographers do not use these techniques.

Methods: This qualitative study is based on a cross-sectional electronic survey with open-ended questions. The data were analysed using an inductive qualitative content analysis with quantification of the findings. In total, 111 radiographers from 20 hospitals in Sweden participated.

Results: Three categories appear related to barriers that could obstruct the radiographer from using compression, gonad shields and asking about pregnancy: patient characteristics, interaction between the patient and the radiographer and issues related to the situation and examination.

Conclusions: The barriers to not using radiation protection measures varied depending on the specific measure. However, the barriers were mainly related to the patient experiencing pain, communication difficulties and cultural reasons. In addition, the lack of adequate and user-friendly equipment was seen as a barrier to applying compression and using gonad shielding.

Background

Interventional radiology (IR) has evolved into a well-established medical discipline known for its minimally invasive procedures. Establishing a culture of safety in IR settings is crucial to improve patient safety and quality of care. This study describes and compares attitudes about patient safety among professionals working with IR in Sweden. In addition, this study evaluates whether the WHO Safety Checklist for IR is routinely used for radiological interventions.

Methods

This cross-sectional survey uses an electronic questionnaire to collect data from 25 IR units. The attitudes of IR team members (radiographers, physicians, nurses, and assistant nurses) were assessed using the Swedish Safety Attitudes Questionnaire (SAQ), which was adapted for this context.

Results

The two highest factor scores/percentages of positive responses from the IR team were found for job satisfaction (90/94%) and teamwork climate (85/92%), and stress recognition had the lowest values (54/25%). The attitudes were relatively consistent, with few significant differences between the professions (Factor scores: P = 0.039 for job satisfaction, and P = 0.050 for working conditions. Percentage of positive responses: P = 0.027 for perceptions of management). The radiographers tended to have slightly lower values compared to the other professions among these factors (P < 0.05). The WHO safety checklist for IR was not being used on a regular basis, but the respondents recognized its importance for patient safety.

Conclusions

This study shows high factor scores for the different safety climate factors, with job satisfaction having the highest values. Areas that need improvement are perceptions of management and stress recognition. Attitudes were consistent across professions in the IR team, but radiographers had slightly lower values in some aspects.

This study investigates radiographers' views on implementing dose-reduction measures, with a focus on verifying patient identity and pregnancy status, practising gonad shielding in men and using compression. An electronic questionnaire was distributed to radiographers working in general radiography and/or computed tomography. The questionnaire was based on factors from a framework for analysing risk and safety in clinical medicine. Ordered logistic regressions were used to analyse associations among factors and use of dose-reduction measures. In total, 466 questionnaires were distributed and 170 radiographers (36%) completed them. Clear instructions and routines, support from colleagues, knowledge and experience, a strong safety culture, managerial support and access to proper equipment influence the likelihood of using dose-reduction measures. The strongest associations were found between support from colleagues and verifying pregnancy status (OR = 5.65, P = 0.026), safety culture and use of gonad shielding (OR = 2.36, P = 0.042), and having enough time and use of compression (OR = 2.11, P = 0.003). A strong safety culture and a supportive work environment appears to be essential for the use of dose-reduction measures, and education, training and stress management can improve utilisation of dose-reduction measures.

Background: The lightweight mobile radiography systems allow for almost hand-held radiography, potentially enhancing the accessibility of diagnostic imaging outside the hospital. While such mobile X-ray systems are easy to handle, they must still provide high image quality to ensure accurate diagnosis. The aim of this study was to optimize the use of mobile radiography equipment by investigating exposure parameters to ensure high image quality, comparing image quality with stationary radiography equipment, and evaluating the potential for dose reduction without compromising image quality.

Methods: Thirty-six images of the chest, pelvis and hip (26 mobile; 10 stationary) on a whole-body phantom were acquired with different exposure parameters. The images were evaluated by six observers. Subjective image quality was scored on a 5-point ordinal scale. The data were analyzed via visual grading characteristics analysis. The dose was measured by the dose-area product (DAP).

Results: The optimal tube voltages for the mobile radiography equipment were 70 kVp (small-sized phantom) and 90 kVp (medium-sized phantom) for pelvis AP images, 80kVp for hip AP, and 90kVp for hip cross-table lateral images. The mobile radiography equipment showed significantly better image quality than the stationary equipment for pelvis AP (small-sized phantom), hip AP and hip cross-table lateral as well as for chest AP and for lateral images (medium-sized phantom) with AUCVGA values ranging from 0.68 to 0.95. For chest images acquired with reduced tube load, no significant difference in image quality was found between the mobile and stationary radiography equipment for chest AP images and chest lateral images for the medium-sized phantom. Stationary radiography equipment showed better image quality for small phantom size. The DAP values were lower for the mobile system than for the stationary system.

Conclusions: The image quality for the lightweight radiographic equipment was at least as good as that of a stationary system at a lower radiation dose. Reduced tube load allowed for dose reduction by approximately 35% for chest AP images.

Introduction: Adverse reactions to iodinated contrast media, which is used during computed tomography (CT) examinations, are rare. As a result, radiographers have limited experience handling those situations and may feel uncertainty and a lack of confidence. The aim of this study was to investigate radiographers' confidence in handling hypersensitivity reactions to contrast media during CT examinations.

Methods: A survey in the form of a questionnaire was conducted to gather both quantitative and qualitative data. There were 31 clinics that participated in this study, of which four were university hospitals, 17 were medium-sized hospitals and 10 were small hospitals. In total, the questionnaires were distributed to 700 radiographers. The questionnaire contained 12 questions and was distributed via email with a link to the questionnaire.

Results: Two hundred-ninety radiographers participated in the survey. 72% of the respondents answered in the middle of the four-point scale (2–3) in response to the statement “I feel confident in handling hypersensitivity reactions”. 65% answered that they did not have routines for training regularly regarding hypersensitivity reactions. Qualitative data showed that many of the respondents wished to receive education and training regularly.

Conclusions: The confidence of radiographers regarding the management of hypersensitivity reactions was deficient and most of the respondents wished they felt more confident.

Implication for practice: To increase radiographers' confidence in handling hypersensitivity reactions, it is recommended that the radiology clinics review their routines and the possibility to implement regular training.

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG), known to regulate bone mass by inhibiting osteoclast differentiation and activation, might also play a role in vascular calcification. Increased circulating OPG levels in patients with CKD are associated with aortic calcification and increased mortality. We assessed the predictive role of OPG for all-cause and cardiovascular mortality in patients with CKD stages 3–5 over a 5-year follow-up period. We evaluated the relationship between OPG and all-cause and cardiovascular mortality in 145 CKD patients (stages 3–5) in a prospective observational follow-up study. Inflammation markers, including high-sensitivity C-reactive protein, standard echocardiography, and estimation of intima-media thickness in the common carotid artery, were assessed at baseline, and correlations with OPG levels were determined. The cutoff values for OPG were defined using ROC curves for cardiovascular mortality. Survival was assessed during follow up lasting for up to 5.5 years using Fine and Gray model. A total of 145 (89 men; age 58.9 ± 15.0 years) were followed up. The cutoff value for OPG determined using ROC was 10 pmol/L for general causes mortality and 10.08 pmol/L for CV causes mortality. Patients with higher serum OPG levels presented with higher mortality rates compared to patients with lower levels. Aalen–Johansen cumulative incidence curve analysis demonstrated significantly worse survival rates in individuals with higher baseline OPG levels for all-cause and cardiovascular mortality (p < 0.001). In multivariate analysis, OPG was a marker of general and cardiovascular mortality independent of sex, age, CVD, diabetes, and CRP levels. When CKD stages were included in the multivariate analysis, OPG was an independent marker of all-cause mortality but not cardiovascular mortality. Elevated serum OPG levels were associated with higher all-cause and cardiovascular mortality risk, independent of age, CVD, diabetes, and inflammatory markers, in patients with CKD.

Introduction: The radiography profession is challenged by greater responsibilities and shortage of educated radiographers. Implementation of task shifting is one strategy to deal with the current situation in health care. The aim of this studiy was to evaluate radiographers’ perception of assistant nurses and nurses carrying out tasks that traditionally were undertaken within the radiography profession in a Swedish context.

Methods: An electronic questionnaire was distributed to radiographers at eleven hospitals in Sweden. The questionnaire included background questions and questions about radiographers’ perception about task shifting to nurses and assistant nurses. The respondents rated their agreement level regarding task shifting on a five-point Likert scale. Data was statistically evaluated in SPSS using Mann Whitney U test.

Results: Sixty-five radiographers participated in the study. Most radiographers responded negatively to task shifting to nurses (72%) or assistant nurses (65%). Most radiographers disagree that nurses should perform mammography screening or work within interventional radiography, while the attitude towards nurses calculating glomerular filtration rate was more positive. A majority disagree regarding assistant nurses performing conventional radiographs, informing the patient about contrast media administration or inserting peripheral intravenous catheters, while there was a positive attitude towards assistant nurses preparing patients for examinations. The attitude towards task shifting was not influenced by age, however radiographers with less working experience were more positive to task shifting in general.

Conclusion: A majority of the radiographers had a negative attitude towards task shifting to nurses and assistant nurses. The radiographers were more positive to hand over tasks related to patient care and administrative tasks than technical related tasks within the profession.

Implications for practice: Knowledge about radiographers’ perception on task shifting within the profession is essential when planning and implementing strategies for task shifting in the clinical settings.

INTRODUCTION: Guidelines concerning intravenous iodinated contrast media (CM) during computed tomography (CT) examinations are important to follow to minimize the risk for post-contrast acute kidney injury (PC-AKI). The purpose of this study was to investigate the radiology departmental policy compliance with Swedish guidelines concerning PC-AKI.

METHODS: In February 2020, an electronic survey was distributed to the responsible radiographer at 41 radiology departments in all university hospitals and medium-sized hospitals in Sweden. The questions focused on routines around renal functional tests, individualized contrast administration and handling of patients with diabetes mellitus taking metformin.

RESULTS: The response rate was 83%. Seventy-six percent (n = 26) of radiology departments calculated estimated glomerular filtration rate (eGFR) from serum creatinine prior to CM administration, but only 24% (n = 8) followed the recommendation to calculate eGFR from both serum creatinine and cystatin C. For acute/inpatients, 55% (n = 18) followed the recommendation that renal functional tests should be performed within 12 h before CM administration. For elective patients, 97% (n = 33) followed the recommendation to have eGFR newer than three months which is acceptable for patients with no history of disease that may have affected renal function. Approximately 80% of the radiology departments followed the recommendation that CM dose always should be individually adjusted to patient eGFR. Seventy-six percent (n = 26) followed the recommendation to continue with metformin at eGFR ≥ 45 ml/min.

CONCLUSION: Compliance with the national guidelines was high regarding routines around renal functional tests, dose adjustment of CM and metformin discontinuation. Improvements can be made in using both cystatin C and serum creatinine for eGFR calculations as well as ensuring renal function tests within 12 h for acute/inpatients with acute disease that may affect renal function.

IMPLICATIONS FOR PRACTICE: This study raises awareness of the importance of adhering to guidelines in healthcare. To have knowledge about the current level of compliance regarding PCI-AKI is important to maintain and develop effective clinical implementation of guidelines. The variation in practice seen in this study emphasizes the need of more effective implementation strategies to ensure adherence with best practice.